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Visual Acuity Change and Mortality in Older Adults

¹From the Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore, Maryland; the ²Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, Maryland; and the ³Institute of Ophthalmology, University College London, United Kingdom.

PURPOSE. Several studies indicate an increased mortality rate in older adults who have visual impairment, but few have attempted to address a potential causal mechanism. The goals of this study are to determine whether visual acuity loss increases the risk of dying and to examine whether depressive symptoms act as a mediator in this relationship.

METHODS. Data were derived from the 2520 older adults who participated in the Salisbury Eye Evaluation project, a population-based prospective 8-year cohort study. Presenting binocular visual acuity was measured with the Early Treatment Diabetic Retinopathy Study [ETDRS] eye chart and depressive symptoms with the General Health Questionnaire Part D subscale. Mortality data were collected by staff follow-up. Analyses were performed with the Cox proportional hazards regression.

RESULTS. Worse baseline acuity was associated with a higher mortality rate (hazard ratio [HR] = 1.05; 95% confidence interval [CI], 1.01–1.09). Also, those who gained two or more lines of visual acuity over 2 years had a lower adjusted risk of dying (HR = 0.47; 95% CI, 0.23–0.95). An interaction was detected, in that women who lost 3 lines of visual acuity over a 2-year period had a higher adjusted risk of dying (HR = 3.97; 95% CI, 2.21–7.15), whereas men did not (HR = 1.32; 95% CI, 0.66–2.63). Depressive symptoms did not mediate these relationships.

CONCLUSIONS. If the relationship between visual acuity and mortality is indeed causal, it most likely acts via numerous pathways through a variety of intervening variables. The identification of these intervening variables could give additional targets for intervention if acuity cannot be restored.

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