Visual Acuity, Contrast Sensitivity, and Mortality in Older Women: Study of Osteoporotic Fractures

Abstract

OBJECTIVES:To determine whether poorer visual acuity and contrast sensitivity are independent risk factors for all-cause and traumatic mortality in older women. DESIGN: Twelve-year prospective cohort study (1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003). SETTING: Four U.S. clinical centers. PARTICIPANTS: Nine thousand seven hundred four postmenopausal white women aged 65 and older. MEASUREMENTS: Habitually corrected binocular visual acuity and low-and high-frequency contrast sensitivity were measured at baseline using a standard protocol. A study physician adjudicated the primary cause of death from death certificates and medical record review. RESULTS: During an average of 12.2 years of followup, 3,427 women died (35%), 72 (0.7%) from traumatic events. In multivariate models adjusted for age, chronic medical problems, and smoking, all-cause mortality risk was 19% greater for persons in the worst quartile of visual acuity than for those in the best (hazard ratio (HR) 5 1.19, P 5.008) and 39% greater for persons with the worst contrast sensitivity (HR 5 1.39, Po.001) than for those with the best. Traumatic mortality risk was 2.4 times greater for women with the worst contrast sensitivity than for those with the best (HR 5 2.44, P 5.03). CONCLUSION: Poorer visual acuity and contrast sensitivity are associated with greater risk of traumatic and allcause mortality in older women, even after controlling for demographic and clinical characteristics. Although further research is necessary to determine how treating reversible causes of visual impairment or improving current refraction affects mortality in older women, clinical detection and follow-up of these visual impairments holds promise for identifying those who are at risk of mortality from other systemic conditions. J Am Geriatr Soc 54:1871-1877, 2006. Key words: mortality; visual acuity; contrast sensitivity V isual impairment is one of the most common conditions affecting older individuals. Approximately 92% of persons aged 70 and older require corrective lenses, and 2% are legally blind without correction.1 Additionally, 14% of persons aged 70 to 74 and 32% of persons aged 85 and older report trouble seeing even while wearing glasses. 1Visual impairment likely reflects biological aging and disease processes, and its health effect is substantial. Impaired vision increases the risk of falls, hip fractures, 2-8 and decline in functional status. [9][10][11][12][13] Although previous studies have demonstrated a relationship between sensory impairment and quality of life, they conflict on its relationship with mortality.14-24 Cross-sectional design, small study sample, self-reported visual impairment, and limited adjustment for the independent influence of other chronic medical conditions have limited prior studies.It was hypothesized that any association between visual impairment and all-cause mortality is likely a consequence of other comorbidities related to vision and mortality. It was also hypothesize...

The association between visual impairment and the risk of mortality: a meta-analysis of prospective studies

“…Overall, 18 studies were conducted in participants older than 65 years 4 16 19 22 24 26–28 31 33 34 36 37. Eight studies were conducted in women19 22 23 28 31 33 35 36 and seven in men 22 23 28 31 33 35 36.…”

“…Eight studies were conducted in women19 22 23 28 31 33 35 36 and seven in men 22 23 28 31 33 35 36. With regard to the study region, nine studies were conducted in North America,4 16 18–20 35 36 four in Oceania,21 22 29 seven in Asia17 23 25 26 28 30 and nine in Europe 24 27 31–34 37.…”

Impact of Low Vision on Well-Being in 10 European Countries

“…Other research has linked reportedly severe bilateral visual impairment with an increased risk of death in women [10, 11]. In addition, the older visually impaired in general have a higher prevalence of depression [7, 9, 12] and an increased risk of suicide [13].…”

Impact of Low Vision on Employment

“…Most particularly, poorer self- reported visual functioning results in difficulties with driving, executing both distant and near tasks, and managing money [3,5,6,7]. In the elderly, visual impairment appears to strongly influence independence [3,4,5,8,9] and mental health [5,8,10], leading to an increased risk of suicide [11] and death in general [12,13]. Low vision also has a major economic impact and produces high costs [8,14] that rank with those of cancer, dementia, and arthritis [14] and increase almost linearly as vision loss progresses [8].…”