Visual Functioning Reduces Mortality Risk in Patients With AMD

Visual functioning reduces mortality risk for patients with age-related macular degeneration (AMD), according to an observational cohort study published in Ophthalmology Retina. Adequate driving ability and better general health is associated with a significantly lower risk of mortality in patients with age-related macular degeneration (AMD), the study shows.

Researchers analyzed 876 patients (average age, 78.7 years; 60.2% women) with AMD who were enrolled in the University of Colorado AMD Registry between July 19, 2014 and December 31, 2021. They classified AMD cases into early AMD, intermediate AMD, geographic atrophy (GA), neovascular AMD (NV) or both advanced types of AMD (NV and GA both present) utilizing multi-modal imaging and the Beckman and Classification of Atrophy Meetings (CAM) criteria. They calculated VFQ-25 composite and subscale scores at time of study enrollment.

The researchers report that a total of 180 (20.6%) patients with AMD died during the follow-up period (average follow-up time, 52.5 months). 

In univariate analysis, age (P <.0001), AMD category (P <.0001), marital status (P <.0001), and history of smoking (P =.003) were significantly associated with time to mortality. Ocular pain was not significantly associated with time to mortality. 

Chronic conditions such as diabetes (P =.044), treated hypertension (P <.0001), kidney disease (P <.0001), stroke (P <.0001), peripheral vascular disease (P =.025), atrial fibrillation (P =.0009), lung disease (P =.0005), and heart disease (P <.0001) were significantly associated with time to mortality.

According to the multivariable analysis, for each 10-point increase in a patient’s VFQ-25 scores for general health and driving, the risk of mortality decreased with hazard ratios of 0.85 (95% CI: 0.80, 0.91, P <.0001) and 0.92 (95% CI: 0.87, 0.97, P =.005), respectively.

Study limitations include failure to obtain mortality data outside of the state of Colorado, some patients did not complete the full 8-year follow-up, and the research did not take into account the effects of socioeconomic status or geographic location.

“Proposed reasons for decline after an individual ceases driving include decreased access to healthcare, increased dependency on others, and decreased access to socialization,” according to the researchers. These findings suggest that, in the long run, improved visual functioning reduces mortality risk in patients with AMD.

“Previous studies have also proposed that the relationship between driving cessation and health status has a reciprocal relationship; declines in general health or changes in visual acuity often lead to driving cessation, which in turn leads to further health decline due to the aforementioned factors.”

Disclosure: This research was supported by multiple sources. Please see the original reference for a full list of disclosures.