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Jonathan P Wright, Arthika Chandramohan, Xuan Duong Fernandez, Eleonora Lad, Jie Zhuang, Scott W Cousins, Heather E Whitson; Is discrepancy in self-reported vision and visual acuity related to neurocognitive status of AMD patients?. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1371.
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© ARVO (1962-2015); The Authors (2016-present)
Age-related macular degeneration (AMD) is highly comorbid with depression and dementia. Our goal was to investigate whether discrepancy in self-reported vision (SRV) and visual acuity (VA) relates to neurocognitive status in a sample of AMD patients.
In an ongoing observational study, we have enrolled 26 AMD patients, ages 61-92 (75.3 ± 9.5). Participants are included if they have AMD (AREDs 2-4) in one or both eyes and are free of other significant eye disease. All participants receive a standard neurocognitive battery to assess depressive symptomatology and these cognitive domains: memory, verbal fluency, and reaction time. No tasks in the battery rely on visual ability. Binocular VA is assessed with a Snellen chart and converted to logMAR values. SRV is from a single question on the National Eye Institute Visual Function Questionnaire. Participants rated their vision on a scale from excellent (5) to completely blind (0). The definition of VA/SRV discrepancy was based on a previous population-based study. T tests were used to compare the groups with respect to age, education, and neurocognitive scores. Multivariable logistic regression modeled discrepant status as a dependent variable.
Of the 26 participants, 20 were classified as concordant and 6 as discrepant. In this sample, discrepancy always occurred in the same direction (SRV was worse than expected). In univariate analysis, persons with discrepancy tended to be older and less educated and had lower scores on tests of verbal fluency and slower mean reaction times (Table). Neither group differed with respect to depressive symptomatology or memory scores. After adjusting for age and education, none of the cognitive variables were independent predictors of VA/SRV discrepancy.
Discrepancy between SRV and VA was common in AMD patients, with SRV rated worse than measured VA. Patients with discrepancy tended to be older and less educated, and after adjustment for these factors, discrepancy was not explained by depressive symptoms or cognitive ability. Our ongoing brain MRI analyses will assess whether discrepancy is related to integrity in relevant white matter tracts. Discrepancy may reflect non-acuity aspects of visual function (e.g., contrast sensitivity, visual processing), which may also be age-related, and potentially addressable with vision rehabilitation.
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