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S.K. West, B. Munoz, G. Rubin, K. Turano, A. Broman, K.B. Roche; Are Compensatory Strategies a Marker for Incident Disability in those with Visual Impairment? Evidence for "Pre-clinical Disability" in the SEE Project . Invest. Ophthalmol. Vis. Sci. 2003;44(13):987.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To determine if use of compensatory strategies is a marker for incident disability in those with visual impairment who report no difficulties with task performance. Methods: The SEE project population of 2520 adults age 65-84 were tested for visual acuity, using ETDRS methods, and contrast sensitivity, using Pelli-Robson charts, at baseline. Acuity loss was defined as presenting acuity worse than 20/40 in the better eye, and contrast sensitivity loss was defined as log contrast worse than 1.5 in the better eye. Participants were also asked questions on functional status in domains of mobility, driving, and activities of daily life. Those who reported no difficulties carrying out activities were further classified as those who did or did not use compensatory strategies (changed the way they carried out tasks or changed the frequency of performing the task). Participants were followed up two years later, and incident disability determined (defined as new self-report of difficulty performing the task). Final models predicting incident disability were created using age, gender, number of co-morbid conditions, visual impairment status (contrast sensitivity loss alone, visual acuity loss regardless of contrast loss, and no visual loss), and use of compensatory strategies for the task at baseline. Results: On average, between 52% and 90% of persons report no difficulty doing a task, and between 6% and 25% of that group also report using compensatory strategies. For every task, the use of compensatory strategies was significantly associated with incident disability two years later, adjusting for other factors (ORs between 2.1 and 5.8, p<.05). Visual acuity impairment was independently related to tasks of mobility, meal preparation and shopping, and contrast sensitivity impairment to tasks of mobility, driving, and shopping. Among those with either type visual impairment, the use of compensatory strategies was related to subsequent disability. Conclusions: Among those with visual impairment who report no difficulties carrying out a task, those who use compensatory strategies were more likely to develop incident disability than those who did not report such use. Use of compensatory strategies appears to identify a sub-group with pre-clinical disability in our population study.
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