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Rebecca A Deffler, San-San Cooley, Frederick Davidorf, Bradley E Dougherty; Mediators of the relationship between socioeconomic status and visual acuity in age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2020;61(7):1572.
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Age-related macular degeneration (AMD) is a leading cause of blindness in older adults. We have previously found that socioeconomic status (SES), as represented by educational attainment, is inversely related to visual acuity in people being managed for AMD. Relationships between vision and SES are documented in the literature, but potential reasons for this relationship are not well understood. The purpose of this study was to evaluate for causal factors in the relationship between SES and vision in patients with AMD, using multiple approaches to mediation analysis.
Socioeconomic status was represented as self-reported highest level of education. Visual acuity was measured via ETDRS chart with letter-by-letter scoring with habitual correction. The influence of uncorrected refractive error was assessed using autorefraction. Data collected included lifetime pack-years of smoking and transportation access, number of years since AMD diagnosis, C-reactive protein levels, and the number of missed clinical appointments. Regression analysis between each variable and better-eye visual acuity and socioeconomic status was performed. Mediation analyses were performed for each variable associated with both SES and visual acuity using multiple approaches.
Seventy-eight people with AMD (47% female, mean ± age of 82 ± 9 years) were recruited. Better eye visual acuity ranged from 0.00 to 1.64 logMAR (mean ± SD = 0.51 ± 0.46). Patients with lower levels of education had poorer visual acuity, adjusted for age (p=0.017). Lower levels of education were associated smoking, controlling for age (p<0.001), and smoking was also associated with poorer visual acuity (p=0.029). More missed appointments, controlling for years since diagnosis, was related to both education (p=0.006) and visual acuity (p=0.001). Variables not significantly related to both SES and AMD included: uncorrected refractive error, dietary intake, and inflammation. A bootstrapping procedure was used to generate confidence intervals for indirect mediation effect strength.
Pack-years of smoking and missed clinical appointments are potential mediators of the relationship between SES and visual acuity in patients with AMD. Determination of mediators in this pathway may guide future studies on interventions related to missed appointments to improve outcomes.
This is a 2020 ARVO Annual Meeting abstract.
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