June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Visual impairment, age-related eye disease, and neuropsychiatric outcomes in older adults
Author Affiliations & Notes
  • Ali G Hamedani
    Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
    Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Allison W Willis
    Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Gui-Shuang Ying
    Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   Ali Hamedani Biogen, Biohaven, Code F (Financial Support); Allison Willis None; Gui-Shuang Ying None
  • Footnotes
    Support  NEI K23 EY033438-01
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 4208. doi:
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    • Get Citation

      Ali G Hamedani, Allison W Willis, Gui-Shuang Ying; Visual impairment, age-related eye disease, and neuropsychiatric outcomes in older adults. Invest. Ophthalmol. Vis. Sci. 2023;64(8):4208.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To determine the relationship between self-reported visual impairment, age-related eye disease, and neuropsychiatric outcomes in older adults.

Methods : We performed a retrospective cohort study using Medicare-linked survey data from the National Health and Aging Trends Study, an ongoing nationally representative survey of older U.S. adults (n=10,088). Using Medicare claims, we identified NHATS participants who were diagnosed with age-related macular degeneration (AMD), primary open-angle glaucoma (POAG), diabetic retinopathy, or cataracts. For each condition of interest, controls with complete Medicare Part A and B eligibility and at least one visit with an ophthalmologist or optometrist were identified. Participants completed annual questionnaires about self-reported visual impairment and screening assessments for dementia, depression, anxiety, and hallucinations. We used semiparametric discrete time proportional hazards models to measure the association between each ophthalmic exposure of interest and incident dementia, and generalized estimating equations to examine longitudinal associations with depression, anxiety, and hallucinations.

Results : Self-reported visual impairment was associated with dementia (HR 1.16, 95% CI: 1.00-1.34), depression (OR 1.14, 95% CI: 1.04-1.26), anxiety (OR 1.17, 95% CI: 1.06-1.29), and hallucinations (OR 1.54, 95% CI: 1.29-1.84) after adjusting for confounders. Diabetic retinopathy was associated only with depression (adjusted OR 1.31, 95% CI: 1.05-1.64), and cataracts were associated with a lower risk of depression (adjusted OR 0.85, 95% CI: 0.75-0.96) and anxiety (adjusted OR 0.87, 95% CI: 0.76-1.00). There were no other associations between age-related eye disease and neuropsychiatric outcomes.

Conclusions : Self-reported visual impairment is consistently associated with dementia and other neuropsychiatric outcomes in older adults to a much greater degree than age-related eye disease, even for diseases in which vision loss is expected to be severe. Negative associations between cataract diagnoses and depression and anxiety likely reflect confounding by healthcare utilization patterns. These findings highlight the distinction between self-reported vision and clinically diagnosed eye disease with regard to health outcomes in older adults.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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