Stevenson M R, Hart P M, Montgomery A-M, McCulloch D W, Chakravarthy U
Centre for Ophthalmology and Vision Science, The Queen's University of Belfast and Royal Group of Hospitals, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, UK.
Br J Ophthalmol. 2004 Sep;88(9):1125-30. doi: 10.1136/bjo.2003.032383.
To study the relation between visual impairment and ability to care for oneself or a dependant in older people with age related macular degeneration (AMD).
Cross sectional study of older people with visual impairment due to AMD in a specialised retinal service clinic. 199 subjects who underwent visual function assessment (fully corrected distance and near acuity and contrast sensitivity in both eyes), followed by completion of a package of questionnaires dealing with general health status (SF36), visual functioning (Daily Living Tasks Dependent on Vision, DLTV) and ability to care for self or provide care to others. The outcome measure was self reported ability to care for self and others. Three levels of self reported ability to care were identified--inability to care for self (level 1), ability to care for self but not others (level 2), and ability to care for self and others (level 3).
People who reported good general health status and visual functioning (that is, had high scores on SF36 and DLTV) were more likely to state that they were able to care for self and others. Similarly people with good vision in the better seeing eye were more likely to report ability to care for self and others. People with a distance visual acuity (DVA) worse than 0.4 logMAR (Snellen 6/15) had less than 50% probability of assigning themselves to care level 3 and those with DVA worse than 1.0 logMAR (Snellen 6/60) had a probability of greater than 50% or for assigning themselves to care level 1. Regression analyses with level of care as the dependent variable and demographic factors, DLTV subscales, and SF36 dimensions as the explanatory variables confirmed that the DLTV subscale 1 was the most important variable in the transition from care level 3 to care level 2. The regression analyses also confirmed that the DLTV subscale 2 was the most important in the transition from care level 3 to care level 1.
Ability to care for self and dependants has a strong relation with self reported visual functioning and quality of life and is adversely influenced by visual impairment. The acuity at which the balance of probability shifts in the direction of diminished ability to care for self or others is lower than the level set by social care agencies for provision of support. These findings have implications for those involved with visual rehabilitation and for studies of the cost effectiveness of interventions in AMD.
研究年龄相关性黄斑变性（AMD）老年患者的视力损害与自我照料或照料他人能力之间的关系。
在一家专业视网膜服务诊所对因AMD导致视力损害的老年人进行横断面研究。199名受试者接受了视力功能评估（双眼的全矫正远视力和近视力以及对比敏感度），随后完成了一系列问卷，内容涉及一般健康状况（SF36）、视觉功能（依赖视力的日常生活任务，DLTV）以及自我照料或照料他人的能力。结局指标是自我报告的自我照料和照料他人的能力。确定了自我报告照料能力的三个水平——无法自我照料（水平1）、能够自我照料但不能照料他人（水平2）以及能够自我照料和照料他人（水平3）。
报告一般健康状况和视觉功能良好（即SF36和DLTV得分高）的人更有可能表示他们能够自我照料和照料他人。同样，较好眼视力良好的人更有可能报告有自我照料和照料他人的能力。远视力（DVA）低于0.4 logMAR（Snellen 6/15）的人将自己归为照料水平3的可能性小于50%，而DVA低于1.0 logMAR（Snellen 6/60）的人将自己归为照料水平1的可能性大于50%。以照料水平作为因变量，人口统计学因素、DLTV子量表和SF36维度作为解释变量的回归分析证实，DLTV子量表1是从照料水平3转变为照料水平2过程中最重要的变量。回归分析还证实，DLTV子量表2是从照料水平3转变为照料水平1过程中最重要的变量。
自我照料和照料他人的能力与自我报告的视觉功能和生活质量密切相关，并受到视力损害的不利影响。自我照料或照料他人能力下降方向的概率平衡点的视力低于社会护理机构提供支持所设定的水平。这些发现对参与视觉康复的人员以及AMD干预措施成本效益研究具有启示意义。
