Wilmer Eye Institute, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD 21287, USA.
Invest Ophthalmol Vis Sci. 2012 May 31;53(6):3201-6. doi: 10.1167/iovs.12-9469.
To determine if glaucoma and/or age-related macular degeneration (AMD) are associated with disability in instrumental activities of daily living (IADLs).
Glaucoma subjects (n = 84) with bilateral visual field (VF) loss and AMD subjects (n = 47) with bilateral or severe unilateral visual acuity (VA) loss were compared with 60 subjects with normal vision (controls). Subjects completed a standard IADL disability questionnaire, with disability defined as an inability to perform one or more IADLs unassisted.
Disability in one or more IADLs was present in 18.3% of controls as compared with 25.0% of glaucoma subjects (P = 0.34) and 44.7% of AMD subjects (P = 0.003). The specific IADL disabilities occurring more frequently in both AMD and glaucoma subjects were preparing meals, grocery shopping, and out-of-home travelling (P < 0.05 for both). In multivariate logistic regression models run adjusting for age, sex, mental status, comorbidity, and years of education, AMD (odds ratio [OR] = 3.4, P = 0.02) but not glaucoma (OR = 1.4, P = 0.45) was associated with IADL disability. However, among glaucoma and control patients, the odds of IADL disability increased 1.6-fold with every 5 dB of VF loss in the better-seeing eye (P = 0.001). Additionally, severe glaucoma subjects (better-eye MD worse than -13.5 dB) had higher odds of IADL disability (OR = 4.2, P = 0.02). Among AMD and control subjects, every Early Treatment of Diabetic Retinopathy Study line of worse acuity was associated with a greater likelihood of IADL disability (OR = 1.3).
VA loss in AMD and severe VF loss in glaucoma are associated with self-reported difficulties with IADLs. These limitations become more likely with increasing magnitude of VA or VF loss.
确定青光眼和/或年龄相关性黄斑变性（AMD）是否与工具性日常生活活动（IADLs）障碍有关。
比较了 84 例双侧视野（VF）丧失的青光眼患者和 47 例双侧或单侧严重视力丧失的 AMD 患者与 60 例正常视力患者（对照组）。受试者完成了一项标准的 IADL 残疾问卷，定义为无法独立完成一项或多项 IADL。
对照组中有 18.3%的人存在一项或多项 IADL 障碍，而青光眼患者为 25.0%（P=0.34），AMD 患者为 44.7%（P=0.003）。在 AMD 和青光眼患者中，更频繁出现的特定 IADL 残疾是准备膳食、杂货店购物和外出旅行（两者均为 P<0.05）。在调整年龄、性别、精神状态、合并症和受教育年限的多变量逻辑回归模型中，AMD（比值比[OR]为 3.4，P=0.02）而不是青光眼（OR 为 1.4，P=0.45）与 IADL 障碍有关。然而，在青光眼和对照组患者中，随着最佳眼 VF 丧失每增加 5dB，IADL 障碍的几率增加 1.6 倍（P=0.001）。此外，严重青光眼患者（最佳眼 MD 差于-13.5dB）IADL 障碍的几率更高（OR=4.2，P=0.02）。在 AMD 和对照组患者中，每增加一条更差的早期糖尿病视网膜病变研究视力线，IADL 障碍的可能性就会增加 1.3 倍（OR=1.3）。
AMD 中的 VA 丧失和青光眼的严重 VF 丧失与自我报告的 IADL 困难有关。这些限制随着 VA 或 VF 丧失程度的增加而变得更有可能。
