Meharry Medical College, Nashville, Tennessee.
Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ophthalmology. 2024 Dec;131(12):1447-1456. doi: 10.1016/j.ophtha.2024.06.009. Epub 2024 Jun 12.
To examine the performance of self-reported visual difficulty (VD) in predicting objective visual impairment (VI) in older adults and explore factors that influence discordance.
Cross-sectional analysis of the National Health and Aging Trends Study (2022).
Participants reporting blindness or difficulties with distance or near vision were characterized as having VD. Presenting binocular distance visual acuity (VA), near VA, and contrast sensitivity (CS) were assessed. Objective VI was defined as having VI in distance VA (worse than 20/40), near VA (worse than 20/40), or CS (worse than 1.55 logCS). Receiver operating characteristic analysis was used to compare performance of VD in predicting VI. To investigate factors that influence discordance, we limited our sample to adults with VI and used a multivariable logistic regression model to identify factors associated with not reporting VD. Similar analyses were performed to explore factors associated with reporting VD in adults without VI.
Discordance factors.
Four thousand nine hundred ninety-nine adults were included in the 2022 cohort. Visual difficulty achieved an area under the curve (AUC) of 56.0 (95% confidence interval [CI], 55.2-56.9) in predicting VI, with a sensitivity of 15.8 (95% CI, 14.2-17.5) and specificity of 96.3 (95% CI, 95.5-96.9). Characteristics associated with not reporting VD in adults with VI included female gender (odds ratio [OR], 0.64 [95% CI, 0.42-0.99]), Hispanic ethnicity (OR, 0.49 [95% CI, 0.31-0.78), higher income (≥75 000, OR, 1.99 [95% CI, 1.14-3.45]), ≥4 comorbidities (OR, 0.46 [95% CI, 0.29-0.72]), and depressive symptoms (OR, 0.49 [95% CI, 0.25-0.93]). Factors associated with self-reporting VD in the absence of VI included Hispanic ethnicity (OR, 2.11 [95% CI, 1.15-3.86]), higher income (≥$75 000, OR, 0.27 [95% CI, 0.12-0.63]), and anxiety symptoms (OR, 3.05 [95% CI, 1.56-5.97]).
Self-reported VD is a distinct measure assessing disability and has limited ability in predicting objective VI. Caution is advised when using self-reported VD as a surrogate measure for objective VI in epidemiological studies, although it may still be an effective way to capture risk of current or future disability.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
研究老年人自我报告的视觉困难（VD）在预测客观视觉障碍（VI）中的表现，并探讨影响不一致的因素。
国家健康与老龄化趋势研究（2022 年）的横断面分析。
报告失明或远距离或近距离视力困难的参与者被定义为有 VD。评估了双眼远距视力（VA）、近距 VA 和对比敏感度（CS）。客观 VI 定义为远距 VA（差于 20/40）、近距 VA（差于 20/40）或 CS（差于 1.55 logCS）有 VI。使用受试者工作特征分析比较 VD 预测 VI 的表现。为了研究影响不一致的因素，我们将样本限制在有 VI 的成年人中，并使用多变量逻辑回归模型来确定与不报告 VD 相关的因素。对没有 VI 的成年人报告 VD 的相关因素进行了类似的分析。
不一致因素。
2022 年队列纳入了 4999 名成年人。视觉困难在预测 VI 方面的曲线下面积（AUC）为 56.0（95%置信区间[CI]，55.2-56.9），灵敏度为 15.8（95%CI，14.2-17.5），特异性为 96.3（95%CI，95.5-96.9）。与有 VI 的成年人不报告 VD 相关的特征包括女性性别（优势比[OR]，0.64[95%CI，0.42-0.99]）、西班牙裔（OR，0.49[95%CI，0.31-0.78]）、较高收入（≥75000 美元，OR，1.99[95%CI，1.14-3.45]）、≥4 种合并症（OR，0.46[95%CI，0.29-0.72]）和抑郁症状（OR，0.49[95%CI，0.25-0.93]）。与无 VI 但自我报告 VD 相关的因素包括西班牙裔（OR，2.11[95%CI，1.15-3.86]）、较高收入（≥75000 美元，OR，0.27[95%CI，0.12-0.63]）和焦虑症状（OR，3.05[95%CI，1.56-5.97]）。
自我报告的 VD 是一种评估残疾的独特方法，在预测客观 VI 方面能力有限。在流行病学研究中，当使用自我报告的 VD 作为客观 VI 的替代指标时，应谨慎使用，尽管它仍然是捕捉当前或未来残疾风险的有效方法。
