Early age-related maculopathy and self-reported visual difficulty in daily life

To determine whether early age-related maculopathy (ARM) is associated with visual difficulty in daily activities beyond the difficulty that would be expected based on normal retinal aging; to determine whether scotopic sensitivity and visual acuity are associated with visual difficulties in these older adults.

Comparative, cross-sectional questionnaire study.

Ninety-two older adults with early ARM in at least one eye as defined by one or more large (>63 microm) drusen and/or focal hyperpigmentation but no choroidal neovascularization or geographic atrophy, acuity of 20/60 or better, and a reference group of 55 older adults in the same age range without these fundus features and acuity of 20/35 or better in each eye.

Tests of visual acuity and scotopic sensitivity and a general health questionnaire were carried out. The Activities of Daily Vision Scale (ADVS) was administered to assess self-reported visual difficulties in everyday tasks and expressed on a scale of 0 (extreme difficulty) to 100 (no difficulty). Fundus photographs were taken and graded to characterize the presence and severity of ARM to determine eligibility.

For purposes of analysis, the early ARM group was divided into those whose fellow eye (FE) was 20/60 or better and those whose FE was worse than 20/60. ADVS subscale scores were substantially lower in the early ARM group with FE worse than 20/60 (medians, 58-83) compared with the normal retinal health group (medians, 97-100). Even for those with early ARM with FE 20/60 or better, four of five subscale scores were lower (medians, 81-97), albeit slightly in some cases, than those of the reference group. For both ARM subgroups, the night driving subscale had the lowest scores of all subscales. Persons with early ARM with FE 20/60 or better were more likely to report difficulty on the night driving (odds ratio [OR], 4.3; 95% confidence interval [CI], 1.6-11.4), near vision (OR, 5.0; 95% CI, 1.9-12.9), and glare disability (OR, 2.7; 95% CI, 1.1-6.3) subscales compared with those in normal retinal health, adjusting for age, gender, medical comorbidities, and lens density. For early ARM patients with FE worse than 20/60, there was widespread reporting of difficulty on all subscales (ORs ranging from 4.7-52.9). Poor scotopic sensitivity was highly associated with difficulty on the night driving subscale (OR, 6.6; 95% CI, 1.2-35.5) but not with any other subscale. Acuity worse than 20/25 in both eyes was significantly associated with difficulty on all ADVS subscales; when this acuity impairment was present in one eye only, associations were still significantly present on some subscales, although they were weaker.

Persons in the early phases of ARM, even when their fellow eye has relatively good acuity, are more likely to experience difficulty in night driving, near vision tasks, and glare disability compared with those in good retinal health. Scotopic dysfunction, a functional marker of early ARM, is linked to reported night driving problems. Even when acuity impairment occurs in one eye only, patients report difficulties with day driving and near and far vision tasks.