Self-reported Visual Difficulty, Age-related Eye Disease, and Neuropsychiatric Outcomes in Older Adults

ABSTRACT

Purpose

Self-reported visual difficulty is consistently associated with dementia and other neuropsychiatric outcomes, but studies of specific age-related eye diseases have yielded conflicting results.

Methods

We conducted a retrospective cohort study using data from The National Health and Aging Trends Study, an ongoing nationally representative survey of older U.S. adults (n = 10,089). All subjects are screened for self-reported visual difficulty annually. Using linked Medicare claims data, we identified subjects with age-related macular degeneration (AMD), primary open-angle glaucoma (POAG), diabetic retinopathy, and cataract. For each condition, controls with complete Medicare eligibility and at least one eye care encounter were selected. We used semiparametric discrete time proportional hazards models to measure associations with incident dementia, and generalized estimating equations to examine longitudinal associations with depression, anxiety, and hallucinations, adjusting for baseline demographics and time-varying comorbidities.

Results

Self-reported visual difficulty 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). Diabetic retinopathy was associated with depression (OR 1.31, 95% CI: 1.05–1.64), and cataracts were associated with a lower risk of depression (OR 0.84, 95% CI: 0.74–0.95) and anxiety (OR 0.86, 95% CI: 0.75–0.99). There were no other associations between age-related eye disease and neuropsychiatric outcomes.

Conclusion

Self-reported visual difficulty is associated with dementia and other neuropsychiatric outcomes to a greater degree than age-related eye disease. These findings highlight the distinction between self-reported vision and clinically diagnosed eye disease with regard to health outcomes in older adults.

KEYWORDS:

• Age-related eye disease
• anxiety
• dementia
• depression
• visual impairment

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09286586.2024.2343725.

Additional information

Funding

This work was funded by the National Institutes of Health [NEI K23 EY033438-01 to AGH and NIA K24 AG075234-01 to AWW]. The sponsor or funding organization had no role in the design or conduct of this research. The National Health and Aging Trends Study (NHATS) is sponsored by the National Institute on Aging [grant number NIA U01AG032947] through a cooperative agreement with the Johns Hopkins Bloomberg School of Public Health.