On vision in old age. A longitudinal study of subjects 70 to 97 years old

Abstract

Aims. The main purpose of this study was to investigate different aspects of vision and visual function in old people, like change in vision and visual ability, to study the natural course of eye diseases, assess needs of visual intervention, investigate risk factors for ocular disorders late in life, and also to investigate coexistence between visual and hearing impairments. Materials and Methods. Within the framework of the Gerontological and Geriatric Population Studies, the H70 Study , launched 1971 in Göteborg, Sweden, a cohort comprising 958 subjects at the start of the study was eye-examined longitudinally at ages 70, 82, 88, 95, and 97 years. At ages 95 and 97, cross-sectional groups were added to extend the sample. Audiological and laboratory data were analysed in connection with the ophthalmological examinations.Results. At age 70, best-corrected normal vision (VA ³0.8) was found in 86%, at age 82 in 48%, at age 88 in 24%, and at age 95 in 8% of subjects. At age 97, severe visual impairment (VA £0.1) was found in every third subject. The deterioration rate (i.e., logMAR change per year) was faster in the highest age interval. At age 82, the visual ability score correlated with distance VA (r = 0.62). In subjects with no pathological findings, median VA was 0.9 at age 82 and 0.8 at age 88. Geographic atrophy was more common than exudative late ARM. At 97 years 30% had undergone cataract surgery. The benefit of regular eye examinations, improvement of glasses, and early cataract surgery was assessed. At age 70, blood folate levels, and physical activity earlier, correlated positively, and body mass index (BMI) correlated negatively, to VA ³0.8 at ages 82 and 88. Higher BMI at 70 correlated to cataract disease at age 88, and smoking at age 70 correlated to early ARM at age 82. Mild impairments of vision and hearing increased from 2% at age 70 to 22% at age 82.Conclusions. In old age, gradual deterioration of vision is encountered. Regular eye screening, with improvement of glasses, and/or cost-effective cataract surgery, should be performed early to increase the time of improved vision. Lifestyle variables may prospectively correlate to future eye health and vision. Combined visual and hearing impairment can result in pronounced problems in everyday activities.