title: Association of vision loss in glaucoma and age-related macular degeneration with IADL disability.
abstract: OBJECTIVE
  To determine if glaucoma and/or age-related macular degeneration (AMD) are associated with disability in instrumental activities of daily living (IADLs).
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD 21287, USA.
authors.forename: Chad
authors.initials: C
authors.lastname: Hochberg
authors.forename: Eugenio
authors.initials: E
authors.lastname: Maul
authors.forename: Emilie S
authors.initials: ES
authors.lastname: Chan
authors.forename: Suzanne
authors.initials: S
authors.lastname: Van Landingham
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
authors.forename: David S
authors.initials: DS
authors.lastname: Friedman
authors.forename: Pradeep Y
authors.initials: PY
authors.lastname: Ramulu
mesh_terms: D000368:Aged; D001766:Blindness / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D004185:Disability Evaluation; D005260:Female; D005901:Glaucoma / Q000150:complications* / Q000503:physiopathology / Q000534:rehabilitation; D006801:Humans; D008268:Macular Degeneration / Q000150:complications* / Q000503:physiopathology / Q000534:rehabilitation; D008297:Male; D011379:Prognosis; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014792:Visual Acuity