Age-related eye diseases and increased risk of mobility and balance impairment and functional disability
Mohammad Javad Ghanbarnia1 *, Seyed Reza Hosseini2 , Seyed Ahmad Rasoulinejad1 , Mehrnoosh Ghasemi1 , Gholam Abbas Roustaei 1 , Ebrahim Mekaniki1 , Ali Bijani2 , Reza Ghadimi2
- Department of Ophthalmology, Babol University of Medical Sciences, Babol, Iran
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
Abstract: Older adults with balance, mobility and functional deficits are at increased risk of adverse health outcomes such as falls, injuries and decreased survival. Eye diseases may exacerbate such adverse health outcomes by independently influencing functional performance. Herein, we evaluated the association between age-related eye diseases and balance, mobility and functional performance in a population of Iranian older adults.
Methods: In this cross-sectional study, we included individuals with complete ophthalmic and medical records who participated in the second cycle of the Amirkola Health and Aging Project (AHAP). Mobility and balance were evaluated using the timed up and go (TUG) test and Berg balance scale (BBS) respectively. Rosow-Breslau’s scale and Lawton’s instrumental activities of daily living (IADL) were used to assess functional disability. Ophthalmic examinations were performed by ophthalmologists. Cataract was defined as grade 2 or higher nuclear, cortical, or posterior subcapsular cataract (WHO cataract grading system) in at least one eye. Diabetic retinopathy (DR), age-related macular degeneration (AMD), elevated intraocular pressure (IOP ≥ 21 mmHg) and glaucoma suspects (vertical cup to disc ratio (VCDR) ≥ 0.6) were diagnosed based on standardized grading protocols. Individuals with previous bilateral cataract surgery and those with ungradable images were excluded from the study.
Results: A total of 1138 participants aged 60 years and older (mean age 68.7±6.8, 44.5% female) were included in the final analysis. After adjusting for variables such as age, sex, literacy, self-evaluated health, self-evaluated income, living status, diabetes mellitus, hypertension, hypercholesterolemia and BMI, cataract was significantly associated with worse balance (OR 1.90, 95% CI 1.20-3.00), slower TUG (OR 1.65, 95% CI 1.02-2.66), functional disability based on IADL (OR 1.45, 95% CI 1.01-2.08) and Rosow-Breslau scale (OR 1.46, 95% CI 1.10-1.94). AMD was only significantly associated with Rosow-Breslau functional disability (OR 1.85, 95% CI 1.07-3.20). Other ophthalmic conditions such as DR, glaucoma suspect and elevated IOP were not significantly associated with any of the four functional measures in the adjusted model.
Conclusion: In this population of older adults, cataract and AMD hindered functional performance, with cataract having the most substantial effect across the four functional measures. Further research should evaluate whether functional performance improves following AMD management or cataract surgery.
