ABSTRACT
Vision impairment (VI) is a significant public health problem among older adults. VI impacts a broad range of
activities and is associated with reduced quality of life and poorer physical and mental health. As the population
is aging, VI will become an increasingly important problem. Yet, data on VI in the oldest old (aged 80+) are
limited. Available data suggest that a significant proportion of older adults have uncorrected refractive error
(URE) – a condition that is easily addressed with spectacles – as well as vision-limiting cataract. While distance
visual acuity is the most commonly measured aspect of VI, contrast sensitivity (CS; the ability to differentiate
objects in low light settings) is also important for many activities. However, few population-based studies have
measured contrast sensitivity in older adults; data are needed to understand the impact of distance acuity and
contrast sensitivity deficits in the oldest old.
In this study, we will add distance visual acuity and CS tests to an already funded, one-time visit in the homes of
4,200 older women who have participated in the Women’s Health Initiative (WHI) for nearly 30 years. These data
will be used to characterize the prevalence of VI in the oldest old (Aim 1) and to assess the impact of VI on
social, psychosocial, cognitive, and physical health indicators (Aim 2). Given the unique opportunity to link to an
ongoing cohort, we will be able to describe cross-sectional associations (Aim 2a) and to prospectively evaluate
trajectories of functional decline (Aim 2b). Additionally, we will utilize the WHI-Medicare claims link to analyze
associations between VI and healthcare utilization and costs (Aim 2c). We will recommend eye care for
individuals with VI and will characterize differences between those who seek care vs. those who do not and will
examine reported barriers to care (Aim 3a). By engaging a patient care navigator, we aim to help facilitate care
for those who do not initially seek it, and we will evaluate the potential impact of patient care navigation on
improving uptake of needed eye care (Aim 3b).
Adding these vision measures to the rich repository of WHI data provides a unique opportunity to evaluate the
role of VI on a broad range of health domains. Project results will be used to develop interventions to improve
vision health in older adults, with the ultimate goal of extending independence and improving quality of life in
older adults. Renowned vision experts have highlighted the need for obtaining quality estimates of VI in the
oldest old, in order for health systems to prepare for serving the growing population of affected individuals. This
innovative project fills an important gap in our knowledge of VI and its impact on the lives of our society’s oldest
members.