Alteration of Travel Patterns With Vision Loss From Glaucoma and Macular Degeneration | Geriatrics | JAMA Ophthalmology | JAMA Network
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Original Investigation
Epidemiology
November 2013

Alteration of Travel Patterns With Vision Loss From Glaucoma and Macular Degeneration

Author Affiliations
  • 1Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 2Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 3Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 4Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
  • 5Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
JAMA Ophthalmol. 2013;131(11):1420-1426. doi:10.1001/jamaophthalmol.2013.4471
Abstract

Importance  The distance patients can travel outside the home influences how much of the world they can sample and to what extent they can live independently. Recent technological advances have allowed travel outside the home to be directly measured in patients’ real-world routines.

Objective  To determine whether decreased visual acuity (VA) from age-related macular degeneration (AMD) and visual field (VF) loss from glaucoma are associated with restricted travel patterns in older adults.

Design  Cross-sectional study.

Setting  Patients were recruited from an eye clinic, while travel patterns were recorded during their real-world routines using a cellular tracking device.

Participants  Sixty-one control subjects with normal vision, 84 subjects with glaucoma with bilateral VF loss, and 65 subjects with AMD with bilateral or severe unilateral loss of VA had their location tracked every 15 minutes between 7 am and 11 pm for 7 days using a tracking device.

Main Outcomes and Measures  Average daily excursion size (defined as maximum distance away from home) and average daily excursion span (defined as maximum span of travel) were defined for each individual. The effects of vision loss on travel patterns were evaluated after controlling for individual and geographic factors.

Results  In multivariable models comparing subjects with AMD and control subjects, average excursion size and span decreased by approximately one-quarter mile for each line of better-eye VA loss (P≤ .03 for both). Similar but not statistically significant associations were observed between average daily excursion size and span for severity of better-eye VF loss in subjects with glaucoma and control subjects. Being married or living with someone and younger age were associated with more distant travel, while less-distant travel was noted for older individuals, African Americans, and those living in more densely populated regions.

Conclusions and Relevance  Age-related macular degeneration–related loss of VA, but not glaucoma-related loss of VF, is associated with restriction of travel to more nearby locations. This constriction of life space may impact quality of life and restrict access to services.

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