Importance of screening for contrast sensitivity, falls and mobility limitations in older adults with maculopathy

Abstract

Objective: Assess the potential value of adding questions on falls/balance difficulties due to vision loss and testing contrast sensitivity in patients with maculopathy (mainly age-related macular degeneration, AMD) to help guide referral for mobility rehabilitation.
Design: Cross-sectional study.
Participants: 125 patients over 55 years old with binocular maculopathy and intact peripheral vision presenting for a low vision rehabilitation consultation.
Methods: Patients were asked questions regarding difficulties with their balance and mobility, including the 9-item Glaucoma Activity Limitation questionnaire (GAL-9). For analysis, patients were grouped by visual impairment severity using better-eye visual acuity (VA) and binocular contrast sensitivity (CS).
Main Outcome Measures: Visual function, self-reported balance and mobility difficulties, falls history, and rehabilitation referrals were examined across visual impairment severity groups.
Results: 52% of patients reported balance or gait difficulties and 36% attributed mobility limitations to vision loss. Increasing vision deficit severity related to greater mobility concerns (>50% of patients in the severe categories rated difficulty as 3/5 or higher) and higher referral rates. Scores on the GAL-9 increased with greater vision loss and were predicted by contrast sensitivity, female sex, larger relative scotomata and falls history (R2 = 0.45, p < 0.0001). CS was a better predictor of mobility difficulties than VA. Based on reported concerns, 31.2% of patients were referred to orientation and mobility training and/or physical therapy (>50% in the severe groups).
Conclusions: Mobility limitations and falls affect a substantial proportion of AMD patients yet may go undiscussed in eye clinics. Incorporating screening questions and explicit discussion of mobility difficulties in clinical practice in maculopathy can help elucidate patient mobility limitations. Realization of these limitations is the prerequisite to initiate appropriate referrals to low vision and mobility specialists to improve mobility and manage falls risk. Clinical practice may also benefit from assessment of contrast sensitivity as this is a better indicator of difficulties in daily living. Our results, along with prior literature, underscore the need to recognize the role of central vision loss, and vision loss more broadly, in mobility decline. Thus, a central vision loss-specific mobility questionnaire may be needed to facilitate patient screening in the future.