Ocular and Health Trajectories: The SEE Study

描述（由申请人提供）：视力问题是导致美国人残疾的十大原因之一；这些情况通常与死亡风险增加有关。本研究将利用结构方程模型（SEM）研究视力障碍和其他眼部疾病与发病率和死亡率之间的关系，以回答以下问题：1)眼系统衰退对整体健康和功能状态变化的相对贡献是什么？2)眼部健康的改善，无论是通过有效的眼部疾病医疗管理还是改变危险因素（如戒烟），是否会导致功能状态的改善和死亡风险的降低？3)眼系统功能下降是否直接导致死亡风险增加，或者这些变化是否通过对功能状态指标的不利影响间接影响死亡风险？4)视觉障碍在衰老过程中的作用是什么？也就是说，VI仅仅是潜在虚弱的一种症状，还是与健康恶化独立相关？这项研究的数据将来自索尔兹伯里眼科评估（SEE）项目，这是一项关于老年人视力和功能的研究。该研究随机招募了2520名65至84岁的社区居民。参与者接受了全面的视力测试和眼部检查，并进行了多次功能状态测试，其中部分测试在随后的10年时间里重复了三轮。截至2003年的死亡率状况；将整个队列与2009年的全国死亡指数（NDI）进行全面联系，作为该应用的一部分，并将产生足够的死亡人数和随访人年，以80%的有效性可靠地检测小于1.34的风险比关联。这种统计能力，结合四个时间段内评估的眼部和功能状态指标的综合评估，将使我们能够：1)检查视力水平的变化与功能流动性和其他发病率指标（例如握力）的变化之间的关联，以及在调整时变的眼部状况后，SEE参与者的抑郁症状，并选择健康状况和慢性疾病风险因素；2)检查视力相关因素（如视力状况的改变、眼部疾病的存在、眼部保健的利用）与健康相关因素（如健康行为、健康状况和死亡风险）之间的关系。拟议的研究旨在支持美国国家眼科研究所（NEI）眼部流行病学战略规划报告的关键目标，包括：1)确定不断变化的人群中眼病的负担及其视力结果，以及2)开发新的方法来支持眼科流行病学研究。

DESCRIPTION (provided by applicant: Vision problems are among the top ten conditions responsible for disability among Americans; these conditions are often associated with an increased risk of death. This study will utilize structural equation modeling (SEM) to study linkages between visual impairment and other ocular conditions with morbidity status and mortality risk to answer the following questions: 1) What is the relative contribution of ocular system declines to changes in overall health and functional status?; 2) Do improvements in ocular health, either via effective medical management of ocular conditions or risk factor modification (e.g., smoking cessation) lead to improvements in functional status and lower mortality risk?; 3) Do ocular system declines directly lead to an increased risk of mortality, or do these changes also indirectly influence mortality risk via adverse impacts on functional status indicators?; and 4) What is the role of visual impairment (VI) in the aging process? That is, is VI simply a symptom of underlying frailty or is it independently associated with worsening health? Data for this study will come from the Salisbury Eye Evaluation (SEE) Project, a study of vision and function in older adults. The study enrolled a random sample of 2520 community residents 65 to 84 years of age. Participants underwent comprehensive vision testing and ocular examinations, and were administered multiple tests of functional status, portions of which were repeated in three subsequent rounds over a 10-year period. Mortality status was obtained thru 2003; full linkage of the entire cohort with the National Death Index (NDI) thru 2009 is proposed as part of this application and will yield a sufficient number of deaths and person-years of follow-up to reliably detect hazard ratio associations smaller than 1.34 with 80% power. This statistical power, in combination with the comprehensive assessment of ocular and functional status indicators assessed over four time periods, will enable us to: 1) examine associations between change in visual acuity levels and change in functional mobility and other morbidity indicators (e.g., grip strength) and depressive symptoms among SEE participants following adjustment for time-varying ocular conditions, and select health conditions and chronic disease risk factors; and 2) examine associations between vision related factors (e.g. changes in visual acuity status, presence of ocular conditions, ocular healthcare utilization) and health-related factors (e.g. health behaviors, health conditions, and mortality risk). Proposed study aims support key goals of the National Eye Institute (NEI) Ocular Epidemiology Strategic Planning Report, including: 1) Determine the burden of eye diseases and their visual outcomes in a changing population, and 2) develop new methodologies to support ophthalmic epidemiological research. PUBLIC HEALTH RELEVANCE: Vision problems are among the top ten conditions responsible for disability among Americans and are also associated with an increased risk of death. This study will examine, in a comprehensive manner, the role of the development of these vision conditions on health, functioning, and risk of death. It will also determine if improvements in visual functioning due to either treatment (e.g., cataract surgery) and/or improvements in lifestyle (e.g., smoking cessation) leads to improved health and a lower risk of death.