Longitudinal Relationships Among Visual Acuity, Daily Functional Status, and Mortality: The Salisbury Eye Evaluation Study

IMPORTANCE: Determination of the mechanisms by which visual loss increases mortality risk is important for developing interventional strategies. OBJECTIVE: To evaluate the direct and indirect effects of loss of visual acuity (VA) on mortality risk through functional status changes among aging adults. DESIGN, SETTING, AND PARTICIPANTS: Prospective longitudinal study of a population-based sample of 2520 noninstitutionalized adults aged 65 to 84 years from September 16, 1993, through July 26, 2003, in the greater Salisbury area of Maryland. Participants underwent reassessment 2, 6, and 8 years after baseline. Mortality status was ascertained from linkage with the National Death Index through 2009. EXPOSURES: Results of VA testing and self-reported functional status based on activities of daily living (ADL) and instrumental ADL (IADL). MAIN OUTCOMES AND MEASURE: Mortality. RESULTS: Worse VA levels at baseline were associated with an increased the risk for mortality (hazard ratio [HR], 1.16 [95% CI, 1.04-1.28]; P