Development and Validation of Performance-Based Assessment of Daily Living Tasks in Age-Related Macular Degeneration

Transl Vis Sci Technol. 2024 Jun 3;13(6):9. doi: 10.1167/tvst.13.6.9.

Abstract

Purpose: To establish the reliability and validity of five performance-based activities of daily living task tests (ADLTT), to correlate structure to function, to evaluate the impact of visual impairment (VI) on age-related macular degeneration (AMD), and to develop new outcome measures.

Methods: A multidisciplinary team developed five ADLTTs: (1) reading test (RT); (2) facial expression (FE) recognition; (3) item search (IS) task; (4) money counting (MC) task; and (5) making a drink (MD), tested with binocular and monocular vision. ADLTTs were tested for known-group (i.e., difference between AMD group and controls) and convergent (i.e., correlation to other measures of visual function), validity metrics, and test-retest reliability in 36 patients with VI (visual acuity (logMAR VA > 0.4) in at least one eye caused by AMD versus 36 healthy controls without VI.

Results: Compared to controls, AMD patients had a slower reading speed (-77.41 words/min; P < 0.001); took longer to complete MC using monocular worse eye and binocular vision (15.13 seconds and 4.06 seconds longer compared to controls, respectively; P < 0.001); and MD using monocular worse eye vision (9.37 sec; P = 0.033), demonstrating known-group validity. Only RT and MC demonstrated convergent validity, showing correlations with VA, contrast sensitivity, and microperimetry testing. Moderate to good test-retest reliability was observed for MC and MD (interclass correlation coefficient = 0.55 and 0.77; P < 0.001) using monocular worse eye vision.

Conclusions: Real-world ADL functioning associated with VI-related AMD can be assessed with our validated ADLTTs, particularly MC and MD.

Translational relevance: This study validates visual function outcome measures that are developed for use in future clinical practice and clinical trials.

Publication types

  • Validation Study

MeSH terms

  • Activities of Daily Living*
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Macular Degeneration* / diagnosis
  • Macular Degeneration* / physiopathology
  • Male
  • Middle Aged
  • Reading
  • Reproducibility of Results
  • Vision Tests / methods
  • Vision, Binocular / physiology
  • Visual Acuity* / physiology