Visual acuity, contrast sensitivity, and mortality in older women: Study of osteoporotic fractures

OBJECTIVES: To determine whether poorer visual acuity and contrast sensitivity are independent risk factors for all-cause and traumatic mortality in older women. DESIGN: Twelve-year prospective cohort study (1986-2003). SETTING: Four U.S. clinical centers. PARTICIPANTS: Nine thousand seven hundred four postmenopausal white women aged 65 and older. MEASUREMENTS: Habitually corrected binocular visual acuity and low- and high-frequency contrast sensitivity were measured at baseline using a standard protocol. A study physician adjudicated the primary cause of death from death certificates and medical record review. RESULTS: During an average of 12.2 years of follow-up, 3,427 women died (35%), 72 (0.7%) from traumatic events. In multivariate models adjusted for age, chronic medical problems, and smoking, all-cause mortality risk was 19% greater for persons in the worst quartile of visual acuity than for those in the best (hazard ratio (HR) = 1.19, P =.008) and 39% greater for persons with the worst contrast sensitivity (HR = 1.39, P <.001) than for those with the best. Traumatic mortality risk was 2.4 times greater for women with the worst contrast sensitivity than for those with the best (HR = 2.44, P =.03). CONCLUSION: Poorer visual acuity and contrast sensitivity are associated with greater risk of traumatic and all-cause mortality in older women, even after controlling for demographic and clinical characteristics. Although further research is necessary to determine how treating reversible causes of visual impairment or improving current refraction affects mortality in older women, clinical detection and follow-up of these visual impairments holds promise for identifying those who are at risk of mortality from other systemic conditions.