Academic journal article Journal of Visual Impairment & Blindness

The Societal Impact of Age-Related Macular Degeneration: Use of Social Support Resources Differs by the Severity of the Impairment

Academic journal article Journal of Visual Impairment & Blindness

The Societal Impact of Age-Related Macular Degeneration: Use of Social Support Resources Differs by the Severity of the Impairment

Article excerpt

Abstract: Objective and subjective severity of visual impairment were examined in relation to the receipt of social support over time among 384 adults with age-related macular degeneration. Both types of impairment were related to greater family support, with those with discrepant subjective and objective impairment (high and low, respectively) reporting the most instrumental support.


Age-related macular degeneration (AMD) is the leading cause of legal blindness among persons aged 50 years and older and is most prevalent among individuals of European descent aged 65 and older (Friedman et al., 2004; Rosenthal & Thompson, 2003). The number of persons affected by AMD will likely double within the next 30 years concomitant with the aging of the population. AMD manifests as both a "dry" form (85%) and the less common "wet" form (15%; National Eye Institute, NEI, 2010). Risk factors for AMD include age, smoking, cardiovascular disease, diet, and variation in the complement factor H gene (Klein et al., 2005; Seddon, 2000). No current treatments exist for the dry form of AMD, which progresses slowly. The wet form progresses at a variable rate. Although both types of AMD may result in the loss of central vision, two-thirds of those with advanced AMD have the wet type (NEI, 2010).

By affecting central vision, AMD interferes with such tasks as reading, driving, and activities of daily living (Owsley et al., 2006; Rosenthal & Thompson, 2003; Rovner & Casten, 2002; Wahl, Schilling, & Becker, 2007). This type of functional visual impairment also has a negative impact on participation in social activities, such as seeing or visiting with family members, friends, and neighbors (Crews & Campbell, 2001). Given its negative impact on functional ability, it is not surprising that AMD has negative consequences for mental health; one-third of older adults with advanced AMD have clinically significant depressive symptomatology (Brody et al., 2001; Horowitz, Reinhardt, & Kennedy, 2005; Rovner, Casten, & Tasman, 2002).

Social support resources are an important positive factor in adapting to age-related visual impairment. These resources include both affective (emotional) and instrumental aspects of support (Reinhardt, 2001) from both friends and family members (Horowitz, Reinhardt, Boerner, & Travis, 2003; Reinhardt, 1996). Affective support often involves talking over problems or giving advice, while instrumental support consists of help with everyday tasks like shopping. With age-related visual impairment and its resulting disability, it is also important to understand the predictors of the use of social support. For example, although functional disability has been associated with greater amounts of family instrumental support over time in older adults with visual impairments, it has been associated with a decreased amount of affective support from friends (Reinhardt, Boerner, & Benn, 2003). In general, continuing social relationships and receiving necessary assistance are both important for adjusting to age-related vision loss. Thus, a further examination of the effects of the severity of visual impairment on social support is needed.

Both objective and subjective aspects of visual impairment must be considered in relation to social support because they may capture different dimensions of the impact of an eye disease. For example, the objectively assessed aspects of an eye disease, such as binocular acuity or contrast sensitivity, are related to difficulty with tasks like reading, driving, and mobility (Rubin, Bandeen-Roche, Prasada-Rao, & Fried, 1994). But self-reported subjective visual impairment across broad functional domains may provide more insight into the true psychosocial impact of AMD and has been reported to be more strongly related to depressive symptomatology than such objective measures as acuity (Horowitz, Reinhardt, McInerney, & Balistreri, 1994). …

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