The Relationship Between Low Vision and Musculoskeletal Complaints. A Case Control Study Between Age-related Macular Degeneration Patients and Age-matched Controls with Normal Vision

Abstract

INTRODUCTION:Age-related Macular Degeneration (ARMD) patients often describe complaints from neck and scapula area muscles and a decreased postural control. In clinical assessment, these complaints are considered to be due to old age. PURPOSE: This study focuses on low-vision patients with ARMD, comparing them to age-matched controls without any eye disease, in order to evaluate if the linkage between self-rated visual complaints and musculoskeletal complaints is more prominent when low vision is present. METHODS:In a cross-sectional study, 24 ARMD patients, aged 65 to 85, were compared to a group of 24 controls without visual problems having a similar age distribution. Visual acuity, the need for magnification plus other optical and visual parameters were assessed. Visual, musculoskeletal and balance/proprioceptive complaints were collected by means of a self-rating questionnaire. The Visual Functioning Questionnaire -Near Activities Subscale (VFQ-NAS) was used to evaluate visual function and related complaints. KEY WORDS: age; ARMD; low vision; balance/proprioception; musculoskeletal complaints; age-related maculopathy; perception. RESUMEN INTRODUCCIÓN:Los pacientes con degeneración macular asociada a la edad (DMAE) a menudo refieren dolores musculares en el cuello y en la zona escapular, así como un menor control postural. En la evaluación clínica, se suele considerar que estas dolencias son debidas a la edad avanzada del paciente. OBJETIVO: Este estudio se centra en los pacientes con DMAE y con baja visión, comparándolos con pacientes de referencia sin patologías oculares y de edades similares, con el fin de analizar si la conexión entre las afecciones visuales y las dolencias musculares (que refiere el paciente mismo) es más estrecha cuando el paciente padece baja visión. MÉTODOS: En un estudio transversal, se comparó un grupo de 24 pacientes con DMAE de edades comprendidas entre 65 y 85 años, con un grupo de 24 sujetos de referencia (controles) sin problemas visuales que presentaba una distribución de edades similar. Se obtuvieron datos relativos a la agudeza visual, a la necesidad o no de utilizar instrumentos con aumentos, así como a otros parámetros ópticos y visuales. Se recogieron datos sobre problemas visuales, dolencias osteomusculares y problemas de equilibrio/propiocepción, utilizando para ello un cuestionario que habían de contestar los pacientes mismos. Se utilizó la subsección sobre actividades de visión cercana del Cuestionario de la Función Visual (en inglés, Visual Functioning Questionnaire -Near Activities Subscale, o sus siglas VFQ-NAS) para evaluar la función visual y los problemas asociados. RESULTADOS: El coeficiente de correlación entre los problemas visuales y los problemas de tipo osteomuscular alcanzó valores significativos tanto cuando la correlación se realizó en cada grupo por separado, como cuando se llevó a cabo analizando juntos todos los sujetos participantes [DMAE, rho de Spearman (ρ)=0,60, P=0,002; grupo de referencia (controles) ρ=0,59, P=0,004; los dos grupos jun...

Reliability and Validity of the Visual, Musculoskeletal, and Balance Complaints Questionnaire

“…A case to item ratio of 5:1 is regarded adequate 50. In the current study, the ratio was 83:1 compared to the 3:1 in the original study 24. The use of Rasch analysis in the present study enabled a detailed examination of the operation of each VMB domain, corresponding with the notion that Rasch analysis is an important tool in instrument development in vision science 51.…”

“…Items were refined after patient and expert reviews to achieve face validity. From a pool of items, 15 were deemed representative by the research group and were tested on patients with age-related macular degeneration 24. Principal component analysis (PCA) resulted in a three-factor solution comprising visual, musculoskeletal, and balance complaints.…”

Visual, Musculoskeletal, and Balance Complaints in AMD: A Follow-Up Study

“…In primary health care these symptoms are often downplayed as part of the aging processes [18] and not typically associated with visual impairments [6, 19]. However, research indicates that people suffering from AMD may pose a higher risk of developing visual, musculoskeletal, and balance complaints [20]. …”

“…Previous research addressing the impact of visual loss in AMD patients on visual, musculoskeletal, and balance complaints is limited or has used cross-sectional design [20]. This research has identified concurrent relationships; however, less is known about the influences of visual decline in AMD on visual, musculoskeletal, and balance complaints across time.…”

Geriatric Vision Care – a New Look at the Old

“…5 Age-related macular degeneration is associated with more visual stress and an increase in musculoskeletal complaints. 6 Poor vision is an important predictor of falls 7 with poor visual acuity, contrast sensitivity, stereopsis and visual impairment all increasing the frequency of lost balance 8,9 and the degeneration of coordination that results from decreased spatial orientation and awareness. Interestingly, the Morse Falls Scale Assessment, 10 which is a standardised instrument used for intake into some hospital settings, does not include any questions on vision.…”