The decline in attentional visual fields over time among older participants in the Salisbury Eye Evaluation driving study

Purpose. The loss of attentional visual field (AVF) has been linked to poor mobility and car crashes. We investigated the risk factors associated with a decrease in AVF over time among participants in the Salisbury Eye Evaluation Driving Study (SEEDS). Methods. In a longitudinal cohort of 968 individuals ages 67 to 87, demographic, medical, visual, and cognitive factors were obtained at baseline (2005-2006) and follow-up (2007-2008) using structured medical questionnaires and onsite examinations. Using the standard deviation for the difference in AVF over 2 years of 4.3°, two subgroups were created: Those who lost 5° or more in two years and those who had no loss (i.e., loss of 5° or less, or no loss). Age-adjusted and multivariate odds ratios (OR) with 95% confidence intervals (95% CI) for each explanatory factor were determined using logistic regression. Results. The overall change in AVF was -0.34° (SD = 4.32), which was a significant decline from baseline. Of the population, 14% lost 5° or more of AVF. The following determinants were associated with a minimum loss of 5° over 2 years: female sex (OR = 1.59, P = 0.03), history of stroke (OR = 1.90, P = 0.03), depression (OR = 1.07, P = 0.02), a lower baseline Trails A and B scores (OR = 1.09, P = 0.003 and OR = 1.02, P = 0.02, respectively), and lower baseline visual acuity (OR = 1.21, P = 0.03). In addition, decline was related to a lower baseline measure of auditory attention (OR = 1.14, P = 0.007) and lower baseline visual fields in the central 20° (OR = 1.24, P = 0.01). Conclusions. Loss in AVF over time is related independently to decrements in cognition and vision. The higher odds of loss in female subjects, independent of these factors, deserves further research.