Original Investigation | Epidemiology

Alteration of Travel Patterns With Vision Loss From Glaucoma and Macular Degeneration

Frank C. Curriero, PhD1,2; Jessie Pinchoff, MPH3; Suzanne W. van Landingham, MD4; Luigi Ferrucci, MD, PhD5; David S. Friedman, MD, PhD4; Pradeep Y. Ramulu, MD4
[+] Author Affiliations
1Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
2Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
3Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
4Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
5Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
JAMA Ophthalmol. 2013;131(11):1420-1426. doi:10.1001/jamaophthalmol.2013.4471.
Text Size: A A A
Published online

Importance  The distance patients can travel outside the home influences how much of the world they can sample and to what extent they can live independently. Recent technological advances have allowed travel outside the home to be directly measured in patients’ real-world routines.

Objective  To determine whether decreased visual acuity (VA) from age-related macular degeneration (AMD) and visual field (VF) loss from glaucoma are associated with restricted travel patterns in older adults.

Design  Cross-sectional study.

Setting  Patients were recruited from an eye clinic, while travel patterns were recorded during their real-world routines using a cellular tracking device.

Participants  Sixty-one control subjects with normal vision, 84 subjects with glaucoma with bilateral VF loss, and 65 subjects with AMD with bilateral or severe unilateral loss of VA had their location tracked every 15 minutes between 7 am and 11 pm for 7 days using a tracking device.

Main Outcomes and Measures  Average daily excursion size (defined as maximum distance away from home) and average daily excursion span (defined as maximum span of travel) were defined for each individual. The effects of vision loss on travel patterns were evaluated after controlling for individual and geographic factors.

Results  In multivariable models comparing subjects with AMD and control subjects, average excursion size and span decreased by approximately one-quarter mile for each line of better-eye VA loss (P≤ .03 for both). Similar but not statistically significant associations were observed between average daily excursion size and span for severity of better-eye VF loss in subjects with glaucoma and control subjects. Being married or living with someone and younger age were associated with more distant travel, while less-distant travel was noted for older individuals, African Americans, and those living in more densely populated regions.

Conclusions and Relevance  Age-related macular degeneration–related loss of VA, but not glaucoma-related loss of VF, is associated with restriction of travel to more nearby locations. This constriction of life space may impact quality of life and restrict access to services.

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours


Place holder to copy figure label and caption
Figure 1.
Schematic of Distance-Based Metrics

Schematic demonstrating the 2 distance-based metrics used for describing travel patterns: excursion size (maximum distance away from home) and excursion span. Three different excursion examples are shown: compact travel close to home (A), larger travel span close to home (B), and compact travel far from home (C). Comparing excursions A vs B, both excursions have the same excursion size; however, once away from home, excursion A is more compact (smaller excursion span) than excursion B. In A vs C, excursion C is further away from home; however, once away from home, both have the same excursion span. In B vs C, excursion C is further away from home than excursion B but also more compact so both excursions may have close to the same overall travel distance.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Scatterplots of Daily Average Excursion Size

Scatterplots of daily average excursion size averaged for each person’s week of travel as a function of disease severity. A, Plot of visual acuity (logMAR) vs person mean average daily excursion size for the participants with age-related macular degeneration and control subjects. B, Plot of better-eye visual field (VF) mean deviation (MD) vs person mean average daily excursion size for those with glaucoma and control subjects.

Graphic Jump Location




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics