Coping strategies may not be reflected by simulated performance-based measures of functional ability

Purpose: To determine whether the Melbourne Low Vision Index (MLVI) can be used to characterise the ability to carry out Activities of Daily Living (ADL) in a group of older people with age-related macular degeneration (AMD) which was reflective of actual day-to-day function according to in-depth interviews which encompassed questions about personal and environmental coping strategies. Method: Thirty-one individuals (23 females, 8 males, aged 79.1 ± 5.6 years) with AMD (16 dry, 15 wet) and no other ocular diseases underwent tests of clinical visual function, the MLVI and a semi-structured interview intended to highlight functionality in the home environment. Results: Participants' clinical visual measures were correlated with MLVI score such that poorer visual function was associated with poorer functional ability for daily living activities (p < 0.05). Moreover, part (a) of the MLVI, which is assessed by observation of task performance, has a significant correlation with the severity of AMD (p < 0.05). Semi-structured interviews revealed a mismatch between MLVI part (a) and self-reported functionality in their own home environment. Conclusion: Low functionality score (total) with MLVI is associated with severity of AMD and poor clinical visual function. The disparity between observed measures of functional vision (MLVI part (a)) and self-reported measures in the MLVI and in the semi-structured interviews may be explained in part by individual participant coping and adaptation strategies. The MLVI is therefore reflective of function in unfamiliar environments where people with low vision may not have recourse to compensatory strategies.