Date of Award


Degree Name

Doctor of Philosophy


Interdisciplinary Health Sciences

First Advisor

Dr. Amy B. Curtis

Second Advisor

Dr. John E. Crews

Third Advisor

Dr. Elyse M. Connors


Visual impairment, activities of daily living, NHANES, older adults, multimorbidity, chronic conditions


In the past 10 years, the number of American adults with visual impairments has increased from 1 million to 4 million and is expected to double to 8 million people by the year 2050 (The Eye Diseases Prevalence Research Group, 2004; National Eye Institute, 2013). Therapies to treat retinal diseases causing visual impairment, such as diabetic retinopathy and age-related macular degeneration (Massof, 2002; Mogk, 2011), have evolved in the past two decades (Gupta et al., 2013; Hooper & Guymer, 2003), but little research has examined recent population and difficulties with performing daily activities. Different types of professionals, including ophthalmologists, optometrists, occupational therapists, orientation and mobility specialists, vision rehabilitation therapists, and low vision therapists, work to assist adults with visual impairments remain independent with daily tasks, and an understanding of population characteristics is critical to providing successful treatment (Court, McLean, Guthrie, Mercer, & Smith, 2014; Johnson & Romanello, 2005; Salive, 2013). The studies in this three-paper dissertation examine difficulties with daily tasks, factors contributing to these difficulties, and similarities and differences over time in adults with visual impairments.

This research indicated that adults with even mild visual impairment report difficulty with their daily tasks. The first and second dissertation studies examined similarities and differences over time in two different populations of adults with visual impairments. The first study compared characteristics of adults receiving services from a Midwest hospital-based vision rehabilitation center from 1997-2003 with 2007-2012, and the second study compared National Health and Nutrition Examination Survey (NHANES) participants from years 1999/2000 versus 2007/2008. Both studies revealed a greater percentage of subjects with less severe vision impairment in the later time periods; however, overall, approximately 30% of people with less severe vision impairment reported difficulty with daily tasks, such as reading and driving. Results from the third study indicated as multimorbidity increased, the number of adults with visual impairment who reported difficulty increased, and this was accentuated with more severe visual impairment. These studies provide a better understanding of similarities and differences over time in visual function, and in the associations between visual impairment, multimorbidity status, and self-reported performance in daily activities in visually impaired adults. Vision rehabilitation professionals need to understand the population in order to manage the treatment of adults with mild to severe visual impairments, but also in 54% of the cases complicated by multimorbidity.

Access Setting

Dissertation-Open Access

Included in

Optometry Commons