Disability results when the demands of a task, in the environment where a task is performed, exceed the ability of the individual. However, little is known about the environmental features which might best allow persons with visual impairment, particularly those with irreversible conditions such as glaucoma or age-related macular degeneration, to perform important tasks enabling independence (i.e. instrumental activities of daily living), and to remain safe within their homes (i.e. by avoiding falls).
In Aim 1 of this proposal, we will investigate the importance of visual impairment to home functionality, as judged by objectively-evaluated in-home task performance. During in-home task performance, we will look for specific environmental impediments (lighting, contrast, text size, clutter, need for fine motor manipulation) associated with performance, allowing us to directly link environmental impediments to functionality.
In Aim 2 of this proposal, we will investigate the importance of visual impairment to rates of falls at home. Also, we will identify specific home hazard types which increase the risk of falls in a novel approach which matches the in-home location of falls, how much physical activity (steps) occurs in each region of the home (defined through integration of accelerometer and IPS data), and the number and type of hazards in each in-home region (defined through a home assessment). Unlike prior research, the current proposal will assign risk to home hazards only with regards to falls occurring near the hazard, and only proportional to the number of steps taken in the vicinity of the hazard (judged by integrated IPS and accelerometer data), an approach which is hypothesized to successfully identify hazards relevant to in-home falls in persons with visual impairment. By identifying home features associated with greater home functionality and safety, the proposal will further the National Eye Institute?s commitment to research which ?improves quality of life for people of all ages?.

Public Health Relevance

The proposed work will identify specific home features which enable older adults with visual impairment to live safely, functionally, and, if they so choose, independently in their own home ? a strong preference for most adults.18 Identification of such features will help intelligently define guidelines for home safety and functionality, and set up future randomized trials designed to evaluate the effectiveness of home modification programs to prevent falls and maintain functionality in persons with visual impairment.

National Institute of Health (NIH)
National Eye Institute (NEI)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Wiggs, Cheri
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Johns Hopkins University
Schools of Medicine
United States
Zip Code
Lee, Moon Jeong; Wang, Jiangxia; Friedman, David S et al. (2018) Greater Physical Activity Is Associated with Slower Visual Field Loss in Glaucoma. Ophthalmology :
Sotimehin, Ayodeji E; Yonge, Andrea V; Mihailovic, Aleksandra et al. (2018) Locations, Circumstances, and Outcomes of Falls in Patients With Glaucoma. Am J Ophthalmol 192:131-141
Yohannan, Jithin; Wang, Jiangxia; Brown, Jamie et al. (2017) Evidence-based Criteria for Assessment of Visual Field Reliability. Ophthalmology 124:1612-1620
Mathews, Priya M; Ramulu, Pradeep Y; Swenor, Bonnielin S et al. (2017) Functional impairment of reading in patients with dry eye. Br J Ophthalmol 101:481-486
de Luna, Regina A; Nguyen, Angeline M; Ramulu, Pradeep Y (2017) Reading Ability among Patients Presenting for Ophthalmic and Nonophthalmic Surgery. Ophthalmology 124:918-919
Yonge, Andrea V; Swenor, Bonnielin K; Miller, Rhonda et al. (2017) Quantifying Fall-Related Hazards in the Homes of Persons with Glaucoma. Ophthalmology 124:562-571
Odden, Jamie L; Mihailovic, Aleksandra; Boland, Michael V et al. (2016) Evaluation of Central and Peripheral Visual Field Concordance in Glaucoma. Invest Ophthalmol Vis Sci 57:2797-804
Willis, Jeffrey; Ramulu, Pradeep Y (2016) Poor Vision and Self-Reported Functional Difficulties among Recently Hospitalized Individuals in the United States. Ophthalmic Epidemiol 23:154-61
Dave, Pujan; Villarreal Jr, Guadalupe; Friedman, David S et al. (2015) Ability of Bottle Cap Color to Facilitate Accurate Patient-Physician Communication Regarding Medication Identity in Patients with Glaucoma. Ophthalmology 122:2373-9
Loprinzi, Paul D; Swenor, Bonnielin K; Ramulu, Pradeep Y (2015) Age-Related Macular Degeneration Is Associated with Less Physical Activity among US Adults: Cross-Sectional Study. PLoS One 10:e0125394

Showing the most recent 10 out of 14 publications