A Case-Control Study to Assess Vision-Related Quality of Life in Patients With and Without Diabetic Retinopathy from a Multiethnic Population in Malaysia

Although the association between visual acuity (VA) and vision-related quality of life (VRQoL) has been well reported in patients with type 2 diabetes mellitus (T2DM), little is known about how unilateral and bilateral VA affects daily performance in such patients. For this cross-sectional study, patients were recruited from the Diabetes Shared Care Network of the Division of Endocrinology and Metabolism, Zhong-Xiao Branch, Taipei City Hospital in Taiwan. Ninety patients with T2DM (51 men and 39 women) with a mean age of 60.3 ± 10.5 (standard deviation) years, 47% of whom had diabetic retinopathy, were included. The purposes were to compare the impacts of VA in the better eye, both eyes, and three forms of functional acuity scores (FAS) on VRQoL in patients with T2DM. VRQoL and corrected VA were assessed with the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and Early Treatment Diabetic Retinopathy Study (ETDRS) chart, respectively. Three FAS algorithms proposed by Colenbrander and the American Medical Association were used to assess FAS. Regression analyses were performed to determine the correlations among the five types of VA, the original composite scores, and the Rasch-calibrated composite scores of the NEI VFQ-25 on all patients with T2DM and on the same patients stratified by diabetic retinopathy (DR) and no-DR. The VA of both eyes had a higher impact on VRQoL and revealed a lower reduction estimated by the two forms of composite scores than did the VA of the better eye and three FAS algorithms (compared with binocular VA β estimates, − 14.5%, − 15.8%, − 29.3%, and − 11.8% for original composite scores, and − 16.1%, − 14.0%, − 24.6%, and 10.3% for Rasch-calibrated composite scores). When the T2DM group was stratified into DR and no-DR groups, significant associations between VA and VRQoL were observed only in the DR group. The VA of both eyes also had the greatest impact and reduction after stratification. The results indicated that unilateral better-eye VA and VA estimated by the three FAS algorithms seems to underestimate the impact of visual impairment on self-report VRQoL in patients with T2DM. This study provides empirical support for the importance of binocular VA assessment in regular clinical diabetes eye care.

To evaluate vision related quality of life in the patients enrolled in The European Consortium for the Early Treatment of Diabetic Retinopathy, a clinical trial on prevention of diabetic retinopathy. Four-hundred-forty-nine patients, 153 women, with type 2 Diabetes and no or mild diabetic retinopathy were enrolled in a 2-year multicenter randomized controlled trial. The 25-item National Eye Institute Visual Functioning Questionnaire was used to explore 12 subscales of vision related quality of life. The patients were 62.8 ± 6.7 years old and had 11.1 ± 5.6 years known disease duration. Diabetic retinopathy was absent in 193 (43.0 %) and mild in 256 (57.0 %). Patients without diabetic retinopathy were older, had shorter diabetes duration and used less insulin and glucose-lowering agents but did not differ by gender, best corrected visual acuity or any subscale, except vision specific mental health and vision specific role difficulties. Patients with reduced retinal thickness at the ganglion cell layer (n = 36) did not differ for diabetic retinopathy but were older, had lower best corrected visual acuity and worse scores for ocular pain, color vision and peripheral vision. On multivariable analysis, worse scores for general vision remained associated with reduced retinal thickness, diabetes duration and best corrected visual acuity, and scores for visual specific mental health with diabetic retinopathy and lower best corrected visual acuity. Visual specific role difficulties were only associated with reduced best corrected visual acuity. Scores for driving decreased among females, with worsening of Hemoglobin A1c and best corrected visual acuity. Color vision depended only on reduced retinal thickness, and peripheral vision on both reduced thickness and best corrected visual acuity. The National Eye Institute Visual Functioning Questionnaire could detect subtle changes in patients' perception of visual function, despite absent/minimal diabetic retinopathy.

Resident Perspectives

The Impact of Eyeglasses on Vision-Related Quality of Life in American Indian/Alaska Natives

Purpose To evaluate the association between visual-related quality of life (VRQoL) and visual field (VF) loss in patients with primary angle-closure glaucoma (PACG). Methods In this case-control study, a total of 79 patients with PACG (with or without VF detects) and 35 healthy controls were included. The patients underwent the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25), clinical examination, and VF testing. VF defects were identified by simplified Hodapp's classification. NEI VFQ-25 scores were compared between the three groups. Results No significant differences were found in gender, VFQ rating for “composite score” and “color vision” between the three groups. PACG patients with VF loss were most likely to be older and had lower best corrected visual acuity (BCVA), spherical equivalent (SE), mean deviation (MD), and visual field index (VFI), but higher pattern standard deviation (PSD) (all P < 0.05). Furthermore, patients with VF loss had significantly lower NVE-VFQ-25 subscale scores for general health, general vision, ocular pain, near activities, distance activities, social functioning, mental health, role difficulties, dependency, driving, and peripheral vision than PACG patients without VF loss and healthy controls (all P < 0.05). VFI (β = 1.498, P=0.003) and MD (β = −3.891, P=0.016) were significantly correlated with Role Difficulties scores. Additionally, PSD was significantly correlated with Peripheral Vision scores (β = −1.346, P=0.003). Conclusions PACG patients with VF loss reported lower NEI VFQ-25 composite and subscale scores. VF indices including VFI, MD, and PSD were strongly correlated with VRQoL as assessed by NEI VFQ-25; thus, VRQoL may be significantly impacted by glaucomatous VF defects.

It is reasonable to hypothesize that for 2 patients with similar degrees of integrated binocular visual field (BVF) loss, the patient with a history of faster disease progression will report worse vision-related quality of life (VRQOL) than the patient with slowly progressing damage. However, to our knowledge, this hypothesis has not been investigated in the literature. To evaluate the association between binocular rates of visual field change and VRQOL in patients with glaucoma. DESIGN Observational cohort study. Patients were recruited from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. The study included 796 eyes of 398 patients with diagnosed or suspected glaucoma followed up from October 1, 1998, until January 31, 2012, for a mean (SD) of 7.3 (2.0) years. The VRQOL was evaluated using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) at the last follow-up visit. The NEI VFQ-25 was completed for all patients during the period extending from December 1, 2009, through January 31, 2012. Integrated BVFs were calculated from the monocular fields of each patient. Linear regression of mean deviation values was used to evaluate rates of BVF change during the follow-up period. Logistic regression models were used to investigate the association between abnormal VRQOL and rates of BVF change, while adjusting for potentially confounding socioeconomic and demographic variables. Thirty-two patients (8.0%) had abnormal VRQOL as determined by the results of the NEI VFQ-25. Patients with abnormal VRQOL had significantly faster rates of BVF change than those with normal VRQOL (-0.18 vs -0.06 dB/y; P < .001). Rates of BVF change were significantly associated with abnormality in VRQOL (odds ratio = 1.31 per 0.1 dB/y faster; P = .04), after adjustment for confounding variables. Patients with faster rates of BVF change were at higher risk of reporting abnormal VRQOL. Assessment of rates of BVF change may provide useful information in determining risk of functional impairment in glaucoma.

AimTo evaluate vision-related quality of life in persons with branch retinal vein occlusion (BRVO) using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25).DesignObservational, cross-sectional, interviewer-administered study.Methods46 patients with...

Vision-related quality of life in patients with bilateral severe age-related macular degeneration

PDB103 HUMANISTIC BURDEN ASSOCIATED WITH DIABETIC RETINOPATHY: EVIDENCE FROM A LITERATURE REVIEW

The purpose of this study was to assess the vision-related quality of life (VR-QoL) in glaucoma patients and its correlations with psychological disturbances and visual function components. The 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) and Hospital Anxiety and Depression Scale (HADS) questionnaires were administered to 428 Chinese glaucoma patients to evaluate their VR-QoL and anxiety and depression disorders, respectively. Sociodemographical and clinical factors were collected at the same time. Univariate analyses were used to investigate the associations between the variables and the VR-QoL. Multivariate linear regression analyses were used to identify the independent psychological and visual functional predictors of the VR-QoL. Standardized partial regression analyses were used to reveal the variables that mostly relevant to the VR-QoL. The composite score (mean±SD) was 71.88±14.44 for NEI VFQ-25 and 13.17±6.56 for HADS. Visual function indices, including best-corrected visual acuity and mean deviation of both eyes in addition to psychological symptoms including anxiety and depression were both correlated with VR-QoL significantly, even after adjusting for sociodemographical and clinical factors. Standardized partial regression analyses further suggested that psychological disorders, especially anxiety rather than visual function components, were mostly relevant to VR-QoL. Deterioration of vision impairment and visual field defects in addition to increased recognition of psychological disturbances reduce the VR-QoL of glaucoma patients significantly. Alleviating psychological symptoms, especially anxiety, perhaps have a greater influence on the improvement of VR-QoL.

The purpose of the study was to investigate the relationship between vision-related quality of life (VRQOL) and mean deviation (MD) of the monocular visual field and integrated binocular visual field (IBVF). One hundred eighty VFs (90 pairs) obtained from 90 patients with normal tension glaucoma were included. VRQOL was evaluated using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). IBVF was calculated using maximal sensitivity and binocular summation and IBVF MD was calculated. Multiple linear regression analysis was used to assess the impact of IBVF deficit on VRQOL after adjusting for confounding factors. These results were compared to those of monocular visual field. Mean subject age was 59.4 years. The average MD of maximal sensitivity was significantly higher than that of binocular summation, the better eye, and the worse eye (-3.27, -3.78, -3.96, and -8.66 dB, respectively, P<0.001). Rasch-analyzed NEI VFQ-25 subscales and composite scores were significantly correlated with IBVF deficit. The impact that IBVF had on VRQOL was similar to that of the better eye (R of 0.431, 0.422, and 0.422 for MD of the better eye, binocular summation, and maximal sensitivity, respectively). In contrast, the worse eye showed the least correlation with VRQOL (0.363). The impact of IBVF on VRQOL was similar to that of the better eye irrespective of integration method. Therefore, better eye MD could be a good indicator for VRQOL.

To identify factors influencing vision-related quality of life (VRQOL) according to glaucoma severity. A total of 901 patients with varying stages of glaucoma were recruited from the prospectively designed LIGHT (Life Quality of Glaucoma Patients Who Underwent Treatment) study organized by the Korean Glaucoma Society. Participants completed a basic questionnaire collecting socioeconomic status and clinical information, in addition to the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Subjects were classified by mean deviation (MD) of integrated binocular visual field (IVF) into mild, moderate and severe damage groups. Factors were evaluated for their influence on VRQOL according to glaucoma severity using univariate and multivariable regression models between Rasch-analysed NEI VFQ-25 subscale scores and different variables. The mild, moderate and severe groups contained 720, 111 and 70 patients, respectively; the mean IVF MD in each group was -1.4, -8.5 and -17.9 dB. Significant differences were observed among the three groups with respect to age, IVF MD, visual acuity (VA), education level, income level, number of glaucoma medications prescribed and follow-up period. The most influential factor associated with VRQOL according to glaucoma severity was VA. The VA of the better eye was much more influential on VRQOL than the VA of the worse eye in the moderate and severe defect groups, and the impact of VA on VRQOL was more prominent in advanced glaucoma. Visual acuity is the most influential factor on VRQOL in patients with glaucoma. Preservation of VA should be strongly prioritized to maintain good VRQOL.

Aims:The aim of this study was to determine the impact of diabetic macular oedema (DME) on the quality of life (QOL) in patients with type 2 diabetes mellitus.Methods:The study was...

Central retinal artery occlusion (CRAO) is a major cause for severe visual impairment. Its effect on vision-related quality of life has not yet been determined. The purpose of the present study was thus to assess vision-related quality of life in patients with CRAO using the 39-item National Eye Institute Visual Function Questionnaire. The case-control study comprised 26 patients with unilateral CRAO and a control group consisting of 26 control subjects, matched for age and sex. Vision-related quality of life was measured using the 39-item National Eye Institute Visual Function Questionnaire. After Bonferroni correction, the median 39-item National Eye Institute Visual Function Questionnaire composite score was significantly lower in patients with CRAO than in those in the control group (P(corr) < 0.001). Patients with CRAO showed significantly lower median scores in 9 of 12 subscales: general vision (P(corr) < 0.001), peripheral vision (P(corr) < 0.001), difficulties with near-vision activities (P(corr) < 0.001), difficulties with distance-vision activities (P(corr) < 0.001), role difficulties as a result of vision problems (P(corr) < 0.001), dependency on others because of vision problems (P(corr) < 0.001), limitations in social functioning because of vision problems (P(corr) < 0.001), mental health symptoms because of vision problems (P(corr) < 0.001), and general health (P(corr) = 0.008). Our data suggest that vision-related quality of life is reduced in patients with CRAO.

To determine changes in the vision-related quality of life in patients undergoing deep anterior lamellar keratoplasty (DALK) by using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Thirty-five patients who were scheduled for DALK between March 1, 2013, and March 1, 2014 were asked to complete the NEI VFQ-25. NEI VFQ-25 was administered again at 6 months and at 1 year postoperatively. Data on patients' age, sex, preoperative diagnosis, preoperative and postoperative best-corrected visual acuity, and postoperative astigmatism were recorded. Successful DALK with the Anwar big bubble technique was achieved in 23 of 35 (65.7%) patients. The indications for surgery were keratoconus in 15 patients (62.2%), stromal corneal dystrophies in 4 (17%), and corneal scar in 4 (17%). The mean preoperative NEI VFQ-25 composite score (55.2±19.7) improved significantly (76.9±11.6) at 6 months after DALK and continued to improve (84.3±6.6) at 1 year postoperatively (Friedman test, P=0.001). All NEI VFQ-25 subscale item scores increased significantly after surgery. The patients' age was significantly correlated with the NEI VFQ-25 subscale score of mental health at 6 month and at 1 year postoperatively (r=0.92, P=0.008 and r=0.94, P=0.005, respectively). There was a negative relationship between postoperative astigmatism at 1 year and NEI VFQ-25 ocular pain, social functioning, peripheral vision, and mental health subscale scores (r=-0.76, P=-0.07; r=-0.53, P=0.2; r=-0.53, P=0.27; r=-0.80, P=0.05). Vision-related quality of life improved significantly after DALK and continued to improve after suture removal.