Abstract
BackgroundUtility of visual impairment caused by amblyopia is important for the cost-effectiveness of screening for amblyopia (lazy eye, prevalence 3–3.5 %). We previously measured decrease of utility in 35-year-old persons with unilateral persistent amblyopia. The current observational case–control study aimed to measure loss of utility in patients with amblyopia with recent decrease of vision in their better eye. As these patients are rare, the sample was supplemented by patients with bilateral age-related macular degeneration with similar decrease of vision.MethodsFrom our out-patient department, two groups of patients with recent deterioration to bilateral visual acuity less than Snellen 0.5 (bilateral visual impairment, BVI) were recruited, with either persistent amblyopia and age-related macular degeneration (AMB + AMD), or with bilateral age-related macular degeneration (BAMD). To measure utility, the time trade-off method and the standard gamble method were applied through interviews. Correlations were sought between utility values and visual acuity, age and Visual Function Questionnaire-25 scores.ResultsSeventeen AMB + AMD patients (mean age 72.9 years), and 63 BAMD patients (mean age 79.6 years) were included in the study. Among AMB + AMD, 80 % were willing to trade lifetime in exchange for cure. The overall mean time trade-off utility was 0.925. Among BAMD, 75 % were willing to trade, utility was 0.917. Among AMB + AMD, 38 % accepted risk of death in exchange for cure, overall mean standard gamble utility was 0.999. Among BAMD, 49 % accepted risk of death, utility was 0.998. Utility was not related to visual acuity but it was to age (p = 0.02).ConclusionElderly patients with BVI, caused by persistent amblyopia and age-related macular degeneration (AMD) or by bilateral AMD, had an approximately 8 % loss of TTO utility. Notably, the 8 % loss in elderly with BVI differs little from the 3.7 % loss we found previously in 35-year-old persons with unilateral amblyopia with good vision in the other eye. The moderate impact of BVI in senescence could be explained by adaptation, comorbidity, avoidance of risk and a changed percept of cure.
Highlights
Utility of visual impairment caused by amblyopia is important for the cost-effectiveness of screening for amblyopia
In a report by Carlton et al [2] the cost-effectiveness of vision screening up to the age of 4–5 years was examined. They concluded that the cost-effectiveness of screening for amblyopia depends primarily on the long-term utility van de Graaf et al BMC Ophthalmology (2016) 16:56 effects of unilateral vision loss caused by persistent amblyopia and that there is currently no evidence of loss in utility that would render any screening to be cost-effective
The 8 % utility loss in elderly with bilateral visual impairment (BVI) we found in this study differs little from the utility loss of 3.7 % we found previously in young adult persons with unilateral persistent amblyopia with good vision in the other eye [5]
Summary
Utility of visual impairment caused by amblyopia is important for the cost-effectiveness of screening for amblyopia (lazy eye, prevalence 3–3.5 %). We subsequently measured the loss of utility due to unilateral persistent amblyopia in the same historic cohort of adult persons with unilateral persistent amblyopia, 35–40 years old, who had, 30–35 years previously, been treated for amblyopia in Waterland, a rural region north of Amsterdam [5] This historic cohort formed an almost random sample, as almost all children with amblyopia and/or strabismus were referred and treated by the only ophthalmologist and only orthoptist in Waterland at the time. Almost half of them could be contacted 30–35 years later Seventy percent of these persons (N = 135) were willing to trade lifetime in exchange for cure, i.e. perfect vision, measured by the Time TradeOff (TTO) method. The loss of utility correlated with the current visual acuity of the amblyopic eye [5]
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