Vision and quality-of-life. Trans Am Ophthalmol Soc 1999;97:473–511.

Abstract

The author sought to determine the relationship of visual acuity loss to quality of life. Three hundred twenty-five patients with visual loss to a minimum of 20/40 or greater in at least one eye were interviewed in a standardized fashion using a modified VF-14 questionnaire. Utility values were also obtained using both the time trade-off and standard gamble methods of utility assessment. Best-corrected visual acuity was correlated with the visual function score on the modified VF-14 questionnaire, as well as with utility values obtained using both the time trade-off and standard gamble methods. Decreasing levels of vision in the eye with better acuity correlated directly with decreasing visual function scores on the modified VF-14 questionnaire, as did decreasing utility values using the time trade-off method of utility evaluation. The standard gamble method of utility evaluation was not as directly correlated with vision as the time trade-off method. Age, level of education, gender, race, length of time of visual loss, and the number of associated systemic comorbidities did not significantly affect the time trade-off utility values associated with visual loss in the better eye. The level of reduced vision in the better eye, rather than the specific disease process causing reduced vision, was related to mean utility values. The average person with 20/40 vision in the better seeing eye was willing to trade two of every ten years of life in return for perfect vision (utility value of 0.8), while the average person with counting fingers vision in the better eye was willing to trade approximately five of every ten remaining years of life (utility value of 0.52) in return for perfect vision. The author concludes that the time trade-off method of utility evaluation appears to be an effective method for assessing quality of life associated with visual loss. Time trade-off utility values decrease in direct conjunction with decreasing vision in the better-seeing eye. Unlike the modified VF-14 test and its counterparts, utility values allow the quality of life associated with visual 1oss to be more readily compared to the quality of life associated with other health (disease) states. The author feels that this information can be employed for cost effective analyses that objectively compare evidence-based medicine, patient-based preferences, and sound econometric principles across all specialties in health care.—Thomas J. Liesegang.