National Eye Institute Visual Function Questionnaire Research Articles

Risk factors for poorer quality of life in patients with neovascular age-related macular degeneration: a longitudinal clinic-based study.

To examine the risk factors for poor vision-related and health-related quality of life (QoL) in patients with neovascular age-related macular degeneration (nAMD) who present for anti-vascular endothelial growth factor (anti-VEGF) therapy. In a clinic-based cohort of 547 nAMD patients who presented for treatment, the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ25), Short-Form 36 (SF-36) and EuroQoL EQ-5D-5L questionnaires were administered to assess vision-related and health-related QoL. Of these, 83 participants were followed up one-year later to provide longitudinal data. Individuals with mild or moderate visual impairment or blindness at baseline had significantly lower NEI-VFQ-25 scores at follow-up. The presence of ≥3 chronic diseases was associated with lower SF-36 mental component scores (MCS) (p = 0.04) and EQ-VAS scores (p = 0.05). Depressive symptoms were associated with significantly lower MCS (p < 0.0001) and EQ-VAS scores (p = 0.02). Individuals with versus without impaired basic activities of daily living (ADLs) exhibited NEI-VFQ-25 and EQ-VAS scores that were 10.96 (p = 0.03) and 0.13 (p = 0.02) points lower. Those with impaired instrumental ADLs scored 11.62 (p = 0.02), 13.13 (p < 0.0001) and 15.8 (p = 0.0012) points lower in the NEI-VFQ-25, SF-36 physical component score and EQ-5D-5L summary score, respectively. The QoL of nAMD patients is affected by visual acuity as well as patients' medical history, mental health and functional status.

Vision-Related Quality of Life Among Healthy, Preperimetric Glaucoma, and Perimetric Glaucoma Patients

To investigate the association of vision-related quality of life (VRQOL) with the central visual field and macular ganglion cell complex (GCC) thickness in healthy control participants, patients with preperimetric glaucoma, and patients with perimetric glaucoma. Retrospective cross-sectional study. A total of 39 healthy, 34 preperimetric glaucoma, and 145 perimetric glaucoma patients completed the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ). A linear mixed-effect models was used to investigate the association between the glaucoma stage as measured by binocular 10-2 visual field mean sensitivity (VFMS) and GCC thickness with the Rasch-calibrated NEI-VFQ score. A total of 436 eyes from 218 participants (mean age=67.2 [95% CI=65.1 to 69.2] years) were enrolled. VRQOL calculated by the NEI-VFQ Rasch-calibrated score was worst for patients with perimetric glaucoma (50.7 [95% CI=47.2 to 54.2]), followed by patients with preperimetric glaucoma (41.2 [95% CI=34.5 to 47.9]) and healthy controls (29.3 [95% CI=24.0 to 34.7]. Worse VRQOL had a moderate association with a worse global binocular 10-2 VFMS (-3.4 [95% CI=-5.0 to -1.9] dB per 1 score; P < .001; adjusted R2=0.27), but not with a thinner global GCC in the better eye (-0.1 [95% CI=-0.2 to 0.1] µm per 1 score; P =.0485; adjusted R2=0.17). These findings suggest that patients with perimetric and preperimetric glaucoma have worse VRQOL than patients with healthy eyes. As compared to macular thickness measurements, the central visual field is more strongly associated with VRQOL and may better help to identify patients in need of intervention.

Quality of life in glaucoma patients: Comparison of medical therapy, trabeculectomy, and glaucoma drainage device surgery.

To compare the quality of life (QoL) in patients with glaucoma on medical therapy and after trabeculectomy and glaucoma drainage device (GDD) using vision, glaucoma, and surgery-specific questionnaires. This cross-sectional study enrolled 30 patients of moderate to severe glaucoma, each in medical, trabeculectomy, and GDD groups. National Eye Institute Visual Function Questionnaire 25 (NEIVFQ-25), Glaucoma Quality of Life (GQL-15), and Surgery Specific Questionnaire (SSQ) were administered, and cumulative scores were compared. The mean age of the participants was 58.95 ± 13.6 years with a male preponderance (73.3%, n = 66). The mean scores (SD) in the medical, trabeculectomy, and GDD groups using NEIVFQ-25 were 68.97 (6.98), 72.83 (7.81), and 75.20 (8.77), respectively, those using GQL-15 were 20.63 (6.00), 26.23 (9.12), and 28.43 (7.74), respectively, and for the SSQ, they were 74.33 (8.75) and 72.10 (5.92) in trabeculectomy and GDD groups, respectively. NEIVFQ-25 showed a better QoL in the GDD group compared to the medical group, whereas GQL-15 showed a better QoL in the medical group and comparable QoL in trabeculectomy and GDD. Both these QoL scores correlated to the LogMAR visual acuity. SSQ scores did not show a significant difference in the QoL across both surgical groups. NEIVFQ-25 questionnaire scores provided a holistic measure of QoL. GQL-15 assessed the activity limitation and visual disability of the patients but did not take into account the general health and psychological factors influencing the QoL. We did not find a significant difference between trabeculectomy and GDD using the SSQ. For QoL assessment in medically or surgically treated glaucoma, vision-specific and disease-specific questionnaires should always be used in conjunction.

The influence of the topographic location of geographic atrophy on vision-related quality of life in nonexudative age-related macular degeneration.

To examine associations between the topographic distribution of geographic atrophy (GA) and vision-related quality of life (VRQoL). This study included 237 eyes from 161 participants in the Age-Related Eye Disease Study (AREDS). GA lesions were manually delineated with color fundus photographs obtained by the AREDS Research Group and atrophic area was measured in an Early Treatment Diabetic Retinopathy Study (ETDRS) grid. VRQoL was measured using the National Eye Institute Visual Function Questionnaire (NEI-VFQ). Area of atrophy in the ETDRS grid subfields was correlated with VRQoL by linear regression modeling. The average area of atrophy in the better and worse eye was 3.43mm2 and 7.15mm2 respectively. In multivariable analysis, VRQoL was not associated with total area of atrophy in the better eye(β, - 0.53; 95% confidence interval [CI], - 1.11 to 0.05; P = 0.07) or worse eye (β, 0.12; 95% CI, - 0.32 to 0.55; P = 0.59). However, area of atrophy in the central 1-mm-diameter zone of the better eye was significantly associated with VRQoL when the ETDRS subfields were examined individually (β, - 14.57; 95% CI, - 27.12 to - 2.02; P = 0.023), grouped into quadrants (β, - 18.35; 95% CI, - 30.03 to - 6.67; P = 0.002), inner and outer zones (β, - 17.26; 95% CI, - 29.38 to - 5.14; P = 0.006), or vertical and horizontal zones (β, - 18.97; 95% CI, - 30.18 to - 7.77; P = 0.001). In patients with GA, greater area of atrophy in the central 1-mm-diameter zone of the better eye was independently associated with lower VRQoL, while total area of atrophy in the better or worse eye was not.

Randomised, Single Blind, Controlled, Three-Month Clinical Trial on the Evaluation and Treatment of the Ocular Surface Damage Following Phacoemulsification.

Background: To determine efficacy of two lacrimal substitutes on signs and symptoms of ocular surface disease after phacoemulsification; to determine impact of surgery on patients’ vision related quality of life. Monocentric, randomised, physician blinded, three parallel groups clinical trial. Design and Methods: Patients in the operative list for phacoemulsification have been screened for eligibility; they underwent (at time 0, 15, 45 and 90 days): slit lamp examination; tear film break-up time (BUT); corneal staining; tear volume; 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ); Ocular Surface Disease Index (OSDI). Treatments to be compared were: 1. standard of care-SOC (lomefloxacine and tobramicine/dexamethasone fixed combination 4 times a day for 2 weeks), 2. SOC + carboxymethylcellulose sodium 0.5% and glycerin 0.9%, 3. SOC + Sodium Hyaluronate 0.15%. Study treatment started at T15. Groups were compared with parametric or nonparametric tests, and with Pearson’s χ2 test. Correlation between continuous variables was assessed by means of Pearson’s or Spearman’s coefficient. Results: Fifty-three patients were enrolled. At 45 and at 90 days from surgery, the group receiving lacrimal substitutes presented better BUT and Schirmer I test (p = 0.009, <0.001, <0.001 and 0.001, respectively); dry eye presence showed significant difference by group at time 90 (p = 0.019). General vision, near activity and vision-specific dependency subscales improved after surgery (p = <0.001, 0.004 and 0.048, respectively). At 45 and 90 days from surgery, the OSDI score significantly changed (p < 0.001).Conclusions: Cataract surgery causes the onset or the worsening of dry eye. Use of artificial tears can significantly reduce symptoms and signs of dry eye in patients after phacoemulsification.

Chinese Version of the Vision-Related Quality of Life (NEI-VFQ-25) among Patients with Various Ocular Disorders: A Pilot Study.

Background and Objectives: Subjective visual function is currently becoming an increasing appreciation in assessing the health-related quality of life. This study aimed to assess the vision-related quality of life (VRQOL) among patients with refractive errors, keratoconus, senile cataract, and age-related macular degeneration (AMD) using the Chinese version of the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25). Materials and Methods: The questionnaire of NEI-VFQ-25 was filled out in a clinical setting or by telephone/mail. Univariate and multivariate analyses were used to determine which factors are associated with the NEI-VFQ-25. Results: From June 2018 to January 2019, 28 patients with refractive error, 20 patients with keratoconus, 61 with senile cataracts, and 17 with AMD completed the questionnaire NEI-VFQ-25. There were significant differences in the NEI-VFQ-25 subscale of general vision (p = 0.0017), ocular pain (p = 0.0156), near activities (p = 0.0002), vision-specific social functioning (p = 0.007), vision-specific mental health (p = 0.0083), vision-specific dependency (p = 0.0049), color vision (p < 0.0001), peripheral vision (p = 0.0065), and total score (p < 0.0001) among four disease groups, respectively. The multiple linear regression revealed that the best-corrected visual acuity (BCVA) and disease group were important factors of the total NEI-VFQ-25. After adjusting for BCVA, patients with AMD had a worse total NEI-VFQ-25 score than patients with refractive error, keratoconus, or senile cataracts. Conclusions: Among the patients with four ocular disorders and a broad vision spectrum from normal, partial sight, low vision to legal blindness, the BCVA of their better eye was the most important factor in the VRQOL.

Comparison of vision-related quality of life in patients with homonymous hemianopia and monocular blindness

To evaluate the vision-related quality of life (QoL) in patients with homonymous hemianopia (HH). The study compared the QoL in 32 patients with HH and 33 patients with monocular blindness. Best-corrected visual acuity (BCVA) and visual field test were investigated. The National Eye Institute-Visual Function Questionnaire 25 (NEI VFQ-25) and independent mobility questionnaires (IMQs) were used to assess their perceived visual and physical functioning abilities. The results of QoL questionnaires were compared in two groups. The mean deviation (MD) in the better eye was significantly lower in the HH group than in the monocular blindness group. The composite scores of NEI-VFQ and IMQs were significantly lower in the HH patients than in the monocular blindness patients. The driving-related score was significantly lower in patients with right hemianopsia than in those with left hemianopsia. The outdoor activity-related score was significantly lower in patients aged less than 55 years than in patients aged 55 years and more. Homonymous hemianopia had a negative impact on patients’ QoL by limiting their vision related activities compared to monocular blindness. The MD of the better eye in the HH patients reflects the binocular visual field and can affect the real visual function and QoL.

The Quality of Life of Medically Versus Surgically Treated Primary Open-angle Glaucoma Patients at a Nigerian Hospital.

The purpose of this study is to compare the quality of life (QoL) of medically treated versus surgically treated primary open-angle glaucoma (POAG) patients attending Lagos University Teaching Hospital, Lagos, Nigeria. The study was a hospital-based, comparative cross-sectional study. Consecutive consenting POAG participants who met the inclusion criteria were recruited until the sample size was achieved. QoL of all participants was assessed using the glaucoma QoL-15 and National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) questionnaires. Analysis was done using the IBM statistical package for the social sciences version 25.0. The study involved 81 participants who were only on medical treatment for POAG and 81 age- and sex-matched POAG participants who had trabeculectomy surgery. Surgically treated participants had a lower mean intraocular pressure 11.68 mmHg when compared to the medically treated participants 14.82 mmHg. Medically treated participants however had a better overall mean glaucoma QoL using the glaucoma QoL-15 (medical 34.36 ± 10.4, surgical 39.11 ± 13.9 P = 0.015) and NEI-VFQ-25 questionnaires (medical 68.32 ± 15.0, surgical 62.44 ± 18.8 P = 0.029). Controlling for the severity of glaucoma using the glaucoma QoL-15 questionnaire, medically treated participants had a better QoL only among participants with severe POAG (medical 49.13 ± 5.9, surgical 54.06 ± 4.6 P = 0.003). While using the NEI-VFQ-25 questionnaire, medically treated participants had a significantly better QoL only among participants with moderate (medical 74.70 ± 6.6, surgical 67.07 ± 15.6 P = 0.012) and severe POAG (medical 54.52 ± 6.3, surgical 45.51 ± 10.0 P = 0.004). The study demonstrated that although participants that had trabeculectomy had a lower mean intraocular pressure, their overall mean QoL was reduced compared to the medically treated participants.

Exploring the Quality of Life Related to Health and Vision in a Group of Patients with Diabetic Retinopathy.

(1) Background: Visual impairment of people with diabetic retinopathy (DR) and its high impact on different dimensions of their lives can cause a significant deterioration in the quality of life. The aim of this study was to examine the association and relationship between quality of life related to vision and the relevant clinical and sociodemographic variables in a group of patients with DR in Spain. (2) Methods: A descriptive cross-sectional study was conducted in all patients with DR over 18 years under follow-up in the Retina Service of the University Hospital of Burgos (HUBU), recruited during the months of January and February 2020. The main study variable was quality of life related to health and vision, obtained using the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25). (3) Results: In total 87 participants made up the sample, and significant differences were found in the NEI-VFQ-25 according to gender, type of diabetes, episodes of decompensated diabetes and high blood pressure (HBP) (p < 0.05). Best-corrected visual acuity (BCVA) was also correlated with the NEI-VFQ-25 (p < 0.05). (4) Conclusions: These data could facilitate the design of action protocols focused on the well-being of the patient, in addition to considering the clinical characteristics. Further studies are needed to help understand the causal relationship between variables and that includes a wider variety of factors.

Neovasküler Yaşa Bağlı Makula Dejeneransı Olan Hastalarda COVID-19 Pandemisi Sırasında Görme İlişkili Yaşam Kalitesinin Değerlendirilmesi: Retrospektif Çalışma

Objective: To evaluate vision-related quality of life (QoL) using National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) in neovascular age-related macular degeneration (nAMD) patients during coronavirus disease-2019 (COVID-19) pandemic. Material and Methods: nAMD patients whose intravitreal injection had to be postponed due to restrictions of COVID-19 lockdown between April and June 2020, NEI-VFQ-25 was administered last visit pre-COVID-19 and first visit during COVID-19. NEI-VFQ-25 scores, best-corrected visual acuity (BCVA) and central macular thickness (CMT) were compared between visits. Results: Fifty six patients with nAMD were participitated in the study. The composite score of NEIVFQ-25 was statistically significantly lower at first visit during COVID-19 when compared with at last pre-COVID-19 (95% confidence interval, 2.33-4.24; p=0.000). Decrease in NEI-VFQ-25 composite score was moderately associated with an impairment in BCVA at first visit during COVID-19 and duration of treatment delay after adjusting for age, gender, BCVA at last visit pre COVID-19 and CMT (β coefficient=0.42 and 0.41 and p=0.016 and 0.015). Conclusion: Negative impacts of delayed treatment during COVID-19 pandemic were observed by decrease NEI-VFQ-25 composite scores in patients with nAMD observed on psychological well-being and ability of performing daily life activities that depend on visual function.

Effects of a new-generation hybrid contact lens on visual performance and vision-related quality of life in patients with keratoconus.

The aim of this study was to evaluate the efficacy of a new-generation hybrid contact lens for improving visual outcomes and vision-related quality-of-life performance in patients with keratoconus who had intolerance or treatment failure of conventional correction methods such as the use of soft silicone-hydrogel or rigid gas-permeable contact lenses. Twenty-eight patients with keratoconus (42 eyes) were enrolled in this prospective cross-sectional study. Airflex (Swisslens) lenses were fitted in the patients' eyes in accordance with the manufacturer's instruction. Ophthalmologic examinations, including manifest refraction, best-corrected distance visual acuity, slit-lamp biomicroscopy, and National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) assessment, were performed at baseline and the 6-month visit. An adequate fit was achieved in 39 eyes (92.9%) of 26 patients. Six eyes of 3 patients were excluded from the study owing to discontinuation of lens wearing. The mean age of the successful wearers was 20.3 ± 4.9 years. The mean best-corrected distance visual acuity was statistically significantly improved from 0.62 ± 0.30 to 0.11 ± 0.06 logMAR with the Airflex hybrid contact lenses (p<0.001). The mean overall composite NEI-VFQ-25 score statistically significantly increased with the Airflex hybrid contact lenses at the 6-month visit as compared with that at baseline (from 77.1 ± 16.3 to 90.9 ± 7.3, p=0.036). Statistically significantly better scores were obtained with the Airflex hybrid contact lenses in all the NEI-VFQ-25 subscale items (all p<0.05). No significant adverse effects were observed. New-generation hybrid contact lenses can be used as an effective alternative for correction of irregular astigmatism in patients with keratoconus who have intolerance or treatment failure of conventional methods. Significant improvement in vision-related quality-of-life in patients with keratoconus can be achieved with these lenses.

Associations between Visual, Hearing Functioning and Cognitive Functioning among Hispanics/Latinos

Findings that visual impairment (VI) and hearing impairment (HI) are associated with cognitive functioning are drawn from studies that involved few Hispanic/Latino participants. We utilized data from the Miami Ocular SOL ancillary study to the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) with 1056 participants aged 45 and older. The outcomes were neurocognitive performances assessed by the Digit Symbol Substitution Test (DSST, executive function), Word Frequency Test (verbal fluency), Brief Spanish-English Verbal Learning Test-recall (B-SEVLT recall, episodic memory), and the Six-Item Screener (global cognitive functioning). Visual functioning was measured by National Eye Institute Visual Function Questionnaire (NEI-VFQ). Hearing function which was measured by Hearing Handicap Inventory for Adults and Elderly (HHIA/HHIE) was available for all HCHS/SOL participants (n=9343). Multiple regression was performed for each cognitive outcome while controlling for age, gender, education, Hispanic/Latino ethnicity background, cardiovascular risk factors, depression and complex design. NEI-VFQ was associated with 3 of the 4 cognitive outcomes: DSST (β =0.14, se=0.027, p<0.01), Word Frequency Test (β=0.042, se=0.016, p<0.01), B-SEVLT-recall (β=0.021, se=0.007, p<0.03). HHIA/HHIE was not associated with any of the cognitive measures examined. The HHIA/HHIE analysis was repeated using data from all sites; similar results were observed. Visual functioning but not hearing functioning is associated with worse cognition in Hispanics/Latinos, although previous HCHS/SOL analysis indicated that hearing loss as assessed by pure tone audiometry was associated with worse cognitive functioning. Longitudinal assessment of both clinical and functional measures is needed to understand the impact of sensory impairment on cognition in Hispanics/Latinos.

Assessment of Vision Function and Cognitive Dysfunction in Older Adults through Questionnaire Surveys

AbstractBackgroundVisual impairment in older adults has been associated with increased risk and severity of Alzheimer’s disease (AD) [Cronin‐Golomb, 1995]. There is a great need to understand the relationship between these two disease processes in an effort to improve coordinated care for these patients. The purpose of the study is to determine the relationship between cognitive dysfunction and self‐reported visual function using the National Eye Institute Visual Function Questionnaire (NEI‐VFQ) and Mini‐Mental Status Exam (MMSE).MethodsSubjects for this investigation were enrolled from the Alzheimer’s Disease in Primary Care (ADPC) study, in which each participant undergoes a medical exam, interview, neuropsychological testing, 3T MRI of the brain and PET amyloid scans. This study recruited 131 participants from the ADPC cohort to complete the NEI VFQ‐25. The 25‐item questionnaire consists of 12 subscales that measure the impact of ocular disease on several domains of health. To examine the relationship between cognition and self‐reported visual function, we correlated mini‐mental state exam (MMSE) scores with NEI‐VFQ overall composite scores.ResultsWe observed a significant association between overall NEI‐VFQ composite score and MMSE score (p = 0.0359). On average, for every 1‐point increase in MMSE total score, the overall composite score increases by 0.3992 units.ConclusionsThe consideration of visual function and quality of life is an important component during the ophthalmic and neuropsychological evaluation of a patient with cognitive dysfunction. Vision tests, such as visual acuity, are not a comprehensive representation of visual impairment experienced by individuals [Cullinan, 1978, Genensky, 1976], and do not account for the influence of visual disability on health‐related quality of life (HRQOL) such as emotional well‐being or social function [Mangione, 2001]. The use of the NEI‐VFQ in a primary care setting could help identify patients with reduced self‐reported visual function, which could simultaneously identify those at increased risk for cognitive dysfunction.

Artificial vision: the effectiveness of the OrCam in patients with advanced inherited retinal dystrophies.

PurposeTo investigate the impact of the OrCam MyEye 2.0 (OrCam) on the quality of life and rehabilitation needs in patients with advanced retinitis pigmentosa (RP) or cone‐rod dystrophies (CRD). The OrCam is a wearable low‐vision aid that converts visual information to auditive feedback (e.g. text‐to‐speech, barcode and facial recognition).MethodsPatients with a clinical diagnosis of RP (n = 9, 45%) or CRD (n = 11; 55%), and a best‐corrected visual acuity of ≤20/400 Snellen were invited to participate in this study. Questionnaires were administered at baseline and after 5.2 (standard deviation ± 1.5) weeks, which included the Dutch version of the National Eye Institute Visual Functioning Questionnaire (NEI‐VFQ), the Participation and Activity Inventory (PAI) and the OrCam Function Questionnaire (OFQ).ResultsFollowing OrCam testing, significant improvements were observed in the ‘near activities’ subscale of the NEI‐VFQ (p < 0.001); the ‘visual functioning’ subscale of the re‐engineered NEI‐VFQ (p = 0.001); the ‘reading’ rehabilitation goal of the PAI (p = 0.005) and the overall score of the OFQ (p < 0.001). The observed changes in questionnaire scores did not differ between phenotypes. Advantages and limitations of the OrCam were reported by patients. Three patients (15%) continued rehabilitation with the OrCam after completion of this study.ConclusionsThe OrCam mainly improves reading domains in patients with advanced stages of RP or CRD. Further improvements in the OrCam are needed to address current limitations, which may enhance its utility for patients with RP or CRD.

Vision-Related Quality Of Life And Depression In Brazilian Patients With Toxoplasmic Retinochoroiditis

To investigate visual-related quality of life (VRQL) and prevalence and severity of depressive symptoms in Brazilian individuals with toxoplasmic retinochoroiditis (TRC). Comparative observational cross-sectional study. The National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) and Beck Depression Inventory-II (BDI-II) were applied to respectively assess VRQL and depression in individuals consecutively seen at a uveitis referral center. Clinical/demographical data were collected. Descriptive/analytic statistics were employed, with P<0.05. Patients and controls were comparable concerning age, sex and socioeconomic level. VRQL scores for all subscales were significantly lower in TRC when compared with controls, particularly associated (P<0.05) with female sex, history of ≥2 prior TRC recurrences, concomitant use of systemic corticosteroids, monocular vision and blindness. Depressive symptoms were more prevalent in TRC (55/188; 29.2%) than in controls (34/182; 18.7%) (P=0.023), also being associated with lower VRQL scores (P<0.001). Seropositive and seronegative controls for toxoplasmosis had similar VRQL scores and comparable rates of depressive symptoms. TRC affects VRQL in Brazilian individuals, particularly women, using systemic corticosteroids, with visual impairment and presenting recurrences of TRC. One-third of patients with TRC had evidence of depression, which was also associated with lower VRQL scores. Mental health issues in subjects with TRC should not be overlooked.

The effects of age-related macular degeneration on quality of life in a Brazilian population

BackgroundTo evaluate the impact of age-related macular degeneration (AMD) on the quality of life (QoL) in a Brazilian population using The National Eye Institute-Visual Function Questionnaire-25 (NEI-VFQ-25).MethodsThis observational study included 462 participants from the Departments of Ophthalmology of the University of Campinas and Conderg-Divinolândia. The NEI-VFQ-25 questionnaire and Rasch analysis were used to assess the vision-related quality of life (VRQoL). Patients with macular neovascularization were interviewed at enrollment and after three loading doses of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment.ResultsOne hundred thirty-three patients were excluded because they had another ophthalmic disease, for a total of 349 patients included in the study (177 in the AMD group, 172 in the control group; 56.4% were women; mean ± standard deviation age, 70.6 ± 9.5 years). Most NEI-VFQ-25 subscale scores were significantly lower in the AMD group compared with the control group. The Rasch-calibrated NEI-VFQ-25 median score in the visual-functioning component was 56.41 for the AMD group and 61.53 for the control group, a difference of ± 4.00 (P = 0.0001). Separate analyses of the sociodemographic and ocular characteristics showed that the NEI-VFQ-25 scores were affected mostly by family income, educational level, descent, diet (vegetables/fruits), physical activity, and visual acuity (VA). The longitudinal component assessed a different group of 48 patients with exudative disease treated with anti-VEGF drugs. The mean logarithm of the minimum angle of resolution change in VA in treated eyes was a 0.16 decrease (P = 0.01). The mean change in the optical coherence tomography macular thickness was a 36.74-μm decrease (P = 0.012) from baseline to 4 months. The mean NEI-VFQ-25 scores improved significantly from baseline to follow-up at 4 months in almost all subscales.ConclusionsIn a Brazilian community, patients with AMD had a worse VRQoL than controls. The AMD severity and bilaterality were associated with decreased NEI-VFQ-25 scores. Higher family income, educational level, descent, and lifestyle significantly improved several subscales of the NEI-VFQ-25 questionnaire. Treated patients with exudative AMD had improvements in the VA, macular thickness, and most NEI-VFQ-25 subscale scores.

Ocular Health of Patients with Relapsed/Refractory Multiple Myeloma (RRMM): Baseline Data from the DREAMM-2 Trial of Belantamab Mafodotin (Belamaf)

Ocular Health of Patients with Relapsed/Refractory Multiple Myeloma (RRMM): Baseline Data from the DREAMM-2 Trial of Belantamab Mafodotin (Belamaf)

Effects of Long-Term DME Control With 0.2 µg/Day Fluocinolone Acetonide Implant on Quality of Life: An Exploratory Analysis From the FAME Trial.

Exploratory investigation of the effect of diabetic macular edema (DME) control with the 0.2 µg/day fluocinolone acetonide (FAc) intravitreal implant on quality of life (QOL) outcomes. Post-hoc analysis of patients from the FAME study who received the FAc implant and had answered the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) at baseline and Year 3 (N = 324). Patients were divided into quartiles (area under the curve [AUC]-central subfield thickness [CST]/day; n = 81/quartile). NEIVFQ-25 and best-corrected visual acuity (BCVA) changes were analyzed per quartile during a period of 3 years. NEI-VFQ-25 scores were significantly higher in patients with low AUC-CST/day (Quartiles 1 [P < .001] and 2 [P = .004]). Increases in NEIVFQ-25 subscale scores correlated with AUC-CST/day quartiles. BCVA significantly improved in patients with the lowest AUC-CST/day (Quartiles 1 and 2 [P < .001]). There was a positive and sustained correlation between the long-term control of DME and patient-reported QOL outcomes for up to 3 years following a single FAc implant in patients with controlled DME. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:658-667.].

Glaucomatous visual fields and neurocognitive function are independently associated with poor lane maintenance during driving simulation

BackgroundDriving simulators are a safe alternative to on-road vehicles for studying driving behavior in glaucoma drivers. Visual field (VF) loss severity is associated with higher driving simulator crash risk, though mechanisms explaining this relationship remain unknown. Furthermore, associations between driving behavior and neurocognitive performance in glaucoma are unexplored. Here, we evaluated the hypothesis that VF loss severity and neurocognitive performance interact to influence simulated vehicle control in glaucoma drivers.MethodsGlaucoma patients (n = 25) and suspects (n = 18) were recruited into the study. All had > 20/40 corrected visual acuity in each eye and were experienced field takers with at least three stable (reliability > 20%) fields over the last 2 years. Diagnosis of neurological disorder or cognitive impairment were exclusion criteria. Binocular VFs were derived from monocular Humphrey VFs to estimate a binocular VF index (OU-VFI). Montreal Cognitive Assessment (MoCA) was administered to assess global and sub-domain neurocognitive performance. National Eye Institute Visual Function Questionnaire (NEI-VFQ) was administered to assess peripheral vision and driving difficulties sub-scores. Driving performance was evaluated using a driving simulator with a 290° panoramic field of view constructed around a full-sized automotive cab. Vehicle control metrics, such as lateral acceleration variability and steering wheel variability, were calculated from vehicle sensor data while patients drove on a straight two-lane rural road. Linear mixed models were constructed to evaluate associations between driving performance and clinical characteristics.ResultsPatients were 9.5 years older than suspects (p = 0.015). OU-VFI in the glaucoma group ranged from 24 to 98% (85.6 ± 18.3; M ± SD). OU-VFI (p = .0066) was associated with MoCA total (p = .0066) and visuo-spatial and executive function sub-domain scores (p = .012). During driving simulation, patients showed greater steering wheel variability (p = 0.0001) and lateral acceleration variability (p < .0001) relative to suspects. Greater steering wheel variability was independently associated with OU-VFI (p = .0069), MoCA total scores (p = 0.028), and VFQ driving sub-scores (p = 0.0087), but not age (p = 0.61).ConclusionsPoor vehicle control was independently associated with greater VF loss and worse neurocognitive performance, suggesting both factors contribute to information processing models of driving performance in glaucoma. Future research must demonstrate the external validity of current findings to on-road performance in glaucoma.

Clinical Characteristics of Visual Dysfunction in Carbon Monoxide Poisoning Patients.

Purpose The aim of the present study was to analyze the clinical characteristics of visual dysfunction in patients with carbon monoxide (CO) poisoning. Methods A total of 436 patients with CO poisoning were enrolled in our hospital from October 2012 to December 2018, including 193 patients with moderate poisoning (MP group), 165 with severe poisoning (SP group), and 78 with delayed encephalopathy (DE group). The clinical characteristics of visual dysfunction in patients with CO poisoning were analyzed through the collection of medical history, regular physical examination, brain magnetic resonance imaging (MRI), ophthalmological examination, the National Eye Institute Visual Function Questionnaire (NEI-VFQ), and its influencing factors. Results Some patients in the three groups had visual dysfunction. The main ocular symptoms were local pain, eye movement disorder, and visual field defect. The key pathological factors were keratopathy, retinal nerve cell damage, optic nerve damage, retinal vascular disease, macular disease, and occipital visual center damage. The clinical symptoms of visual dysfunction after CO poisoning lasted for a long time (>12 months) and were not completely consistent with the positive results of the ophthalmological examination. A few sequelae of ophthalmology were still left after the help of medicine. Conclusion The incidence of visual dysfunction in patients with CO poisoning was high, the clinical symptoms were rich and diverse, the duration of disease was long, and the prognosis was poor. Thus, the relevant ophthalmological examination and intervention treatment should be perfected as soon as possible.