Vision-specific Role Difficulties Research Articles

The effects of loading ranibizumab on vision-related quality of life in the treatment of low-risk neovascular age-related macular degeneration.

Background:The loss of central vision plays a major role in the quality of life (QoL). This study evaluates the changes in QoL in the treatment of low-risk neovascular age-related macular degeneration (AMD).Objectives:The aim of this study was to evaluate the changes in vision-related QoL in patients receiving intravitreal ranibizumab loading dose for low-risk neovascular AMD.Design:A prospective study.Methods:Forty-two eyes of 42 patients receiving ranibizumab injections for neovascular AMD were included in this prospective study. The changes in best-corrected visual acuity (BCVA), central macular thickness (CMT) of the patients before the treatment, and 1 month after three loading doses were evaluated. Turkish version of the National Eye Institute 25-Item Vision Function Questionnaire (NEI VFQ-25 TR) was conducted. The changes of QoL scores through the NEI VFQ-25 TR questionnaire were compared with visual acuity (VA) and CMT measurements before the injections and 1 month after the loading dose.Results:Forty-two patients (19 females and 23 males) were included in the study, and the mean age was 72.69 ± 7.12 years. After the treatment, a statistically significant improvement in BCVA (0.98 ± 0.44, 0.76 ± 0.42 logMAR, p < 0.001) and a significant decrease in CMT (357.90 ± 71.71, 274.50 ± 58.35 μm, p < 0.001) was observed. The QoL composite score was found to be statistically significantly higher after the treatment (64.27 ± 11.47, 68.56 ± 11.39, p < 0.001). General vision (p < 0.001), ocular pain (p = 0.025), near activities (p < 0.001), distance activities (p = 0.027), vision-specific mental health (p = 0.014), vision-specific role difficulties (p < 0.001), and peripheral vision (p = 0.046) were significantly higher after the treatment.Conclusion:NEI VFQ-25 TR is a useful questionnaire for evaluating changes in visual functions and psychosocial characteristics of low-risk neovascular AMD patients before and after the injections.

Impact of Lighting Assessment and Optimization on Participation and Quality of Life in Individuals with Vision Loss

This pilot study was designed to investigate the effects of a holistic lighting intervention on the quality of life for individuals with low vision. Sixty participants (44 women; median age 69 years) with visual impairment received lighting interventions, including a home visit and consultation in a lighting lab. Assisted by low vision consultants, participants evaluated their performance using the Canadian Occupational Performance Measure (COPM) before and after the intervention. Improvements in visual functioning and quality of life were evaluated using the 39-item National Eye Institute Visual Function Questionnaire (NEI VFQ-39), the Groffman Visual Tracing Test, and the Farnsworth Dichotomous Test (D15). Following the lighting intervention, scores improved for all activities in the COPM (p < 0.01), for near activities and vision-specific role difficulties in the VFQ-39 (p < 0.05), and overall in the D15 test (p < 0.05). These results suggest the intervention provided an effective method for improving the participants’ quality of life and performance.

Quality of life in patients affected by age-related macular degeneration

Context: Age-related macular degeneration (ARMD) is an eye condition which results in loss of vision because of damage to the retina. ARMD affects central vision, and it shows association with psychological distress and depression. Aims: Our study aimed to evaluate the quality of life (QoL) in patients with ARMD and its association with best-corrected visual acuity (BCVA) and treatment. Subjects and Methods: A cross-sectional study including patients clinically diagnosed as neovascular ARMD (wet ARMD) and geographic atrophy (dry ARMD). Patients were classified into Group 1: Patients with dry ARMD, Group 2: Patients with wet ARMD not treated with anti-vascular endothelial growth factor (VEGF) injections, and Group 3: Patients with wet ARMD who had received at least 3 anti-VEGF injections. To assess the vision-related QoL, National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) was used. Results: We included 60 patients, 20 in each group. There were 23 women and 37 men; with mean age of 78.2 ± 7.9 years. We observed significant difference in near activities (P = 0.03), distance activities (P = 0.002), and vision-specific social functioning (P = 0.001), when comparing VFQ-25 subdomain scores with patients with better eye BCVA. We found Group 3 had significantly more vision-specific role difficulties than Group 1 (41.87 ± 21.94 vs. 26.87 ± 25.73). We found Group 2 had significantly better vision-specific mental health (49.37 ± 19.8 vs. 35.31 ± 19.9) and lesser vision-specific dependency than Group 3 (57.08 ± 26.6 vs. 40.00 ± 26.7). Conclusions: Vision-specific mental health is better in untreated wet ARMD patients than those who have taken anti-VEGF injections in our study population.

A follow-on study on vision-related quality of life assessment using the NEI-VFQ-25 in those with a history of unilateral and bilateral congenital cataracts.

To assess vision-specific health-related quality of life (using the NEI-VFQ-25), educational attainment and visual acuity (VA) in patients with a history of congenital cataracts and appraise these in relation to Kirwan etal.'s (Pediatr Ophthalmol Strabismus 49, 2012, 26) study. A retrospective hospital-based study of patients with unilateral and bilateral congenital cataracts whounderwent surgery aged younger than 12months. Those 13years or older at follow-up were selected for inclusion. Patients with glaucoma, other associated ocular complications or systemic abnormalities were excluded. Educational attainment and VA at latest review were recorded. Twelve patients with unilateral cataract (mean age: 26±4.5) and fifteen with bilateral cataract (mean age 22±4.3) were included. Bilateral group had greater difficulty with near and distance activities, vision-specific role difficulties, vision-specific dependency and general health than the unilateral group. There were no significant differences with regard to ocular pain, vision-specific social functioning, vision-specific mental health, driving, colour vision, peripheral vision or educational attainment between the groups. All patients attended mainstream school, and majority progressed to third-level education. Follow up at an increased time from surgery - 6.2±5.13 (unilateral) and 6.5±6.4 years (bilateral) - compared to Kirwan et al.'s study. Results were in keeping with Kirwan etal.'s. Bilateral group had greater difficulty with day-to-day tasks compared to the unilateral group, including near and distance vision activities. They had greater vision-specific role difficulties and vision-specific dependency. There was no difference between the groups in regard to vision-specific social functioning, vision-specific mental health or educational attainment. This can be a source of reassurance to parents and patients.

Vision related quality of life in patients with type 2 diabetes in the EUROCONDOR trial.

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.

National Eye Institute Visual Function Scale in Type 2 Diabetes Patients.

Aim. To examine subscale and total scores of NEI-VFQ questionnaire of type 2 diabetes patients at different diabetic retinopathy (DRP) stages. Methods. A total number of 201 patients have been included. Prior to ophthalmological examination all patients participated in the NEI-VFQ questionnaire. The patients were divided into 5 groups according to the International Clinical Diabetic Retinopathy Disease Severity Scale (ICDRS). Results. The diabetes duration in general health scores (p = 0.029); the stage (p = 0.011); and clinically significant macular edema (CSME) (p = 0.019) in general vision were found to be the most efficient factors. In near vision activities the most efficient factors were near vision acuity (NVA) (p = 0.0001) and DRP stage (p = 0.020). EDTRS visual acuity was found to be the most efficient factor in vision specific role difficulties (p = 0.034) and dependency (p = 0.011) whereas Snellen visual acuity was found to be among the most effective factors in distance activities (DA) (p = 0.014) and total scores (p = 0.026). Discussion. Difference was based not on the diabetes duration, clinically significant cataract (CSCat), CSME presence, and DRP stage but on the visual acuity levels of the better seeing eye of the patients.

Patient-reported vision-related quality of life differences between superior and inferior hemifield visual field defects in primary open-angle glaucoma.

Previous studies have found that glaucoma is associated with impaired patient-reported vision-related quality of life (pVRQOL) but few, to our knowledge, have assessed how the visual field (VF) defect location impacts the pVRQOL. To investigate the associations of VF defects in the superior vs inferior hemifields with pVRQOL outcomes in patients with primary open-angle glaucoma. Prospective cross-sectional study at a tertiary referral center from March 1, 2012, to January 1, 2013, including patients with primary open-angle glaucoma who had a best-corrected visual acuity in the better eye equal to or better than 20/60 and reliable VF tests. The pVRQOL was assessed by a validated Taiwanese version of the 25-item National Eye Institute Visual Function Questionnaire. Reliable VF tests obtained within 3 months of enrollment were transformed to binocular integrated VF (IVF). The IVF was further stratified by VF location (superior vs inferior hemifield). The association between each domain of the 25-item National Eye Institute Visual Function Questionnaire and superior or inferior hemifield IVF was determined using multivariable linear regression analysis. The analysis included 186 patients with primary open-angle glaucoma with a mean age of 59.1 years (range, 19-86 years) and IVF mean deviation (MD) of -4.84 dB (range, -27.56 to 2.17 dB). In the multivariable linear regression analysis, the MD of the full-field IVF showed positive associations with near activities (β = 0.05; R2 = 0.20; P < .001), vision-specific role difficulties (β = 0.04; R2 = 0.19; P = .01), vision-specific dependency (β = 0.04; R2 = 0.20; P < .001), driving (β = 0.05; R2 = 0.24; P < .001), peripheral vision (β = 0.03; R2 = 0.18; P = .02), and composite scores (β = 0.04; R2 = 0.27; P = .005). Subsequent analysis showed that the MD of the superior hemifield IVF was associated only with near activities (β = 0.04; R2 = 0.21; P < .001) while the MD of the inferior hemifield IVF was associated with general vision (β = 0.04; R2 = 0.12; P = .01), vision-specific role difficulties (β = 0.04; R2 = 0.20; P = .01), and peripheral vision (β = 0.03; R2 = 0.17; P = .03). Superior hemifield IVF was strongly associated with difficulty with near activities. Inferior hemifield IVF impacted vision-specific role difficulties and general and peripheral vision. The impact of a VF defect on a patient's pVRQOL may depend not only on its severity, but also on its hemifield location.

Vision related quality of life in patients with keratoconus.

Purpose. The purpose of this study is to evaluate the vision related quality of life in patients with keratoconus by using the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25). Methods. Thirty patients presented with keratoconus (keratoconus group) and 30 healthy patients (control group) were included in this study. Twenty patients were using rigid gas permeable and 10 patients were not using contact lenses in keratoconus group. High and low contrast visual acuity and mean K values of the patients were recorded. Each subject completed the 25-item NEI-VFQ-25. Results. All subscales of NEI-VFQ-25 were lower in the keratoconus patients. The difference was more evident in the subscales of general vision, ocular pain, near vision, vision-specific mental health, vision-specific role difficulties, and peripheral vision (P < 0.05). Overall composite score was 75.2 ± 17.2 in the keratoconus group and 93.2 ± 5.6 in the control group (P = 0.00). Contact lens wearers had higher best corrected visual acuity in comparison with noncontact lens wearers (P = 0.028). Patients with low visual acuity (logMAR > 0.4) in the better eye had lower distance vision, social functioning, mental health, and role difficulties. Meanwhile, patients with low visual acuity (logMAR > 0.4) in the worse eye had lower general health scores (P < 0.05). Conclusions. Vision related quality of life was worse in keratoconus patients. Success in the contact lens usage and maintaining higher visual acuity may improve vision related quality of life.

Vision-Related Functioning Outcomes of Dexamethasone Intravitreal Implant in Noninfectious Intermediate or Posterior Uveitis

To evaluate the effect of a single treatment with dexamethasone intravitreal implant (DEX implant) on patient-reported visual functioning in patients with noninfectious intermediate or posterior uveitis. Patient eyes with noninfectious intermediate or posterior uveitis were randomized to a single treatment with DEX implant 0.70 mg (n=77), DEX implant 0.35 mg (n=76), or a sham procedure (n=76) and followed for 26 weeks. Vision-related functioning was measured using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) assessed at baseline and at weeks 8, 16, and 26 or early exit. Analysis of covariance and mixed model analysis of covariance were used to compare vision-related functioning between the DEX implant 0.70 and 0.35 mg groups and the sham group. By 8 weeks, the DEX implant 0.70 mg group demonstrated significant improvements in NEI VFQ-25 subscales near vision (P=0.031), distance vision (P=0.023), peripheral vision (P=0.045), vision-specific social functioning (P=0.019), and the NEI VFQ-25 composite score (P=0.007) compared with sham. After 26 weeks, the DEX implant 0.70 mg group reported significant improvements in NEI VFQ-25 subscales distance vision (P=0.003), vision-specific role difficulties (P=0.038), vision-specific dependency (P=0.017), vision-specific social functioning (P=0.009), vision-specific mental health (P=0.036), and the composite score (P=0.001) compared with sham. In patients with noninfectious intermediate or posterior uveitis receiving a single treatment of DEX implant 0.70 mg, significant and clinically meaningful improvements in patient-reported visual functioning were observed as early as week 8 and were maintained over 26 weeks. (ClinicalTrials.gov number, NCT00333814.).

Risk factors for poor vision-related quality of life among cataract patients. Evaluation of baseline data

Our study aims to investigate the possible risk factors for poor vision-related quality of life in patients scheduled to undergo phacoemulsification. Participants in our study were 220 patients who were eligible for phacoemulsification cataract surgery. All participants underwent a routine ophthalmological examination and completed the Visual Function Questionnaire-25 (VFQ-25), which encompasses 12 subscales and the composite score. Sociodemographic and lifestyle parameters were evaluated as potential risk factors for low VFQ-25 composite score, as well as subscale scores. Multivariate regression analysis was performed. Composite score did not exhibit any significant associations. General Health subscale score was positively associated with higher educational level. Patients who currently worked presented with lower Vision Specific Mental Health subscale score (OR: 0.33, 95 % CI: 0.18 to 0.63). Vision Specific Role Difficulties subscale score was positively associated with exercise (OR: 1.89, 95 % CI: 1.30 to 2.75). Vision Specific Dependency subscale score was independently positively associated with marital status (married vs single/widowed/divorced, OR: 1.83, 95 % CI: 1.08 to 3.12) but inversely with current working status (OR: 0.40, 95 % CI: 0.20 to 0.79). Males exhibited lower Peripheral Vision subscale score compared with females (OR: 0.19, 95 % CI: 0.04 to 0.91). Baseline vision-related quality of life in cataract patients presenting for surgery seems affected by inherent sociodemographic and lifestyle parameters, such as gender, educational level, marital status, current working status and exercise. Therefore, clinicians should be aware of the discrepancies that risk factors may confer, and should thus focus on the most vulnerable subgroups.

Evaluation of vision-specific quality-of-life in albinism

Human albinism is a genetic condition associated with visual impairment that affects many aspects of daily life. Office measurements of visual acuity do not necessarily reflect daily visual function and health status. This study used the National Eye Institute Visual Function Questionnaire (NEI-VFQ) to determine the effect of albinism-associated ophthalmopathy on quality of life (QOL). We administered the NEI-VFQ, which consists of 25 questions about QOL (VFQ-25) and 14 questions about well-being (VFQ-39), to 44 consenting participants with albinism older than the age of 18 years. Nineteen male and 25 female subjects completed the study. Median age was 30.5 years (range, 18-79 years). Mean best-corrected visual acuity was 20/83 (range, 20/20 to 20/320). Forty-eight percent reported that they were currently able to drive with their condition. Participants perceived midscale problems with their general vision (median subscale score 60.0). Visual acuity correlated moderately with overall NEI-VFQ composite scores (r(s) = 0.40, p = 0.01 for VFQ-25 and r(s) = 0.36, p = 0.02 for VFQ-39). Most notable impairment was recorded for distance acuity, vision-specific mental health, and vision-specific role difficulties (VFQ-39 median subscale scores 66.7, 70.0, and 75.0, respectively). Differences by sex were insignificant. Greater ceiling effects were noted for the VFQ-25 than for the VFQ-39. The NEI-VFQ-39 is a method to evaluate self-reported effects of vision-related QOL in albinism and may be used as a baseline for evaluating outcomes in interventional studies in these patients.

Evaluation of vision-specific quality of life in albinism

Introduction: Office measurements of visual acuity do not necessarily reflect daily visual function and health status. We evaluated vision-targeted health-related quality of life (QOL) in albinism with a self-administered tool. Methods: Consenting participants completed the NEI Visual Function Questionnaire (NEI-VFQ-25) consisting of 25 questions about QOL and 12 questions about well-being. Best-corrected binocular visual acuity (BCVA) and type of albinism were recorded. Results: Fourteen males and 25 females with albinism completed the study. Median age was 30 years (range, 18 to 79 years). Mean BCVA was 20/95 (range, 20/20 to 20/320). Eighteen (46%) reported that they were currently driving. Participants perceived moderate problems with their general vision (mean subscale score, 58.97). BCVA was moderately correlated with overall NEI-VFQ-25 scores (r = 0.443). Most notable impairment was noted on distance acuity, vision-specific mental health, and vision-specific role difficulties subscales (mean subscale scores, 67.09, 67.07, and 68.27, respectively). Differences by gender were insignificant. Ceiling effect >80% was noted for ocular pain, vision-specific dependency, and color vision. Discussion: Self assessment of QOL with the NEI-VFQ-25 has been used in groups with specific vision disorders. The vision-related results reported herein are similar to those with moderate to severe diabetic retinopathy, although those with albinism reported better general health. Conclusions: The NEI-VFQ-25 is a valuable method to evaluate self-reported effects of vision-related QOL in albinism.

Visual function and quality of life among patients with glaucoma.

This study determines the relation between visual field impairment, visual functioning, and global quality of life in patients with glaucoma. Binocular visual field impairment was calculated from simultaneous Esterman visual field testing using the Humphrey automated perimeter. Visual acuity impairment, defined with the American Medical Association's Guides to the Evaluation of Permanent Impairment; visual functioning, measured with the VF-14 and the field test version of the National Eye Institute-Visual Functioning Questionnaire; and global quality of life, assessed with the Medical Outcomes Study 36-Item Short Form Health Survey, were determined in 147 consecutive patients with glaucoma. None of the Medical Outcomes Study 36-Item Short Form Health Survey domains demonstrated more than a weak correlation with visual field impairment. The VF-14 scores were moderately correlated (r = -0.58). Of the National Eye Institute-Visual Functioning Questionnaire scales, peripheral vision (r = -0.60), distance activities (r = -0.56), and vision-specific dependency (r = -0.56) were moderately correlated with visual field impairment; vision-specific social functioning, near activities, vision-specific role difficulties, general vision, vision-specific mental health, color vision, and driving were modestly correlated with visual field impairment (r value between -0.32 and -0.55); visual pain was weakly correlated with visual field impairment; and general health and vision-specific expectations were not notably correlated with visual field impairment. Statistically adjusting for visual acuity weakened the correlations. The Medical Outcomes Study 36-Item Short Form Health Survey indicated that our patients with glaucoma were comparable with previously studied patients without severe systemic medical problems. However, the Medical Outcomes Study 36-Item Short Form Health Survey scores did not correlate with visual field impairment in our study. Based on the moderate correlation between binocular visual field impairment with the VF-14 and the National Eye Institute-Visual Functioning Questionnaire, these questionnaires may be useful among patients with glaucoma.

Visual impairment, visual functioning, and quality of life assessments in patients with glaucoma

To determine the relation between visual impairment, visual functioning, and the global quality of life in patients with glaucoma.Visual impairment, defined with the American Medical Association Guides to the Evaluation of Permanent Impairment; visual functioning, measured with the VF-14 and the Field Test Version of the National Eye Institute-Visual Functioning Questionnaire (NEI-VFQ); and the global quality of life, assessed with the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), were determined in 147 consecutive patients with glaucoma.None of the SF-36 domains demonstrated more than a weak correlation with visual impairment. The VF-14 scores were moderately correlated with visual impairment. Of the twelve NEI-VFQ scales, distance activities and vision specific dependency were moderately correlated with visual impairment. Of the twelve NEI-VFQ scales, distance activities and vision specific dependency were moderately correlated with visual field impairment; vision specific social functioning, near activities, vision specific role difficulties, general vision, vision specific mental health, color vision, and driving were modestly correlated; visual pain was weakly correlated; and two were not significantly correlated. Correcting for visual actuity weakened the strength of the correlation coefficients.The SF-36 is unlikely to be useful in determining visual impairment in patients with glaucoma. Based on the moderate correlation between visual field impairment and the VF-14 score, this questionnaire may be generalizable to patients with glaucoma. Several of the NEI-VFQ scales correlate with visual field impairment scores in patients with a wide range of glaucomatous damage.