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Zhang Z, Griva K, Rojas-Carabali W, Patnaik G, Liu R, Sobrin L, Kempen JH, Finger RP, Gupta V, Ang B, Agrawal R. Psychosocial Well-Being and Quality of Life in Uveitis: A Review. Ocul Immunol Inflamm 2024; 32:1380-1394. [PMID: 37713271 DOI: 10.1080/09273948.2023.2247077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE As a potentially sight-threatening disease with ocular, systemic, and treatment-related complications, uveitis diminishes quality of life (QOL) and affects psychosocial well-being. This review summarizes the existing tools for evaluating psychosocial well-being and/or QOL in patients with uveitis, explores the biological and non-biological factors affecting psychosocial well-being and/or QOL, and proposes future directions for incorporating these tools into clinical practice. METHODS A systematic search of the MEDLINE, Embase, and Cochrane databases from inception to June 8, 2022 was conducted, screening for articles focused on psychosocial well-being and/or QOL in patients with uveitis. Both quantitative and qualitative analyses were performed. RESULTS In uveitis research, the most frequently studied patient-reported outcome measures were vision-related QOL (e.g. Visual Function Questionnaire [VFQ-25]) and health-related QOL (e.g. Short Form Survey [SF-36]), followed by mental health indicators including depression and anxiety. Instruments have also been developed specific to the pediatric population (e.g. Effects of Youngsters' Eyesight on Quality of Life [EYE-Q]). Generally, studies report worse psychosocial outcomes and QOL in patients with uveitis compared to the general population. Contributory factors include both clinical (e.g. visual impairment, ocular comorbidities) and patient-related (e.g. older age, female sex) factors. CONCLUSION Given the heterogeneity of instruments used, it is worth considering standardization across large uveitis studies and trials. Beyond research, given the biopsychosocial effects on patients with uveitis, there are benefits to incorporating QOL and psychosocial assessments into clinical practice. Simplification of questionnaires into abridged forms, focusing on the most clinically relevant aspects of patient care, may be considered.
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Affiliation(s)
- Zheting Zhang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - William Rojas-Carabali
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Gazal Patnaik
- Sankara Netralaya, Medical Research Foundation, Chennai, India
| | - Renee Liu
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM Comprehensive Specialized Hospital and MyungSung Medical School, Addis Ababa, Ethiopia
| | - Robert P Finger
- Department of Ophthalmology, St. Franziskus Hospital Münster, Münster, Germany
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bryan Ang
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Department of Ophthalmology and Visual Sciences, Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
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Lin Z, Li D, Lin W, Wen L, Wang Y, Lin Z. THE IMPACT OF BILATERAL VISION STATUS ON VISION-RELATED QUALITY OF LIFE IN PEOPLE WITH DIABETES MELLITUS. Retina 2024; 44:1021-1025. [PMID: 38194676 DOI: 10.1097/iae.0000000000004047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
PURPOSE To assess the impact of bilateral vision status on vision-related quality of life (VR-QOL) in patients with Type 2 diabetes in a Chinese cohort. METHODS Patients with presenting visual acuity (PVA) and VR-QOL data from the Fushun Diabetic Retinopathy Cohort Study were included. Vision-related quality of life was assessed using the National Eye Institute Visual Function Questionnaire-25. Monocular PVA (Snellen) was categorized into three levels for both the better-seeing eye and worse-seeing eye: 1) high PVA (H, > 6/18); 2) moderate PVA (M, 6/18-6/60); and 3) low PVA (L, < 6/60). Based on the monocular PVAs, six categories of bilateral vision status were defined (H-H, H-M, H-L, M-M, M-L, and L-L). The parameters of VR-QOL were analyzed between the groups. RESULTS A total of 1,717 patients were enrolled. For better-seeing eyes in the same PVA level, the Visual Function Questionnaire-25 composite score decreased significantly with declining PVA in the worse-seeing eye (H-M vs. H-L: 80.5 ± 17.9 vs. 73.6 ± 22.5, P = 0.01; M-M vs. M-L: 78.7 ± 19.6 vs. 69.1 ± 26.4, P = 0.01). Conversely, for worse-seeing eyes in the same PVA level, there was no significant difference in the Visual Function Questionnaire-25 composite score as PVA changed in the better-seeing eye (H-M vs. M-M, 80.5 ± 17.9 vs. 78.7 ± 19.6, P = 0.30; H-L vs. M-L: 73.6 ± 22.5 vs. 69.1 ± 26.4, P = 0.25). CONCLUSION The PVA of the worse-seeing eye in bilateral vision has a greater impact on VR-QOL in diabetic patients. Priority treatment may be considered for the worse-seeing eye for diabetic patients with different bilateral vision statuses, to better improve VR-QOL.
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Affiliation(s)
- Zushun Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China ; and
| | - Dong Li
- Fushun Eye Hospital, Fushun, Liaoning, China
| | - Wei Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China ; and
| | - Liang Wen
- Fushun Eye Hospital, Fushun, Liaoning, China
| | - Yu Wang
- Fushun Eye Hospital, Fushun, Liaoning, China
| | - Zhong Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China ; and
- Fushun Eye Hospital, Fushun, Liaoning, China
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Zayed MG, Karsan W, Peto T, Saravanan P, Virgili G, Preiss D. Diabetic Retinopathy and Quality of Life: A Systematic Review and Meta-Analysis. JAMA Ophthalmol 2024; 142:199-207. [PMID: 38300578 PMCID: PMC10835609 DOI: 10.1001/jamaophthalmol.2023.6435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/28/2023] [Indexed: 02/02/2024]
Abstract
Importance The association between diabetic retinopathy (DR) and quality of life (QoL) has not been thoroughly investigated. Objective To investigate the association between DR and both vision-related QoL (VRQoL) and general health-related QoL (HRQoL). Data Sources MEDLINE, EBSCO, Embase, and Web of Science were searched from their inception to April 2022. Study Selection Studies included adults with DR and a measure of QoL. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Two assumption-free meta-analyses were conducted. Analysis 1 included studies with participants without DR as the referent group to which QoL scores of participants with DR, grouped according to DR severity, were compared. Analysis 2 included all studies with participants with DR and a measure of QoL. QoL scores were pooled within categories of DR severity, and comparisons were made between these categories. Main Outcome and Measures QoL measured using HRQoL and VRQoL scales. Results A total of 93 articles were included: 79 in the meta-analyses and 14 in the narrative results. VRQoL was recorded in 54 studies, HRQoL in 26, and both in 13 studies. The most commonly used scales were the National Eye Institute 25-item Visual Function Questionnaire (VFQ-25) (n = 49) for VRQoL and the Short Form (SF) Health Survey (n = 18) for HRQoL. Thirty-five studies reported VFQ-25 composite scores. Analysis 1 consisted of 8 studies including 1138 participants with DR and 347 participants without DR. Compared with participants without DR, the composite VFQ-25 score was 3.8 (95% CI, 1.0-6.7) points lower in those with non-vision-threatening DR (NVTDR), 12.5 (95% CI, 8.5-16.5) lower in those with any DR, and 25.1 (95% CI, 22.8-27.2) lower in VTDR (P < .001 for trend). Analysis 2 consisted of 35 studies including 6351 participants with DR. The pooled mean VFQ-25 composite score was 91.8 (95% CI, 91.0-92.7) for participants with NVTDR, 77.6 (95% CI, 76.9-78.3) for any DR, and 73.2 (95% CI, 72.6-73.7) for VTDR (P < .001 for trend). HRQoL scores had weak or no associations with NVTDR and strong associations with VTDR. Conclusions and Relevance This study found that VRQoL declined with the presence and severity of DR. Interventions to reduce progression of DR at both early and more advanced stages could improve VRQoL.
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Affiliation(s)
- Mohammed G. Zayed
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Waseem Karsan
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Tunde Peto
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Ponnusamy Saravanan
- Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Diabetes, Endocrinology and Metabolism, George Eliot Hospital NHS Trust, Nuneaton, United Kingdom
| | - Gianni Virgili
- AOU Careggi, Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, Florence, Italy
- Ophthalmology, IRCCS-Fondazione Bietti, Rome, Italy
| | - David Preiss
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Vujosevic S, Chew E, Labriola L, Sivaprasad S, Lamoureux E. Measuring Quality of Life in Diabetic Retinal Disease: A Narrative Review of Available Patient-Reported Outcome Measures. OPHTHALMOLOGY SCIENCE 2024; 4:100378. [PMID: 37868790 PMCID: PMC10585645 DOI: 10.1016/j.xops.2023.100378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/21/2023] [Accepted: 08/02/2023] [Indexed: 10/24/2023]
Abstract
Topic Several patient-reported outcome measures (PROMs) are available to measure health-related quality of life (HRQoL) in patients with late-stage clinical diabetic retinal diseases (DRDs). However, an understanding of the psychometric properties of PROMs is needed to assess how they could relate to severity levels of a revised DRD grading system. This narrative review assessed the available generic-, vision-, and DRD-related PROMs used in DRD research and highlights areas for improvement. Clinical Relevance Diabetic retinal disease is a common complication of diabetes and can lead to sight-threatening complications with a devastating effect on HRQoL. Methods The Quality of Life working group is one of 6 working groups organized for the DRD Staging System Update Effort, a project of the Juvenile Diabetes Research Foundation Mary Tyler Moore Vision Initiative. PubMed, Cochrane Library, Embase, and Google Scholar databases were searched using core keywords to retrieve ophthalmology-related review articles, randomized clinical trials, and prospective, observational, and cross-sectional studies in the English language. A detailed review of 12 PROMs (4 QoL questionnaires and 8 utilities) that met a minimum level of evidence (LOE) was conducted. The relevance of each PROM to DRD disease stage and Biomarker Qualification guidelines (Biomarkers, EndpointS, and other Tools) categories was also defined. Results The National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25), Impact of vision impairment-computerized adaptive testing, and Diabetic Retinopathy and Macular Edema Computerized Adaptive Testing System had a LOE of II in detecting change due to late-stage DRD (diabetic macular edema), although several areas for improvement (e.g., psychometrics and generalizability) were identified. Other PROMs, particularly the utilities, had a LOE of III due to cross-sectional evidence in late-stage clinical DRD. Although the NEI VFQ-25 has been the most widely used PROM in late-stage DRD, more work is required to improve its multidimensional structure and other psychometric limitations. No PROM was deemed relevant for subclinical or early/mid-DRD. Conclusion This narrative review found that the most commonly used PROM is NEI VFQ-25, but none meets the ideal psychometric, responsiveness, and clinical setting digital administration requirements that could be included in an updated DRD staging system for diagnosis and monitoring of DRD progression. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Eye Clinic, IRCCS MultiMedica, Milan, Italy
| | - Emily Chew
- Division of Epidemiology and Clinical Applications, Clinical Trials Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Leanne Labriola
- Ophthalmology Department, Carle Foundation Hospital, Urbana, Illinois
- Surgery Department, University of Illinois College of Medicine, Urbana, Illinois
| | - Sobha Sivaprasad
- Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
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Ramin S, Rostami F, Ahmadieh H, Daftarian N, Nourinia R, Abbasi A, Kheiri B, Sabbaghi H, Sheibani K. Vision-related quality of life in patients with retinal vein occlusion. Int Ophthalmol 2024; 44:114. [PMID: 38409518 DOI: 10.1007/s10792-024-02916-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 12/24/2023] [Indexed: 02/28/2024]
Abstract
PURPOSE This study aims to assess the vision-related quality of life in patients with retinal vein occlusion (RVO) among those referred to Labbafinejad Medical Center and Imam Hossein Hospital between 2019 and 2021. METHODS This comparative study included 37 eligible patients diagnosed with various types of RVO, with an average age of 61 ± 9. To ensure data validity, we included 74 age- and sex-matched healthy individuals. Only cases with a definitive diagnosis of RVO, confirmed by two retina specialists (ND and RN), were included. We assessed the vision-related quality of life of our participants using the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25). All participants underwent interviews. RESULTS In our study, we examined the vision-related quality of life in different subgroups of RVO patients. Overall, RVO patients had a significantly lower total VRQoL score compared to healthy individuals (P < 0.001), except in the subscale analysis of specific factors such as ocular pain, color vision, and driving, where no statistically significant difference was observed. A statistically significant difference was found in the comparison of subgroups, indicating lower VRQoL in central retinal vein occlusion (CRVO) patients (P = 0.010). Furthermore, a significant correlation was observed between lower VRQoL and decreased vision (P = 0.009) as well as longer disease duration (P = 0.011). CONCLUSION Retinal vein occlusion can significantly reduce vision-related quality of life, particularly in more severe cases.
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Affiliation(s)
- Shahrokh Ramin
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- NanoBaran Lab, Incubation Center for Pharmaceutical Technology (ICPT), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rostami
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narsis Daftarian
- Experimental Medicine, Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Ramin Nourinia
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Abbasi
- NanoBaran Lab, Incubation Center for Pharmaceutical Technology (ICPT), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Kheiri
- Department of Epidemiology and Biostatistics, School of Medicine and Dentistry, Western University, Ontario, Canada
| | - Hamideh Sabbaghi
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, 23 Paidar Fard, Bostan 9, Pasdaran Ave., Tehran, 16666, Iran.
| | - Kourosh Sheibani
- Basir Eye Health Research Center, Iran University of Medical Sciences, Tehran, Iran
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Fernández-Vigo JI, Blanco-Darriba D, Etxabe-Avila H, Montolío-Marzo E, Robles-Amor P, Escobar-Moreno MJ, Burgos-Blasco B. Comparative analysis of the quality of life among different retinal diseases. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:633-639. [PMID: 37748684 DOI: 10.1016/j.oftale.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/26/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE To assess the impact on the quality of life (QoL) among different retinal diseases such as diabetic macular edema (DME), retinal vein occlusion (RVO), pathologic myopia (PM), neovascular age-related macular degeneration (nAMD) and central serous chorioretinopathy (CSC). METHODS A cross-sectional study was carried out in 241 patients, affected by DME (n=44), RVO (n=41), PM (n=34) and nAMD (n=85) receiving intravitreal injections due to the presence of macular edema or choroidal neovascularization. The CSC patients included (n=37) were candidates for laser treatment. The patients included completed the National Eye Visual Functioning Questioning-25 (NEI VFQ-25). Best eye visual acuity (BEVA) was recorded using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. RESULTS There were significant differences between subgroups for all the domains, except for the general vision in which all scores among diseases ranged from 40.7 to 45.2 out of 100 (P=.436), despite the difference in BEVA (CSC: 86.3±11.9; RVO: 78.5±15.5, DME: 73.3±15.2, nAMD: 72.9±12.6 and PM: 68.5±18.1 letters respectively; P<.001). The lowest VFQ-25 total score was observed in the PM patients (52.1±20.9), followed by nAMD (55.3±20.8), RVO (65.0±22.3), DME (68.6±21.0) and CSC (70.9±16.2). The DME group reported the worst score for general health (38.9±21.4). Mental health and role difficulties were lowest for PM (48.2±28.8 and 48.2±31.9, P<.007). CONCLUSIONS This study reveals the differences in the QoL among DME, RVO, nAMD, PM and CSC, describing the different repercussions that they can suffer, observing a higher impact in PM and nAMD.
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Affiliation(s)
- J I Fernández-Vigo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain; Centro Internacional de Oftalmología Avanzada, Madrid, Spain.
| | - D Blanco-Darriba
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - H Etxabe-Avila
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - E Montolío-Marzo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - P Robles-Amor
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - M J Escobar-Moreno
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - B Burgos-Blasco
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
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Abdalla Elsayed MEA, Taylor LJ, Josan AS, Fischer MD, MacLaren RE. Choroideremia: The Endpoint Endgame. Int J Mol Sci 2023; 24:14354. [PMID: 37762657 PMCID: PMC10532430 DOI: 10.3390/ijms241814354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/25/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Choroideremia is an X-linked retinal degeneration resulting from the progressive, centripetal loss of photoreceptors and choriocapillaris, secondary to the degeneration of the retinal pigment epithelium. Affected individuals present in late childhood or early teenage years with nyctalopia and progressive peripheral visual loss. Typically, by the fourth decade, the macula and fovea also degenerate, resulting in advanced sight loss. Currently, there are no approved treatments for this condition. Gene therapy offers the most promising therapeutic modality for halting or regressing functional loss. The aims of the current review are to highlight the lessons learnt from clinical trials in choroideremia, review endpoints, and propose a future strategy for clinical trials.
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Affiliation(s)
- Maram E. A. Abdalla Elsayed
- Oxford Eye Hospital, Oxford University Hospitals National Health Service Foundation Trust, Oxford OX3 9DU, UK
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Laura J. Taylor
- Oxford Eye Hospital, Oxford University Hospitals National Health Service Foundation Trust, Oxford OX3 9DU, UK
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Amandeep S. Josan
- Oxford Eye Hospital, Oxford University Hospitals National Health Service Foundation Trust, Oxford OX3 9DU, UK
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - M. Dominik Fischer
- Oxford Eye Hospital, Oxford University Hospitals National Health Service Foundation Trust, Oxford OX3 9DU, UK
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Robert E. MacLaren
- Oxford Eye Hospital, Oxford University Hospitals National Health Service Foundation Trust, Oxford OX3 9DU, UK
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
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Reitan G, Kjellevold Haugen IB, Andersen K, Bragadottir R, Bindesbøll C. Through the Eyes of Patients: Understanding Treatment Burden of Intravitreal Anti-VEGF Injections for nAMD Patients in Norway. Clin Ophthalmol 2023; 17:1465-1474. [PMID: 37256195 PMCID: PMC10226541 DOI: 10.2147/opth.s409103] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/12/2023] [Indexed: 06/01/2023] Open
Abstract
Purpose Patients with neovascular age-related macular degeneration (nAMD) are treated with frequent intravitreal injections to maintain vision. The treatment frequency impacts the life of patients and caregivers and poses a major capacity challenge for Norwegian ophthalmic clinics. The purpose of this survey was to document patient-reported outcomes on how the disease and the treatment impact nAMD patients in Norway. Methods Norwegian nAMD patients voluntarily completed the survey. The patients reported the time spent on each treatment appointment, the need for caregiver support, treatment intervals, and the emotional impact of the treatment. There was no active selection of patients to the survey. Respondents had to confirm the nAMD diagnosis prior to submitting the response. All data was included in the analysis as submitted by the respondents. This survey was market research involving anonymous patient data, and no participants were identifiable. Results In total, 130 patients responded to the survey. The majority of patients reported to receive nine or more injections per year (48.8%), and many patients needed caregiver support for every treatment appointment (37.7%). Patients reported to be anxious one day (25.4%), two days (8.5%), one week (10.8%) or more than one week (3.1%) prior to treatment. The week before the treatment, 33.1% of patients reported to be stressed and 15.4% struggled to sleep. The majority of patients reported the treatment as uncomfortable (54.6%) or as somewhat painful (26.2%). The results on yearly number of injections, time used each treatment day and need for caregiver support suggested a variation between Norwegian hospital regions. Conclusions This survey uncovers how treatment with intravitreal injections represents a substantial burden for Norwegian patients with nAMD. Future research on how the treatment burden impacts nAMD patients may lead to more patient-centered care and help guide treatment decisions. New treatments with longer intervals between injections are likely to both reduce the treatment burden and improve capacity in ophthalmology clinics.
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Affiliation(s)
- Gudrun Reitan
- Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | | | | | - Ragnheidur Bragadottir
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
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Bikbov MM, Kazakbaeva GM, Iakupova EM, Panda-Jonas S, Fakhretdinova AA, Tuliakova AM, Rusakova IA, Jonas JB. Cognitive impairment in the population-based ural very old study. Front Aging Neurosci 2022; 14:912755. [PMID: 35928990 PMCID: PMC9344888 DOI: 10.3389/fnagi.2022.912755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022] Open
Abstract
Background Despite its marked importance in public health, the prevalence of cognitive impairment (CI) and its associated factors have only rarely been examined in old populations in general or in Russia at all. Objective To assess CI prevalence and its determinants in a very elderly population in Russia. Materials and methods The population-based Ural Very Old Study, conducted in rural and urban region in Bashkortostan/Russia, included 1,526 (81.1%) out of 1,882 eligible individuals aged 85+ years. A series of medical examinations including the Mini-Mental State Examination (MMSE) for the assessment of CI was performed. Results Mini-Mental State Examination data were available for 1,442 (94.5%) individuals (mean age: 88.3 ± 2.9 years; range: 85–103 years). The median MMSE score was 24 (interquartile range: 19, 27). Prevalence of any CI (MMSE score < 24 points) was 701/1,442 [48.6%; 95% confidence interval (CI): 46.0, 51.2]. Prevalence of mild, moderate and severe CI (MMSE score 19–23 points, 10–18 points, and ≤9 points, respectively) was 357/1,442 (24.8%; 95% CI: 22.5, 27.0), 246/1,442 (17.1%; 95% CI: 15.1, 19.0), and 98/1,442 (6.8%; 95% CI: 5.5, 8.1), resp. A lower MMSE score correlated (regression coefficient r2: 0.31) with older age (beta: −0.13; P < 0.001), rural region of habitation (beta: 0.15; P < 0.001), lower level of education (beta: 0.19; P < 0.001), higher depression score (beta: −0.33; P < 0.001) (or alternatively, higher prevalence of hearing loss (beta: −0.10; P = 0.001), worse visual acuity (beta: −0.10; P = 0.001), and lower physical activity (beta: 0.06; P = 0.04). Conclusion In this elderly study population from rural and urban Russia, prevalence of any, mild, moderate and severe CI was 48.6, 24.8, 17.1, and 6.8%, resp. Besides medical and lifestyle factors, vision and hearing impairment were major factors associated with CI.
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Affiliation(s)
- Mukharram M. Bikbov
- Ufa Eye Research Institute, Ufa, Russia
- *Correspondence: Mukharram M. Bikbov,
| | - Gyulli M. Kazakbaeva
- Ufa Eye Research Institute, Ufa, Russia
- Ural Ophthalmology Institute, Ufa, Russia
| | | | | | | | | | | | - Jost B. Jonas
- Privatpraxis Prof. Jonas und Dr. Panda-Jonas, Heidelberg, Germany
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
- Jost B. Jonas,
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10
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Bikbov MM, Kazakbaeva GM, Rakhimova EM, Rusakova IA, Fakhretdinova AA, Tuliakova AM, Panda‐Jonas S, Gilmanshin TR, Zainullin RM, Bolshakova NI, Safiullina KR, Gizzatov AV, Ponomarev IP, Yakupova DF, Baymukhametov NE, Nikitin NA, Jonas JB. The prevalence of dry eye in a very old population. Acta Ophthalmol 2022; 100:262-268. [PMID: 34124850 DOI: 10.1111/aos.14937] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/01/2021] [Accepted: 05/20/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess the prevalence of dry eye disease (DED) and Meibomian gland dysfunction (MGD) in a very old population. METHODS The Ural Very Old Study (UVOS), a population-based cohort study performed in rural and urban Bashkortostan/Russia, included 1526 (81.1%) out of 1882 eligible individuals aged 85+ years. The participants underwent a detailed medical and ophthalmological examination including Schirmer´s test, slit-lamp based assessment of the Meibomian glands and an interview. RESULTS The study included 1493 (97.8%) individuals with available information about DED (mean age: 88.3 ± 2.9 years). Schirmer´s test was ≤5 mm in 388 individuals (34.3%; 95% confidence interval (CI): 31.5, 37.1), and the mean score of subjective dry eye symptoms was 7.52 ± 2.14 (median: 6; range: 6-18; 95%CI: 7.41, 7.63). An MGD grade 1, 2, 3 and 4 was diagnosed in 367 (31.4%), 309 (26.4%), 89 (7.6%) and 39 (3.3%) eyes, respectively. The prevalence of DED diagnosis definition #2 (dry eye score ≥8, Schirmer´s test ≤5 mm) and definition #4 (dry eye score ≥7, Schirmer test ≤5 mm, MGD grade 1+), were 164/1132 (14.5%; 95%CI: 12.4, 16.5), and 167/1131 (14.8%; 95%CI: 12.7, 16.8), respectively. In multivariate analysis, higher DED prevalence was associated with female sex (odds ratio (OR): 2.36; 95%CI: 1.18, 4.71; p = 0.02), rural region of habitation (OR: 2.72; 95%CI: 1.10, 6.70; p = 0.03), longer axial length (OR: 1.30; 95%CI: 1.04,1.62; p = 0.02), higher hearing loss score (OR: 1.03; 95%CI: 1.01, 1.05; p = 0.001) and lower self-reported salt consumption (OR: 0.64; 95%CI: 0.54, 0.75; p < 0.001). CONCLUSIONS In this population-based recruited very old study sample aged 85+ years, higher DED prevalence (dry eye score ≥8, Schirmer´s test <5 mm; mean: 14.5%) and MGD prevalence (any grade:68.8%) was associated with female sex, rural region of habitation, longer axial length, higher hearing loss score and lower salt consumption.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jost B. Jonas
- Department of Ophthalmology Medical Faculty Mannheim of the Ruprecht‐Karls‐University of Heidelberg Mannheim Germany
- Institute of Molecular and Clinical Ophthalmology Basel Switzerland
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11
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Bikbov MM, Kazakbaeva GM, Rakhimova EM, Rusakova IA, Fakhretdinova AA, Tuliakova AM, Panda-Jonas S, Gilmanshin TR, Zainullin RM, Bolshakova NI, Safiullina KR, Gizzatov AV, Ponomarev IP, Yakupova DF, Baymukhametov NE, Nikitin NA, Jonas JB. Axial length and its associations in the Ural Very Old Study. Sci Rep 2021; 11:18459. [PMID: 34531490 PMCID: PMC8446056 DOI: 10.1038/s41598-021-98039-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022] Open
Abstract
To assess the distribution of axial length as surrogate for myopia and its determinants in an old population, we performed the Ural Very Old Study as a population-based cohort study. Out of 1882 eligible individuals aged 85 + years, the Ural Very Old Study performed in an urban and rural region in Bashkortostan/Russia included 1526 (81.1%) individuals undergoing ophthalmological and medical examinations with sonographic axial length measurement. Biometric data were available for 717 (47.0%) individuals with a mean age of 88.0 ± 2.6 years (range 85–98 years; 25%). Mean axial length was 23.1 ± 1.1 mm (range 19.37–28.89 mm). Prevalences of moderate myopia (axial length 24.5–< 26.5 mm) and high myopia (axial length ≥ 26.5 mm) were 47/717 (6.6%; 95% CI 4.7, 8.4) and 10/717 (1.4%; 95% CI 0.5, 2.3), respectively. In multivariable analysis, longer axial length was associated (coefficient of determination r2 0.25) with taller body height (standardized regression coefficient beta:0.16;non-standardized regression coefficient B: 0.02; 95% confidence interval (CI) 0.01, 0.03; P < 0.001), higher level of education (beta: 0.12; B: 0.07; 95% CI 0.02, 0.11; P = 0.002), and lower corneal refractive power (beta: − 0.35; B: − 0.23; 95% CI − 0.28, − 0.18; P < 0.001). Higher prevalence of moderate myopia, however not of high myopia, was associated with higher educational level (OR 1.39; 95% CI 1.09, 1.68; P = 0.007) and lower corneal refractive power (OR 0.77; 95% CI 0.63, 0.94; P = 0.01). In this old study population, prevalence of moderate axial myopia (6.6% versus 9.7%) was lower than, and prevalence of high axial myopia (1.4% versus 1.4%) was similar as, in a corresponding study on a younger population from the same Russian region. Both myopia prevalence rates were higher than in rural Central India (1.5% and 0.4%, respectively). As in other, younger, populations, axial length and moderate myopia prevalence increased with higher educational level, while high myopia prevalence was independent of the educational level.
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Affiliation(s)
- Mukharram M Bikbov
- Ufa Eye Research Institute, 90 Pushkin Street, Ufa, 450077, Bashkortostan, Russia.
| | - Gyulli M Kazakbaeva
- Ufa Eye Research Institute, 90 Pushkin Street, Ufa, 450077, Bashkortostan, Russia
| | - Ellina M Rakhimova
- Ufa Eye Research Institute, 90 Pushkin Street, Ufa, 450077, Bashkortostan, Russia
| | - Iuliia A Rusakova
- Ufa Eye Research Institute, 90 Pushkin Street, Ufa, 450077, Bashkortostan, Russia
| | | | - Azaliia M Tuliakova
- Ufa Eye Research Institute, 90 Pushkin Street, Ufa, 450077, Bashkortostan, Russia
| | - Songhomitra Panda-Jonas
- Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany
| | - Timur R Gilmanshin
- Ufa Eye Research Institute, 90 Pushkin Street, Ufa, 450077, Bashkortostan, Russia
| | - Rinat M Zainullin
- Ufa Eye Research Institute, 90 Pushkin Street, Ufa, 450077, Bashkortostan, Russia
| | - Natalia I Bolshakova
- Ufa Eye Research Institute, 90 Pushkin Street, Ufa, 450077, Bashkortostan, Russia
| | - Kamilia R Safiullina
- Ufa Eye Research Institute, 90 Pushkin Street, Ufa, 450077, Bashkortostan, Russia
| | - Ainur V Gizzatov
- Ufa Eye Research Institute, 90 Pushkin Street, Ufa, 450077, Bashkortostan, Russia
| | - Ildar P Ponomarev
- Ufa Eye Research Institute, 90 Pushkin Street, Ufa, 450077, Bashkortostan, Russia
| | - Dilya F Yakupova
- Ufa Eye Research Institute, 90 Pushkin Street, Ufa, 450077, Bashkortostan, Russia
| | - Nail E Baymukhametov
- Ufa Eye Research Institute, 90 Pushkin Street, Ufa, 450077, Bashkortostan, Russia
| | - Nikolay A Nikitin
- Ufa Eye Research Institute, 90 Pushkin Street, Ufa, 450077, Bashkortostan, Russia
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Theodor-Kutzerufer 1, 68167, Mannheim, Germany. .,Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.
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12
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Silverstein SM, Sörensen S, Sunkara A, Lai A, Fradkin SI, Ramchandran RS. Association of vision loss and depressive symptomatology in older adults assessed for ocular health in senior living facilities. Ophthalmic Physiol Opt 2021; 41:985-995. [PMID: 34382220 DOI: 10.1111/opo.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE People with vision loss are at increased risk for major depressive disorder (MDD) and subclinical depression. However, screening for depression is rarely done in eye care settings or among groups in the general population known to have vision disorders. METHODS We examined the prevalence of depression, using the Patient Health Questionnaire - 2 (PHQ-2), among a group of older adults (N = 204; mean age = 82.15) at two senior living facilities (SLFs) and determined the relationships between severity of depression and objective visual findings, visual function, beliefs about taking an active role in one's own eye care (i.e., patient activation) and level of social support. RESULTS Approximately 50% of the sample had impaired vision in at least one eye, and close to 30% of the sample obtained a score on the PHQ-2 indicating the likely presence of major depressive disorder. Visual testing findings were related to visual function (e.g., ability to read), but not to depression. Patient activation was also not significantly related to the level of depression. However, impaired visual functioning and less social support were both strong predictors of depression. These two variables and their interaction accounted for 17% of the total PHQ-2 score variance. CONCLUSIONS These data indicate the potential utility of screening for depression as part of vision care in populations likely to have significant vision loss. The findings also suggest that a comprehensive approach to depression prevention and/or reduction in SLF and similar populations may require interventions to address reduced visual functioning and methods to strengthen social networks.
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Affiliation(s)
- Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.,Department of Neuroscience, University of Rochester Medical Center, Rochester, New York, USA.,Department of Ophthalmology, University of Rochester Medical Center, Rochester, New York, USA.,Center for Visual Science, University of Rochester, Rochester, New York, USA
| | - Silvia Sörensen
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.,Department of Ophthalmology, University of Rochester Medical Center, Rochester, New York, USA.,Department of Counseling and Human Development, Margaret Warner Graduate School of Education and Human Development, University of Rochester, Rochester, New York, USA.,Center for Community Health and Prevention, University of Rochester, Rochester, New York, USA
| | - Anoop Sunkara
- Department of Economics, University of Notre Dame, Notre Dame, Indiana, USA
| | - Adriann Lai
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Samantha I Fradkin
- Department of Psychology, University of Rochester, Rochester, New York, USA
| | - Rajeev S Ramchandran
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, New York, USA.,Center for Community Health and Prevention, University of Rochester, Rochester, New York, USA.,Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
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13
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Abstract
Objectives: To compare the quality of life assessed by the Low Vision Quality of Life Questionnaire (LVQOL) and National Eye Institute Visual Function Questionnaire (NEI VFQ-25) in patients with low vision. Materials and Methods: A total of 64 consecutive patients who presented to the Ankara University Low Vision Rehabilitation Department for the first time were included in the study. Patients aged 18 or older who had a best-corrected visual acuity of less than 20/60 or a visual field of equal to or less than 20° from the fixation point in the better eye were included. After examination, the patients were asked to complete the LVQOL and NEI VFQ-25 questionnaires. Results: A very strong correlation was found between the total scores of the two questionnaires. A strong correlation was found between the “distance vision” subscale score of LVQOL and “distance activities” subscale score of NEI VFQ-25. There was also a strong correlation between the “reading and fine work” subscale score of LVQOL and “near activities” subscale score of NEI VFQ-25. There was a weak correlation between the LVQOL total score and visual acuity. There were moderate negative correlations between age at disease onset and the total scores of the two questionnaires. Conclusion: Both the LVQOL and NEI VFQ-25 are able to quantify the quality of life of individuals with low vision and it is possible to compare the studies carried out with these two questionnaires which are validated in Turkish.
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Affiliation(s)
- Esra Şahlı
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Şefay Aysun İdil
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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14
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Rojananuangnit K, Sudjinda N. Utility Index and Patient-Reported Outcome Measures in Glaucomatous Patients Comparing with Normal Participants. Clin Ophthalmol 2021; 15:835-843. [PMID: 33658759 PMCID: PMC7920622 DOI: 10.2147/opth.s300226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/03/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Utility index is a significant outcome in terms of health economics assessment while patient-reported outcome measure (PROMs) evaluates quality of life (QOL) from patient’s perspective. Our objective was to evaluate both utility indices and PROMs using generic and eye specific QOL in glaucomatous patients compared with normal population. Methods This is a case-control study. We interviewed normal and glaucomatous participants with the European Quality of Life questionnaire (EQ-5D-5L), the European visual analogue scale (EQ-VAS) and the visual function questionnaire 28 (Thai version) (VFQ-28). The visual function questionnaire utility index (VFQ-UI) and generic utility index from EQ-5D-5L were calculated. Results There were 47 normal and 127 glaucomatous participants in this study. Amongst glaucoma group, 35 participants were in the early stage of the disease, 43 were in the moderate stage, 30 normal vision participants were in the severe stage, 14 participants had blindness one eye, and 5 had blindness both eyes. The mean age of the participants in both groups was statistically similar (63.78±6.84 vs 66.30±8.93 years old, respectively, p=0.062). Underlying diseases between groups were also comparable. The EQ-5D-5L utility index score and the EQ-VAS score were not statistically different between normal and glaucomatous groups, respectively (EQ-5D-5L: 0.874±0.122 vs 0.837±0.191, p=0.215; EQ VAS: 76.06±15.07 vs 74.02 ±15.10, p=0.43). By contrast, VFQ-UI of the glaucomatous group was significantly lower than that of the normal group, (VFQ-UI: 0.833±0.147 vs 0.895±0.070, accordingly, p<0.05). Conclusions Utility index from the VFQ-UI was a relevant PROMs for evaluating the QOL of glaucomatous patients in terms of visual function specificity and acceptable validity.
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Affiliation(s)
- Kulawan Rojananuangnit
- Glaucoma Unit, Ophthalmology Department, Mettapracharak (Wat Rai Khing) Hospital, Nakhon Pathom, Thailand
| | - Nuttawan Sudjinda
- Glaucoma Unit, Ophthalmology Department, Mettapracharak (Wat Rai Khing) Hospital, Nakhon Pathom, Thailand
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Potic J, Bergin C, Giacuzzo C, Konstantinidis L, Daruich A, Wolfensberger TJ. APPLICATION OF MODIFIED NEI VFQ-25 AFTER RETINAL DETACHMENT TO VISION-RELATED QUALITY OF LIFE. Retina 2021; 41:653-660. [PMID: 32568989 PMCID: PMC7889283 DOI: 10.1097/iae.0000000000002894] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We examined the postoperative visual recovery and quality of life after retinal detachment (RD) surgery. METHODS In addition to a baseline clinical examination, patients filled out the National Eye Institute Visual Functioning Questionnaire at three time points: preoperatively and 1 and 3 months postoperatively (M1 and M3, respectively). We analyzed the composite score and short-form scores (socioemotional scale [SFSES] and visual functioning scale [SFVFS]). RESULTS One hundred ninety-four patients were enrolled in this study; 47 (26 macula-ON RD and 21 macula-OFF RD) returned all three questionnaires. The best corrected visual acuity was Snellen equivalent 20/25, 20/25, and 20/20 at the preoperative, M1, and M3 assessment, respectively. At M3, we found a positive correlation between SFSES and best corrected visual acuity measures among macula-OFF patients (P < 0.001, R2 = 0.58). A significant correlation with the best corrected visual acuity among macula-ON patients was observed only at M3 with the SFVFS score (P < 0.001, R2 = 0.41). CONCLUSION The quality of life differs between ON and OFF RD in regard to the composite score and especially SFSES and SFVFS. We found a transient decrease in the quality of life at M1 for macula-ON patients, whereas the quality of life improved throughout follow-up among macula-OFF patients. These data may help improve the management of patients' expectations after RD surgery.
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Affiliation(s)
- Jelena Potic
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland; and
- Eye Trauma and Vitreoretinal Surgery Unit, Clinics for Eye Diseases, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ciara Bergin
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland; and
| | - Clarice Giacuzzo
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland; and
| | - Lazaros Konstantinidis
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland; and
| | - Alejandra Daruich
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland; and
| | - Thomas J. Wolfensberger
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland; and
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Liao KM, Wu WC, Jang Y, Su FY, Tsai LT. Impacts of monocular, binocular, and functional visual acuity on vision-related quality of life in patients with type 2 diabetes. Sci Rep 2021; 11:298. [PMID: 33431910 PMCID: PMC7801718 DOI: 10.1038/s41598-020-79483-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/09/2020] [Indexed: 11/09/2022] Open
Abstract
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.
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Affiliation(s)
- Kuo-Meng Liao
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Zhong-Xiao Branch, Taipei City Hospital, Taipei, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital and Chang Gung University, School of Medicine, Taoyuan, Taiwan
| | - Yuh Jang
- School of Occupational Therapy, College of Medicine, National Taiwan University, 4F, No. 17, Xuzhou Rd., Zhongzheng Dist., Taipei, 100, Taiwan
| | - Fan-Ya Su
- Department of Psychiatry, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Li-Ting Tsai
- School of Occupational Therapy, College of Medicine, National Taiwan University, 4F, No. 17, Xuzhou Rd., Zhongzheng Dist., Taipei, 100, Taiwan.
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Krarup T, Nisted I, Christensen U, Kiilgaard JF, Cour M. Monocular and binocular end-points after epiretinal membrane surgery and their correlation to patient-reported outcomes. Acta Ophthalmol 2020; 98:716-725. [PMID: 32323909 DOI: 10.1111/aos.14449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 03/28/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE This study evaluates current available endpoints for epiretinal membrane (ERM) surgery and examine their correlation to patient reported outcomes (PRO). METHODS Retrospective study including 38 eyes of 38 patients who underwent cataract extraction and subsequent vitrectomy for idiopathic ERM. The fellow eye was phakic with good visual acuity. The registered outcomes were monocular and binocular visual acuity, stereoacuity, M-chart metamorphopsia score, aniseikonia and aniseikonia tolerance range (ATR). Two questionnaires were completed: the convergence insufficiency symptom survey and Visual Function Questionnaire (VFQ-39). RESULTS Median total aniseikonia was 11% (range 0-35). There was a statistically significant correlation between the mean total M-chart score of the study eye and VFQ-Near (Spearman rho: VFQ-Near: -0.54, p < 0.01). There was no correlation between the best corrected visual acuity (BCVA) of the project eye, binocular BCVA, stereoacuity, ATR or mean total aniseikonia and PRO (Spearman p-values > 0.05). There was no correlation between mean total aniseikonia and mean total M-chart score (Spearman rho: 0.21 p = 0.26). There was a large variation between the mean total M-chart scores and questionnaire results. CONCLUSION The mean total M-chart score is currently the best end-points to predict PRO of ERM surgery; however, it is possible to have high M-chart values and have no visual complaints.
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Affiliation(s)
- Therese Krarup
- Department of Ophthalmology Rigshospitalet‐Glostrup Glostrup Denmark
| | - Ivan Nisted
- Institute for Clinical Medicine Aarhus University Faculty of Health Sciences Aarhus Denmark
| | - Ulrik Christensen
- Department of Ophthalmology Rigshospitalet‐Glostrup Glostrup Denmark
| | | | - Morten Cour
- Department of Ophthalmology Rigshospitalet‐Glostrup Glostrup Denmark
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A critical review: Psychophysical assessments of diabetic retinopathy. Surv Ophthalmol 2020; 66:213-230. [PMID: 32866468 DOI: 10.1016/j.survophthal.2020.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 02/08/2023]
Abstract
Diabetic retinal disease remains a leading cause of vision loss despite currently available screening methods, ocular treatments, and efforts to control metabolic dysfunction. It is now understood that diabetes damages the entire retina and the cellular components of the neurovascular unit. Multiple studies have demonstrated impairment of various aspects of retinal function across the spectrum of retinopathy severity. Here we review these tests, the principles underlying their use, clinical data from multiple publications, the strengths and limitations of the studies, and prospects for their application to understand the pathophysiology of diabetic retinal disease and monitor its response to therapy. We focus on visual acuity, contrast sensitivity, color vision, visual field, and dark adaptation and their use to understand the pathophysiology of diabetic retinopathy and as potential endpoints for clinical trials.
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Varma R, Bressler NM, Doan QV, Suñer IJ, Danese M, Dolan CM, Lee A, Ehrlich JS, Rajput Y. Diabetic Population-Based Model to Estimate Impact of Ranibizumab on Diabetic Retinopathy Severity in Patients with Diabetic Macular Edema. Clin Ophthalmol 2020; 14:1249-1259. [PMID: 32440092 PMCID: PMC7213867 DOI: 10.2147/opth.s236636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/04/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Estimate effects of ranibizumab on diabetic retinopathy (DR) severity in US Hispanic and non-Hispanic white persons with center-involved diabetic macular edema (DME) causing vision impairment for whom ranibizumab treatment would be considered. PATIENTS AND METHODS This model simulated DR severity outcomes over 2 years in the better-seeing eye using US census, National Health and Nutrition Examination Survey, Wisconsin Epidemiologic Study of Diabetic Retinopathy, and Los Angeles Latino Eye Study data. Baseline DR severity estimated from Diabetic Retinopathy Clinical Research Network trial data. Changes in DR severity after 2 years, with/without monthly ranibizumab (0.3 or 0.5 mg), were estimated from Phase III clinical trial data (RIDE/RISE) using a 2-dimensional Monte Carlo simulation model. Number of patients over a 2-year period for whom 1) DR severity worsening was avoided, 2) DR severity improved, and 3) selected clinical events related to proliferative DR (PDR) occurred, was estimated. RESULTS An estimated 37,274 US Hispanic and non-Hispanic white persons were projected to have DR with center-involved DME and be eligible for ranibizumab treatment. The number of persons with moderately severe non-proliferative DR (NPDR) or less severe DR at baseline who would worsen to PDR and experience a PDR complication over 2 years would be reduced from 437 with no ranibizumab to 19 with ranibizumab (95% reduction; 95% simulation interval [SI], 79-100%). The number of persons with severe NPDR or less severe DR at baseline who would be expected to improve by ≥2 DR severity levels over 2 years would increase from 1706 with no ranibizumab to 13,042 with ranibizumab (682% increase; 95% SI, 478-967%). CONCLUSION This model estimates that ranibizumab treatment in US Hispanic and non-Hispanic white patients with center-involved DME causing vision impairment would potentially reduce the number of patients with worsening DR and potentially increase the number with DR improvements.
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Affiliation(s)
- Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, CA, USA
| | | | - Quan V Doan
- Outcomes Insights, Inc., Westlake Village, CA, USA
| | | | - Mark Danese
- Outcomes Insights, Inc., Westlake Village, CA, USA
| | | | - Abraham Lee
- Outcomes Insights, Inc., Westlake Village, CA, USA
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Ang MJ, Chamberlain W, Lin CC, Pickel J, Austin A, Rose-Nussbaumer J. Effect of Unilateral Endothelial Keratoplasty on Vision-Related Quality-of-Life Outcomes in the Descemet Endothelial Thickness Comparison Trial (DETECT): A Secondary Analysis of a Randomized Clinical Trial. JAMA Ophthalmol 2020; 137:747-754. [PMID: 31046075 DOI: 10.1001/jamaophthalmol.2019.0877] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Vision-related quality of life can be a valuable outcome for some interventions in ophthalmology. In the primary Descemet Endothelial Thickness Comparison Trial (DETECT), Descemet membrane endothelial keratoplasty (DMEK) had superior postoperative visual acuity compared with ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK). It is of interest to determine whether this trend extends to quality of life. Objective To determine the effect of UT-DSAEK and DMEK on vision-related quality of life. Design, Setting, and Participants A prespecified secondary analysis of a 2-surgeon patient- and outcome-masked randomized clinical trial was conducted at the Casey Eye Institute in Portland, Oregon, and Byers Eye Institute in Palo Alto, California. The study was conducted between January 20, 2015, and April 26, 2017. DETECT enrolled 38 individuals and included 50 eyes with isolated endothelial dysfunction; for this analysis, the second eye from a single participant was excluded along with any questionnaires in the first eye after second eye surgery for evaluation of 38 eyes at baseline and 3 months and 26 eyes at 12 months. Mean (SD) baseline visual acuity was 0.35 (0.31) logMAR in the DMEK arm and 0.28 (0.22) logMAR in the UT-DSAEK arm. Each arm consisted of 19 participants: 18 individuals with Fuchs dystrophy and 1 participant with pseudophakic bullous keratopathy. Interventions Study eyes were randomized to receive either UT-DSAEK or DMEK. Main Outcomes and Measures Responses to the National Eye Institute (NEI) Visual Function Questionnaire-39 (VFQ-39) administered at baseline and 3 and 12 months postoperatively were analyzed using the NEI-defined traditional subscales and composite score on a 100-point scale and with a Rasch-refined analysis. Results There were more women in both arms of the study (UT-DSAEK, 12 [63%]; DMEK, 11 [58%]); mean (SD) age was 68 (11) years in the UT-DSAEK arm and 68 (4) years in the DMEK arm. Overall, study participants experienced a 9.1-point improvement in NEI VFQ-39 composite score at 3 months compared with baseline (N = 38; 95% CI, 4.9-13.3; P < .001), and an 11.6-point improvement at 12 months compared with baseline (n = 26; 95% CI, 6.8-16.4; P < .001). Eyes randomized to DMEK had 0.9 points more improvement in NEI VFQ-39 composite score at 3 months compared with UT-DSAEK after controlling for baseline NEI VFQ-39 (95% CI, -6.2 to 8.0; P = .80). Conclusions and Relevance Improvement in vision-related quality of life was not shown to be greater with DMEK compared with UT-DSAEK. Trial Registration ClinicalTrials.gov identifier: NCT02373137.
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Affiliation(s)
- Michael J Ang
- Department of Ophthalmology, California Pacific Medical Center, San Francisco
| | | | - Charles C Lin
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Julia Pickel
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Ariana Austin
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Jennifer Rose-Nussbaumer
- Francis I. Proctor Foundation, University of California, San Francisco.,Department of Ophthalmology, University of California, San Francisco
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Trento M, Charrier L, Cavallo F, Bertello S, Oleandri S, Donati MC, Rizzo S, Virgili G, Picca G, Bandello F, Lattanzio R, Aragona E, Perilli R, Casati S, Beltramo E, Mazzeo A, Fornengo P, Durando O, Merlo S, Porta M. Vision-related quality of life and locus of control in type 1 diabetes: a multicenter observational study. Acta Diabetol 2019; 56:1209-1216. [PMID: 31313005 DOI: 10.1007/s00592-019-01384-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/22/2019] [Indexed: 10/26/2022]
Abstract
AIMS Diabetic retinopathy remains asymptomatic until its late stages but remains a leading cause of vision impairment and blindness. We studied quality of life and the ability to deal with the discomfort deriving from the presence of a chronic disease in patients with type 1 diabetes and different stages of retinopathy. METHODS Multicenter collaborative observational study involving nine centers screening for retinopathy in different areas of Italy. The National Eye Institute 25-item visual functioning questionnaire and the locus of control tool were administered to 449 people with type 1 diabetes between February 2016 and March 2018. Socio-demographic and clinical data were collected. RESULTS On multivariable analysis, severe retinopathy is associated with worse scores for general vision, ocular pain, near vision activities, distance vision activities, driving, color vision, peripheral vision and lower values of internal control, independently of visual acuity. Women had a perception of worse general health, distance vision activities and driving, and lower internal control and trust in others. Worse scores for visual-specific social functioning, visual-specific mental health, visual-specific role difficulties, visual-specific dependency and peripheral vision were associated with higher HbA1c levels. Fatalism increased with rising HbA1c levels. CONCLUSIONS These results confirm that a gap exists between patients' knowledge and expectations on retinopathy and providers' expertise and assumptions. To bridge this gap, patient-centered education and engaging approaches may be more effective than simple information given during consultations.
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Affiliation(s)
- Marina Trento
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy.
| | - Lorena Charrier
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Franco Cavallo
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Stefania Bertello
- Endocrinology and Diabetology Unit, Health Unit 1, Savigliano, Italy
| | | | - Maria Carla Donati
- Eye Clinic, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Salvatore Rizzo
- Eye Clinic, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Gianni Virgili
- Eye Clinic, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Giuseppe Picca
- Endocrinology and Metabolic Diseases Unit, Hospital of Foggia, Foggia, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Rosangela Lattanzio
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Elena Aragona
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Roberto Perilli
- Department of Ophthalmology, Territorial Ophthalmology, Pescara, Italy
| | - Stefano Casati
- Eye Clinic, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elena Beltramo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Aurora Mazzeo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Fornengo
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy
| | - Olga Durando
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy
| | - Stefano Merlo
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy
| | - Massimo Porta
- Department of Medical Sciences, University of Turin, Turin, Italy
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Chen XD, Gardner TW. Patient-Reported Outcomes Reveal Impairments Not Explained by Psychophysical Testing in Patients With Regressed PDR. Transl Vis Sci Technol 2019; 8:11. [PMID: 31380143 PMCID: PMC6664865 DOI: 10.1167/tvst.8.4.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/28/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose We evaluated the correlations between visual deficits and patient-reported symptoms in patients with regressed proliferative diabetic retinopathy (PDR) to determine whether there is a psychophysical basis for vision-related impairments. Methods Visual acuity, reading acuity, contrast sensitivity, frequency doubling perimetry (FDP), Humphrey field analyzer (HFA), and dark adaptation assessed visual function. The National Eye Institute Vision Function Questionnaire-25 (NEI VFQ-25) and Low Luminance Questionnaire (LLQ) assessed quality of life. Results We recruited 30 adults who received panretinal photocoagulation (PRP) for PDR and 15 control subjects; 22 diabetic and 11 control participants completed a second evaluation 5 years later. Visual acuity of the worse-seeing eyes tended to correlate better with NEI VFQ-25 and LLQ than did the acuity of the better-seeing eyes. Other vision measures were generally not associated with either questionnaire, especially responses related to driving ability and mental health. Visual acuity only detected subnormal performance in 43% to 45% of patients, while FDP 24-2, HFA 60-4, and LLQ detected abnormal performance in >80% of patients. Conclusions Poor visual acuity may explain some vision-related impairments in daily function. However, many patients with regressed PDR have normal acuity but reduced visual field and poor quality of life. In these patients, their reported symptoms were not fully explained by visual acuity or any psychophysical tests alone. Translational Relevance Visual acuity is a poor indicator of overall visual function in people with regressed PDR. In clinical settings, visual field tests and patient-reported outcomes may provide more comprehensive assessments of their functional deficits than visual acuity.
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Affiliation(s)
- Xing D Chen
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Thomas W Gardner
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
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Chakravarthy U, Pearce I, Banerjee S, Burton BJL, Downey L, Gale R, Patel J, Patra S, Sivaprasad S, Stevenson M, Lupton S. Patient-reported outcomes in the RELIGHT clinical trial of ranibizumab in diabetic macular oedema. BMJ Open Ophthalmol 2019; 4:e000226. [PMID: 31179389 PMCID: PMC6528749 DOI: 10.1136/bmjophth-2018-000226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background/aims The RELIGHT clinical trial used an individualised treatment regimen of ranibizumab to treat diabetic macular oedema (DMO). We report findings from two patient-reported outcome instruments. Methods The National Eye Institute Visual Function Questionnaire (NEI-VFQ) was administered before starting treatment (M0) and at M6, 12 and 18. The Macular Disease Society Treatment Satisfaction Questionnaire (MacTSQ) was administered 1 month after treatment start (M1) and at M6, 12 and 18. Relationships between best-corrected visual acuity (BCVA) in the study eye (SE) and the status of the eye at baseline (as better or worse eye by BCVA) and the two instrument measures were investigated. Results BCVA in the SE correlated strongly with the NEI-VFQ composite scores and the majority of the subscales but not with the MacTSQ subscales. Statistically significant improvements were observed in the majority of the subscales of the NEI-VFQ at M6, 12 and 18. For the MacTSQ, improvements between baseline M6, 12 and 18 were seen for subscale 1 but only reached statistical significance at M12. In subscale 2, the changes in mean scores were statistically significant at all timepoints. Conclusions Although ranibizumab treatment in DMO over an 18-month period resulted in improvements in visual functioning and patient satisfaction, no correlation was found between the instruments used to measure these outcomes. Our finding of a lack of correlation between BCVA and the MacTSQ suggests the presence of psychophysical factors not measured by traditional means.
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Affiliation(s)
| | - Ian Pearce
- St Paul's Eye Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | | | - Benjamin J L Burton
- Departmentof Ophthalmology, James Paget University Hospital, Great Yarmouth, UK
| | - Louise Downey
- Department of Ophthalmology, Hull Royal Infirmary, Hull, UK
| | - Richard Gale
- Departmentof Ophthalmology, The York Hospital UK, York, UK
| | | | | | | | | | - Susanne Lupton
- Departmentof Ophthalmology, Novartis Pharma UK, Frimley, UK
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25
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La Grow SJ. The Effectiveness of Comprehensive Low Vision Services for Older Persons with Visual Impairments in New Zealand. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2019. [DOI: 10.1177/0145482x0409801103] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study evaluated the effects of providing comprehensive low vision services to elderly persons with visual impairments in New Zealand. The 93 participants were matched on age, gender, and visual function with 93 who did not have access to comprehensive low vision services. No significant differences were found between the groups at posttest and follow-up on the three primary dependent variables of visual function, instrumental activities of daily living, and quality of life.
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Affiliation(s)
- Steven J. La Grow
- School of Health Sciences, Massey University, Private Bag 11 222, Palmerston North, New Zealand
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26
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Vision-related quality of life after pars plana vitrectomy with or without combined cataract surgery for idiopathic macular hole patients. Int Ophthalmol 2019; 39:2775-2783. [PMID: 31144239 DOI: 10.1007/s10792-019-01124-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the influence of vision-related quality of life (VR-QOL) after pars plana vitrectomy (PPV) with or without combined cataract surgery for idiopathic macular hole (IMH) patients. METHODS This prospective consecutive case series study included 53 eyes of 53 consecutive IMH patients who were divided into two groups: 34 eyes underwent PPV combined with cataract surgery (combined group), 19 eyes only underwent PPV (vitrectomy group). Clinical data were collected at baseline and 3 and 6 months after surgery, respectively, including VR-QOL evaluated by The National Eye Institute 25-Item Visual Function Questionnaire (VFQ-25), logarithm of minimal angle of resolution best-corrected visual acuity (logMAR BCVA) using ETDRS chart, severity of metamorphopsia evaluated by M-Charts, contrast sensitivity evaluated by functional acuity contrast test, MH diameter detected by SD-OCT and lens opacity assessment evaluated by Lens Opacity Classification System III (LOCS III). ANOVA and LSD, Wilcoxon signed-rank test were used to compare the difference in logMAR BCVA, metamorphopsia scores, contrast sensitivity, LOCS III scores and VFQ-25 scores between three time points; Spearman's rank correlation test was used to test the correlations between logMAR BCVA, metamorphopsia scores, contrast sensitivity, LOCS III scores and VFQ-25 scores. RESULTS All eyes had achieved an anatomical success after surgery in both groups. BCVA (logMAR), metamorphopsia and contrast sensitivity were significantly improved at month 3 and month 6 (p = < 0.005). VFQ-25 composite and four subscale scores (general vision, near activities, distant activities, role difficulties) were significantly improved in combined group at month 6 compared with baseline (p = 0.011, 0.001, 0.003, < 0.001, 0.009). VFQ-25 composite and two subscale scores (general vision, role difficulties) were significantly and negatively correlated with logMAR BCVA (p = 0.046, 0.011, 0.012) and metamorphopsia (p = 0.009, 0.002, < 0.001) in combined group. VFQ-25 composite and four subscale scores (general vision, near activities, distance activities, mental health) were significantly improved in vitrectomy group at month 3 compared with baseline (p = 0.014, 0.047, 0.011, 0.018, 0.037). VFQ-25 composite score and mental health score were significantly decreased in vitrectomy group at month 6 compared with month 3 (p = 0.031, 0.029) and were significantly and negatively correlated with LOCS III score (p = 0.047, 0.017) at month 6. CONCLUSION Visual function and VR-QOL were significantly improved after successful macular hole surgery. The fluctuation of VR-QOL after surgery was attributed to the progression of the lens opacity. PPV combined with cataract surgery can help macular hole patients to maintain stable VR-QOL improvement by degrees.
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Choi SU, Chun YS, Lee JK, Kim JT, Jeong JH, Moon NJ. Comparison of vision-related quality of life and mental health between congenital and acquired low-vision patients. Eye (Lond) 2019; 33:1540-1546. [PMID: 31019263 PMCID: PMC7002576 DOI: 10.1038/s41433-019-0439-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/12/2018] [Accepted: 04/03/2019] [Indexed: 11/22/2022] Open
Abstract
Purpose To evaluate the impact of the age of onset of low vision on patients’ vision-related quality of life (VR-QoL) and mental health. Methods Low-vision patients who visited Chung-Ang University hospital from January 2012 to December 2014 were included. Patients were divided into the congenital low-vision (CLV) and acquired low-vision (ALV) groups according to the age of disease onset. People with normal visual function comprised the control group. VR-QoL was estimated with the National Eye Institute Visual Function Questionnaire (NEI VFQ-25), while mental health was assessed through the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). The mean scores of each questionnaire were compared between the groups in independent t-tests. Results Overall, 125 low-vision patients (55 CLV and 70 ALV) and 71 control subjects were included. Although the subscale and composite scores of the NEI VFQ-25 were lower in the ALV group than in the CLV group, the differences were not significant. However, the BDI and BAI scores were significantly higher in the ALV group than in the CLV group (12.07 ± 11.97 vs. 7.67 ± 9.04, P = 0.021; 9.11 ± 10.51 vs. 5.69 ± 6.85, P = 0.030, respectively). Also, the number of patients requiring expert consultation for depression was higher in the ALV group than in the CLV group (P = 0.010). Conclusion ALV patients have more vulnerable mental health states than CLV patients. Therefore, assessment of the age of onset of low vision and mental health plays a critical role in successful rehabilitation.
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Affiliation(s)
- Sang Uk Choi
- Department of Ophthalmology, College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Yeoun Sook Chun
- Department of Ophthalmology, College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jeong Kyu Lee
- Department of Ophthalmology, College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jee Taek Kim
- Department of Ophthalmology, College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jae Hoon Jeong
- Departement of Ophthalmology, Konyang University Hospital, Daejeon, Republic of Korea
| | - Nam Ju Moon
- Department of Ophthalmology, College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea.
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Aggarwal S, Ju D, Allen AM, Rose LA, Gill KP, Shen SA, Temko JE, Chang I, Faraj J, Brabender DE, Herbst de Cortina S, Marik-Reis O, Mehta MC. Regional differences in vision health: findings from Mwanza, Tanzania. Int Health 2019; 10:457-465. [PMID: 30016443 DOI: 10.1093/inthealth/ihy046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/30/2018] [Indexed: 11/13/2022] Open
Abstract
Background Visual impairment in developing countries has both social and economic impact on individuals and communities. Understanding the subjective visual functioning of populations will allow for local policymakers to identify the need for optometric or ophthalmic services in their communities. Methods The authors surveyed 644 adult patients in Mwanza, Tanzania at three clinics (Buzuruga, Mwananchi and Kisesa) using a modified Visual Functioning Questionnaire 25. Responses were categorized into General health, General vision, Ocular pain, Near activities, Distance activities, Social function, Mental health, Role difficulties, Color vision, Peripheral vision and Dependency. Results Patients at Buzuruga reported the lowest scores on most subscales. Of 100 employed patients, 37% claimed to have at least some difficulty in performing job duties due to their eyesight. At Kisesa, 146 (246/221) patients (66.1%) had never had an eye exam, compared with 134/227 (59.0%) at Buzuruga and 69/173 (39.9%) at Mwananchi (p<0.01). Common reasons for not seeing an eye doctor were the perceived expense and lack of vision problems. Conclusions Due to regional differences in visual functioning in Mwanza, a national effort for vision health cannot be entirely successful without addressing the individualized needs of local communities. Reducing the cost of vision care appointments may expand vision health care utilization in Mwanza.
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Affiliation(s)
- Sahil Aggarwal
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - David Ju
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - Angela M Allen
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - Laura A Rose
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - Karam P Gill
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - S Aricia Shen
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - Jamie E Temko
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - Irene Chang
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - Jessica Faraj
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - Danielle E Brabender
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | | | - Olivia Marik-Reis
- University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA
| | - Mitul C Mehta
- Gavin Herbert Eye Institute, University of California, 850 Health Sciences Road, Irvine, CA, USA
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Fenwick EK, Man REK, Gan ATL, Kumari N, Wong C, Aravindhan A, Gupta P, Wang JJ, Mitchell P, Wong TY, Cheng CY, Lamoureux EL. Beyond vision loss: the independent impact of diabetic retinopathy on vision-related quality of life in a Chinese Singaporean population. Br J Ophthalmol 2018; 103:1314-1319. [PMID: 30361276 DOI: 10.1136/bjophthalmol-2018-313082] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/10/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIMS To assess the independent impact of diabetic retinopathy (DR) on three domains of vision-related quality of life (VRQoL) in a Chinese Singapore population. METHODS The Singapore Chinese Eye Study (n=3353; 2009-2011) was a population-based, prospective, cross-sectional study conducted at the Singapore Eye Research Institute. The study population included 292 adults with diabetes, with and without DR. DR (better eye) was categorised as presence and absence of any DR; severity of DR (no vision-threatening DR (VTDR); severe non-proliferative DR (NPDR); PDR and/or clinically significant macular oedema and VTDR). Our main outcome was VRQoL which was measured using Rasch-calibrated scores from the 'Reading', 'Mobility' and 'Emotional' domains of the Impact of Vision Impairment questionnaire. The relationship between DR and VRQoL was assessed using multiple linear regression models. RESULTS Of the 292 individuals (mean age 61.35 ± 9.66 years; 55.8% male), 201 (68.8%), 49 (16.8%), 20 (6.8%), 22 (7.5%) and 27 (9.2%) had no DR, minimal-mild NPDR, moderate-severe NPDR, PDR and VTDR, respectively. Any DR and VTDR were independently associated with 6% and 12% worse Reading scores and 7% and 18% poorer Emotional well-being, respectively, compared with those without DR. These associations persisted after separate adjustment for visual impairment and presenting visual acuity. No significant difference was found in the Mobility domain between persons with and without DR. CONCLUSIONS We documented that DR, particularly VTDR, was independently associated with restrictions in Reading and Emotional well-being. Understanding factors underlying the detrimental DR-VRQoL relationship may optimise rehabilitation outcomes for individuals with DR.
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Affiliation(s)
- Eva K Fenwick
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Ryan E K Man
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | | | - Neelam Kumari
- Singapore Eye Research Institute, Singapore, Singapore
| | - Charlene Wong
- Singapore Eye Research Institute, Singapore, Singapore
| | | | - Preeti Gupta
- Singapore Eye Research Institute, Singapore, Singapore
| | - Jie Jin Wang
- Singapore Eye Research Institute, Singapore, Singapore
| | - Paul Mitchell
- The University of Sydney, Sydney, New South Wales, Australia
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore
| | - Ecosse Luc Lamoureux
- Singapore Eye Research Institute, Singapore, Singapore .,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Das A, Quartilho A, Xing W, Bunce C, Rubin G, MacKenzie K, Adams G, Dahlmann-Noor A, Theodorou M. Visual functioning in adults with Idiopathic Infantile Nystagmus Syndrome (IINS). Strabismus 2018; 26:203-209. [PMID: 30325248 DOI: 10.1080/09273972.2018.1526958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE IINS is associated with mild/moderate visual impairment, strabismus and compensatory head postures (CHP), which can negatively impact quality of life. Standard visual acuity assessments tend to underestimate the effect of IINS on visual functioning. Published evidence on the effect of INS on quality of life is slowly emerging. Our study examines visual functioning of adults with IINS using the National Eye Institute Visual Function Questionairre-25 (VFQ-25). METHODS 38 participants were recruited to participate in the study. All participants underwent detailed clinical examination, as well as appropriate investigations and were asked to complete the self administered VFQ-25. RESULTS 35/38 participants completed the questionnaire. The mean age of the population was 35.1 years (range 17-64). Mean overall VFQ-25 score at baseline was 65 (SD 13, range 34-91). Participants specifically demonstrated lowest scores for the impact of IINS on mental health, role limitations and dependency. 26/35 of participants were not driving, either due to sub-normal vision, lack of confidence or difficulties with contrast sensitivity. CONCLUSIONS IINS can have a greater than expected impact on an individual's quality of life, without necessarily causing markedly reduced visual acuity. Our study showed lowest scores in the domains of mental health and wellbeing. Patients also reported reduced visual functioning in driving, which can impact adversely on employability and independence. Visual functioning questionnaires such as the VFQ-25 may provide more functional information on the impact of nystagmus on an individual's quality of life than objective measures such as high contrast Snellen and/or LogMAR visual acuity.
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Affiliation(s)
- Aditi Das
- a Paediatric Ophthalmology and Strabismus , Moorfields Eye Hospital , London
| | - Ana Quartilho
- b National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital , London.,c UCL Institute of Ophthalmology , University College London
| | - Wen Xing
- b National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital , London
| | - Catey Bunce
- b National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital , London.,d Kings College , University of London.,e London School of Hygiene & Tropical Medicine, University of London , London
| | - Gary Rubin
- b National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital , London.,c UCL Institute of Ophthalmology , University College London
| | - Kelly MacKenzie
- a Paediatric Ophthalmology and Strabismus , Moorfields Eye Hospital , London
| | - Gillian Adams
- a Paediatric Ophthalmology and Strabismus , Moorfields Eye Hospital , London
| | - Annegret Dahlmann-Noor
- a Paediatric Ophthalmology and Strabismus , Moorfields Eye Hospital , London.,b National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital , London
| | - Maria Theodorou
- a Paediatric Ophthalmology and Strabismus , Moorfields Eye Hospital , London.,b National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital , London
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Heo W, Kim JS, Chung CK, Lee SK. Relationship between cortical resection and visual function after occipital lobe epilepsy surgery. J Neurosurg 2017; 129:524-532. [PMID: 29076788 DOI: 10.3171/2017.5.jns162963] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE In this study, the authors investigated long-term clinical and visual outcomes of patients after occipital lobe epilepsy (OLE) surgery and analyzed the relationship between visual cortical resection and visual function after OLE surgery. METHODS A total of 42 consecutive patients who were diagnosed with OLE and underwent occipital lobe resection between June 1995 and November 2013 were included. Clinical, radiological, and histopathological data were reviewed retrospectively. Seizure outcomes were categorized according to the Engel classification. Visual function after surgery was assessed using the National Eye Institute Visual Functioning Questionnaire 25. The relationship between the resected area of the visual cortex and visual function was demonstrated by multivariate linear regression models. RESULTS After a mean follow-up period of 102.2 months, 27 (64.3%) patients were seizure free, and 6 (14.3%) patients had an Engel Class II outcome. Nineteen (57.6%) of 33 patients had a normal visual field or quadrantanopia after surgery (normal and quadrantanopia groups). Patients in the normal and quadrantanopia groups had better vision-related quality of life than those in the hemianopsia group. The resection of lateral occipital areas 1 and 2 of the occipital lobe was significantly associated with difficulties in general vision, peripheral vision, and vision-specific roles. In addition, the resection of intraparietal sulcus 3 or 4 was significantly associated with decreased social functioning. CONCLUSIONS The authors found a favorable seizure control rate (Engel Class I or II) of 78.6%, and 57.6% of the subjects had good visual function (normal vision or quadrantanopia) after OLE surgery. Lateral occipital cortical resection had a significant effect on visual function despite preservation of the visual field.
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Affiliation(s)
- Won Heo
- Departments of1Neurosurgery and.,4Clinical Research Institute, Seoul National University Hospital
| | - June Sic Kim
- 5Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Chun Kee Chung
- Departments of1Neurosurgery and.,5Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Sang Kun Lee
- 3Neuroscience Research Institute, Seoul National University Medical Research Center; and.,4Clinical Research Institute, Seoul National University Hospital.,6Neurology, Seoul National University College of Medicine
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Harutyunyan T, Giloyan A, Petrosyan V. Factors associated with vision-related quality of life among the adult population living in Nagorno Karabagh. Public Health 2017; 153:137-146. [PMID: 29049920 DOI: 10.1016/j.puhe.2017.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 08/16/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Visual impairment and blindness are major public health problems causing significant suffering, disability, loss of productivity, and diminishing quality of life for millions of people. This study explored the factors associated with the overall vision-related quality of life (VRQoL) and its different domains in the adult population of Nagorno Karabakh and assessed the independent contribution of specific eye diseases to VRQoL. STUDY DESIGN A cross-sectional study. METHODS We conducted interviewer-administered survey along with free eye screenings among adult residents of Hadrut and Martuni regions of Nagorno Karabakh (Artsakh) in 2014-2015. The study questionnaire included questions about sociodemographic characteristics, non-communicable diseases, use of eye care services, visual acuity, eye diseases, and VRQoL. National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) was used to assess VRQoL. In total, 531 adults participated in the study. RESULTS The mean age of participants was 60.1 years (standard deviation [SD] = 13.7), ranging from 18 to 90 years. The majority of participants were female (71.4%). The most frequently diagnosed eye disorder was cataract (33.8%). The prevalence of moderate and severe visual impairment was 7.0% and 0.8%, respectively. Almost 2.8% (15) of participants were blind. The mean global score of VFQ-25 in all study participants was 71.1 ± 19.28 (SD), whereas the mean global scores of VFQ-25 among not visually impaired, visually impaired, and blind participants were 74.0 ± 16.47 (SD), 51.7 ± 21.77 (SD), and 30.9 ± 20.2 (SD), respectively. In the adjusted linear regression model having moderate/severe visual impairment or blindness, age, socio-economic status, and having eye diseases such as glaucoma and cataract were significantly associated with VFQ-25 global score. The subscales of near vision, distance vision, peripheral vision, role difficulties, and mental health had significant associations with severe/moderate visual impairment in the adjusted analysis. After adjusting for visual impairment and demographic variables, participants with cataract and glaucoma were found to have statistically significant lower subscale scores than those without eye disease. CONCLUSION Our data suggest that visual impairment was associated with lower scores of VRQoL. The strength of that association correlated with the increase in the level of visual impairment (from moderate/severe impairment to blindness). VRQoL was also shown to be affected by age, socio-economic status, and having eye diseases such as glaucoma and cataract. Further actions of remediation of visual impairment in this population are warranted.
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Affiliation(s)
- T Harutyunyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, 40 Marshal Baghramian Ave., Yerevan 0019, Armenia.
| | - A Giloyan
- Garo Meghrigian Institute for Preventive Ophthalmology, Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, 40 Marshal Baghramian Ave., Yerevan 0019, Armenia.
| | - V Petrosyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, 40 Marshal Baghramian Ave., Yerevan 0019, Armenia.
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Nickels S, Schuster AK, Singer S, Wild PS, Laubert-Reh D, Schulz A, Finger RP, Michal M, Beutel ME, Münzel T, Lackner KJ, Pfeiffer N. The National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25) - reference data from the German population-based Gutenberg Health Study (GHS). Health Qual Life Outcomes 2017; 15:156. [PMID: 28789656 PMCID: PMC5549396 DOI: 10.1186/s12955-017-0732-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 08/02/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To estimate the burden of diseases, it is important to consider patient-reported outcomes including Quality of Life (QoL). The aim of this study is to provide population-based reference data for the National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25), stratified by sex and age. METHODS The Gutenberg Health Study (GHS) is a population-based, prospective, observational cohort study in Germany, including 15,010 participants aged between 35 and 74. The baseline examination was conducted between 2007 and 2012. To overcome known shortcomings of the NEI VFQ-25, we calculated the previously proposed visual functioning scale and the socio-emotional scale based on Rasch-transformed person-level data. We present mean values, standard deviations and percentiles for age decades stratified by sex. We used a linear regression model to assess the influence of age, sex, socioeconomic status, distance-corrected visual acuity (better-seeing eye) and the absolute difference in distance-corrected visual acuity of both eyes on vision-related QoL. RESULTS NEI VFQ-25 data are available from 12,231 participants (82%). Both the long-form visual functioning scale (LFVFS) and the long-form socio-emotional scale (LFSES) showed a clear age dependency, with an average LFVFS score of 92.8 for men and 90.5 for women in the youngest age group and 85.7 and 83.4 in the oldest age group, and a LFSES score of 98.3 for men and 98.1 in women in the youngest and 94.7 and 94.5 in the oldest decade. The largest difference was observed between the youngest age group (35-44 years) and the 45-54 years group. Men tended to have slightly higher scores than women. In the multivariable linear regression analysis, age (per 5 years -0.42), female sex (-1.57), worse distance-corrected visual acuity of the better eye (per 0.1 increase in logMAR -2.92) and the difference between both eyes (per 0.1 increase in logMAR -0.87) were associated with a reduced LFVFS score (all p < 0.001). For the LFSES score, we showed that the influence of sex was minor, and that age (per 5 years -0.22), visual acuity of the better eye (-1.65), and the difference between both eyes (-0.56) were associated with a lower score (all p < 0.001). CONCLUSIONS We report age- and sex-specific reference data from a large population-based study of mainly Caucasian ethnicity of two unidimensional scores based on Rasch-transformed NEI VFQ-25 data. Vision-related QoL is lower in older and in female individuals. Our results support the association of vision-related QoL not only with the distance-corrected visual acuity of the better eye but also with the difference in visual acuity between each eye. Our findings could be used as a reference for comparison in future studies addressing the influence of eye diseases on vision-related QoL.
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Affiliation(s)
- Stefan Nickels
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Alexander K Schuster
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Susanne Singer
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany
| | - Dagmar Laubert-Reh
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Robert P Finger
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Thomas Münzel
- Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Karl J Lackner
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
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Pereira DM, Shah A, D'Souza M, Simon P, George T, D'Souza N, Suresh S, Baliga MS. Quality of Life in People with Diabetic Retinopathy: Indian Study. J Clin Diagn Res 2017; 11:NC01-NC06. [PMID: 28571177 DOI: 10.7860/jcdr/2017/24496.9686] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/04/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Diabetic Retinopathy (DR) is a well-known consequence of long standing and poorly controlled Diabetes Mellitus (DM). Several studies have demonstrated both a qualitative and quantitative reduction in health related quality of life in persons with DR. But no such study has been done in the Indian population. AIM To assess health related and vision related quality of life in people with DR. MATERIALS AND METHODS The present study included two groups of patients with Type 1 and Type 2 diabetes. Cases included 97 patients with DR. The control group (n=26) consisted of diabetic cases with no clinically detectable DR changes. After taking informed consent, health and vision related quality of life was assessed using National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25). Demographic information, social history and diabetic history were also obtained from all patients. DR was graded using the Early Treatment Diabetic Retinopathy Study (ETDRS) classification. RESULTS Of the 97 cases with DR, 42.3% were females. Of the 26 controls, 53.8% were females. The mean±SD age in years of the cases was 55.09±9.56 and controls were 54.12±13.01. The mean±SD of DM in years for the cases was 10.98±5.62 and for controls was 6.69±2.29. There were statistically significant (p<0.001) lower VFQ-25 composite and sub scale scores of the cases when compared with controls. As the grade of DR increased, VFQ-25 sub-scale scores decreased and this was statistically significant for composite and all sub scales (p<0.005) except ocular pain. Mann-Whitney test Z-value was highest in general health, general vision, composite score and mental health. CONCLUSION Quality of life was significantly lower in diabetics with DR when compared with those without DR with maximum effect seen on general health, general vision and mental health. Quality of life decreased as the duration of retinopathy and severity of retinopathy increased.
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Affiliation(s)
| | - Amish Shah
- Assistant Professor, Department of Ophthalmology, Father Muller Medical College, Mangalore, Karnataka, India
| | - May D'Souza
- Senior Resident, Department of Ophthalmology, Father Muller Medical College, Mangalore, Karnataka, India
| | - Paul Simon
- Research Assistant, Father Muller Research Centre, Mangalore, Karnataka, India
| | - Thomas George
- Student, Father Muller Research Centre, Mangalore, Karnataka, India
| | - Nameeth D'Souza
- Assistant Professor, Department of Ophthalmology, K.S. Hegde Medical Academy, Mangalore, Karnataka, India
| | - Sucharitha Suresh
- Assistant Professor, Department of Community Medicine, Father Muller Medical College, Mangalore, Karnataka, India
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Winters D, Casten R, Rovner B, Murchison A, Leiby BE, Haller JA, Hark L, Weiss DM, Pizzi LT. Cost-Effectiveness of Behavior Activation Versus Supportive Therapy on Adherence to Eye Exams in Older African Americans With Diabetes. Am J Med Qual 2016; 32:661-667. [DOI: 10.1177/1062860616680290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although the importance of ophthalmologic screening in diabetic patients is widely recognized by clinicians, the cost-effectiveness of strategies aimed at improving eye care utilization in this population is not well established. A cost-effectiveness analysis was performed comparing behavior activation (BA) to supportive therapy (ST) in activating patients to receive a dilated fundus exam (DFE) and promoting healthy management of diabetes. Two hundred six subjects were randomized to receive either BA or ST between 2009 and 2013. Cost-effectiveness was calculated as incremental cost-effectiveness ratio (ICER) of BA versus ST. Total costs for BA and ST per participant were $259.02 and $216.12, respectively. At the 6-month follow-up, 87.91% of BA subjects received a DFE compared to 34.48% of ST subjects. The ICER for BA versus ST was $80.29/percent increase in DFE rate. In terms of improving DFE rates, BA was found to be more cost-effective than ST.
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Affiliation(s)
| | - Robin Casten
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Barry Rovner
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | | | - Benjamin E. Leiby
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | | | - Lisa Hark
- Wills Eye Hospital, Philadelphia, PA
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Changing Clinical Presentation, Current Knowledge-Attitude-Practice, and Current Vision Related Quality of Life in Self-Reported Type 2 Diabetes Patients with Retinopathy in Eastern India: The LVPEI Eye and Diabetes Study. J Ophthalmol 2016; 2016:3423814. [PMID: 27843643 PMCID: PMC5098084 DOI: 10.1155/2016/3423814] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 09/08/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. To document the changing clinical presentation of diabetic retinopathy (DR) over a decade, the current knowledge-attitude-practice (KAP) of known type 2 diabetes mellitus (DM) patients, and the current vision related quality of life (VR-QOL) of patients with DR in a tertiary eye care center in Eastern India. Methods. Two hundred and forty patients with known type-2 DM were evaluated. The evaluation included status of DR (n = 240), KAP (n = 232), and VR-QOL (n = 75). International classification of DR was used in the study. The DR status was compared with another cohort (n = 472) examined a decade earlier, in year 2001. The KAP-25 questions were designed after literature review. The National Eye Institute Visual Function Questionnaire (NEI-VFQ; including optional items) was validated by Rasch analysis. Both KAP and VR-QOL were analyzed according to degree of DR, duration of known DM, and educational qualification. Results. Average age of the current cohort (n = 240) was 57.16 ± 9.03 years; there were 205 (85.4%) male patients and 143 (59.6%) patients had received less than graduate qualification. The mean duration of DM since diagnosis was 10 ± 7.8 months (range 8 months to 30 years); 118 (49.16%) patients had DR. In a decade time, 2001 to 2011, there was a change of retinopathy status at presentation (more often nonproliferative diabetic retinopathy, NPDR). One-third of NPDR patients had poor vision and half of them were hypertensive. KAP was better in patients with higher education and those having DR. VFQ score was higher in better seeing patients. Conclusion. Patients currently presenting at earlier stage of retinopathy are probably related to poor vision. Early detection and treatment of DR is likely to preserve and/or improve vision.
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Bertelmann T, Feltgen N, Scheffler M, Hufenbach U, Wiedon A, Wilhelm H, Ziemssen F. Vision-related quality of life in patients receiving intravitreal ranibizumab injections in routine clinical practice: baseline data from the German OCEAN study. Health Qual Life Outcomes 2016; 14:132. [PMID: 27644469 PMCID: PMC5029004 DOI: 10.1186/s12955-016-0536-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 09/09/2016] [Indexed: 11/19/2022] Open
Abstract
Background Vision-related quality of life (vrQoL) is advancing more and more into the focus of interest in ophthalmological clinical research. However, to date only little information is available about vrQoL from large non-interventional studies in terms of "real-world evidence". The purpose of this investigation was to describe baseline VFQ-25 visual function scores, to evaluate whether they differ from previous phase III clinical trials, to determine which contributing factors (e.g. indication, age, gender) affect VFQ-25 scores and to identify its impact on driving. Methods The non-interventional OCEAN study (Observation of treatment patterns with LuCEntis and real life ophthalmic monitoring, including optional OCT in Approved iNdications) is the largest ophthalmic study conducted in Germany, to evaluate the real world situation of patients treated with ranibizumab (NCT02194803). The NEI-VFQ-25 questionnaire was conducted at baseline, months 4, 12 and 24. Descriptive statistics was used to analyse the baseline data. ANOVA was performed to evaluate the impact of various contributing factors on composite and selected subscale scores. Results Overall, 4844 (84.1 %) of all 5760 OCEAN patients completed the VFQ-25 questionnaire at baseline. Thereof, 3414 treatment-naïve patients were further analysed. Overall, the VFQ subscore general health was most affected by the ocular disease, followed by general vision. No major differences were detected in comparison to corresponding VFQ-25 scores of previous phase III clinical trials, except in DME patients, or with respect to possible contributing factors. A tendency towards a more decreased VFQ-25 composite score was observed for nAMD, for elderly patients ≥75 years of age, for female patients, for patients with low baseline visual acuity (VA; <50 letters) and for those with statutory health insurance. Indication, age, gender, baseline VA (all p <0.01) and the interaction of age and indication, as well as baseline VA and indication (p <0.01 each) had a significant impact on composite, general vision and distance vision scores (ANOVA). About 10 % of patients gave up driving due to eyesight issues. Conclusions The knowledge of a patient’s subjective disease burden is crucial to understanding anxieties and mental anguish. Additionally, the understanding of the impact of various contributing factors on the VFQ-25 scores and the extent to which they can be influenced help to optimize patient care. It demonstrates the need for medical and mental support by all medical staff, to encourage patients’ compliance with a comprehensive anti-VEGF therapy, to increase BCVA and, consecutively, VFQ-25 scores. Trial registration NCT02194803 Electronic supplementary material The online version of this article (doi:10.1186/s12955-016-0536-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas Bertelmann
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany. .,Novartis Pharma GmbH, Nuremberg, Germany.
| | - Nicolas Feltgen
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | | | | | | | - Helmut Wilhelm
- Centre for Ophthalmology, Eberhard-Karl University, Tuebingen, Germany
| | - Focke Ziemssen
- Centre for Ophthalmology, Eberhard-Karl University, Tuebingen, Germany
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Gubitosi-Klug RA, Sun W, Cleary PA, Braffett BH, Aiello LP, Das A, Tamborlane W, Klein R. Effects of Prior Intensive Insulin Therapy and Risk Factors on Patient-Reported Visual Function Outcomes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Cohort. JAMA Ophthalmol 2016; 134:137-45. [PMID: 26584339 DOI: 10.1001/jamaophthalmol.2015.4606] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Preservation of vision in patients with diabetes mellitus is critical. Interventions to improve glycemic control through early intensive treatment of diabetes reduce rates of severe retinopathy and preserve visual acuity. OBJECTIVE To assess the effects of prior intensive insulin treatment and risk factors on patient-reported visual function in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort. DESIGN, SETTING, AND PARTICIPANTS Cohort study of 1184 participants with type 1 diabetes from the DCCT/EDIC study (randomized clinical trial followed by an observational follow-up study) who completed the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) during EDIC years 17 through 20 (September 1, 2009, through April 30, 2014) in 28 institutions across the United States and Canada. MAIN OUTCOMES AND MEASURES The primary outcome was the composite NEI-VFQ-25 score. Secondary outcomes were visual acuity (measured by the Early Treatment Diabetic Retinopathy Study protocol), retinopathy level (determined by masked grading of stereoscopic color fundus photographs), and NEI-VFQ-25 subscale scores. The composite NEI-VFQ-25 scale and its subscales were scored 0 to 100, corresponding to poor to excellent function, respectively. RESULTS The overall average NEI-VFQ-25 score for 1184 DCCT/EDIC participants (mean [SD] age, 52.3 [6.9] years; 48% female) with a 30-year duration of diabetes was high (all participants: median, 91.7; interquartile range [IQR], 89.7-96.9; intensive treatment [n = 605]: median, 94.7; IQR, 91.0-97.2; conventional treatment [n = 579]: median, 94.0; IQR, 88.4-96.1; P = .006 for intensive vs conventional). After adjustment for sex, age, hemoglobin A1c level, and retinopathy level at DCCT baseline, the former intensive treatment group had a significant, albeit modest, improvement in overall NEI-VFQ-25 score compared with the former conventional diabetes treatment group (median difference, -1.0; 95% CI, -1.7 to -0.3; P = .006). This beneficial treatment effect was fully attributed to the prior glycemic control in DCCT (explained treatment effect: 100%). Those with visual acuity worse than 20/100 reported the largest decline in visual function (median difference, -21.0; 95% CI, -40.5 to -1.6; P = .03). CONCLUSIONS AND RELEVANCE In the DCCT/EDIC cohort, patient-reported visual function remains high in both treatment groups, comparable to previous reports of overall health-related quality of life. Intensive diabetes therapy modestly improved NEI-VFQ-25 score 30 years after the start of the DCCT, the benefit underestimated owing to more nonparticipants from the conventional treatment group. Visual acuity had the greatest effect on patient-reported visual function from among all risk factors. TRIAL REGISTRATION clinicaltrials.gov Identifiers: NCT00360815 and NCT00360893.
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Affiliation(s)
| | | | - Wanjie Sun
- Biostatistics Center, George Washington University, Rockville, Maryland
| | - Patricia A Cleary
- Biostatistics Center, George Washington University, Rockville, Maryland
| | | | - Lloyd Paul Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Arup Das
- University of New Mexico, Albuquerque
| | | | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison
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Sivaprasad S, Oyetunde S. Impact of injection therapy on retinal patients with diabetic macular edema or retinal vein occlusion. Clin Ophthalmol 2016; 10:939-46. [PMID: 27307696 PMCID: PMC4888735 DOI: 10.2147/opth.s100168] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose An important factor in the choice of therapy is the impact it has on the patient’s quality of life. This survey aimed to understand treatment burden, treatment-related anxiety and worry, and practical issues such as appointment attendance and work absence in patients receiving injection therapy for diabetic macular edema (DME) or retinal vein occlusion (RVO). Patients and methods A European sample of 131 retinal patients completed a detailed questionnaire to elucidate the impact of injection therapy on individuals with DME or RVO. Results RVO and DME greatly impact a patient’s quality of life. An intensive injection regimen and the requirements for multiple hospital visits place a large practical burden on the patient. Each intravitreal injection appointment (including travel time) was reported to take an average of 4.5 hours, with a total appointment burden over 6 months of 13.5 hours and 20 hours for RVO and DME patients, respectively. This creates a significant burden on patient time and may make appointment attendance difficult. Indeed, 53% of working patients needed to take at least 1 day off work per appointment and 71% of patients required a carer’s assistance at the time of the injection appointment, ~6.3 hours per injection. In addition to practical issues, three-quarters of patients reported experiencing anxiety about their most recent injection treatment, with 54% of patients reporting that they were anxious for at least 2 days prior to the injection. Patients’ most desired improvement to their treatment regimen was to have fewer injections and to require fewer appointments, to achieve the same visual results. Conclusion Patients’ quality of life is clearly very affected by having to manage an intensive intravitreal injection regimen, with a considerable treatment burden having a large negative effect. Reducing the appointment burden to achieve the same visual outcomes and the provision of additional support for patients to attend appointments would greatly benefit those receiving intravitreal injection therapies for DME and RVO.
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Affiliation(s)
- Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London, UK
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The association between legal Japanese visual impairment grades and vision-related quality of life. Jpn J Ophthalmol 2016; 60:219-25. [PMID: 26972696 DOI: 10.1007/s10384-016-0437-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE This study examines the relationship between quality of life (QOL) and the legal Japanese grade of visual impairment as defined by the Physically Disabled Persons Welfare Act. METHODS Participants of this cross-sectional study were 98 Japanese patients legally classified as visually impaired, from six ophthalmology departments. Vision-related QOL was evaluated using the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25). The short Japanese version of this questionnaire (VFQ-J11) score was calculated from the VFQ-25 results for each participant. Health utility was measured using the EuroQoL Index (EQ-5D). Data were collected for age, gender, vision-disability level, the corrected visual acuity of each eye, and disease type. RESULTS The mean age was 66.8 years (SD = 17.8). Visual impairment grade was significantly associated with VFQ-J11 score and the composite score developed from the VFQ-25 (p < 0.001), but not with the health utility score obtained from the EQ-5D. CONCLUSIONS In general, the Japanese legally designated grading system for visual impairment reflects the degree of vision-related QOL, but does not reflect general health utility as determined by the EQ-5D.
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National Eye Institute Visual Function Scale in Type 2 Diabetes Patients. J Ophthalmol 2016; 2016:1549318. [PMID: 26998350 PMCID: PMC4779533 DOI: 10.1155/2016/1549318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 11/19/2015] [Accepted: 12/06/2015] [Indexed: 11/24/2022] Open
Abstract
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.
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Granström T, Forsman H, Leksell J, Jani S, Raghib AM, Granstam E. Visual functioning and health-related quality of life in diabetic patients about to undergo anti-vascular endothelial growth factor treatment for sight-threatening macular edema. J Diabetes Complications 2015; 29:1183-90. [PMID: 26318959 DOI: 10.1016/j.jdiacomp.2015.07.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 07/29/2015] [Accepted: 07/31/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE To examine patient-reported outcome (PRO) in a selected group of Swedish patients about to receive anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular edema (DME). MATERIAL AND METHODS In this cross-sectional study, 59 patients with diabetes mellitus, who regularly visited the outpatient eye-clinics, were included. Sociodemographic and clinical data were collected and the patients completed PRO measures before starting anti-VEGF treatment. PRO measures assessed eye-specific outcomes (NEI-VFQ-25) and generic health-related quality of life (SF-36). RESULTS The participants consisted of 30 men and 29 women (mean age, 68.5years); 54 (92%) patients had type 2 diabetes; 5 (9%) patients had moderate or severe visual impairment; 28 (47%) were classified as having mild visual impairment. Some of the patients reported overall problems in their daily lives, such as with social relationships, as well as problems with impaired sight as a result of reduced distance vision. CONCLUSIONS Further studies are needed to investigate PRO factors related to low perceived general health in this patient population. It is important to increase our understanding of such underlying mechanisms to promote improvements in the quality of patient care.
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Affiliation(s)
- Therese Granström
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Henrietta Forsman
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Janeth Leksell
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Siba Jani
- Center for Clinical Research Västmanland County Hospital, Uppsala University/County Council of Västmanland, Västerås, Sweden
| | | | - Elisabet Granstam
- Center for Clinical Research Västmanland County Hospital, Uppsala University/County Council of Västmanland, Västerås, Sweden; Department of Ophthalmology, Västmanland County Hospital, Västerås, Sweden
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Rose-Nussbaumer J, Prajna NV, Krishnan KT, Mascarenhas J, Rajaraman R, Srinivasan M, Raghavan A, Oldenburg CE, O'Brien KS, Ray KJ, McLeod SD, Porco TC, Lietman TM, Acharya NR, Keenan JD. Vision-Related Quality-of-Life Outcomes in the Mycotic Ulcer Treatment Trial I: A Randomized Clinical Trial. JAMA Ophthalmol 2015; 133:642-6. [PMID: 25764482 DOI: 10.1001/jamaophthalmol.2015.0319] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Given the limitations in health care resources, quality-of-life measures for interventions have gained importance. OBJECTIVE To determine whether vision-related quality-of-life outcomes were different between the natamycin and voriconazole treatment arms in the Mycotic Ulcer Treatment Trial I, as measured by an Indian Vision Function Questionnaire. DESIGN, SETTING, AND PARTICIPANTS Secondary analysis (performed October 11-25, 2014) of a double-masked, multicenter, randomized, active comparator-controlled, clinical trial at multiple locations of the Aravind Eye Care System in South India that enrolled patients with culture- or smear-positive filamentous fungal corneal ulcers who had a baseline visual acuity of 20/40 to 20/400 (logMAR of 0.3-1.3). INTERVENTIONS Study participants were randomly assigned to topical voriconazole, 1%, or topical natamycin, 5%. MAIN OUTCOMES AND MEASURES Subscale score on the Indian Vision Function Questionnaire from each of the 4 subscales (mobility, activity limitation, psychosocial impact, and visual function) at 3 months. RESULTS A total of 323 patients were enrolled in the trial, and 292 (90.4%) completed the Indian Vision Function Questionnaire at 3 months. The majority of study participants had subscale scores consistent with excellent function. After adjusting for baseline visual acuity and organism, we found that study participants in the natamycin-treated group scored, on average, 4.3 points (95% CI, 0.1-8.5) higher than study participants in the voriconazole-treated group (P = .046). In subgroup analyses looking at ulcers caused by Fusarium species and adjusting for baseline best spectacle-corrected visual acuity, the natamycin-treated group scored 8.4 points (95% CI, 1.9-14.9) higher than the voriconazole-treated group (P = .01). Differences in quality of life were not detected for patients with Aspergillus or other non-Fusarium species as the causative organism (1.5 points [95% CI, -3.9 to 6.9]; P = .52). CONCLUSIONS AND RELEVANCE We found evidence of improvement in vision-related quality of life among patients with fungal ulcers who were randomly assigned to natamycin compared with those randomly assigned to voriconazole, and especially among patients with Fusarium species as the causative organism. Incorporation of quality-of-life measures in clinical trials is important to fully evaluate the effect of the studied interventions. TRIAL REGISTRATION clinicaltrials.gov Identifier:NCT00996736.
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Affiliation(s)
- Jennifer Rose-Nussbaumer
- Francis I. Proctor Foundation, University of California, San Francisco2Department of Ophthalmology, University of California, San Francisco3Department of Optometry, University of California, Berkeley
| | - N Venkatesh Prajna
- Aravind Eye Care System, Madurai, India5Aravind Eye Care System, Pondicherry, India6Aravind Eye Care System, Coimbatore, India
| | - K Tiruvengada Krishnan
- Aravind Eye Care System, Madurai, India5Aravind Eye Care System, Pondicherry, India6Aravind Eye Care System, Coimbatore, India
| | - Jeena Mascarenhas
- Aravind Eye Care System, Madurai, India5Aravind Eye Care System, Pondicherry, India6Aravind Eye Care System, Coimbatore, India
| | - Revathi Rajaraman
- Aravind Eye Care System, Madurai, India5Aravind Eye Care System, Pondicherry, India6Aravind Eye Care System, Coimbatore, India
| | - Muthiah Srinivasan
- Aravind Eye Care System, Madurai, India5Aravind Eye Care System, Pondicherry, India6Aravind Eye Care System, Coimbatore, India
| | - Anita Raghavan
- Aravind Eye Care System, Madurai, India5Aravind Eye Care System, Pondicherry, India6Aravind Eye Care System, Coimbatore, India
| | | | - Kieran S O'Brien
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Kathryn J Ray
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Stephen D McLeod
- Department of Ophthalmology, University of California, San Francisco
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco2Department of Ophthalmology, University of California, San Francisco7Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco2Department of Ophthalmology, University of California, San Francisco7Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Nisha R Acharya
- Francis I. Proctor Foundation, University of California, San Francisco2Department of Ophthalmology, University of California, San Francisco
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco2Department of Ophthalmology, University of California, San Francisco
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Saboo US, Amparo F, Abud TB, Schaumberg DA, Dana R. Vision-Related Quality of Life in Patients with Ocular Graft-versus-Host Disease. Ophthalmology 2015; 122:1669-74. [PMID: 26001816 DOI: 10.1016/j.ophtha.2015.04.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/07/2015] [Accepted: 04/09/2015] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To assess the vision-related quality of life (QOL) in a cohort of patients with ocular graft-versus-host disease (GVHD). DESIGN Prospective study. PARTICIPANTS Eighty-four patients diagnosed with chronic ocular GVHD. METHODS We assessed the vision-related QOL with the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). The symptoms of ocular GVHD were assessed using the Ocular Surface Disease Index (OSDI) and Symptom Assessment in Dry Eye (SANDE) questionnaires. MAIN OUTCOME MEASURES We assessed vision-related QOL with the NEI-VFQ-25 and compared the scores obtained from patients with ocular GVHD with those from a healthy population. In the ocular GVHD population, we also evaluated the associations between the NEI-VFQ-25 and the dry eye symptoms measured by the OSDI and SANDE questionnaires, age, duration of disease, best-corrected visual acuity (BCVA), corneal fluorescein staining (CFS), tear break-up time, and Schirmer test. RESULTS The mean composite NEI-VFQ-25 score in patients with ocular GVHD was 76.5±17. Compared with healthy subjects, patients with ocular GVHD reported reduced scores on all NEI-VFQ-25 subscales (each P < 0.001) with the exception of color vision (P = 0.11). The NEI-VFQ-25 composite scores significantly correlated with OSDI (R = -0.81, P < 0.001), SANDE (R = -0.56, P < 0.001), CFS (R = -0.36, P = 0.001), and BCVA (R = -0.30, P = 0.004). CONCLUSIONS Patients with ocular GVHD experience measurable impairment of vision-related QOL. This study highlights the impact of ocular GVHD on the vision-related QOL, and thus the importance of comprehensive diagnosis and treatment of this condition.
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Affiliation(s)
- Ujwala S Saboo
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Francisco Amparo
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Tulio B Abud
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Debra A Schaumberg
- Moran Center for Translational Medicine, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Reza Dana
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
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van de Put MAJ, Hoeksema L, Wanders W, Nolte IM, Hooymans JMM, Los LI. Postoperative vision-related quality of life in macula-off rhegmatogenous retinal detachment patients and its relation to visual function. PLoS One 2014; 9:e114489. [PMID: 25460011 PMCID: PMC4252118 DOI: 10.1371/journal.pone.0114489] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 11/10/2014] [Indexed: 12/02/2022] Open
Abstract
Objective To determine the vision-related quality of life (VR-QOL) after surgery for macula-off rhegmatogenous retinal detachment (RRD) in relation to visual acuity, contrast acuity, and color vision. Methods In a prospective observational study, we included 55 patients with a macula-off RRD. Best corrected visual acuity (BCVA), color vision (saturated and desaturated color confusion indices (CCI)) and contrast acuity were measured at 12 months postoperatively in both the RRD eye and the fellow control eye, and the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was filled out. Results Operated and fellow control eyes differed significantly in mean LogMAR BCVA (P<0.0001), median Log contrast acuity (P<0.0001), saturated CCI (P = 0.009), and desaturated CCI (P = 0.016). Significant correlations were observed between the NEI VFQ-25 overall composite score and postoperative LogMAR BCVA (R = −0.551, P<0.0001), contrast acuity (R = 0.472, P<0.0001), saturated CCI (R = −0.315, P = 0.023), and desaturated CCI (R = −0.283, P = 0.044). Conclusions A lower VR-QOL was highly correlated to a worse postoperative BCVA and contrast acuity and to a lesser extent to color vision disturbances.
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Affiliation(s)
- Mathijs A. J. van de Put
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- * E-mail:
| | - Lisette Hoeksema
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- W.J. Kolff Institute, Graduate School of Medical Sciences, University of Groningen, Groningen, the Netherlands
| | - Wouter Wanders
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ilja M. Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Johanna M. M. Hooymans
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- W.J. Kolff Institute, Graduate School of Medical Sciences, University of Groningen, Groningen, the Netherlands
| | - Leonoor I. Los
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- W.J. Kolff Institute, Graduate School of Medical Sciences, University of Groningen, Groningen, the Netherlands
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Shih YH, Chang HY, Lu MI, Hurng BS. Time trend of prevalence of self-reported cataract and its association with prolonged sitting in Taiwan from 2001 and 2013. BMC Ophthalmol 2014; 14:128. [PMID: 25370503 PMCID: PMC4232657 DOI: 10.1186/1471-2415-14-128] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 10/22/2014] [Indexed: 01/09/2023] Open
Abstract
Background Prolong sitting has been found associated with metabolic disorders. Little is known about the self-reported cataract status in general population of Taiwan, not to mention its relation to prolong sitting. We aimed to examine the prevalence of cataract between 2001 and 2013 in Taiwan and to the association between prolonged sitting and cataract. Methods We used three data sets with those aged 40 years and older from the National Health Interview Survey (NHIS) from 2001 (n = 8334), 2009 (n = 11207), and 2013 (n = 10940). Subsequent statistical analyses involved chi-square test, t test, and logistic regression modeling. SUDAAN was used to account for sampling scheme. Results The prevalence of cataract ranged from 10.7% in 2001, 13.13% in 2009, to 11.84% in 2013. Participants who sat for more than 7 hours per day had a significantly higher risk of cataract (OR = 1.20, CI = (1.04-1.39)) compared with those who sat for fewer than 3 hours per day after controlling for age and other risk factors like being older or female, lower education level, not being currently employed, living in a highly urbanized area, having hypertension, diabetes, myopia, and being an former smoker (compared to a never smoker). Conclusion Increased daily sitting time was associated with cataract, especially for people who sat more than 7 hours per day.
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Affiliation(s)
| | - Hsing-Yi Chang
- Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan.
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Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSION Our data suggest that vision-related quality of life is reduced in patients with CRAO.
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Trousdale ER, Hodge DO, Baratz KH, Maguire LJ, Bourne WM, Patel SV. Vision-related Quality of Life Before and After Keratoplasty for Fuchs' Endothelial Dystrophy. Ophthalmology 2014; 121:2147-52. [DOI: 10.1016/j.ophtha.2014.04.046] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 02/27/2014] [Accepted: 04/30/2014] [Indexed: 11/24/2022] Open
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Kay S, Ferreira A. Mapping the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) to EQ-5D utility scores. Ophthalmic Epidemiol 2014; 21:66-78. [PMID: 24568628 DOI: 10.3109/09286586.2014.888456] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To develop a mapping algorithm for the estimation of EQ-5D-based utility scores from observed 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) scores, a disease-specific, patient-reported outcome measure used in several retinal disorders to evaluate vision-specific functioning. METHODS The dataset comprised 951 paired EQ-5D/NEI VFQ-25 observations from 344 patients in RESTORE, a 12-month, randomized, double-blind trial in individuals with visual impairment due to diabetic macular edema. EQ-5D index scores (utilities) were calculated based on the UK tariff. We evaluated 11 models using predictor sets based on the NEI VFQ-25 subscales to estimate utility as a function of NEI VFQ-25 score, based on four modeling techniques. Model performance was assessed by 10-fold cross-validation comparing root mean squared error (RMSE), mean absolute error (MAE) and correlation with EQ-5D score (Pearson and Spearman correlation coefficients). RESULTS Mapping results were similar across all techniques and predictor sets. The reverse two-part generalized estimating equation model used fewest predictors and had the best predictive performance (RMSE 0.200, MAE 0.140). Predicted and original EQ-5D values were not strongly correlated (squared Spearman correlation coefficient, 0.34). CONCLUSIONS Although mapping disease-specific instruments to EQ-5D utilities is a preferred method by some reimbursement bodies, finding an appropriate mapping equation is not straightforward. In this study, mapping NEI VFQ-25 scores to EQ-5D utilities provided low predictive power, independent of the modeling methodology applied, suggesting an inability of the EQ-5D to discriminate vision-related activities, and highlighting that mapping exercises may lead to inaccurate utility values that do not represent patients' preferences.
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