[Measuring patient's quality of life in ophthalmology]

Evaluation of quality of life after implantation of a new trifocal intraocular lens

PURPOSE

To evaluate the vision-related quality of life (QOL) after implantation of a new trifocal intraocular lens (IOL), by using the National Eye Institute Visual Function Questionnaire-14 (VF-14 QOL questionnaire).

SETTING

Baskent University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey.

DESIGN

Prospective noncomparative case series.

METHODS

Consecutive patients who had a new trifocal IOL (PanOptix) bilaterally implanted were included in the study. The vision-related QOL was assessed 3 months after the surgery in the second eye. The VF-14 QOL questionnaire was used, with a grading scale of 0, no difficulty; 1, a little difficulty; 2, moderate difficulty; 3, quite difficult; 4, impossible to perform. A subgroup of 14 patients, with an interval of at least 3 months between the surgery in the first eye and the surgery in the fellow eye, were also interviewed 3 months after the monocular IOL implantation. In this subgroup, the QOL with monocular and binocular implantation was compared.

RESULTS

The study comprised 48 patients. Reading small print, driving at night, and doing fine handwork were the most difficult tasks to perform, with the mean values of the VF-14 QOL questionnaire being 0.94 ± 0.81 (SD), 0.89 ± 0.68, and 0.64 ± 0.67, respectively. Binocular implantation was associated with improvement in vision-related QOL when compared with monocular implantation, with significant differences in doing fine handwork such as sewing (P = .02) and using a computer (P = .03).

CONCLUSIONS

With mean values of 1.00 or lower for each question, the results of the VF-14 QOL questionnaire indicated that patients who have the new trifocal IOL bilaterally implanted have an overall high satisfaction rate and a high vision-related QOL.

Vision-related quality of life in patients receiving intravitreal ranibizumab injections in routine clinical practice: baseline data from the German OCEAN study

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.

Vision-related Quality of Life Outcomes of Cataract Surgery in Advanced Glaucoma Patients

PURPOSE

To demonstrate longitudinal postoperative vision-related quality of life and visual acuity changes after cataract surgery in advanced glaucoma patients.

MATERIALS AND METHODS

In total, 93 patients who underwent cataract surgeries were collected from June 2010 through June 2013 in Shanghai First People's Hospital, Shanghai Jiao Tong University, and were followed up for at least 3 months. Patients with advanced glaucoma, here defined as near total cupping of the optic nerve with severe visual field loss within 10 degrees of fixation, were enrolled. A standard phacoemulsification technique with the insertion of an intraocular lens was used. No complications occurred intraoperatively or postoperatively. Preoperative and 3-month postoperative vision-related quality of life were assessed in face-to-face interviews. The Chinese-version of the Low Vision Quality of Life Questionnaire (CLVQOL) was used. Wilcoxon signed-rank test was used to compare the differences in the best-corrected visual acuity (BCVA), weighted average LogMAR (WMAR), and CLVQOL scores. A binary logistic regression analysis was conducted to explore the potential factors associated with the change in CLVQOL scores.

RESULTS

The overall changes in the CLVQOL composite scores ranged between 4 and 42 (median=19). Statistically significant increases occurred in the composite scores of all of the subscales, the total CLVQOL, the BCVA in the surgery eye, and the WMAR (all P<0.001). Greater increases in the CLVQOL composite scores was associated with superior preoperative WMAR (odds ratio: 9.920, P<0.05), and age below 60 years (odds ratio: 9.905, P<0.05).

CONCLUSIONS

Cataract surgery should be recommended for advanced glaucoma patients with stable intraocular pressure.

[Outcomes and health services research in ophthalmology]

This article describes the role of outcomes and health services research in the field of ophthalmology in Germany. First, the need for more information and data on the performance of ophthalmic care in Germany is explored. The concept, goals and methods of outcomes and health services research are explained and illustrated by examples of already existing research projects in ophthalmology. Future topics for research projects are highlighted. The article also describes how the field of outcomes and health services research can become a more important part within the scientific ophthalmological community in Germany.

Health status and patient satisfaction after corneal graft: results from the corneal transplant epidemiological study

Purpose. To evaluate effects of corneal transplantation on the health-related quality of life and patients' satisfaction. Methods. Patients scheduled for elective penetrating or anterior lamellar keratoplasty completed by telephone interview the SF-12 Health Survey, before and one year after surgery, and a 6-item questionnaire on the satisfaction for graft outcomes. Results. The two questionnaires were answered by 1,223 patients. Transplantation did not influence the PCS-12 in males (ES = -0.01) and had a negative effect in females (ES = -0.18). Both sexes improved their MCS-12 (ES = 0.18 and 0.23, resp.). The majority of patients (83.1%) were satisfied by the outcome of the graft. Conclusions. This is the first report on the use of the SF-12 and one of the few that assess quality of life in patients after corneal transplantation. We showed that grafting improves patients' health-related quality of life results of patients, influencing mental health (i.e., psychological attitude, social interaction, and emotions) with minor effects on physical health (limitation, pain, and vitality).

[Value-based medicine for glaucoma]

The application of value-based medicine (VBM) tenets in the area of glaucoma research requires valid and reliable data concerning the quality of life with glaucoma. A multitude of instruments for measuring quality of life of patients with glaucoma have been employed in the past. Any instrument used would need to capture peripheral vision loss and its influence on patient-reported quality of life as this is one of the hallmarks of this disease. Cost-utility analyses can then be based on the reported quality of life and the cost of glaucoma therapy. Several cost-utility analyses have been applied in the field of glaucoma screening as well as treating ocular hypertension and based on this a recommendation regarding population subgroups which can be treated cost efficiently can be made.

Utility values in patients with acquired anophthalmus

BACKGROUND

Loss of an eye can be supposed to lead to reduced health-related quality of life. This can be due to monophthalmia in acquired anophthalmus and/or because of cosmetic impairment. Meanwhile several methods exist to evaluate the quality of life and the impairment in utility values in patients with ophthalmological diseases.

METHODS

Twenty-three patients who underwent enucleation of one eye with good visual acuity of the fellow eye (>20/30) were included. All patients were asked to complete a standardized time trade-off (TTO) utility assessment form as well as the self-administered National Eye Institute Visual Function Questionnaire 25 (VFQ 25). TTO was assessed for restoring vision (TTO-A) and for restoring cosmetic appearance (TTO-B).

RESULTS

The mean TTO value for visual function (TTO-A) was 0.87, the mean TTO value for cosmetic restoration (TTO-B) was 0.90 with a significant correlation. These values are surprisingly high compared to current TTO data. Visual acuity of the last eye and utility values were not correlated. TTO was not influenced by the underlying diagnosis. Patients older than 50 years were willing to trade off relatively more years than younger patients. TTO values were independent from the duration of the acquired anophthalmus. The mean VFQ-25 composite score was 81.0 and significantly lower than in the normal population. There was no significant correlation between TTO and the VFQ-25 composite score or any of the 12 subscales of the VFQ-25.

CONCLUSION

Utility of patients with acquired anophthalmus and good vision of the last eye is very similar to patients with two eyes of which one is worse and good binocular vision. The VFQ-25 is no predictor for time trade-off.

The NEI VFQ-25 vision-related quality of life and prevalence of eye disease in a working population

PURPOSE

To apply the National Eye Institute 25-item Visual Function Questionnaire (VFQ-25) to a large group of working people and assess the prevalence of eye disease.

METHODS

In this cross-sectional study, 619 employees of two large enterprises in Munich, Germany, underwent complete ophthalmological examination and assessment of the vision-related quality of life by the Visual Function Questionnaire (VFQ-25, German translation). Statistical analysis including binary logistic regression to investigate predictive factors of eye disease was performed.

RESULTS

The age of the participants was mean 42 years. In 108 patients (17.4%) an ophthalmological disease was present. The mean VFQ-25 composite score was 91.1, and was not significantly different between the group with (88.8) or without (91.6) eye disease. A clear age dependency of VFQ-25 scores was seen. Most reduced subscales in eye disease were ocular pain and role difficulties. Patients with amblyopia did not show any reduction in visual quality of life (composite score 93.4). In the binary regression model, considering the clinical parameters intraocular pressure (IOP), cup/disc ratio (CDR), and spherical equivalent, as well as some of the VFQ-25 subscales, the presence of eye disease could be predicted with a high specificity of 98.7% but a low sensitivity of 12.2%.

CONCLUSIONS

Normal values of the VFQ-25 performance in a large number of working people in Germany are given with a clear age dependency. A combination of refraction, IOP, CDR and some VFQ subscales could reasonably well exclude any prevalent eye disease. For screening purposes, neither variable nor combination was sufficiently sensitive and specific.

Modified Bahasa Malaysia version of VF-14 questionnaire: assessing the impact of glaucoma in rural area of Malaysia

PURPOSE

To evaluate the functional impairment of glaucoma patients, using a modified Bahasa Malaysia version of VF-14 questionnaire, and to correlate the score with the severity of the disease.

METHODS

One-to-one interview by trained interviewers was conducted on glaucoma patients seen in the eye clinic of Hospital Universiti Sains Malaysia, using a modified validated Bahasa Malaysia version of VF-14 questionnaire. The severity of glaucoma was determined based on the better-eye Advanced Glaucoma Intervention Study Scale (AGIS) score of visual field analysis on the latest most reliable visual field. The literacy rate, living situation, better-eye visual acuity and lens status were also documented.

RESULTS

A total of 110 glaucoma patients were recruited (54.5% primary open-angle glaucoma, 21.8% primary angle-closure glaucoma, 19.2% normotensive glaucoma and 4.5% pseudoexfoliative glaucoma) and majority with bilateral involvement. Based on the better-eye AGIS score, 41.5% were in advanced stage, 29.1% moderate and 29.1% mild. There was a significant association between VF-14 scoring with the better-eye AGIS score (r =-0. 579, P < 0.001), age (r = -0.313, P = 0.000) and better-eye visual acuity (r = -0.752, P = 0.000). Based on the multivariate analysis, there was a significant association of the questionnaire score and better-eye AGIS score (P < 0.001).

CONCLUSION

The Bahasa Malaysia version of modified VF-14 questionnaire is a useful tool in quantifying quality of life among glaucoma patients in rural area with high illiteracy rate and provides moderate correlation with severity of the disease. Customization of quality of life questionnaire according to custom and culture of the community will provide better insight to the functional impairment of glaucoma patients.

The value of vision

BACKGROUND

The value of vision is assumed to be very high. To verify this assumption and to assign resources in medical care accordingly, it is necessary to quantify the value of vision. Although the value of vision is difficult to measure, visual quality of life can be quantified as a surrogate criterion. The measured value gains even more relevance if a comparison can be made between visual quality of life and systemic diseases. Multidisciplinary comparisons are only possible by using utility analysis. Two established methods to measure utility values are the standard gamble method and the time trade-off method. The purpose of this review is to find ophthalmologic utility values, and utility values affected by systemic diseases that correlate to the ophthalmologic ones.

METHODS

A literature search was conducted through PubMed of the National Library of Medicine ( http://www.ncbi.nlm.nih.gov ; date: 06.02.2006). The search terms were: "time trade-off / standard gamble" [text word] and "eye / vision / visual" [text word]; results 24. A report was classified as relevant if visually impaired persons were tested by the time trade-off method or the standard gamble method, or if information was provided on the reliability and validity of these measurements in a group of visually impaired persons. Additional searches were done to find associated publications. A total of 42 publications were found to be of interest.

RESULTS

Results showed that patients, with 20/30-20/50 visual acuity would be willing to pay 19% of their lifetime to get back normal visual acuity. Patients with 20/200-20/400 visual acuity would give up 48% of their lifetime, and blind people would give 60% of their lifetime to regain normal visual acuity. Comparable utility values are seen in patients with AIDS (21%), patients after a stroke who are unable to walk and wash themselves without assistance (46%), and bedridden and incontinent patients following a stroke (66%).

CONCLUSION

Patients attach great value to vision. The time trade-off method appears to be an appropriate tool to quantify visual quality of life, and one that can be used to compare utility values of different diseases.

Visual quality of life after macular hole surgery: outcome and predictive factors

BACKGROUND

In the present study we evaluated the functional success after macular hole surgery in correlation to visual quality of life and looked for predictive factors determining surgical success.

METHODS

Fifty-nine patients that underwent pars plana vitrectomy for idiopathic macular hole were included. Follow-up visits were performed in regular intervals after surgery and included a clinical examination, optical coherence tomography (OCT) and measurement of visual acuity. To assess the visual quality of life patients filled out the National Eye Institute 25-item Visual Function Questionnaire (VFQ-25) before and three months and one year after surgery.

RESULTS

Macular hole closure was achieved in 57 of 59 patients (97%). Mean visual acuity increased from 20/100 preoperatively to 20/34 one year after surgery (p = 0.02). Despite good visual acuity (20/27) in the fellow eye, visual quality of life (VFQ composite score) rose from 75.9 +/- 14.4 (SD) to 81.5 +/- 14.2 one year after surgery (p<0.001). Although there was no correlation between the increase in visual quality of life and visual acuity, the increase in VFQ-25 could be well predicted: low visual acuity and significant impairment on VFQ-25 testing preoperatively made patients most likely to benefit from macular hole surgery. A relatively high retinal thickness measurement at the hole border measured on OCT further increases the predictive value.

CONCLUSION

Macular hole surgery is associated with an increase in visual quality of life despite good visual acuity of the fellow eye. Preoperative visual acuity, VFQ-25 value and partly OCT may help to predict the increase in patients' vision related quality of life after surgery.

„Value-based medicine“ in der Augenheilkunde

PURPOSE

Value-based medicine (VBM) unifies costs and patient-perceived value (improvement in quality of life, length of life, or both) of an intervention. Value-based ophthalmology is of increasing importance for decisions in eye care.

METHODS

The methods of VBM are explained and definitions for a specific terminology in this field are given. The cost-utility analysis as part of health care economic analyses is explained.

RESULTS

VBM exceeds evidence-based medicine by incorporating parameters of cost and benefits from an ophthalmological intervention. The benefit of the intervention is defined as an increase or maintenance of visual quality of life and can be determined by utility analysis. The time trade-off method is valid and reliable for utility analysis. The resources expended for the value gained in VBM are measured with cost-utility analysis in terms of cost per quality-adjusted life years gained (euros/QALY). Numerous cost-utility analyses of different ophthalmological interventions have been published.

CONCLUSION

The fundamental instrument of VBM is cost-utility analysis. The results in cost per QALY allow estimation of cost effectiveness of an ophthalmological intervention. Using the time trade-off method for utility analysis allows the comparison of ophthalmological cost-utility analyses with those of other medical interventions. VBM is important for individual medical decision making and for general health care.

[Visual quality of life after vitreoretinal surgery for epiretinal membranes]

PURPOSE

To date, the increase of visual acuity and morphological parameters have been used to assess the benefit of a surgical intervention. The aim of this prospective study was to evaluate changes in patients' visual quality of life due to vitreoretinal surgery for epiretinal membranes.

PATIENTS AND METHODS

Twenty patients with unilateral epiretinal membrane and good visual acuity of the fellow eye were included. Best corrected visual acuity and visual quality of life assessed by the visual function index (VF-14) were obtained preoperatively and 3 months after pars plana vitrectomy and peeling.

RESULTS

Median visual acuity increased from 0.28 to 0.4 postoperatively. Visual quality of life (VF-14 values) rose from 72.8+/-4.7 (SEM) to 83.3+/-2.9 (p<0.05). Analysis revealed that patients with preoperatively low VF-14 values and preoperatively low visual acuity notably profited from surgery. The increase of visual quality of life can be predicted better than increase of visual acuity. Combined cataract surgery had no significant influence.

CONCLUSION

In addition to best corrected visual acuity, quality of life measurements are important predictive and outcome parameters to estimate the value of vitreoretinal surgery.

Klassifikation biomedizinischer Forschungsberichte als Grundlage evidenzbasierter Medizin in der Augenheilkunde

BACKGROUND

Evidence-based medicine requires careful appraisal of published data derived from experimental and clinical studies. Based on classification of biomedical research reports, evidence levels can be determined and recommendations for therapeutic decisions can be made.

METHODS

A classification system for clinical studies was developed. It was evaluated in classifying the reports published in Der Ophthalmologe during 2003-2004 (study design: descriptive cross-sectional study, case series).

RESULTS

In the 2-year interval, 70 longitudinal and 95 cross-sectional studies were published. The vast majority of the longitudinal studies were interventional cohort studies. Not considering case reports, 73% of the original articles were longitudinal prospective studies, 1% were retrospective (case-control) studies, and 26% were cross-sectional studies.

CONCLUSIONS

The study design of all published articles could be classified using the classification system. This classification system proves to be applicable in the context of clinical studies in ophthalmology and may be helpful in the process of critical appraisal of the literature and synthesis of clinical evidence and an evidence-based recommendation.