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

Measuring the quality of life of patients with diabetic retinopathy in northern India: a comparison of generic and vision specific instruments

BACKGROUND

Estimation of health-related quality of life (HRQoL) in diabetic retinopathy (DR) patients is important to assess the impact of disease, to monitor the treatment outcomes, and conduct health technology assessments. The study aimed to measure the HRQoL in DR patients using the generic as well as disease specific instruments, identify the determinants of HRQoL, empirically investigate the concurrent validity between the QoL instruments, and to develop statistical approaches to map NEI-VFQ-25 (National Eye Institute- Visual Function Questionnaire- 25) composite score based on EQ-5D-5 L (EuroQol 5-dimensions 5-levels) utility values.

METHODS

A facility based cross-sectional study was carried out to measure the HRQoL of 300 DR patients using EQ-5D-5 L, EuroQol visual analogue scale (EQ-VAS), and NEI-VFQ-25 instruments. Mean HRQoL scores, along with DR state specific and visual acuity specific utility values were analysed. Pearson correlation coefficient was used to ascertain concurrent validity between NEI-VFQ-25 composite score and its sub-scale scores, EQ-5D-5L index value, and EQ-VAS score. Lastly, we evaluated statistical models using predictor sets based on the EQ-5D-5 L utility scores to estimate NEI-VFQ-25 scores.

RESULTS

The mean EQ-5D-5 L utility value for DR patients was 0.69 (95% CI: 0.65-0.73). The mean NEI-VFQ-25 composite score and EQ-VAS score were 61.1 (95% CI: 57.5-64.5), and 67.6 (95% CI: 65.6-69.5), respectively. Both EQ-5D-5 L and EQ-VAS had a strong concurrent validity with NEI-VFQ-25 composite score. 'Tobit regression with log of composite score' was assessed to the preferred model to predict the NEI-VFQ-25 composite score using EQ-5D-5L utility values.

CONCLUSION

Diabetic retinopathy has a decremental impact on quality of life, which increases with severity in vision loss. Both generic as well as disease-specific outcome measures are equally reliable to determine quality of life of patients with DR. The EQ-5D-5 L can be utilized for measurement of HRQoL in DR in clinical settings to optimize time of clinicians, with further derivation of NEI-VFQ-25 values through application of the crosswalk algorithm for predicting vision- related QoL.

Vision-Related Quality of Life Among Diabetic Retinopathy Patients in a Hospital-Based Population in the Sultanate of Oman

Background

The global prevalence of diabetic retinopathy (DR) among individuals with diabetes is 22.27%. This highlights the likelihood of developing burden of retinopathy within the at risk population and can have a detrimental impact on an individual's quality of life (QoL). The aim of this study is to assess the vision-related QoL in individuals with (DR) in a hospital-based population in the Al-Buraimi governorate, Sultanate of Oman.

Methods

The study was conducted in the Ophthalmology Outpatient Department of Al Buraimi Hospital and Polyclinic. This study enrolled 218 patients (114 males, 104 females) diagnosed with DR. The NEI-VFQ-25 questionnaire was adopted in this study. The patients were classified into different groups according to their type of diabetes and other relevant demographic information.

Results

A total of 218 patients responded to the NEI-VFQ-25 questionnaire. The mean age of the participants was 57.49 ± 12.3 years, 52.3% were male, and 47.7% were female. The overall QoL score was 41.53± 20.8. Patients aged more than 75 years had the lowest QoL scores compared with the other age groups (p = 0.02). The results showed that the duration of diabetes had no significant impact on the overall QoL scores (p = 0.06). A higher QoL score was observed among patients with type II diabetes mellitus (DM) than with type I diabetes mellitus (p = 0.01). Patients diagnosed with proliferative DR (PDR) had a significantly lower QoL score than those diagnosed at other stages (p < 0.001).

Conclusion

The QoL of the population with DR is negatively affected by various factors, including demographics, disease severity, and in patients with DM type II. It is important to consider these factors to enhance QoL in patients with DR. Regular evaluation of an individual's QoL is beneficial for both physicians and healthcare teams.

Vision-Related Quality of Life in Patients with Systemic Lupus Erythematosus

PURPOSE

To assess vision-related quality of life (VRQoL) in patients with systemic lupus erythematosus (SLE) under treatment with hydroxychloroquine (HCQ), and to find the influencing factors.

METHODS

Cross-sectional study enrolling SLE patients for less than ten years (Group 1), SLE patients for more than ten years (Group 2), and healthy controls (Group 3). SLE patients should be under treatment with HCQ but without ophthalmological affection. Schirmer test, best-corrected visual acuity (BCVA), axial length (AL) with optical biometry, and swept-source optical coherence tomography-angiography (OCTA) Triton (Topcon) were performed. All participants fulfilled the Impact of Visual Impairment questionnaire, and SLE patients answered the Lupus Impact Tracker (LIT) questionnaire. Additional data were obtained from clinical records.

RESULTS

A totals of 41 eyes (41 patients), 31 eyes (31 patients) and 45 eyes (45 volunteers) were enrolled in the study groups. The mean ages were 41.09 ± 9.56, 45.06 ± 8.47 and 40.25 ± 10.83 years, respectively (p = 0.10). The LIT outcomes were 33.49 ± 20.74 and 35.98 ± 22.66 (p = 0.63), respectively. Group 3 referred to a better VRQoL than Group 2 in all categories and than Group 1 in some of them. A linear regression analysis showed that serum ferritin, SLE activity scales, body-mass index (BMI), age, and BCVA influenced VRQoL. The LIT questionnaire was correlated to two categories of the Impact of Visual Impairment questionnaire (IVI).

CONCLUSIONS

Despite no ophthalmological affection, SLE patients refer to poorer VRQoL because of disease activity and a low health-related quality of life, which has a negative influence on VRQoL. This masks the effect of other ophthalmological conditions such as dry eyes. Other variables influencing VRQoL are age and BMI, and BCVA, to a lesser extent.

AAV-Based Strategies for Treatment of Retinal and Choroidal Vascular Diseases: Advances in Age-Related Macular Degeneration and Diabetic Retinopathy Therapies

Age-related macular degeneration (AMD) and diabetic retinopathy (DR) are vascular diseases with high prevalence, ranking among the leading causes of blindness and vision loss worldwide. Despite being effective, current treatments for AMD and DR are burdensome for patients and clinicians, resulting in suboptimal compliance and real risk of vision loss. Thus, there is an unmet need for long-lasting alternatives with improved safety and efficacy. Adeno-associated virus (AAV) is the leading vector for ocular gene delivery, given its ability to enable long-term expression while eliciting relatively mild immune responses. Progress has been made in AAV-based gene therapies for not only inherited retinal diseases but also acquired conditions with preclinical and clinical studies of AMD and DR showing promising results. These studies have explored several pathways involved in the disease pathogenesis, as well as different strategies to optimise gene delivery. These include engineered capsids with enhanced tropism to particular cell types, and expression cassettes incorporating elements for a targeted and controlled expression. Multiple-acting constructs have also been investigated, in addition to gene silencing and editing. Here, we provide an overview of strategies employing AAV-mediated gene delivery to treat AMD and DR. We discuss preclinical efficacy studies and present the latest data from clinical trials for both diseases.

Disease perception and experience in people with diabetic retinopathy: A qualitative study

AIM

The aim of this study was to investigate the lived experience of people with diabetic retinopathy and to understand the impact of the disease on them including the practical problems faced in the day-to-day life.

DESIGN

Descriptive qualitative research.

METHODS

A convenience sample of 11 patients with diabetic retinopathy who were hospitalized in a tertiary hospitals in Shandong province of China were enrolled. Data were collected using semi-structured in-depth interviews. The six-stage thematic analysis of Braun and Clarke was used for data analysis.

RESULTS

Three themes and 12 sub-themes were extracted, namely: countdown to darkness (lack of disease knowledge, bystander's perspective, distrust of grassroots hospitals); Endless abyss (action restrictions, social isolation, stigma, lost of meaning in life, catastrophizing explanations, a heavy burden); Light chaser (craving for light, turning points in behaviour, self-adjustment).

Vision-Related Quality of Life in Patients With Keratoconus: A Nationwide Study in Saudi Arabia

PURPOSE

To evaluate the impact of keratoconus (KC) on quality of life and assess visual performance via the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25) in the Saudi population.

PATIENTS AND METHODS

A descriptive cross-sectional study was conducted using the NEI-VFQ-25 to evaluate the vision-related quality of life among previously diagnosed KC patients. An online questionnaire was used to distribute the validated survey through various social media networks. The data were extracted, reviewed, coded, and then analyzed using the Statistical Package for Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY).

RESULTS

A total of 429 patients completed the questionnaire. The overall score of NEI-VFQ-25 was 58.6 (SD: 18.0). The visual performance was worse in females than males (with a score of 55.1), especially in patients aged less than 30 years. Visual function improved with the use of low-vision aids (spectacles and contact lenses) compared with those who did not use them.

CONCLUSION

Our study confirms the functional impairment in patients with KC, especially in females, patients aged less than 30 years, and those with no low-vision aids. Moreover, it suggests a significant role of these vision aids (spectacles and contact lenses) in improving the quality of life in patients with KC.

The Longitudinal Assessment of Vascular Parameters of the Retina and Their Correlations with Systemic Characteristics in Type 2 Diabetes-A Pilot Study

The aim of the study was to assess various retinal vessel parameters of diabetes mellitus (DM) patients and their correlations with systemic factors in type 2 DM. A retrospective exploratory study in which 21 pairs of baseline and follow-up images of patients affected by DM were randomly chosen from the Sankara Nethralaya−Diabetic Retinopathy Study (SN DREAMS) I and II datasets. Patients’ fundus was photographed, and the diagnosis was made based on Klein classification. Vessel thickness parameters were generated using a web-based retinal vascular analysis platform called VASP. The thickness changes between the baseline and follow-up images were computed and normalized with the actual thicknesses of baseline images. The majority of parameters showed 10~20% changes over time. Vessel width in zone C for the second vein was significantly reduced from baseline to follow-up, which showed positive correlations with systolic blood pressure and serum high-density lipoproteins. Fractal dimension for all vessels in zones B and C and fractal dimension for vein in zones A, B and C showed a minimal increase from baseline to follow-up, which had a linear relationship with diastolic pressure, mean arterial pressure, serum triglycerides (p < 0.05). Lacunarity for all vessels and veins in zones A, B and C showed a minimal decrease from baseline to follow-up which had a negative correlation with pulse pressure and positive correlation with serum triglycerides (p < 0.05). The vessel widths for the first and second arteries significantly increased from baseline to follow-up and had an association with high-density lipoproteins, glycated haemoglobin A1C, serum low-density lipoproteins and total serum cholesterol. The central reflex intensity ratio for the second artery was significantly decreased from baseline to follow-up, and positive correlations were noted with serum triglyceride, serum low-density lipoproteins and total serum cholesterol. The coefficients for branches in zones B and C artery and the junctional exponent deviation for the artery in zone A decreased from baseline to follow-up showed positive correlations with serum triglycerides, serum low-density lipoproteins and total serum cholesterol. Identifying early microvascular changes in diabetic patients will allow for earlier intervention, improve visual outcomes and prevent vision loss.

Diabetic Retinopathy Grading by Deep Graph Correlation Network on Retinal Images Without Manual Annotations

BACKGROUND

Diabetic retinopathy, as a severe public health problem associated with vision loss, should be diagnosed early using an accurate screening tool. While many previous deep learning models have been proposed for this disease, they need sufficient professional annotation data to train the model, requiring more expensive and time-consuming screening skills.

METHOD

This study aims to economize manual power and proposes a deep graph correlation network (DGCN) to develop automated diabetic retinopathy grading without any professional annotations. DGCN involves the novel deep learning algorithm of a graph convolutional network to exploit inherent correlations from independent retinal image features learned by a convolutional neural network. Three designed loss functions of graph-center, pseudo-contrastive, and transformation-invariant constrain the optimisation and application of the DGCN model in an automated diabetic retinopathy grading task.

RESULTS

To evaluate the DGCN model, this study employed EyePACS-1 and Messidor-2 sets to perform grading results. It achieved an accuracy of 89.9% (91.8%), sensitivity of 88.2% (90.2%), and specificity of 91.3% (93.0%) on EyePACS-1 (Messidor-2) data set with a confidence index of 95% and commendable effectiveness on receiver operating characteristic (ROC) curve and t-SNE plots.

CONCLUSION

The grading capability of this study is close to that of retina specialists, but superior to that of trained graders, which demonstrates that the proposed DGCN provides an innovative route for automated diabetic retinopathy grading and other computer-aided diagnostic systems.