The National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25) - reference data from the German population-based Gutenberg Health Study (GHS)

Evaluation of dietary patterns and their impact on eye health among Saudi adults-A multi-regional cross-sectional analysis in Makkah, Riyadh, and Qassim

Background and aim

Nutrition plays a vital role in maintaining and improving vision health. However, little is known about dietary intake habits and their correlation with vision health among adults in the Kingdom of Saudi Arabia (KSA). The present survey was aimed to assess dietary patterns and vision health among Saudi adults and to determine the association between dietary patterns and vision health.

Methods

The present analytical study was carried out among 1,234 Saudi adults in the Makkah, Riyadh, and Qassim regions of KSA. We used the Arabic version of the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) and the diet quality screener (DQS). We applied Mann-Whitney U and Kruskal-Wallis tests to determine the association between vision function score and demographic characteristics. Furthermore, the Spearman correlation test was used to determine the relationship between the DQS and the NEI VFQ-25.

Results

Of the studied population, the highest score obtained through the NEI VFQ-25 was in the social function domain (mean ± SD = 76.64 ± 18.63), followed by the general vision domain (mean ± SD = 75.21 ± 15.16) and was negatively correlated with age. Regarding dietary patterns, the intake of lean protein sources per week was the highest, with a mean intake of 4.17 days per week, followed by that of whole grains and milk or dairy products, with a mean intake of around four days per week. There was a significant correlation between various dietary intakes and visual function scores.

Conclusion

The present survey underscores the significance of understanding regional dietary patterns and their implications for vision health. Furthermore, our study's findings indicate a need for targeted nutritional intervention measures to improve the vision health of this population.

Ophthalmic quality of life in the adult Danish population: an epidemiological study

BACKGROUND

Ophthalmic quality of life (OQoL) has been investigated in selected parts of general populations and in patients with ocular disease, but OQoL in unselected general populations has not been studied in detail. The present study reports OQoL obtained from a representative sample of the adult Danish population 2020-2022.

METHODS

The FORSYN study invited 10 350 citizen representatives for the adult Danish population for a non-mydriatic eye examination and answer the National Eye Institute Visual Function Questionnaire with 39 items in the validated Danish translation. The results from the 3384 (32.7%) persons who participated in the study were weighted on the basis of relevant socio-economic factors, and data were projected to represent the total population. Binocular visual acuity was below 0.1 corresponding to legal blindness in 0.22% of this population.

RESULTS

OQoL was positively correlated with binocular visual acuity up to better than 93 ETDRS letters, negatively correlated with age for persons younger than 60 years of age and again positively correlated with age for persons older than 60 years. OQoL was negatively correlated with increasing ametropia and refractive error above 1 dioptre and encompassed more OQoL parameters for hyperopic than for myopic persons.

CONCLUSIONS

The study underlines the benefits of improving visual acuity even within the normal range and of adjusting uncorrected refraction errors in the general population. OQoL is positively correlated with age in older persons independently of visual acuity, sex, refractive power and previous cataract surgery.

Vision-Related Quality of Life among Patients with Different Types of Age-Related Macular Degeneration

BACKGROUND

This study aimed to assess the vision-related quality of life (VRQol) of patients with age-related macular degeneration (AMD) and to evaluate VRQol according to different types of AMD.

METHODS

In this small-scale, single-center, prospective investigation, patients with AMD and subjects without any signs of macular disease were asked to complete the NEI-VFQ-39. A total of 159 subjects were included and grouped according to the type of AMD as follows: 40 patients with dry AMD in both eyes (DD), 40 patients with exudative AMD in one eye (DE), 41 patients with exudative AMD in both eyes (EE), and 38 subjects without any signs of macular disease, as a control group (CG).

RESULTS

The average age of the participants was 76 ± 7 years, and 44% were male. Most participants were retired (22.4%), and 75% of patients were initially diagnosed by their ophthalmologist. All the AMD groups had significantly worse overall VRQol than the CG. For general vision, near vision, mental health, and role difficulties, all the AMD groups had significantly lower scores than the CG. For distance vision, color vision, peripheral vision, driving difficulties, dependency, and social functioning, only patients in the EE and DE groups had significantly worse scores than the CG. The type of retinal fluid in patients with exudative AMD had no effect on overall VRQol; however, we found that the presence of pigment epithelial detachment could be associated with more role difficulties, such as completing work or working long hours.

CONCLUSION

All types of AMD had a negative effect on vision-related quality of life. This effect was significantly more pronounced in patients with exudative AMD in at least one eye. However, the type of retinal fluid in patients with exudative AMD had no influence on their overall vision-related quality of life.

Evaluation of Quality of Life and Emotional Disturbances in Patients with Diabetic Retinopathy

Diabetes has detrimental effects on many organs, including the kidneys, heart, and the central nervous system, with ophthalmic involvement and Diabetic Retinopathy (DR), specifically, being among the most severe and prominent consequences. Diabetic Retinopathy and especially advanced stages of the disease, have a crucial impact on patients' quality of life and emotional status. In this context, emotional imbalance, psychological side effects and comorbidities, like anxiety disorders, could emerge, deteriorating the patients' condition further. A number of questionnaires can be employed in the evaluation of the potential impact of Diabetic Retinopathy on patients' quality of life, including the Beck Anxiety Inventory (BAI) and The National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25).

PURPOSE

The purpose of this study was to evaluate the association of Diabetic Retinopathy (DR) and diabetic macular edema with vision-related quality of life, as well as the potential association between the disease's severity, emotional status of patients and the manifestation of anxiety and psychological features.

RESULTS

Patients with fundoscopic findings had significantly lower scores in all VFQ-25 subscales, indicating worse quality of life in comparison to patients without DR. Severity of DR, greater levels of anxiety, daily sitting time, unemployment and lower education level, were all found to be significantly, negatively associated with a worse quality of life. Regarding emotional status, more years of suffering from diabetes, treatment with insulin and the hours being idle per day were associated with an increased burden of anxiety. In addition, the presence of a concomitant disease, findings in fundoscopy, diabetic macular edema and treatment with anti-VEFG injections, as well as the number of doses, were significantly associated with greater anxiety. Multivariate analysis showed that having Severe Non-Proliferative Diabetic Retinopathy or having Proliferative Diabetic Retinopathy and receiving insulin therapy (alone or in combination with another treatment), were significantly associated with higher levels of anxiety.

CONCLUSION

The well-established impact of DR on the patients' well-being, quality of life and emotional status render DR and CME prevention, stabilization or delaying progression as a necessity in order to protect patients from developing psychiatric symptoms. On the other hand, the speculated bi-directional association between emotional problems and DR progression highlights the importance of acknowledging and dealing with psychological issues with the aim of delaying DR progression.

Psychosocial Well-Being and Quality of Life in Uveitis: A Review

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.

Comparative Analysis of Health- and Vision-Related Quality of Life Measures among Trinidadians with Low Vision and Normal Vision-A Cross-Sectional Matched Sample Study

This cross-sectional study investigated the health-related and vision-related quality of life measures of adults with low vision compared to healthy individuals in Trinidad and Tobago. The health-related quality of life (HRQOL-14) and the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) were administered to 20 participants with low vision caused by diabetic retinopathy, retinitis pigmentosa, glaucoma, and macular degeneration, as well as 20 participants with no visual problems (control). Participants were recruited from the University Eye Clinic in Trinidad and Tobago. Compared to the controls, more participants in the low-vision group had lower age-adjusted NEI-VFQ-25 scores (48.3% vs. 95.1%; p < 0.001), had poor general (47.5% vs. 10%, p = 0.004) and mental (100% vs. 10%, p < 0.042) health, experienced greater activity limitation due to impairment or health problems (85% vs. 20%, p < 0.001), needed help with personal care (27.5% vs. 0%, p < 0.009) and daily routine (67.5% vs. 0%, p < 0.001), and experienced sleep problems (97.5% vs. 65%, p < 0.001) and symptoms of anxiety (100% vs. 90%, p = 0.042). All the diabetic retinopathy participants (100%, p = 0.028) had two or more impairments or vision problems compared to none in the other low-vision participants. In summary, the HRQOL-14 and NEI-VFQ-25 scores were significantly reduced in low-vision participants, who also demonstrated a greater vulnerability to poor quality of life in the presence of diabetes retinopathy. These findings have important clinical implications regarding offering appropriate support and interventions to improve quality of life outcomes in individuals with low vision.

Impact of Routinely Performed Optical Coherence Tomography Examinations on Quality of Life in Patients with Retinal Diseases-Results from the ALBATROS Data Collection

The use of OCT to monitor intravitreal treatment varies in clinical practice and is not always mandatory. The ALBATROS data collection aimed to clarify the impact of routinely implemented OCT on clinical outcomes and its impact on vision-related quality of life (VRQoL).

METHODS

An observational cohort study included patients with retinal diseases starting an intravitreal anti-vascular endothelial growth factor treatment in Germany. Treatment followed clinical practice except mandatory OCT examination during the 12-month observation period. VRQoL was assessed by NEI VFQ-25 and compared with respect to OCT examinations and number of intravitreal injections in the different diseases (nAMD, DME, BRVO, CRVO).

RESULTS

1478 patients (74.5 ± 10.9 years, 54.9% female) were included in the analysis. Patients had neovascular AMD (65.2%), DME (18.4%), BRVO (9.5%), or CRVO (6.9%). 8.8 ± 2.6 OCT examinations and 6.1 ± 3.2 intravitreal injections were performed within 12 months. VRQoL differed between indications at baseline, with substantially lower values for neovascular AMD and CRVO. After twelve months, an increase in visual acuity and visual functional scale was observed for nAMD, DME, and BRVO, while in DME only, there was an association between number of OCT examinations and VRQoL.

CONCLUSION

Intravitreal treatment was able to maintain VRQoL over twelve months in a real-world setting. Regular OCT examinations were associated with higher gain in VRQoL in DME patients after 12 months.

Impact of Cross-Linking Procedure on Perioperative Quality of Life in Keratoconus Patients

BACKGROUND

To evaluate the effect of crosslinking (CXL) with riboflavin for keratoconus (KC) therapy on quality of life (QoL): comparison of keratoconus patients with and without treatment.

METHODS

Prospective monocentric study. We recruited patients with progressive KC and with stable disease. Patients with progressive disease received cross-linking treatment; patients with stable disease were monitored. We compared QoL in both groups over 6 months and detected the influence of cross-linking treatment on QoL. QoL was assessed by NEI-VFQ-25, EQ-5D 5L, and EQ-Visual analog scale (VAS). In the evaluation of the Nei VFQ, the subgroups LFVFS and LFSES were calculated.

RESULTS

We enrolled 31 eyes of 31 patients in the intervention group and 37 eyes of 37 patients in the control group. Medians with standard deviations (SD) were calculated. All QoL-tests showed equal scores at baseline in both groups. At V2, one day after the treatment, EQ-VAS (56.4), LFVFS (57.4), and EQ5D5L (0.59) were significantly reduced. At V3 (one week after treatment), all results returned to baseline level. LFSES was not affected by the treatment. It remained stable (V2 85.4, V3 84.3). Comparing the baseline scores with the follow-up scores at month 6, we found a significant increase in QoL in all tests in the intervention group. Otherwise, the quality of life in the control group did not change over time.

CONCLUSIONS

Cross-linking led only to a short-term reduction in QoL. Although the treatment is painful for a few days, no effect on general quality of life LVSES has been demonstrated. QoL already returned to baseline after one week and the patients were not limited anymore.

Factors associated with visual function among computer-based administrative workers: a Brazilian cross-sectional study

Introduction

Several studies have shown that eye and vision problems are among the most significant issues reported by individuals who use computers at work.

Objectives

To investigate individual and occupational environmental factors associated with visual function among workers who perform computer-based administrative tasks.

Methods

This is a cross-sectional study conducted in 2014-2015 with 303 workers of a public hospital in the city of São Paulo, Brazil. The participants answered a structured questionnaire, including the 25-Item National Eye Institute Visual Function Questionnaire. Statistical analyses used descriptive analysis, tests of association and multiple linear regression analysis.

Results

Most participants were female (61.1%); the mean age was 46.0 (standard deviation [SD]) ± 12.5, and approximately 91.7% of them reported wearing corrective lenses. Regarding visual function, the mean score at the 25-Item National Eye Institute Visual Function Questionnaire was 78.0, SD ±7.1. A regression analysis showed that visual function declined with age (ß -0.218; 95%CI -0.276--0.16l) and effort at work (ß -0.656; 95%CI -0.928--0.383).

Conclusions

The mean quality of visual health in the studied group was good. The younger the age and the lower the effort at work, the better the visual function. Our results point to the relevance of establishing periodical and preventive health actions, including eye health assessments.

Comparison of three health-related quality of life instruments in relation to visual acuity: EQ-5D, 15D, and EUROHIS-QOL8

PURPOSE

To compare three health-related quality of life (HRQoL) instruments in detecting the effect of distance visual acuity (VA) on generic HRQoL in an adult population.

METHODS

We used cross-sectional, population-based data from a nationwide health survey conducted in Finland in 2011-2012. It included three self-reported HRQoL instruments, EuroQol-5 Dimension (EQ-5D), 15D, and EUROHIS-QOL8, and a health examination in which habitual distance VA was measured binocularly. We assessed 3764 survey participants aged 30 years and older with information available on these parameters. The comparability and sensitivity of the instruments were evaluated using Pearson correlation coefficients and multivariable linear regression in different VA groups.

RESULTS

EQ-5D and 15D index scores showed strong positive correlation (0.65-0.74) with each other regardless of distance VA, whereas EUROHIS-QOL8 index score showed moderate-to-strong correlation (0.46-0.79) with EQ-5D and 15D. All three instruments showed a negative trend with deteriorating VA, although EQ-5D and 15D showed better sensitivity than EUROHIS-QOL8. When adjusted for age, gender, and co-morbidities, adequate vision (VA 0.63-0.8), weak vision (VA 0.32-0.5), and impaired vision or worse (VA ≤ 0.25) were independently associated with declined EQ-5D and 15D, whereas declined EUROHIS-QOL8 was associated only with adequate and weak vision.

CONCLUSION

All three instruments can be viable tools in evaluating the relation between vision and HRQoL. While 15D is preferred due to its wide coverage of dimensions, EQ-5D can be an equal alternative, as it has less respondent burden. The feasibility of EUROHIS-QOL8 on detecting differences between lower VA levels may require further evidence.

The intraocular implant and visual rehabilitation improve the quality of life of elderly patients with geographic atrophy secondary to age-related macular degeneration

INTRODUCTION

The objective of this prospective study was to evaluate the effects of intraocular macular lens implantation and visual rehabilitation on the quality of life of patients with geographic atrophy (GA) secondary to age-related macular degeneration (AMD).

METHODS

Patients with bilaterally decreased near vision (not better than 0.3 logMAR with the best correction), pseudophakia, were included in the project. The Scharioth macula lens (SML) was implanted into the patients' better-seeing eye. Intensive visual rehabilitation of the ability to perform nearby activities was performed for 20 consecutive postoperative days. All subjects were examined before and after SML implantation ophthalmologically. The National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25) was administered before and 6 months after surgery.

RESULTS

Twenty eligible patients with mean age 81 years (63 to 92 years) were included in the project: 7 males and 13 females. Nineteen of them completed the 6-month follow-up. Near uncorrected visual acuity was 1.321 ± 0.208 logMAR before SML implantation and improved to 0.547 ± 0.210 logMAR after 6 months (dz =  - 2.846, p < 0.001, BF₁₀ = 3.29E + 07). In the composite score of the NEI VFQ-25, there was an improvement in the general score and the specific domains related to the implantation. Participants reported fewer difficulties in performing near activities (dz = 0.91, p = 0.001, BF₁₀ = 39.718) and upturns in mental health symptoms related to vision (dz = 0.62, p = .014, BF₁₀ = 3.937).

CONCLUSION

SML implantation, followed by appropriate rehabilitation, improved near vision and increased the quality of life of visually handicapped patients with AMD in our project.

Sharp Edge Eye Syndrome: A Case Report and Survey of Self-Identified Individuals

BACKGROUND

Sharp edge eye syndrome (SEES), sometimes known as visual looming syndrome, is a condition in which the patient experiences ocular pain or discomfort when viewing or mentally picturing sharp objects and edges. Patients may present for medical care because they perceive the condition to represent an ophthalmic problem or a sign of a more serious underlying condition. An individual case report of SEES is included to aid in illustrating syndrome characteristics. Our aim is to describe the syndrome, vision-related quality of life (VRQOL), and psychosocial characteristics in patients with self-identified SEES.

METHODS

A cross-sectional web-based survey was made available on social media webpages dedicated to SEES. The study included 22 questions developed by the research team, demographic questions, and 4 standardized questionnaires [ID Migraine, the National Eye Institute's Visual Function Questionnaire (NEI-VFQ-25), General Anxiety Disorder-2 (GAD-2), and Patient Health Questionnaire (depression) Scale-2].

RESULTS

Seventy-seven respondents had an average age of 29 and were 57% male. 92% reported symptoms before age 18. The main site of pain or discomfort was the eyes, with onset resulting from viewing or thinking of sharp objects and edges. Symptoms lasted from seconds to hours and could be prolonged even after closing eyes or avoiding viewing the trigger. The composite and subscale scores on the NEI-VFQ-25 were low, with a mean composite score of 78 and selected subscores of general health (61), general vision (73), ocular pain (68), driving (79), mental health (61), and role difficulties (72). Anxiety was reported in 58% of participants, and depression in 57%. Migraine or headache was reported in 46% of participants. Participants reported Alice in Wonderland syndrome, visual snow, obsessive-compulsive disorder, attention deficit hyperactivity disorder, stripe-induced visual discomfort, and synesthesia.

CONCLUSION

From this survey, we have the beginnings of an understanding of the characteristics of SEES, as well as VRQOL impacts. These survey responses lead us to postulate that SEES may be a distinct visual phenomenon and to propose SEES criteria. Systematic studies of this condition's clinical features and treatment responses will be additional steps toward improving patient care.

Efficacy Evaluation of the VFQ-25 Scale in Patients with Different Degrees of Vitreous Opacity After Nd : YAG Laser Ablation

Objective

To evaluate the effect of the VFQ-25 scale on the efficacy of Nd : YAG laser ablation in patients with different severity of vitreous opacities.

Methods

From January 2020 to March 2021, data of patients who presented to our department and were diagnosed with vitreous opacity were collected, and the severity of vitreous opacity was divided into four grades: I, II, III, and IV. Preoperative visual acuity, intraocular pressure, dilated fundus, B ultrasound, and other examinations were performed, and the patients were scored using the VFQ-25 scale. All patients underwent Nd : YAG laser ablation and were followed for 6 months. The VFQ-25 scale was again used postoperatively to score the patient's efficacy. The general information and clinical characteristics of the patients we collected. The Spearman's test was used to evaluate the correlation between VFQ-25 score and Nd : YAG laser efficacy in patients.

Results

A total of 80 patients (95 eyes) were included in this study. Vitreous opacities were grade I in 56 eyes (58.9%), grade II in 22 eyes (23.2%), grade III in 10 eyes (10.5%), and grade IV in 7 eyes (7.4%). Compared with preoperative scores, patients with vitreous opacity had significantly higher postoperative scores in terms of overall health (36.54 ± 17.06 vs 33.52 ± 16.74), overall visual acuity (60.39 ± 14.24 vs 57.56 ± 13.13), color vision (88.94 ± 12.56 vs 86.38 ± 12.37), and peripheral visual acuity (74.06 ± 18.38 vs 72.20 ± 18.79) items (all P < 0.001). The overall response rates of vitreous opacities I, II, III, and IV were 100%, 90.9%, 80.0%, and 71.4%, respectively. There was a significant correlation between the postoperative VFQ-25 total score, and the therapeutic effect of laser ablation for grade I vitreous opacities, with a correlation coefficient r of 0.417 (P=0.001). The correlation coefficient r between the total score of postoperative VFQ-25 and the treatment effect of grade II vitreous opacity was 0.622 (P=0.002). However, the correlation between the postoperative efficacy of grade III and IV patients and the VFQ-25 score was not significant.

Conclusion

In patients with different degrees of vitreous opacity undergoing Nd : YAG laser vitreous ablation, the overall health, overall visual acuity, color vision, and peripheral visual acuity were improved after surgery, and the VFQ-25 score was significantly correlated with the postoperative efficacy, which is worthy of clinical use.

Visual acuity, amblyopia, and vision-related quality of life in preterm adults with and without ROP: results from the Gutenberg prematurity eye study

Objectives

This study investigated the effects of prematurity and ROP on visual acuity and VRQoL in adults (18–52 years).

Methods

The Gutenberg Prematurity Eye Study is a retrospective cohort study with a prospective ophthalmologic examination. Preterm and full-term participants at an age from 18 to 52 years were included. Distant corrected visual acuity (DCVA) and VRQoL were assessed in participants (892 eyes of 450 individuals aged 28.6 ± 8.6 years, 251 females) grouped into full-term controls (gestational age [GA] at birth ≥37 weeks), preterm participants without ROP and GA 33–36 weeks (group 2), GA 29–32 weeks (group 3), GA ≤ 28 weeks (group 4), non-treated ROP (group 5) and treated ROP (group 6). Main outcome measures were distant corrected visual acuity (DCVA), VRQoL and prevalence of amblyopia.

Results

The DCVA of the better eye correlated (p < 0.001) with GA, birth weight, ROP, ROP treatment, and perinatal adverse events and was poorer in both ROP groups. Visual acuity of <20/200 in the better eye was observed in two participants (4.2%) in the ROP group and one person (6.7%) in the treated ROP group. The prevalence of amblyopia increased in the ROP groups. Compared to full-term controls, visual functioning VRQoL scores were lower in preterm individuals independent of ROP while socioemotional VRQoL scores were only lower in the treated ROP group.

Conclusion

Participants with postnatal ROP and its treatment showed decreased visual acuity and VRQol in adulthood, with amblyopia occurring more frequently in more preterm participants with ROP.

Health-related quality of life among adult patients with visual impairments in Yazd, Iran

BACKGROUND

Visual impairment (VI) is one of the major public health problems that cause suffering, disability, loss of productivity, and reduced quality of life (QoL). This study aimed to evaluate the health-related QoL (HRQoL) among adults with visual problems in 2021.

MATERIALS AND METHODS

This analytical cross-sectional study was conducted on 300 patients with VIs referring to ophthalmology centers in Yazd, Iran. Data were collected through face-to-face interviews using EQ-5D, visual analog scale (VAS), and demographic information questionnaires. The results were analyzed using independent sample t-test, one-way analysis of variance, Pearson correlation coefficient, and adjusted limited dependent variable mixture model (ALDVMM) model by STATA, and SPSS.

RESULTS

The mean and standard deviation of EQ-5D-5 L index and EQ-VAS score in the studied patients were 0.68 ± 0.25 and 72.46 ± 19.36, respectively. Most problems at unable/extreme level were related to the mobility dimension (12%) and the usual activities dimension (9%). Factors related to HRQoL scores using ALDVMM model showed that divorced or widow marital status, age over 50, having strabismus, and acuter visual problems had significant negative effects on EQ-5D-5 L index values (P < 0.05).

CONCLUSIONS

The results showed that HRQoL was moderate in patients with VIs and reduced in patients with high disease severity, old age, lack of a spouse, retirement, and nonuniversity education. As a result, socioeconomic and demographic characteristics were required to be considered in visual health policies.

Visual functions and disability in Iranian adults: a population-based study

Background

Vision-related quality of life is related to severity of visual impairments and show the impact of eye diseases on daily activities. This study aims to assess visual functions and disability and its association with age, gender, education, marital status, and economic status in adults aged 45–69 years.

Methods

Data in this population-based study were from the second phase of the Shahroud eye cohort study and collected by using a Short-Form Visual Functioning Scale. The scores of visual function and disability were calculated based on Rasch-transformed scores of the National Eye Institute visual functioning questionnaire, where a more negative score indicates a better situation. Multiple linear regression was used to investigate the factors associated with visual functions.

Results

Among 4737 participants the visual function data for 4715 people were analyzed. The visual function of 75.3, 17.1 and 7.5% of participants were “ideal and good”, “moderate”, and “bad and very bad”, respectively, while 0.06% were unable for vision. The running mean of the visual function was calculated to be − 3.95 ± 0.02. The visual performance was worse in females than the males (β = 0.14, p = 0.005). Visual function improved with increasing levels of education (β = − 1.06, p < 0.001). It was worse in low-economic (β = 0.016, p = 0.005) and moderate-economic (β = 0.28, p < 0.001) participants than high-economic ones.

Conclusion

The visual function of Iranian adults aged 45–69 years was moderate. The male gender, higher education and the higher economic status had a better visual function.

Impact of Visual Impairment on Vision-Related Quality of Life in Parkinson's Disease

BACKGROUND

Visual impairment is frequent and highly disabling in Parkinson's disease (PD); however, few studies have comprehensively evaluated its impact on vision-related quality of life.

OBJECTIVE

To evaluate the relationship between visual function tests and the visual impairment perceived by PD patients in daily living activities.

METHODS

We cross-sectionally evaluated 62 PD patients and 33 healthy controls (HC). Visual disability was measured with a comprehensive battery of primary visual function and visual cognition tests (visual outcomes), and vision-related quality of life was evaluated with the National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25). The relationship between visual outcomes and NEI VFQ-25 sub-scores was analyzed with Pearson's correlations and stepwise linear regression.

RESULTS

In PD patients, and not in HC, most NEI VFQ-25 sub-scores were significantly correlated with Cube Analysis and Dot Counting from Visual Object and Space Perception (VOSP) battery (visual perception), Clock Drawing Test (visuoconstructive capacity) and Trail Making Test part-A (visual attention and processing speed) and to a lesser extent with high- and low-contrast visual acuity. Dot Counting (VOSP) was the test primarily associated with most NEI VFQ-25 sub-scores (5 out of 12). Roth-28 color test was the one that best explained the variance of Peripheral Vision (R2: 0.21) and Role Difficulties (R2: 0.36) sub-scores of NEI VFQ-25, while photopic contrast sensitivity explained 41% of Driving sub-score variance.

CONCLUSION

Vision-related quality of life in PD is mainly influenced by alterations in visual perception, visuoconstructive capacity and visual attention and processing speed. Future studies are warranted to confirm and further extend our findings.

The Efficacy and Safety of YAG Laser Vitreolysis for Symptomatic Vitreous Floaters of Complete PVD or Non-PVD

INTRODUCTION

To evaluate and compare the efficacy and safety of YAG laser vitreolysis in treating symptomatic vitreous floaters of complete posterior vitreous detachment (PVD) and non-PVD.

METHODS

In this prospective cohort study, 51 eyes with symptomatic floaters were treated with YAG laser vitreolysis. Participants were divided into complete PVD and non-PVD groups. Objective visual quality measures including the Strehl ratio (SR), internal spherical aberration (SA), internal comatic aberration (CA), internal high-order aberration (HOA), area ratio of modulation transfer function (MTFa) and Vitreous Floaters Symptom Questionnaire (VFSQ-13) scores were used to compare the efficacy of YAG laser vitreolysis treatment between two groups.

RESULTS

The mean age of all patients was 56.80 ± 10.82 years old. In total, 36 of 51 (70.59%; 95% CI 58.10-83.10) patients reported their symptoms as significant or complete improvement after YAG laser vitreolysis treatment. Post-treatment MTFa, internal SA and internal HOA were significantly better compared to baseline (26.19 ± 14.73 vs. 29.19 ± 17.98, p = 0.013; 0.05 ± 0.05 vs. 0.04 ± 0.04, p = 0.031 and 0.23 ± 0.22 vs. 0.16 ± 0.07, p = 0.044; respectively) in all eyes. Twenty-nine of 51 (56.86%) eyes had floaters of non-PVD type. Significant or complete subjective improvements in the PVD group and non-PVD group were 72.73% and 68.97% (p = 0.344), respectively.

CONCLUSIONS

Improved subjective and objective visual quality in participants with symptomatic floaters following YAG laser vitreolysis was found in both groups. The efficacy of YAG laser vitreolysis was comparable in floaters of complete PVD and non-PVD types.

The Unified Visual Function Scale Assessments Show Inter- and Intraobserver Agreement and Correlate with Patient Quality of Life in Skull Base Parasellar Tumors

Background The authors have previously described the Unified Visual Function Scale (UVFS). Here, we assessed intra- and interobserver reliability of the scale, and investigated correlations with patient quality of life (QoL).

Methods Eight healthcare practitioners independently applied the UVFS in 20 representative cases from our parasellar meningioma series. Scoring was compared with consensus grades assigned by lead authors. Inter- and intraobserver agreement was measured using intraclass correlation coefficient (ICC), Fleiss's κ, and Cohen's κ, respectively. Patient QoL was assessed Visual Function Questionnaire 25 (VFQ-25) or Activities of Daily Vision Scale (ADVS), and correlated with UVFS grades for each eye.

Results The interobserver ICC was 0.734 (95% confidence interval [CI]: 0.652–0.811), with Fleiss's κ of 0.758, 0.691, and 0.899 for grades A, B, and C, respectively. The intraobserver ICC was 0.758 (95% CI: 0.638–0.872), and Fleiss's κ was 0.604, 0.268, and 0.910 for grades A, B, and C respectively. The Cohen's κ for agreement between UVFS category grades and consensus grades was 0.816 (95 CI: 0.698–0.934). Survey response rate was 51% (27/53). The UVFS demonstrated strong correlation with VFQ-25 subdivisions general vision (r = 0.7712), near activities (r = 0.7262), peripheral vision (r = 0.6722), and driving (r = 0.6608), and also demonstrated strong correlation with the overall ADVS score (r = 0.5902).

Conclusion This study shows that the UVFS is valid within a small subset of observers, and accurately reflects patient QoL. It is robust and practical, which make it suitable for broad implementation.

Quality of life in patients with glaucoma assessed by 39-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-39)

PURPOSE

The purpose of the study was to evaluate glaucoma patients' quality of life (QoL) as measured by National Eye Institute Visual Functioning Questionnaire (NEI VFQ-39) and to examine the influence of patient characteristics and disease stage measured by visual field loss on QoL.

METHODS

A prospective survey of patients with an established diagnosis of glaucoma without concomitant eye disease was conducted. Patients completed a validated German translation of the NEI VFQ-39 questionnaire. Visual field defects were graded using simplified Hodapp's classification. VFQ-39 scores were compared between groups.

RESULTS

We included 60 patients, 28 of whom were classified as early, 16 as moderate, and 16 as advanced stage glaucoma. No differences were found in sex, visual acuity of the better eye, near visual acuity, treatment type, and VFQ rating for "General health" between groups. In the advanced group, VFQ-39 (p = 0.01) and VFQ-25 (p = 0.01) composite scores were significantly lower than in the early group. In addition, distance visual acuity (worse eye) was significantly worse in the advanced than in early stage patients (p = 0.04, Table 4). Patients with advanced glaucoma had significantly lower VFQ-39 subscale scores for "General vision" (p = 0.023), "Near activities" (p = 0.02), "Distance activities" (p = 0.003), "Mental health" (p = 0.008), "Driving" (p = 0.011), and "Peripheral vision" (p = 0.017) than early glaucoma patients. Patients with moderate glaucoma had significantly lower scores for "Distance activities" (p = 0.028) than early stage glaucoma patients. VFI (better eye: r = 0.65, worse eye: r = 0.5) and MD (better eye: r = 0.6, worse eye: r = 0.49) were significantly (p < 0.001) correlated with VFQ-39. Correlations of VFQ-39 with age, VFI intereye difference, distance, or near visual acuity were not significant.

CONCLUSION

Compared to patients with early glaucoma, patients with moderate stage glaucoma reported higher difficulty with distance activities (e.g. navigating an urban environment, watching television). Patients with advanced stage glaucoma reported lower VFQ-39 composite and subscale scores relevant to topics of general vision complaints, difficulties with near work and finding things, navigating urban outdoor environments, and watching television; worries and frustrations with vision difficulties; and difficulty driving and noticing objects off to the side of footpaths. Visual field indices MD and VFI were strongly correlated with QoL as assessed by VFQ-39. VA was not correlated with QoL. In patients with moderate or advanced glaucoma, QoL may be significantly impacted by glaucomatous visual field defects even when visual acuity is preserved.

Psychometric properties of the Dutch version Adult Strabismus-20 Questionnaire (AS-20)

PURPOSE

Strabismus often has an impact on a patient's quality of life (QoL). The Adult Strabismus-20 questionnaire (AS-20) is an instrument developed to assess the strabismus-specific QoL. The aim was to investigate several psychometric properties of the Dutch-AS-20 among adult patients with strabismus.

METHODS

Patients with any type of strabismus completed the Dutch-AS-20, the EuroQol five-dimensional questionnaire (EQ-5D-5L) and the Amblyopia and Strabismus Questionnaire (A&SQ) (N = 286). Psychometric properties were evaluated with the use of item response theory (IRT) analysis (graded response model) and by determining the internal consistency, test-retest reliability after two weeks, targeting and measurement precision. Construct validity of the AS-20 was tested against the EQ-5D-5L and the A&SQ.

RESULTS

Principal component analysis indicated a psychosocial and function subscale. After collapsing underutilised response options for 10 items, subsequent fit analysis showed that the function subscale benefitted from removal of two items. Differential item functioning (DIF) was detected on four items for age and gender subgroups, but with minimal impact on the total score. Internal consistency (Cronbach's alpha 0.93 psychosocial and 0.87 function subscale) and test-retest reliability (ICC 0.91 psychosocial and 0.88 function subscale) were sufficient. Targeting and measurement precision of both subscales was appropriate for patients with low to moderate levels of visual and psychosocial functioning but suboptimal for patients with high levels of visual and psychosocial functioning. Correlations were between 0.4 and 0.7 for (subscales of) the Dutch-AS-20 and the A&SQ or EQ-5D-5L, confirming expected construct validity.

CONCLUSIONS

The 18-item Dutch-AS-20 has sound psychometric properties to assess the strabismus-specific QoL among Dutch adult patients with low to moderate levels of visual and psychosocial functioning. Care must be taken when interpreting the results due to lower measurement precision at the higher end of both subscales. In future longitudinal studies, properties to assess treatment effects should be evaluated.

Validation and comparison of the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) and the Visual Function Index-14 (VF-14) in patients with cataracts: a multicentre study

PURPOSE

The present study aimed to investigate and compare the psychometric properties of the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) and the Visual Function Index-14 (VF-14) in a large sample of patients with cataracts.

METHODS

A total of 1052 patients with bilateral age-related cataracts were recruited in the study. Patients with other comorbidities that severely impacted vision were excluded. Participants completed the two questionnaires in random order. Classical test theory and Rasch analyses were used to assess the psychometric properties of the questionnaires.

RESULTS

Complete data were obtained from 899 patients. The mean overall index score on the NEI VFQ-25 was 76.1 ± 19.0, while that on the VF-14 was 46.5 ± 15.0. Cronbach's α-values for the NEI VFQ-25 and VF-14 were 0.89 and 0.95, respectively. Ceiling effects were observed on nine of the 12 subscales in the NEI VFQ-25. The correlation between total scores on the NEI VFQ-25 and VF-14 was moderate (r = 0.600; p < 0.001), and subscales of the NEI VFQ-25 were weakly or moderately correlated with the similar domains on the VF-14. Rasch analysis revealed ordered category thresholds and sufficient person separation for both instruments, while the two questionnaires had critical deficiencies in unidimensionality, targeting and differential item functioning.

CONCLUSION

Neither the NEI VFQ-25 nor VF-14 is optimal for the assessment of vision-related quality of life in typical Chinese patients with cataracts. The potential deficiencies of the questionnaires should be taken into consideration prior to application of the instruments or interpretation of the results.

Functional and Structural Changes Following Corneal Neurotisation in the Management of Neurotrophic Keratopathy: UK Single Centre Series

OBJECTIVE

To report the functional and anatomical outcomes including structural changes in corneal nerve density and morphology using in vivo confocal microscopy (IVCM) after corneal neurotisation in patients with neurotrophic keratopathy (NK), using a sural nerve graft.

PATIENTS AND METHODS

Prospective study of patients undergoing corneal neurotisation for NK. Functional outcomes were measured through visual acuity, slit-lamp examination of corneal and conjunctival staining, tear production (Schirmer's 1 test), tear film break-up time, tear film meniscus height, quality and osmolarity, central corneal thickness and corneal sensation using Cochet-Bonnet esthesiometry. Structural outcomes were assessed from changes in corneal nerve density and morphology with IVCM. Subjective outcomes were assessed using VFQ-25 and latest telephonic consultation.

RESULTS

Between February 2016 and April 2018, 11 corneal neurotisations were performed on 11 patients (3 males, 8 females). Median age was 43 (range 25-62) years. Mean follow-up was 14.5 (range, 4-36) months. Snellen visual acuity improved in 6 patients, corneal and conjunctival staining decreased in 10, tear film breakup time increased in 9, tear meniscus height increased in 7, Schirmers test readings increased in 4, tear film osmolarity reduced in 8 and central corneal thickness increased in 10 patients. Corneal sensation improved in nine patients. Complete IVCM data were available in five cases and demonstrated an improvement of corneal nerve density and length at 12 months.

CONCLUSION

This series confirms the fact that the outcomes of this technique are reproducible and that corneal neurotisation surgery helps restore trophic nerve function more consistently than touch-related sensation.

Impact of binocular integrated visual field defects on healthy related quality of life in glaucoma

To investigate the impact of different types of binocular integrated visual field defects on the quality of life in glaucoma.Ninety-six patients with primary glaucoma were divided into 5 groups with 25, 24, 11, 15, and 21 patients according to types of the binocular integrated visual field (BVF) defects. The criteria for BVF grouping included mild visual field defect in binocular eyes, mild visual field defect in 1 eye and moderate or advanced defect in the other, moderate and non-overlapping visual field defect in both eyes, overlapping and moderate visual field defect in binocular eyes, and severe defect in both eyes, respectively. The visual field (VF) evaluation was based on H-P-A visual field grading system. Visual acuity, visual field tests and Glaucoma Quality of Life-15 Questionnaire (GQL-15) were performed for enrolled patients, and binocular visual field results were integrated. The changes and correlations of the Visual field index values and quality of life scores were compared among the 5 groups. The main factors affecting the quality of life in glaucoma were analyzed by multiple regression analysis.The best binocular integrated visual field index (BVFI) and optimal quality of life were observed in group A. The BVFI of group B was better than that of group C or group D, but the peripheral vision glare and dark adaptation were worse. No significant difference was noted between group C and group D in terms of BVFI. However, the glare and dark adaptation in group C were better than that in group D. The BVFI was the lowest and the quality of life was the worst in group E. In all, BVFI and decibels (dB) values were negatively correlated with GQL-15 scores and positively correlated with patients' quality of life.Binocular integrated visual field accurately reflects the visual function in glaucoma. Higher binocular integrated visual field indices represent a better quality of life for patients with glaucoma. Mild to moderate synchronous or complementary binocular VF defects had a slight effect on the quality of life, while severe and non-compensated VF loss significantly impacts on quality of life in glaucoma patients.

Antioxidative activity of probiotics

Probiotics are defined as live microorganisms that have a beneficial effect on health by exhibiting quantitative and qualitative effects on intestinal microflora and/or modification of the immune system. A strain is considered probiotic if it demonstrates a series of clinically proven health benefits. In recent years, the number of studies related to the antioxidant properties of probiotics has significantly increased. Antioxidants are substances that inhibit the degree of oxidation of molecules and cause the transformation of radicals into inactive derivatives. The incorrect or inefficient antioxidant mechanisms results in oxidative stress and may occur in the course of many diseases such as diabetes, atherosclerosis, inflammatory bowel disease or damage to the heart, brain or transplanted organs. Correct functioning of antioxidant mechanisms seems to be crucial for the proper functioning of our body; therefore, probiotics should be carefully investigated for potential antioxidant properties.

Useful Field of View Performance in the Intact Visual Field of Hemianopia Patients

Purpose

Postchiasmatic brain damage commonly results in an area of reduced visual sensitivity or blindness in the contralesional hemifield. Previous studies have shown that the ipsilesional visual field can be impaired too. Here, we examine whether assessing visual functioning of the “intact” ipsilesional visual field can be useful to understand difficulties experienced by patients with visual field defects.

Methods

We compared the performance of 14 patients on a customized version of the useful field of view test that presents stimuli in both hemifields but only assesses functioning of their intact visual half-field (iUFOV) with that of equivalent hemifield assessments in 17 age-matched healthy control participants. In addition, we mapped visual field sensitivity with the Humphrey Field Analyzer. Last, we used an adapted version of the National Eye Institute Visual Quality of Life-25 to measure their experienced visual quality of life.

Results

We found that patients performed worse on the second and third iUFOV subtests, but not on the first subtest. Furthermore, patients scored significantly worse on almost every subscale, except ocular pain. Summed iUFOV scores (assessing the intact hemifield only) and Humphrey field analyzer scores (assessing both hemifields combined) showed almost similar correlations with the subscale scores of the adapted National Eye Institute Visual Quality of Life-25.

Conclusions

The iUFOV test is sensitive to deficits in the visual field that are not picked up by traditional perimetry. We therefore believe this task is of interest for patients with postchiasmatic brain lesions and should be investigated further.

Frequency of cataract surgery and its impact on visual function-results from the German Gutenberg Health Study

Purpose

To determine the frequency of cataract surgery in Germany and to evaluate its impact on visual function in an adult population.

Methods

The population-based Gutenberg Health Study was conducted in Germany with its baseline examination between 2007 and 2012 and a 5-year follow-up examiantion. An ophthalmological examination including slit-lamp examination, ocular biometry, and Scheimpflug imaging was carried out. Overall and age-specific frequencies of unilateral and bilateral cataract surgery within 5 years were computed including the 95% confidential intervals [95%-CI]. Association analyses were conducted to determine social and ocular associated factors using multivariable logistic regression analysis. Vision-related quality of life was assessed using NEI VFQ-25.

Results

A total of 10,544 people aged 35 to 74 years were bilateral phakic at baseline and had information on lens status at the 5-year examination. Of these, 168 had unilateral cataract surgery (1.6% [1.4–1.9%]), and 448 had bilateral cataract surgery (4.2% [3.9–4.7%]) in the following 5 years. The frequency of cataract surgery increased with age: 45–54-year-old subjects had twice as often cataract surgery (in at least on eye: OR = 2.32) than at age 35–44 years. The frequency further strongly increases with age (55–64 years: OR = 10.5; 65–74 years: OR = 43.8, p < 0.001). Subjects with glaucoma were more likely to have cataract surgery (OR = 2.52, p < 0.001). Visual function increased when undergoing bilateral cataract surgery.

Conclusions

The frequency of cataract surgery is low at younger ages and increases up to 26% at age 70–74 years. Persons with glaucoma are more likely to undergo cataract surgery at population-based level in Germany.

Electronic supplementary material

The online version of this article (10.1007/s00417-020-04770-0) contains supplementary material, which is available to authorized users.

Correlation among Lens Opacities Classification System III grading, the 25-item National Eye Institute Visual Functioning Questionnaire, and Visual Function Index-14 for age-related cataract assessment

Purpose

To evaluate the relationship between cataract types and subjective visual function among patients with age-related cataract.

Methods

This was a prospective, multicenter, 831 Chinese patient-based, cross-sectional study. Patients were administered the Visual Function Index-14 (VF-14) and the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) to evaluate their subjective visual function. Lens Opacities Classification System III (LOCS III) was used to evaluate the type of cataract. Relationships among these parameters were analyzed.

Results

LOCS III cortical (C) and posterior subcapsular scores are negatively associated with VF-14 (r = − 0.188, P < 0.01; r = − 0.146, P < 0.01) and total score of NEI-VFQ-25 (r = − 0.223, P < 0.01; r = − 0.160, P < 0.01), respectively; LOCS III nuclear opalescence (NO) score is positively associated with VF-14 (r = 0.087, P < 0.05) and total score of NEI-VFQ-25 (r = 0.097, P < 0.05). In multiple linear regression, a decrease in the LOCS III C score is a significant predictor for improvement of the total score of NEI-VFQ-25 (β = − 1.286, P < 0.05). In contrast, an increase in LOCS III NO score is a significant predictor for improvement of VF-14 (β = 3.826, P < 0.01) and total score of NEI-VFQ-25 (β = 4.618, P < 0.01). Patients with LOCS III C score ≤ 2 have higher VF-14 (49.38 versus 43.74, P < 0.01), total (80.73 versus 71.58, P < 0.01) and subscale scores of NEI-VFQ-25 than patients with LOCS III C score > 2.

Conclusion

Cortical cataract has adverse effects on subjective visual function, while mild-to-moderate nuclear cataract has positive effects. Furthermore, “LOCS III C score > 2” can be a potential cutoff as a reference for cataract surgery without self-assessing questionnaires.

Electronic supplementary material

The online version of this article (10.1007/s10792-020-01353-0) contains supplementary material, which is available to authorized users.

Quality of life of patients with central serous chorioretinopathy - a major cause of vision threat among middle-aged individuals

INTRODUCTION

The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was designed to measure the vision-related quality of life (QoL). We aimed to assess the effect of disease duration, disease type (i.e., acute vs. chronic and unilateral vs. bilateral), and selected sociodemographic data on the QoL of patients with central serous chorioretinopathy (CSC).

MATERIAL AND METHODS

The study included 79 patients diagnosed with CSC. The QoL was assessed using the NEI VFQ-25. The statistical analysis was performed using IBM SPSS Statistics 24.

RESULTS

A significant positive correlation was found between deterioration in peripheral vision as assessed by the NEI VFQ-25 and duration of CSC (r = -0.22, p = 0.046). Compared with women, men obtained higher scores on the scales assessing general health, mental health, ocular pain and role limitations (p = 0.018, p = 0.027, p = 0.009 and p = 0.007, respectively). Patients with acute CSC reported higher levels of social functioning as compared with those with chronic CSC (p = 0.04). There were no differences in any of the scales between patients with unilateral and bilateral CSC. Elderly patients obtained lower scores on 9 of the 12 analyzed scales, as compared with younger patients (p < 0.05).

CONCLUSIONS

Patients with CSC do not assess their QoL in negative terms, which may be related to the fact that the disease presents with transient symptoms. However, the QoL deteriorated with longer disease duration. Men with CSC have better vision-related QoL than women.

Eye Pain and Dry Eye in Patients with Fibromyalgia

Objectives

The aim of this study was to examine visual function and eye symptoms in fibromyalgia patients, with a particular focus on dry eye syndrome and eye pain.

Methods

A tertiary care center-based cross-sectional study was carried out in chronic musculoskeletal pain patients diagnosed with fibromyalgia. Chronic musculoskeletal pain patients without fibromyalgia were enrolled as a comparison group. Self-reported eye pain was investigated with the McGill pain questionnaire and the numeric rating scale. In addition, we assessed corrected visual acuity, vision-related quality of life, and self-reported dry eye syndrome.

Results

A total of 90 musculoskeletal pain patients were included, with 66 patients fulfilling American College of Rheumatology 1990 criteria for fibromyalgia. Sixty-seven percent (95% confidence interval [CI] = 56%-78%) of the fibromyalgia patients reported eye pain, and 62% (95% CI = 43%-81%) of those were without fibromyalgia diagnosis. Sixty-seven percent (95% CI = 56%-78%) of the fibromyalgia patients reported an experience of dry eye compared with 76% (95% CI = 57%-95%) in the nonfibromyalgia group. Vision-related quality of life was noticeably reduced in both groups.

Conclusions

Eye pain and dry eye are common in chronic pain patients, with comparable prevalence in musculoskeletal pain patients with and without fibromyalgia.

Low vision status and declining vision decrease Health-Related Quality of Life: Results from a nationwide 11-year follow-up study

PURPOSE

The impact of visual acuity (VA) on Health-Related Quality of Life (HRQoL) and the cross-sectional and longitudinal differences in HRQoL during the 11-year follow-up were investigated. The aim was to examine the impact declining vision has on HRQoL and to provide comparable data to facilitate the allocation of health-care resources.

METHODS

We utilized nationwide health examination surveys carried out by the National Institute for Health and Welfare in 2000 and 2011, providing a representative sampling of the Finnish adult population aged 30 and older. VA was assessed through Snellen E test, and HRQoL scores were evaluated using EQ-5D and 15D questionnaires. Multiple imputations with Markov chain Monte Carlo method was used to utilize the data more effectively. Regression analyses were conducted to assess the impact of declining VA on HRQoL, adjusted for incident comorbidities.

RESULTS

Lower VA status was associated with significantly lower HRQoL at both time points, most clearly observable below the VA level of 0.5. Declining VA resulted in statistically significant decline in HRQoL during the follow-up, greater with distance than near VA. 15D impairment associated with decline in the distance VA was also clinically meaningful and greater than that associated with any of the examined comorbidities.

CONCLUSIONS

HRQoL was significantly and meaningfully impaired even before the threshold of severe vision loss or blindness was reached. The results encourage the improvement of available treatment options aiming to postpone the onset of visual impairment or declining VA, to maintain better quality of life among the population.

Vision-related quality of life considering both eyes: results from the German population-based Gutenberg Health Study (GHS)

PURPOSE

Most definitions of visual impairment focus on the status of the better-seeing eye only, but this approach might underestimate the influence of the worse-seeing eye on the vision-related quality of life (VRQoL).

METHODS

We assessed distance-corrected visual acuity in both eyes and VRQoL using the "National Eye Institute 25-Item Visual Function Questionnaire" (NEI VFQ-25) in the German population-based Gutenberg Health Study. We calculated the Rasch-based visual functioning scale (VFS) and socioemotional scale (SES). We categorized the visual acuity of the better-seeing eye (BE) and worse-seeing eye (WE) as follows: (1) no visual impairment (VI) (< 0.32 logMAR)), (2) mild VI (0.32-0.5 logMAR), and (3) moderate to severe VI (> 0.5 logMAR). Next, the subjects were categorized as follows: both eyes with no VI (no/no), the better-seeing eye with no VI and the worse-seeing eye with mild VI (no/mild), no VI/severe VI (no/severe), both eyes with mild VI (mild/mild), light VI/severe VI (mild/severe), and both eyes with severe VI (severe/severe). We calculated the median scores for VFS and SES. We used linear regression to estimate the combined influence of BE/WE on VFS and SES.

RESULTS

We included 11,941 participants (49.9% female, age range: 35-74 years) with information on VRQoL and visual acuity. The median VFS/SES scores were 90/100 (no/no VI group), 84/97 (no/mild group), 81/94 (no/severe group), 70/90 (mild/mild group), 67/74 (mild/severe group), and 63/76 (severe/severe group). These differences were supported by the regression analysis results.

CONCLUSION

Relying on the function of the better-seeing eye considerably underestimates the impact of visual impairment on VRQoL.