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Mohammed J, Assegid S, Fekadu L, Kabeta T. Cataract Surgery Visual Outcome and Associated Factors Among Adults Attended Jimma University Medical Center, Jimma, Southwest Ethiopia. Clin Ophthalmol 2023; 17:3341-3351. [PMID: 37941776 PMCID: PMC10629348 DOI: 10.2147/opth.s434453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023] Open
Abstract
Background Cataract is the leading cause of blindness and the second leading cause of visual impairment worldwide, accounting for 51% and 33% of all cases, respectively, in low- and medium-income countries bearing a disproportionately high burden. Hence, this study aimed to assess the visual outcome of age-related cataract surgery and identify factors associated with patients' postoperative visual outcomes in Jimma University Medical Center, Southwest Ethiopia. Methods An institution-based cross-sectional study design was conducted among 386 cataract surgery patients from January 1, 2016, to December 30, 2017. The study participants were selected using a systematic random sampling technique. Data were collected by reviewing the selected patients' medical records using a pre-tested checklist, entered into EpiData version 3.1, and exported to SPSS 20 for analysis. Proportions, summary statistics, and tables were used for presentations of the findings. Binary logistic regression was carried out to identify independent predictors of visual outcome. Findings were presented with adjusted odds ratios and their 95% confidence interval. A p-value <0.05 was used to declare a statistically significant association. Results About 231 individuals (59.8%) had poor visual results following cataract surgery. Furthermore, age >70 (AOR = 3.64; 95% CI [1.35-9.82]), preoperative ocular co-morbidities (AOR = 2.34; [1.32-4.15]), incision-based cataract surgery (AOR = 7.11; [3.16-16.02]), compared phacoemulsification operated by resident surgeons (AOR = 2.19; [1.23-3.89]), presence of intraoperative complication (AOR = 3.41; [1.47-7.92]), lens remnant (AOR = 2.91; [1.11-4.92]), ocular inflammation (OR = 2.56; [1.34-4.92]), and striate keratopathy/corneal edema (AOR = 1.91; [1.07-3.44]) were significantly associated with poor visual outcome. Conclusion The visual outcome following cataract surgery fall below WHO recommendation. In this study, age, ocular co-morbidities, surgical method, surgeon status, intraoperative complication, SK, and ocular inflammation associated with post-operative Uveitis and anterior chamber reaction were associated with a poor visual outcome.
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Affiliation(s)
- Jemmal Mohammed
- Department of Ophthalmology, Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Sahilu Assegid
- Department of Epidemiology, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Lata Fekadu
- Department of Epidemiology, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Teshome Kabeta
- Department of Epidemiology, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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Kai JY, Xu Y, Li DL, Zhou M, Wang P, Pan CW. Impact of major age-related eye disorders on health-related quality of life assessed by EQ-5D: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2023; 261:2455-2463. [PMID: 36917317 DOI: 10.1007/s00417-023-06034-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/13/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
PURPOSE This study is to quantitatively estimate the health-related quality of life (HRQOL) impact of major age-related eye diseases (AREDs) including cataract, glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR) assessed by the EuroQoL Five-Dimensional Questionnaire (EQ-5D). METHODS PubMed, Embase, Cochrane Library, and CINAHL were searched until October 20, 2022. Studies were included if they reported the EQ-5D health utility score (HUS) or visual analogue scale (VAS) score of both AREDs patients and healthy controls. The mean difference (MD) in HUS or VAS score between cases and controls and its 95% confidence interval (95%CI) were pooled using the random-effects model. We also performed sensitivity analysis using the leaving-one-out method and subgroup analyses by sample size and race. The prevalence in reporting any problems in the five EQ-5D dimensions was summarized and compared between cases and controls using the Chi-square test. RESULTS Fifteen articles involving 30,491 participants were included in this review. Pooled estimates indicated reduced HUS in AMD patients (MD = - 0.04, 95%CI - 0.07, - 0.01; P = 0.009), DR patients (MD = - 0.03, 95%CI - 0.05, - 0.01; P = 0.01), and glaucoma patients (MD = - 0.06, 95%CI - 0.10, - 0.01; P = 0.01), compared with the controls. Significantly lower EQ-5D VAS score was also observed in cataract patients (MD = - 11.33, 95%CI - 13.47, - 9.18; P < 0.001) and DR patients (MD = - 6.41, 95%CI - 10.64, - 2.18; P = 0.003). AREDs patients reported usual activities and anxiety/depression problems more frequently than the control group. CONCLUSIONS Our findings confirmed the HRQOL impairment caused by major AREDs including AMD, cataract, DR, and glaucoma. High-quality studies with large sample sizes are warranted to further verify our results.
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Affiliation(s)
- Jia-Yan Kai
- School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou, 215123, China
| | - Yue Xu
- Department of Ophthalmology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Dan-Lin Li
- School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou, 215123, China
| | - Miao Zhou
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Pei Wang
- School of Public Health, Fudan University, 130 Dong An Road, Shanghai, 200032, China.
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, 130 Dong An Road, Shanghai, 200032, China.
| | - Chen-Wei Pan
- School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou, 215123, China.
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Nayeni M, Dang A, Mao AJ, Malvankar-Mehta MS. Quality of life of low vision patients: a systematic review and meta-analysis. Can J Ophthalmol 2020; 56:151-157. [PMID: 33189608 DOI: 10.1016/j.jcjo.2020.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 10/10/2020] [Accepted: 10/12/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Quality of vision plays an important role in everyday living, and low vision (LV) can take a toll on individual's quality of life (QOL). The objective of this paper is to evaluate the impact of LV on QOL and depressive symptoms in LV patients compared with healthy controls. DESIGN Systematic review and meta-analysis. METHODS Literature was systematically searched to obtain all relevant records. Covidence software was used to conduct the systematic review. Duplicate records were removed, and 2 independent reviewers screened records for relevance. After screening, risk of bias assessment was carried out. Data were extracted and meta-analysis was performed using STATA 15.0. Fixed-effect and random-effect models were computed based on heterogeneity. RESULTS In total, 2870 records were retrieved from database and grey literature searches. Twelve articles (35 341 subjects) were included for quantitative analysis. Overall, the QOL of LV patients was significantly lower compared with healthy individuals. Common QOL questionnaires, including 25-item visual function questionnaire (VFQ-25) (standard mean difference [SMD] = 0.91, confidence interval [CI]: [0.42-1.40]), 36-item short form survey (SMD = 0.53, CI: [0.26-0.80]), VFQ-14 (SMD = 0.58, CI: [0.42-0.74]), and visual function QOL questionnaire (SMD = 0.68, CI: [0.54-0.82]), demonstrated a poor QOL in LV patients compared with healthy controls. Additionally, odds of depressive symptoms were significantly greater (odds ratio = 2.25, CI: [1.58-3.21]) in LV patients compared with controls. CONCLUSION LV patients demonstrated a poor QOL and higher odds of depressive symptoms compared with healthy controls.
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Affiliation(s)
- Manav Nayeni
- Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ont
| | - Arpit Dang
- Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ont
| | - Alex J Mao
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ont
| | - Monali S Malvankar-Mehta
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ont.; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ont..
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Wan Y, Wang Y, Zhao L, Sun M, An L, Yang Y, Jiang A, Xu Y, Chen Z, Li X. 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. Int Ophthalmol 2020; 40:1831-1839. [PMID: 32249376 PMCID: PMC7308262 DOI: 10.1007/s10792-020-01353-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/24/2020] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- Yu Wan
- Peking University Third Hospital, Beijing, China
| | - Yinhao Wang
- Peking University Third Hospital, Beijing, China
| | | | - Min Sun
- Huabei Petroleum General Hospital, Renqiu, China
| | - Li An
- Datong Aier Eye Hospital, Datong, China
| | - Yang Yang
- The Hospital of Shunyi District Beijing, Beijing, China
| | - Aimin Jiang
- The Hospital of Shunyi District Beijing, Beijing, China
| | | | | | - Xuemin Li
- Peking University Third Hospital, Beijing, China.
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Breheny K, Hollingworth W, Kandiyali R, Dixon P, Loose A, Craggs P, Grzeda M, Sparrow J. Assessing the construct validity and responsiveness of Preference-Based Measures (PBMs) in cataract surgery patients. Qual Life Res 2020; 29:1935-1946. [PMID: 32080789 PMCID: PMC7295830 DOI: 10.1007/s11136-020-02443-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE The validity and responsiveness of the EQ-5D-3L in visual conditions has been questioned, inspiring development of a vision 'bolt-on' domain (EQ-5D-3L + VIS). Developments in preference-based measures (PBM) also includes the EQ-5D-5L and the ICECAP-O capability wellbeing measure. This study aimed to examine the construct validity and responsiveness of the EQ-5D-3L, EQ-5D-5L, EQ-5D-3L + VIS and ICECAP-O in cataract surgery patients for the first time, to inform choice of PBM for economic evaluation in this population. METHODS The analyses used data from the UK Predict-CAT cataract surgery cohort study. PBMs and the Cat-PROM5 [a validated measure of cataract quality of life (QOL)] were completed before surgery and 4-8 weeks after. Construct validity was assessed using correlations and known-group differences evaluated using regression. Responsiveness was evaluated using effect sizes and analysis of variance to compare change scores between groups, defined by patient-reported and clinical outcomes. RESULTS The sample comprised 1315 patients at baseline. No PBMs were associated with visual acuity and only the ICECAP-O (Spearman's rs = - 0.35), EQ-5D-3L + VIS (rs = - 0.42) and EQ-5D-5L (Value Set for England rs = - 0.31) correlated at least moderately with the Cat-PROM5. Effect sizes of change were consistently largest for the EQ-5D-3L + VIS (range 0.34-0.41), followed by the ICECAP-O (range 0.20-0.34). Results indicated no improvement in responsiveness using the EQ-5D-5L (range 0.13-0.16) compared to the EQ-5D-3L (range 0.17-0.20). CONCLUSIONS Whilst no PBMs comprehensively demonstrated evidence of construct validity and responsiveness in cataract surgery patients, the ICECAP-O was the most responsive generic PBM to improvements in QOL. Surprisingly the EQ-5D-5L was not more responsive than the EQ-5D-3L in this setting.
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Affiliation(s)
- Katie Breheny
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - William Hollingworth
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebecca Kandiyali
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Padraig Dixon
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Abi Loose
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK
| | - Pippa Craggs
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK
| | - Mariusz Grzeda
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK
| | - John Sparrow
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK
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Fung SSM, Luis J, Hussain B, Bunce C, Hingorani M, Hancox J. Patient-reported outcome measuring tools in cataract surgery: Clinical comparison at a tertiary hospital. J Cataract Refract Surg 2018; 42:1759-1767. [PMID: 28007107 DOI: 10.1016/j.jcrs.2016.08.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 08/16/2016] [Accepted: 08/25/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE To assess the performance of patient-reported outcome measure questionnaires and determine their appropriateness for routine use in cataract patients. SETTING Moorfields Eye Hospital, London, United Kingdom. DESIGN Prospective cohort study. METHODS Patients having cataract surgery between February and March 2013 were recruited. The following 4 questionnaires-Catquest-9SF, EuroQol 5-dimensions questionnaire (EQ-5D) and visual analog scale (EQ-VAS), National Eye Institute Socioemotional Scale (NEI-SES), and short-form Visual Function Index (VF-8R)-were completed preoperatively and 3 weeks and 3 months postoperatively. The questionnaires' performances were then compared. The paired Student t test and Pearson correlations were used for statistical analysis. RESULTS One hundred twenty-two patients were recruited; 67.2% and 61.8% completed 3-week and 3-month follow-up, respectively. The changes in the mean scores for the Catquest-9SF, EQ-5D, EQ-VAS, NEI-SES, and VF-8R at 3 weeks were 120.86% (P < .0001), 1.61% (P = .61), 3.37% (P = .09), 16.12% (P = .12), and 61.76 % (P < .0001), respectively. At 3 months, the changes were 162.42% (P < .0001), 4.54% (P = .16), 4.84% (P = .09), 54.63% (P < .0001), and 87.55% (P < .0001), respectively. Correlations between patient-reported outcome measure questionnaires and visual acuity measures were variable and weak at best. CONCLUSIONS It is feasible to assess patient-reported outcomes in cataract surgery as part of routine clinical practice. In addition, visual acuity might not fully reflect patients' visual function. Clinicians should consider using patient-reported outcome measure questionnaires to facilitate surgical decision-making and outcome monitoring. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Simon S M Fung
- From Moorfields Eye Hospital NHS Foundation Trust (Fung, Hussain, Bunce, Hingorani, Hancox) and St. George's University Hospitals NHS Foundation Trust (Luis), London, United Kingdom.
| | - Joshua Luis
- From Moorfields Eye Hospital NHS Foundation Trust (Fung, Hussain, Bunce, Hingorani, Hancox) and St. George's University Hospitals NHS Foundation Trust (Luis), London, United Kingdom
| | - Badrul Hussain
- From Moorfields Eye Hospital NHS Foundation Trust (Fung, Hussain, Bunce, Hingorani, Hancox) and St. George's University Hospitals NHS Foundation Trust (Luis), London, United Kingdom
| | - Catey Bunce
- From Moorfields Eye Hospital NHS Foundation Trust (Fung, Hussain, Bunce, Hingorani, Hancox) and St. George's University Hospitals NHS Foundation Trust (Luis), London, United Kingdom
| | - Melanie Hingorani
- From Moorfields Eye Hospital NHS Foundation Trust (Fung, Hussain, Bunce, Hingorani, Hancox) and St. George's University Hospitals NHS Foundation Trust (Luis), London, United Kingdom
| | - Joanne Hancox
- From Moorfields Eye Hospital NHS Foundation Trust (Fung, Hussain, Bunce, Hingorani, Hancox) and St. George's University Hospitals NHS Foundation Trust (Luis), London, United Kingdom
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Tseng YC, Liu SHY, Lou MF, Huang GS. Quality of life in older adults with sensory impairments: a systematic review. Qual Life Res 2018; 27:1957-1971. [PMID: 29404924 DOI: 10.1007/s11136-018-1799-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE Sensory impairments are common in older adults. Hearing and visual impairments affect their physical and mental health and quality of life adversely. However, systematic reviews of the relationship between hearing impairment, visual impairment, dual sensory impairment, and quality of life are scarce. The purpose of this systematic review was to determine the relationship between hearing impairment, visual impairment, dual sensory impairment, and quality of life. METHODS Searches of EMBASE, PubMed, CINAHL, MEDLINE, Cochrane Library, and Airiti Library were conducted between January 2006 and December 2017 using the keywords "quality of life," "life satisfaction," "well-being," "hearing impairment," and "visual impairment." Two authors independently assessed methodologic quality using a modified Downs and Black tool. Data were extracted by the first author and then cross-checked by the second author. RESULTS Twenty-three studies consisting mostly of community-dwelling older adults were included in our review. Sensory impairment was found to be in significant association with quality of life, with an increase in hearing impairment or visual impairment severity resulting in a lower quality of life. Quality of life for dual sensory impairment was worse than for hearing impairment or visual impairment individually. CONCLUSIONS A significant association was confirmed between hearing impairment, visual impairment, dual sensory impairment, and quality of life. Our review can be used to enhance health care personnel's understanding of sensory impairment in older adults and enable health care personnel to actively assess older adults' sensory functions, so that they can help alleviate the negative impact of sensory impairments on QOL in older adults.
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Affiliation(s)
- Ya-Chuan Tseng
- School of Nursing, College of Medicine, National Taiwan University, No. 1, Jen-Ai Rd. Sec. 1, Taipei, 10051, Taiwan, ROC
| | - Sara Hsin-Yi Liu
- School of Nursing, College of Medicine, National Taiwan University, No. 1, Jen-Ai Rd. Sec. 1, Taipei, 10051, Taiwan, ROC
| | - Meei-Fang Lou
- School of Nursing, College of Medicine, National Taiwan University, No. 1, Jen-Ai Rd. Sec. 1, Taipei, 10051, Taiwan, ROC
| | - Guey-Shiun Huang
- School of Nursing, College of Medicine, National Taiwan University, No. 1, Jen-Ai Rd. Sec. 1, Taipei, 10051, Taiwan, ROC.
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Habtamu E, Wondie T, Aweke S, Tadesse Z, Zerihun M, Mohammed A, Zewudie Z, Callahan K, Emerson PM, Bailey RL, Mabey DCW, Rajak SN, Kuper H, Polack S, Weiss HA, Burton MJ. Impact of Trichiasis Surgery on Quality of Life: A Longitudinal Study in Ethiopia. PLoS Negl Trop Dis 2016; 10:e0004627. [PMID: 27078493 PMCID: PMC4831752 DOI: 10.1371/journal.pntd.0004627] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/23/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Trachomatous trichiasis significantly reduces vision and health related quality of life (QoL). Although trichiasis surgery is widely performed to treat trichiasis, there is little data on the effect of surgery on QoL. We measured the impact of trichiasis surgery on vision and health related QoL in a longitudinal study from Amhara Region, Ethiopia. METHODOLOGY/PRINCIPAL FINDINGS We recruited 1000 adult participants with trichiasis (cases) and 200 comparison participants, matched to every fifth trichiasis case on age (+/- two years), sex and location. Vision-related quality of life (VRQoL) and health-related quality of life (HRQoL) were measured using the WHO/PBD-VF20 and WHOQOL-BREF questionnaires respectively, at enrolment and 12 months after enrolment. All trichiasis cases received free standard trichiasis surgery immediately after enrolment. The mean difference in QoL scores between enrolment and follow-up for cases and comparison participants, and the difference-in-differences by baseline trichiasis status was analysed using random effects linear regression, the later adjusted for age, sex and socioeconomic status. At 12-months follow-up, data was collected from 980 (98%) and 198 (98%) trichiasis cases and comparison participants respectively. At this follow-up visit, VRQoL and HRQoL scores of trichiasis cases improved substantially in all subscales and domains by 19.1-42.0 points (p<0.0001) and 4.7-17.2 points (p<0.0001), respectively. In contrast, among the comparison participants, there was no evidence of improvement in VRQoL and HRQoL domain scores during follow-up. The improvement in VRQoL and HRQoL in cases was independent of the presence of visual acuity improvement at 12 months. CONCLUSIONS/SIGNIFICANCE Trichiasis surgery substantially improves both VRQoL and HRQoL regardless of visual acuity change. Unprecedented effort is needed to scale-up trichiasis surgical programmes not only to prevent the risk of sight loss but also to improve overall wellbeing and health perception of affected individuals.
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Affiliation(s)
- Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Carter Center, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | - Kelly Callahan
- The Carter Center, Atlanta, Georgia, United States of America
| | - Paul M. Emerson
- International Trachoma Initiative, Atlanta, Georgia, United States of America
| | - Robin L. Bailey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David C. W. Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Saul N. Rajak
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen A. Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthew J. Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Habtamu E, Wondie T, Aweke S, Tadesse Z, Zerihun M, Zewudie Z, Gebeyehu W, Callahan K, Emerson PM, Kuper H, Bailey RL, Mabey DCW, Rajak SN, Polack S, Weiss HA, Burton MJ. The Impact of Trachomatous Trichiasis on Quality of Life: A Case Control Study. PLoS Negl Trop Dis 2015; 9:e0004254. [PMID: 26598937 PMCID: PMC4657886 DOI: 10.1371/journal.pntd.0004254] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/01/2015] [Indexed: 12/30/2022] Open
Abstract
Background Trachomatous trichiasis is thought to have a profound effect on quality of life (QoL), however, there is little research in this area. We measured vision and health-related QoL in a case-control study in Amhara Region, Ethiopia. Methodology/Principal Findings We recruited 1000 adult trichiasis cases and 200 trichiasis-free controls, matched to every fifth trichiasis case on age (+/- two years), sex and location. Vision-related quality of life (VRQoL) and health-related quality of life (HRQoL) were measured using the WHO/PBD-VF20 and WHOQOL-BREF questionnaires. Comparisons were made using linear regression adjusted for age, sex and socioeconomic status. Trichiasis cases had substantially lower VRQoL than controls on all subscales (overall eyesight, visual symptom, general functioning and psychosocial, p<0.0001), even in the sub-group with normal vision (p<0.0001). Lower VRQoL scores in cases were associated with longer trichiasis duration, central corneal opacity, visual impairment and poor contrast sensitivity. Trichiasis cases had lower HRQoL in all domains (Physical-health, Psychological, Social, Environment, p<0.0001), lower overall QoL (mean, 34.5 v 64.6; p<0.0001) and overall health satisfaction (mean, 38.2 v 71.7; p<0.0001). This association persisted in a sub-group analysis of cases and controls with normal vision. Not having a marriage partner (p<0.0001), visual impairment (p = 0.0068), daily labouring (p<0.0001), presence of other health problems (p = 0.0018) and low self-rated wealth (p<0.0001) were independently associated with lower overall QoL scores in cases. Among cases, trichiasis caused 596 (59%) to feel embarrassed, 913 (91.3%) to worry they may lose their remaining eyesight and 681 (68.1%) to have sleep disturbance. Conclusions/Significance Trachomatous trichiasis substantially reduces vision and health related QoL and is disabling, even without visual impairment. Prompt trichiasis intervention is needed both to prevent vision loss and to alleviate physical and psychological suffering, social exclusion and improve overall well-being. Implementation of the full SAFE strategy is needed to prevent the development of trachomatous trichiasis. There is clear evidence that visual impairment generally reduces quality of life. However, relatively little is known about the impact that trachomatous trichiasis (TT) has on the lives of affected people with and without the presence of visual impairment. We measured the impact of TT on vision and health-related quality of life in 1000 people with TT using standard WHO quantitative tools and compared these with 200 trichiasis-free controls, matched to every fifth trichiasis case on age, sex and location. We found TT cases had lower vision and health related quality of life than controls regardless of visual impairment and other health problems suggesting the burden of TT goes beyond visual loss. The results provide solid data for advocacy and encourage programme leaders and funders to secure resources to promote trichiasis intervention. Trichiasis causes considerable physical and psychosocial trauma including sleep disturbance, low self-esteem and possibly a less stable marriage regardless of visual impairment. These suggest that, timely treatment is needed not only to prevent visual loss but also alleviate physical and psychological suffering and social exclusion of TT patients, thereby improving their physical and psychological health, general functioning and social relations.
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Affiliation(s)
- Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Carter Center, Addis Ababa, Ethiopia
- * E-mail:
| | | | | | | | | | | | | | - Kelly Callahan
- The Carter Center, Atlanta, Georgia, United States of America
| | - Paul M. Emerson
- International Trachoma Initiative, Atlanta, Georgia, United States of America
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Robin L. Bailey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David C. W. Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Saul N. Rajak
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen A. Weiss
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthew J. Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Habtamu E, Wondie T, Aweke S, Tadesse Z, Zerihun M, Zewdie Z, Callahan K, Emerson PM, Kuper H, Bailey RL, Mabey DCW, Rajak SN, Polack S, Weiss HA, Burton MJ. Trachoma and Relative Poverty: A Case-Control Study. PLoS Negl Trop Dis 2015; 9:e0004228. [PMID: 26600211 PMCID: PMC4657919 DOI: 10.1371/journal.pntd.0004228] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 10/22/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Trachoma is widely considered a disease of poverty. Although there are many epidemiological studies linking trachoma to factors normally associated with poverty, formal quantitative data linking trachoma to household economic poverty within endemic communities is very limited. METHODOLOGY/PRINCIPAL FINDINGS Two hundred people with trachomatous trichiasis were recruited through community-based screening in Amhara Region, Ethiopia. These were individually matched by age and gender to 200 controls without trichiasis, selected randomly from the same sub-village as the case. Household economic poverty was measured through (a) A broad set of asset-based wealth indicators and relative household economic poverty determined by principal component analysis (PCA, (b) Self-rated wealth, and (c) Peer-rated wealth. Activity participation data were collected using a modified 'Stylised Activity List' developed for the World Bank's Living Standards Measurement Survey. Trichiasis cases were more likely to belong to poorer households by all measures: asset-based analysis (OR = 2.79; 95%CI: 2.06-3.78; p<0.0001), self-rated wealth (OR, 4.41, 95%CI, 2.75-7.07; p<0.0001) and peer-rated wealth (OR, 8.22, 95% CI, 4.59-14.72; p<0.0001). Cases had less access to latrines (57% v 76.5%, p = <0.0001) and higher person-to-room density (4.0 v 3.31; P = 0.0204) than the controls. Compared to controls, cases were significantly less likely to participate in economically productive activities regardless of visual impairment and other health problems, more likely to report difficulty in performing activities and more likely to receive assistance in performing productive activities. CONCLUSIONS/SIGNIFICANCE This study demonstrated a strong association between trachomatous trichiasis and relative poverty, suggesting a bidirectional causative relationship possibly may exist between poverty and trachoma. Implementation of the full SAFE strategy in the context of general improvements might lead to a virtuous cycle of improving health and wealth. Trachoma is a good proxy of inequality within communities and it could be used to target and evaluate interventions for health and poverty alleviation.
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Affiliation(s)
- Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- The Carter Center, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Kelly Callahan
- The Carter Center, Atlanta, Georgia, United States of America
| | - Paul M. Emerson
- International Trachoma Initiative, Atlanta, Georgia, United States of America
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robin L. Bailey
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David C. W. Mabey
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saul N. Rajak
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen A. Weiss
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthew J. Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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11
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Yiengprugsawan V, Seubsman SA, Sleigh AC. Association between vision impairment and health among a national cohort of 87,134 Thai adults. Asia Pac J Public Health 2015; 27:NP194-202. [PMID: 22247107 PMCID: PMC3676688 DOI: 10.1177/1010539511433049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To date, more than 300 million people worldwide live with low vision and blindness, imposing social and economic burdens on individuals and families. This study analyzes a cohort of 87 134 Thai adults, reporting odds ratios (ORs) and calculating population attributable fractions (PAFs). PAF estimates the proportion of the disease or condition that would not occur if no one in the population had the risk factor. Approximately 28% and 8% reported having refractive errors and vision impairment not correctable by visual aids. Both types of vision impairment were positively associated with poor self-assessed health (adjusted ORs = 1.23 to 2.03) and poor psychological health (adjusted ORs = 1.13 to 1.63). PAFs show that refractive errors explain 6.1% of poor self-assessed health, 3.5% of poor psychological health, and 2.2% of falls in the last year. PAFs for vision impairment not correctable by visual aids explain 7.5%, 4.7%, and 3.1%, respectively. Incorporating early detection and prevention of vision impairment at the primary health care level will contribute to promoting the health of Thais.
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Affiliation(s)
| | - Sam-ang Seubsman
- The Sukhothai Thammathirat Open University, Nonthaburi, Thailand
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12
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Danquah L, Kuper H, Eusebio C, Rashid MA, Bowen L, Foster A, Polack S. The long term impact of cataract surgery on quality of life, activities and poverty: results from a six year longitudinal study in Bangladesh and the Philippines. PLoS One 2014; 9:e94140. [PMID: 24747192 PMCID: PMC3991652 DOI: 10.1371/journal.pone.0094140] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 03/13/2014] [Indexed: 11/18/2022] Open
Abstract
Background Cataract surgery has been shown to improve quality of life and household economy in the short term. However, it is unclear whether these benefits are sustained over time. This study aims to assess the six year impact of cataract surgery on health related quality of life (HRQoL), daily activities and economic poverty in Bangladesh and The Philippines. Methods and Findings This was a longitudinal study. At baseline people aged ≥50 years with visual impairment due to cataract (‘cases’) and age-, sex-matched controls without visual impairment were interviewed about vision specific and generic HRQoL, daily activities and economic indicators (household per capita expenditure, assets and self-rated wealth). Cases were offered free or subsidised cataract surgery. Cases and controls were re-interviewed approximately one and six years later. At baseline across the two countries there were 455 cases and 443 controls. Fifty percent of cases attended for surgery. Response rates at six years were 47% for operated cases and 53% for controls. At baseline cases had poorer health and vision related QoL, were less likely to undertake productive activities, more likely to receive assistance with activities and were poorer compared to controls (p<0.05). One year after surgery there were significant increases in HRQoL, participation and time spent in productive activities and per capita expenditure and reduction in assistance with activities so that the operated cases were similar to controls. These increases were still evident after six years with the exception that time spent on productive activities decreased among both cases and controls. Conclusion Cataract causing visual loss is associated with reduced HRQoL and economic poverty among older adults in low-income countries. Cataract surgery improves the HRQoL of the individual and economy of the household. The findings of this study suggest these benefits are sustained in the long term.
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Affiliation(s)
- Lisa Danquah
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Liza Bowen
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Allen Foster
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Polack
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
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13
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Abstract
PURPOSE To assess the construct validity and responsiveness of the EuroQoL-5D (EQ-5D) instrument in Asian patients undergoing cataract surgery in Singapore. METHODS In this prospective study, English- or Chinese-speaking patients (n = 216) completed the EQ-5D and the VF-14 questionnaires before and 3 months after they underwent cataract surgery. The impact of cataracts on patients was assessed using two standard gamble (SG) questions before surgery. Construct validity of the EQ-5D index and the visual analog scale (VAS) was assessed by examining their correlation with the VF-14 and SG scores. Responsiveness of the EQ-5D was compared with that of the VF-14 in terms of the magnitude of score change associated with cataract surgery. RESULTS We found that the EQ-5D index correlated with VF-14, SG (death), and SG (blindness) (Pearson r = 0.30, 0.23 and 0.24, respectively; p < 0.01). In contrast, we found no correlation between the EQ-VAS, VF-14, and SG scores. The mean EQ-5D index (difference, 0.06; effect size, 0.35) and VF-14 score (difference, 1.75; effect size, 0.97) of patients improved after cataract surgery (p < 0.0001). CONCLUSIONS Our study demonstrated that the EQ-5D utility index is a valid and responsive outcome measure for evaluating the impact of cataract surgery in our Asian population. However, the implications of using the generic EQ-5D instrument to assess the cost-effectiveness of surgical interventions for visual impairment require further investigation.
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14
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Lee BS, Munoz BE, West SK, Gower EW. Functional improvement after one- and two-eye cataract surgery in the Salisbury Eye Evaluation. Ophthalmology 2013; 120:949-55. [PMID: 23357620 PMCID: PMC3640760 DOI: 10.1016/j.ophtha.2012.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 10/02/2012] [Accepted: 10/03/2012] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To determine the impact that cataract and cataract surgery have on clinical measurements of vision, reading speed, objective mobility performance, and subjective visual functioning. DESIGN Prospective, population-based study. PARTICIPANTS A total of 1739 Salisbury Eye Evaluation (SEE) participants without previous cataract surgery with bilateral baseline best-corrected visual acuity (BCVA) of logarithm of the minimum angle of resolution (logMAR) ≤ 0.3 (≥ 20/40) or cataract surgery between rounds 1 and 2. METHODS Participants were categorized on the basis of cataract surgery by round 2 into no surgery, unilateral surgery, or bilateral surgery. Visual performance, mobility-based tasks, and the Activities of Daily Vision Scale (ADVS) were measured at baseline and 2 years. Mobility score was converted into a z score by subtracting the participant's time from the population baseline average and then dividing by the standard deviation. Comparisons were made between the no surgery and surgery groups using multivariate linear regression. MAIN OUTCOME MEASURES Change in bilateral BCVA in logMAR, contrast sensitivity, reading speed in words per minute (wpm), mobility score, and ADVS. RESULTS During the study period, 29 participants had cataract surgery on both eyes, 90 participants had unilateral surgery, and 1620 participants had no surgery. After adjusting for baseline value, demographics, depression, and mental status, the unilateral surgery group's BCVA improved 0.04 logMAR (P = 0.001) and the bilateral group's BCVA improved 0.13 compared with no surgery (P<0.001). Overall mobility declined in all groups. The unilateral group's z score decreased 0.18 more than that of the no surgery group (P = 0.02), whereas the bilateral group showed a 0.18 z score improvement compared with no surgery (P = 0.19). Change in reading speed significantly improved in the unilateral and bilateral groups compared with no surgery (12 and 31 wpm, respectively). The bilateral surgery group showed significant positive change in ADVS compared with no surgery (5 points of relative improvement; P = 0.01), whereas the unilateral group showed a 5-point relative decline (P<0.001). CONCLUSIONS Cataract negatively affects both subjective quality of life and objective performance measures. Unilateral cataract surgery improves visual functioning, but the largest gains are found in patients who undergo second-eye cataract surgery. This finding supports second-eye cataract surgery for patients with visual or functional symptoms even after successful first-eye surgery. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Bryan S. Lee
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Beatriz E. Munoz
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sheila K. West
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Emily W. Gower
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Ophthalmology, University of Washington, Seattle, Washington
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15
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Finger RP, Kupitz DG, Fenwick E, Balasubramaniam B, Ramani RV, Holz FG, Gilbert CE. The impact of successful cataract surgery on quality of life, household income and social status in South India. PLoS One 2012; 7:e44268. [PMID: 22952945 PMCID: PMC3432104 DOI: 10.1371/journal.pone.0044268] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 07/31/2012] [Indexed: 11/28/2022] Open
Abstract
Background To explore the hypothesis that sight restoring cataract surgery provided to impoverished rural communities will improve not only visual acuity and vision-related quality of life (VRQoL) but also poverty and social status. Methods Participants were recruited at outreach camps in Tamil Nadu, South India, and underwent free routine manual small incision cataract surgery (SICS) with intra-ocular lens (IOL) implantation, and were followed up one year later. Poverty was measured as monthly household income, being engaged in income generating activities and number of working household members. Social status was measured as rates of re-marriage amongst widowed participants. VRQoL was measured using the IND-VFQ-33. Associations were explored using logistic regression (SPSS 19). Results Of the 294 participants, mean age ± standard deviation (SD) 60±8 years, 54% men, only 11% remained vision impaired at follow up (67% at baseline; p<0.001). At one year, more participants were engaged in income generating activities (44.7% to 77.7%; p<0.001) and the proportion of households with a monthly income <1000 Rps. decreased from 50.5% to 20.5% (p<0.05). Overall VRQoL improved (p<0.001). Participants who had successful cataract surgery were less likely to remain in the lower categories of monthly household income (OR 0.05–0.22; p<0.02) and more likely to be engaged in income earning activities one year after surgery (OR 3.28; p = 0.006). Participants widowed at baseline who had successful cataract surgery were less likely to remain widowed at one year (OR 0.02; p = 0.008). Conclusion These findings indicate the broad positive impact of sight restoring cataract surgery on the recipients’ as well as their families’ lives. Providing free high quality cataract surgery to marginalized rural communities will not only alleviate avoidable blindness but also - to some extent - poverty in the long run.
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Affiliation(s)
- Robert P Finger
- Department of Ophthalmology, University of Bonn, Bonn, Germany.
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16
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Chew M, Chiang PPC, Zheng Y, Lavanya R, Wu R, Saw SM, Wong TY, Lamoureux EL. The impact of cataract, cataract types, and cataract grades on vision-specific functioning using Rasch analysis. Am J Ophthalmol 2012; 154:29-38.e2. [PMID: 22541931 DOI: 10.1016/j.ajo.2012.01.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 01/26/2012] [Accepted: 01/26/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine the impact of cataracts and their types and grades on vision-specific functioning. DESIGN Prospective population-based cross-sectional study. METHODS The Singapore Indian Eye Study examined 3400 of 4497 (75.6% response rate) ethnic Indians 40 years of age and older living in Singapore. Three thousand one hundred sixty-eight (93.2%) fulfilled inclusion criteria with complete information for final analysis. Cataracts were assessed on slit-lamp examination and were graded according to the Lens Opacity Classification System III. Vision-specific functioning scores were explored with the Visual Function scale, validated using Rasch analysis. RESULTS Two hundred sixty-nine (8.5%) and 740 (23.4%) of the study participants had unilateral and bilateral cataracts, respectively, and 329 (10.4%), 800 (25.2%), and 128 (4.1%) participants had nuclear, cortical, and posterior subcapsular (PSC) cataracts, respectively. In multivariate linear regression models, the presence of bilateral rather than unilateral cataract (β = -0.12; 95% confidence interval, -0.20 to 0.00) was associated independently with poorer vision-specific functioning, even after adjusting for undercorrected refractive error (β = -0.11; 95% confidence interval, -0.21 to 0.00). Bilateral nuclear, cortical, and PSC cataracts also were associated with poorer vision-specific functioning (β = -0.31, -0.15, and -1.15, respectively), with combinations of them having even greater impact. Significantly poorer vision-specific functioning occurred at Lens Opacity Classification System grades 4 (nuclear opalescence), 5 (nuclear color), 3 (cortical), and 1 (PSC) or higher. CONCLUSIONS People with bilateral but not unilateral cataracts experience difficulty with performing vision-specific daily activities independent of refractive error, with PSC cataracts and cataract combinations having the greatest impact. Cataract types cause poorer vision-specific functioning beginning at different severity grades.
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Frick KD, Drye LT, Kempen JH, Dunn JP, Holland GN, Latkany P, Rao NA, Sen HN, Sugar EA, Thorne JE, Wang RC, Holbrook JT. Associations among visual acuity and vision- and health-related quality of life among patients in the multicenter uveitis steroid treatment trial. Invest Ophthalmol Vis Sci 2012; 53:1169-76. [PMID: 22247489 DOI: 10.1167/iovs.11-8259] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate the associations between visual acuity and self-reported visual function; visual acuity and health-related quality of life (QoL) metrics; a summary measure of self-reported visual function and health-related QoL; and individual domains of self-reported visual function and health-related QoL in patients with uveitis. METHODS Best-corrected visual acuity, vision-related functioning as assessed by the NEI VFQ-25, and health-related QoL as assessed by the SF-36 and EuroQoL EQ-5D questionnaires were obtained at enrollment in a clinical trial of uveitis treatments. Multivariate regression and Spearman correlations were used to evaluate associations between visual acuity, vision-related function, and health-related QoL. RESULTS Among the 255 patients, median visual acuity in the better-seeing eyes was 20/25, the vision-related function score indicated impairment (median, 60), and health-related QoL scores were within the normal population range. Better visual acuity was predictive of higher visual function scores (P ≤ 0.001), a higher SF-36 physical component score, and a higher EQ-5D health utility score (P < 0.001). The vision-specific function score was predictive of all general health-related QoL (P < 0.001). The correlations between visual function score and general quality of life measures were moderate (ρ = 0.29-0.52). CONCLUSIONS The vision-related function score correlated positively with visual acuity and moderately positively with general QoL measures. Cost-utility analyses relying on changes in generic healthy utility measures will be more likely to detect changes when there are clinically meaningful changes in vision-related function, rather than when there are only changes in visual acuity. (ClinicalTrials.gov number, NCT00132691.).
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Affiliation(s)
- Kevin D Frick
- Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Tosh J, Brazier J, Evans P, Longworth L. A review of generic preference-based measures of health-related quality of life in visual disorders. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:118-27. [PMID: 22264979 PMCID: PMC3268858 DOI: 10.1016/j.jval.2011.08.002] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 07/29/2011] [Accepted: 08/02/2011] [Indexed: 05/02/2023]
Abstract
OBJECTIVE This review examines generic preference-based measures and their ability to reflect health-related quality of life in patients with visual disorders. METHODS A systematic search was undertaken to identify clinical studies of patients with visual disorders where health state utility values were measured and reported. Data were extracted to assess the validity and responsiveness of the measures. A narrative synthesis of the data was undertaken due to the heterogeneity between different studies. RESULTS There was considerable heterogeneity in the 31 studies identified in terms of patient characteristics, visual disorders, and outcomes reported. Vision loss was associated with a reduction in scores across the preference-based measure, but the evidence on validity and responsiveness was mixed. The EQ-5D health-related assessment instrument's performance differed according to condition, with poor performance in age-related macular degeneration (AMD) and diabetic retinopathy. The more limited evidence on the HUI-3 instrument found it performed best in differentiating between severity groups of patients with glaucoma, AMD, cataracts, and diabetic retinopathy. One study reported data on the SF-6D instrument and showed it was able to differentiate between patients with AMD. CONCLUSIONS The performance of the EQ-5D in visual disorders was mixed. The HUI-3 seemed to perform better in some conditions, but the evidence on this and SF-6D is limited. More head to head comparisons of these three measures are required. The new five-level version of EQ-5D may do better at the milder end of visual function.
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Affiliation(s)
- Jonathan Tosh
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK.
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Polack S, Eusebio C, Mathenge W, Wadud Z, Mamunur A, Fletcher A, Foster A, Kuper H. The Impact of Cataract Surgery on Health Related Quality of Life in Kenya, the Philippines, and Bangladesh. Ophthalmic Epidemiol 2010; 17:387-99. [DOI: 10.3109/09286586.2010.528136] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Sarah Polack
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | - Allen Foster
- London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Kuper
- London School of Hygiene & Tropical Medicine, London, UK
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