The Effect of Visual Impairment and Its Severity on Vision-Related and Health-Related Quality of Life in Jordan: A Comparative Cross-Sectional Study

Purpose

To assess the effect of visual impairment (VI), its severity, and ocular diseases on vision-related and health-related quality of life (QoL) in Jordan.

Patients and Methods

A comparative, cross-sectional, hospital-based study was conducted among a group of 278 patients with VI aged ≥ 18 years, and age and sex-matched control group of 278 individuals with no VI. An interviewer administered the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and the Medical Outcomes Study 12-Item Short Form Health Survey (SF-12) to all participants.

Results

All the mean VFQ-25 subscales scores, physical component scale (PCS) and the mental component scale (MCS) of the SF-12 were significantly lower in patients with VI compared to controls with no VI. The VFQ-25 subscales (except general health and ocular pain), PCS, and MCS scores significantly decreased with more severity of VI. In the adjusted multivariate analysis, lower level of education (p=0.013), male sex (p=0.016), and the presence of cerebrovascular disease (p=0.019) were significantly associated with lower VFQ-25 composite scores in visually impaired patients compared to controls. Ocular disease duration of >5 years and progressive VI were significantly associated with lower VFQ-25 composite scores (p= 0.026 and p<0.001) respectively, in patients with VI. Glaucoma had a significantly larger reduction in mean scores of all the VFQ-25 subscales, and the PCS of the SF-12 compared to all other ocular diseases.

Conclusion

Both VI and increasing severity of impairment were associated with reduced vision-related and health-related quality of life in adult Jordanians. Glaucoma patients and less educated people were particularly affected. Routine assessment of QoL in visually impaired patients and improving referral protocols to vision rehabilitation services is recommended to improve the QoL in those patients.

Prevalence and Risk Factors of Major Depression in Patients with Diabetic Retinopathy in a Nationally Representative Survey

PURPOSE

Evaluate the prevalence and risk factors of depression in diabetic retinopathy (DR). Compare subjective and objective measures of visual function predictivity of depression.

METHODS

National Health and Nutrition Examination Survey 2005-2008 participants aged ≥40 who underwent fundus photography, Patient Health Questionnaire (PHQ)-9, and Visual Function Questionnaire (VFQ-25) were included in the study. Multivariable logistic regression was used to evaluate whether DR was a significant risk factor for depression and to evaluate the risk factors for depression in those with DR.

RESULTS

A total of 5704 participants, 47% male, and mean age 56.5 years were included in this study. Persons with moderate, severe non-proliferative diabetic retinopathy (NPDR), or proliferative retinopathy (PDR) had higher prevalence of depression than participants with mild retinopathy or no retinopathy (14.3%, 6.9%, 7.0%). Moderate-to-severe NPDR or PDR (OR: 2.36, p = .04) was associated with depression. Among persons with DR, best-corrected visual acuity and HbA1c were not associated with depression. However, self-reported measures of vision were associated with depression: some of the time spent worrying about eyesight (OR: 4.59, p = .010), vision limit activities some of the time (OR: 8.52, p < .001), vision limits activities most/all of the time (OR: 6.99, p < .001).

CONCLUSIONS

A significant proportion of patients with DR in the NHANES population had co-morbid major depression. Best corrected visual acuity was not associated with depression in those with DR, while subjective, self-reported measures were associated with depression, suggesting subjective measures are a better determinant of poor mood and low functional status.

Vision-Related Quality of Life following Combined Cataract and Minimally Invasive Glaucoma Surgery or Cataract Surgery Alone in Glaucoma Patients

This study examined glaucoma patients after undergoing combined cataract and minimally invasive glaucoma surgery (MIGS), microhook ab interno trabeculotomy and goniotomy with the Kahook Dual Blade (KDB), or cataract surgery alone, and it then evaluates their vision-related quality of life (VR-QOL) following the procedure. A total of 75 eyes of 75 consecutive glaucoma patients in this prospective cohort study underwent phacoemulsification (Phaco) or phaco and MIGS (Phaco-TLO) between October 2019 and March 2022. In all cases, the National Eye Institute Visual Function Questionnaire (VFQ-25) was used to evaluate the 20 eyes in the Phaco group and the 55 eyes in the Phaco-TLO group before and at 2 months after surgery. There was a significant increase in the visual acuity (logMAR) at 2 months post-operatively (Phaco group; 0.34 ± 0.10 to -0.07 ± 0.1, p < 0.0001, Phaco-TLO group; 0.37 ± 0.43 to 0.09 ± 0.32, p < 0.0001). The median (25-75th percentile) total VFQ scores in the Phaco group before and at 2 months after surgery were 71.1 (62.4-80.6) and 79.4 (69.0-84.0), respectively. (p = 0.006). The median (25-75th percentile) total VFQ scores in the Phaco-TLO group before and at 2 months after surgery were 69.8 (55.3-78.6) and 74.7 (65.1-83.3), respectively. (p = 0.005). Glaucoma patients who underwent not only cataract surgery alone but also combined cataract surgery and MIGS exhibited significant improvement in the VR-QOL.

Quality of Life among Patients with Retinal Vein Occlusion: A Case-Control Study

Purpose: The purpose of this study was to evaluate health-related quality of life in patients with retinal vein occlusion (RVO) and investigate the possible risk factors for poor quality of life in patients with RVO.Methods: Participants in the study were 67 patients with RVO, 42 male and 25 female, mean-aged 73.1 ± 10.9 years, and 70 sex- and age-matched controls. Demographic data, lifestyle factors and medical history were recorded. All patients underwent best-corrected visual acuity measurement, dilated fundoscopy and optical coherence tomography. All participants completed two questionnaires assessing quality of life (EQ-5D, NEI VFQ-25). Risk factors for health-related quality of life in RVO patients were investigated.Results: Patients with RVO exhibited significantly lower composite score for VFQ-25 compared to controls (74.1 ± 3.8 vs. 91.7 ± 3.9 for patients and controls, respectively, p < .001). In addition, RVO patients had significantly lower EQ-5D Index score compared to controls (0.88 ± 0.15 vs. 0.92 ± 0.12 for patients and controls, respectively, p = .043). Risk factors associated with quality of life in patients with RVO were found the alcohol consumption, the presence of thyroidopathy, coagulation disorders, visual acuity in the eye with RVO, central retinal thickness, the type of edema, the presence of ischemia and the condition of external limiting membrane. In multivariate analysis, only alcohol consumption and visual acuity in the eye with RVO were found to be independent risk factors, affecting quality of life in RVO patients.Conclusions: Patients with RVO presented lower quality of life in comparison with controls. Potential risk factors should be taken into account and their early detection may improve quality of life in such patients and lead to targeted health policies.

Macular pigment optical density and visual quality of life

PURPOSE

There is robust evidence that higher macular pigment concentrations help reduce both veiling and discomfort glare in patients with or without ocular disease. We investigated whether there was also a relationship between macular pigment optical density (MPOD) and patient surveys about glare or ocular discomfort.

METHODS

We measured MPOD psychophysically in 23 healthy subjects and administered the National Eye Institute Visual Functioning Questionnaire (VFQ-25). Responses for each survey question were sorted from low (no limitation) to high (very severe limitation). The median response for each question was determined, and independent t-tests were performed on the mean MPOD values for survey responses above and below the median. We also performed a non-parametric correlation analysis between MPOD and survey responses.

RESULTS

While the median response was "no limitation" for most (22 of 25) survey questions, responses were slightly higher for two questions concerning ocular discomfort and one question related to driving at night. MPOD levels were significantly higher in subjects that reported no discomfort in or around their eyes than in those that reported mild discomfort. There was also a trend toward higher MPOD levels in subjects who reported that pain in or around their eyes never limited their activity as well as in subjects who reported no difficulty driving at night.

CONCLUSION

These preliminary findings are consistent with the well-established discomfort and glare hypotheses for MPOD. The current findings on subjective ocular discomfort in the absence of glare deserve further study.

Influence of cataract surgery for the first or second eye on vision-related quality of life (VR-QOL) and the predictive factors of VR-QOL improvement

PURPOSE

To assess improvements in vision-related quality of life (VR-QOL) in patients undergoing their first or second eye cataract surgery, as well as clinical factors related to VR-QOL.

STUDY DESIGN

Prospective case series.

METHODS

We examined 282 patients undergoing their first (222) or second (60) eye cataract surgery. VR-QOL was evaluated before and after surgery using the 25-item National Eye Institute visual function questionnaire (VFQ-25), along with the best-corrected visual acuity (BCVA), uncorrected visual acuity, and the lens opacities classification system III (LOCSIII). The resulting VFQ-25 subscale scores were compared between patients undergoing their first or second eye cataract surgery, including multiple regression analysis.

RESULTS

The mean VFQ-25 composite score (CS) was 71.5 ± 14.2 before and 84.0 ± 10.2 after the first eye cataract surgery and 73.5 ± 12.7 before and 85.4 ± 10.2 after the second eye cataract surgery. VFQ-25 scores improved significantly, with reduced disparity among patients after surgery in both groups. Preoperative CS was related to the preoperative sum of the BCVA (standardized partial regression coefficient (β) =  - 0.254, P < 0.001). Improvement in the CS was related to a preoperative poor BCVA (β = 0.203, P < 0.001), low CS (β =  - 0.693, P < 0.001), and high general health score (β = 0.118, P = 0.025).

CONCLUSIONS

VR-QOL improved after the first and second eye surgery. Many VFQ-25 subscales were related to the BCVA or LOCSIII scores. Low preoperative VR-QOL and BCVA were related to an improved postoperative VR-QOL.

Visual function response to ocriplasmin for the treatment of vitreomacular traction and macular hole

PURPOSE

To assess the effect of an intravitreal ocriplasmin injection on visual function, measured using visual acuity (VA) and vision-related quality of life.

METHODS

Post hoc analysis of prespecified secondary end-points in two multicentre, randomized, double-masked, phase 3 clinical trials. A total of 652 participants with symptomatic vitreomacular adhesion were enrolled, of whom 464 received a single intravitreal injection of 125 μg ocriplasmin and 188 received a single intravitreal placebo injection. Based on principal components analysis results, visual function response (VFR) was defined as either a VA improvement of ≥2 lines; or an improvement in the composite score of the National Eye Institute Visual Function Questionnaire (VFQ-25) exceeding the minimal clinically important difference (MCID), estimated using the standard error of measurement approach; or an improvement in the VFQ-25 driving subscale score exceeding the MCID. The main outcome measure was VFR at 6 months.

RESULTS

A VFR occurred in 55.1% of the ocriplasmin group versus 34.2% of the placebo injection group (p < 0.0001). This comprised 23.7% versus 11.2% (p = 0.0003) with a ≥ 2-line VA improvement, 35.9% versus 22.7% (p = 0.0016) for the VFQ-25 composite score, and 10.2% versus 6.2% (p = 0.1697) for the driving subscale.

CONCLUSION

Ocriplasmin produces a clinically meaningful visual function benefit.

Vision-related quality of life following glaucoma filtration surgery

BACKGROUND

To evaluate vision-related quality of life (VR-QOL) following glaucoma filtration surgery.

METHODS

A total of 103 glaucoma patients scheduled to undergo glaucoma filtration surgery. Prior to and at three months after glaucoma filtration surgery, trabeculectomy or EX-PRESS, all patients completed the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25). A total of 48 patients underwent combined cataract and filtration surgery. The clinical data collected pre- and postoperatively included best-corrected visual acuity (BCVA) and intraocular pressure (IOP).

RESULTS

The IOP decreased significantly from 19.0 ± 8.1 mmHg to 9.7 ± 3.9 mmHg (P < 0.001). Preoperative VFQ-25 composite score (65.8 ± 15.6) was similar to the postoperative score (67.8 ± 16.6). A significantly improved VFQ-25 composite score (pre: 63.2 ± 17.1, post: 67.7 ± 17.8; P = 0.001) was observed in the patients who underwent combined cataract and filtration surgery. There was a significant association between the BCVA changes in the operated eye and the changes in the VFQ-25 composite score (r = -0.315, P = 0.003).

CONCLUSIONS

Although glaucoma filtration surgery by itself did not decrease the VR-QOL in glaucoma patients, there was significant improvement in the VR-QOL after the patients underwent combined cataract and glaucoma filtration surgery.

Health-related quality of life, visual function and treatment satisfaction following intravitreal dexamethasone implant for diabetic macular edema

PURPOSE

The aim of this study was to explore and describe quantitatively patient-reported outcome measures (PROMs), ie, health-related quality of life (QoL), visual function and treatment satisfaction, in patients with diabetic macular edema (DME) receiving two different regimens of Ozurdex (intravitreal dexamethasone implant).

METHODS

In this multicenter, prospective study, 100 patients with center-involving refractory DME were randomized 1:1 to either five monthly fixed dosing or optical coherence tomography (OCT)-guided pro re nata (PRN) regimen of dexamethasone intravitreal implant therapy. The primary outcome was the difference between arms in change in PROMs and health-related QoL from baseline to 12 months, as measured by the Retinopathy-Dependent Quality of Life (RetDQoL) questionnaire, Visual Function Questionnaire-25 (VFQ-25) and Retinopathy Treatment Satisfaction Questionnaire (RetTSQ).

RESULTS

There was no statistically significant difference in the RetDQoL score and VFQ-25 score at month 12 compared to those at baseline, whereas the total mean RetTSQ score increased significantly at the exit visit. The two treatment arms did not differ significantly regarding the change in PROMs and health-related QoL questionnaires. Logistic regression analysis showed that visual acuity (VA) of ≥55 letters, central foveal thickness <300 μm and macular volume <9.2 mm³ at the exit visit (month 12) predicted a higher change in RetTSQ.

CONCLUSION

This study showed that there is a statistically significant improvement in treatment satisfaction, as measured by RetTSQ, in patients with DME treated with dexamethasone intravitreal implant, independent of the dose regimen, namely, fixed or PRN. However, it should be noted that the clinically meaningful change could not be assessed accurately, since no thresholds for clinically meaningful change currently exist for the RetTSQ. On the other hand, there was no significant change in health-related QoL, as measured using VFQ-25 and RetDQoL. Factors affecting the patients' treatment satisfaction were the final VA, the central foveal thickness and the macular volume.

The Impact of Non-Steroidal Anti-Inflammatory Agents after Phacoemulsification on Quality of Life: A Randomized Study

Introduction

The purpose of our study was to investigate the impact of ketorolac addition to the well-established combination of antibiotic-steroid agent in terms of vision-related quality of life.

Methods

Patients were randomized to: (1) fixed combination of tobramycin 0.3%–dexamethasone 0.1%, one drop qid (n = 68) and (2) fixed combination of tobramycin 0.3%–dexamethasone 0.1%, one drop qid, plus ketorolac tromethamine 0.5%, one drop tid (n = 70). All patients completed the VFQ-25 questionnaire to assess their functional vision before cataract surgery and postoperatively on days 7, 28 and 42. The statistical analysis comprised the point-wise comparison between the two groups at the four time points for all sub-scales of the VFQ-25 questionnaire, as well as the composite score.

Results

No significant differences were noted regarding the composite score, as well as all subscales in all examined time points.

Conclusions

The addition of ketorolac did not seem to offer any additional benefit in terms of vision-related quality of life.

Assessment of quality of life in patients with visual impairments using a new visual function questionnaire: the VFQ-J11

Background

The purpose of the present study was to assess the vision-related quality of life (QOL) of visually impaired patients using the Japanese 11-item National Eye Institute Visual Function Questionnaire (VFQ-J11). Comparisons with the 25-item version (VFQ-25) and the EuroQoL Index using a large group of patients with various degrees of impairments and various causative diseases were performed.

Methods

A total of 232 visually impaired Japanese patients were recruited from six ophthalmology departments in Japan. Information on ophthalmic findings and patient backgrounds was collected, and information on QOL and utility assessments was collected from the patients by means of survey questionnaires.

Results

The average age of patients was 69.6±14.3 years. Both the vision-related QOL scores (VFQ-25 composite and VFQ-J11) were significantly associated with better and worse visual acuity (VA) in visually impaired subjects (all P<0.01). VFQ-J11 was comparable to VFQ-25 regardless of causative diseases. VFQ-25 composite and the VFQ-J11 scores were concurrently associated with a range of systemic medical disorders. EuroQoL Index had a significant association with better eye VA (P<0.01), but not with worse eye VA, or any systemic disorders.

Conclusion

VFQ-J11 provides valid data on vision-related QOL and is less of a burden for patients with vision problems.

Risk Factors for Poor Quality of Life among Patients with Age-Related Macular Degeneration

PURPOSE

The purpose of this study was to evaluate the quality of life in patients with age-related macular degeneration (AMD) and compare it with that of healthy controls. Additionally, our study aims to investigate the possible risk factors for poor quality of life in AMD patients.

METHODS

Participants in the study were 114 patients with AMD, 63 male and 51 female, mean-aged 76.5 ± 6.1 years. Demographic data, lifestyle factors, and medical history were recorded. All patients underwent a routine examination for AMD, including best-corrected visual acuity measurement, dilated fundoscopy and optical coherence tomography, and completed three questionnaires assessing quality of life (SF-36, EQ-5D, NEI VFQ-25). In addition, 100 controls, adjusted for gender and age, were included in the study. Risk factors for quality of life in AMD patients were investigated. Univariate analysis was performed using SPSS 22.0.

RESULTS

Patients with AMD scored lower in vision- and health-related quality-of-life questionnaires compared to controls. Risk factors associated with quality of life in patients with AMD were found to be the female gender, alcohol consumption, the presence of hypertension, diabetes mellitus, cardiovascular diseases, myosceletal problems, migraine, anxiety/depression, subretinal or intraretinal fluid, pigment epithelium detachment, previous treatment for AMD, visual acuity, the stage of the disease, and the integrity of the ellipsoid zone.

CONCLUSION

Patients with AMD presented lower quality of life in comparison with controls. Potential risk factors should be taken into account and clinicians should thus focus on the most vulnerable subgroups.