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Diabetic retinopathy and health-related quality of life

  • Medical Ophthalmology
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Objective

To describe the impact of co-morbidities, visual acuity, diabetic retinopathy (DR) grade, and macular edema (ME) on the health-related quality of life (HRQOL) among patients with diabetic retinopathy.

Methods

Analysis of data of 207 patients with diabetic retinopathy from Germany in 2003. HRQOL assessment was done using the generic (SF-12) questionnaire. It was hypothesized that exogenous variables (co-morbidities, visual acuity impairment, DR, and ME) would have an impact on HRQOL. Using a structural equation modelling procedure, the effects of exogenous variables on endogenous variables physical component summaries (PSC) and mental component summaries (MCS) reflecting HRQOL were tested.

Results

The number of co-morbidities had a negative effect on visual acuity (b = −0.26, standardized) and a similar negative effect on PCS (b = −0.27). DR grade had a negative effect on visual acuity (b = −0.19) and a positive effect on the variable ME (b = 0.44). ME displayed a negative effect on visual acuity (b = −0.58) and also on MCS (b = −0.29). Visual acuity had a positive effect (b = 0.48) on PCS.

Conclusions

Presence of DR and ME, visual acuity impairment and patient co-morbidities lead to significant impairment of both the physical and mental components of HRQOL.

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Abbreviations

DM:

Diabetes mellitus

DR:

Diabetic retinopathy

NPDR:

Non-proliferative diabetic retinopathy

PDR:

Proliferative diabetic retinopathy

ME:

Macular edema

NCSME:

No clinically significant macular edema

CSME:

Clinically significant macular edema

SEM:

Structural equation modelling

HRQOL:

Health-related quality of life

RetDQoL:

Retinopathy Dependent Quality of Life questionnaire

RetTSQ:

Retinopathy Treatment Satisfaction Questionnaire

SF-12:

Short-Form Health Survey

PSC:

Physical Component Summaries

MCS:

Mental Component Summaries

FIML:

Full Information Maximum Likelihood

SD:

Standard deviation

IQR:

Interquartile range

References

  1. Horle S, Gruner F, Kroll P (2002) Epidemiology of diabetes-induced blindness: a review. Klin Monatsbl Augenheilkd 219:777–784 doi:10.1055/s-2002-36318

    Article  PubMed  Google Scholar 

  2. Knudsen S, Bek T, Poulsen P, Hove M, Rehling M, Mogensen C (2002) Macular edema reflects generalized vascular hyperpermeability in type 2 diabetic patients with retinopathy. Diabetes Care 25:2328–2334 doi:10.2337/diacare.25.12.2328

    Article  PubMed  Google Scholar 

  3. Funatsu H, Yamashita H, Ikeda T, Nakanishi Y, Kitano S, Hori S (2002) Angiotensin II and vascular endothelial growth factor in the vitreous fluid of patients with diabetic macular edema and other retinal disorders. Am J Ophthalmol 133:537–543 doi:10.1016/S0002-9394(02)01323-5

    Article  PubMed  CAS  Google Scholar 

  4. Javitt J, Aiello L (1996) Cost-effectiveness of detecting and treating diabetic retinopathy. Ann Intern Med 124:164–169

    PubMed  CAS  Google Scholar 

  5. World Health Organisation (2002) Diabetes mellitus. Fact sheet No 138. Retrieved January 12, 2006, from http://www.who.int/mediacentre/factsheets/fs138/en/print.html

  6. Lamoureux E, Hassell J, Keeffe J (2004) The impact of diabetic retinopathy on participation in daily living. Arch Ophthalmol 122:84–88 doi:10.1001/archopht.122.1.84

    Article  PubMed  Google Scholar 

  7. Klein BE, Klein R, McBride PE, Cruickshanks KJ, Palta M, Knudtson MD, Moss SE, Reinke JO (2004) Cardiovascular disease, mortality, and retinal microvascular characteristics in type 1 diabetes: Wisconsin epidemiologic study of diabetic retinopathy. Arch Intern Med 164:1917–1924 doi:10.1001/archinte.164.17.1917

    Article  PubMed  Google Scholar 

  8. Wilkinson CP, Ferris FL, Klein RE, Lee PP, Agardh CD, Davis M, Dills D, Kampik A, Pararajasegaram R, Verdaguer JT (2003) Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 110:1677–1682 doi:10.1016/S0161-6420(03)00475-5

    Article  PubMed  CAS  Google Scholar 

  9. Happich M, Reitberger U, Breitscheidel L, Ulbig M, Watkins J (2008) The economic burden of diabetic retinopathy in Germany in 2002. Graefes Arch Clin Exp Ophthalmol 246:151–159 doi:10.1007/s00417-007-0573-x

    Article  PubMed  Google Scholar 

  10. Ware J, Kosinski M, Keller S (1996) A 12-Item Short-Form Health Survey. Med Care 34:220–233 doi:10.1097/00005650-199603000-00003

    Article  PubMed  Google Scholar 

  11. Ware J, Sherbourne C (1992) The MOS 36-item short-form health survey (SF-36). Conceptual framework and item selection. Med Care 30:473–483 doi:10.1097/00005650-199206000-00002

    Article  PubMed  Google Scholar 

  12. Woodcock A, Bradley C, Plowright R, Ffytche T, Kennedy-Martin T, Hirsch A (2004) The influence of diabetic retinopathy on quality of life: interviews to guide the design of a condition-specific, individualised questionnaire: the RetDQoL. Patient Educ Couns 53:365–383 doi:10.1016/j.pec.2003.10.007

    Article  PubMed  Google Scholar 

  13. Woodcock A, Bradley C, Plowright R, Kennedy-Martin T, Hirsch A, Ffytche T (2005) Development of the new retinopathy treatment satisfaction questionnaire (ReTSQ). Int Congr Ser 1282:342–346 doi:10.1016/j.ics.2005.04.011

    Article  Google Scholar 

  14. Bollen K (1989) Structural equations with latent variables. Wiley, New York

    Google Scholar 

  15. Byrne B (2001) Structural equation modeling with AMOS. Lawrence Erlbaum Associates, Rahwah, NJ

    Google Scholar 

  16. Muthén L, Muthén B (2007) Mplus user’s guide. Muthén & Muthén, Los Angeles, CA

    Google Scholar 

  17. Flora D, Curran P (2004) An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychol Methods 9:466–491 doi:10.1037/1082-989X.9.4.466

    Article  PubMed  Google Scholar 

  18. Schafer J, Graham J (2002) Missing data: our view of the state of the art. Psychol Methods 7:147–177 doi:10.1037/1082-989X.7.2.147

    Article  PubMed  Google Scholar 

  19. Hu L, Bentler P (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling 6:1–55

    Article  Google Scholar 

  20. Marsh H, Hau K, Wen Z (2004) In search of golden rules: comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu and Bentler’s (1999) findings. Struct Equ Modeling 11:320–341 doi:10.1207/s15328007sem1103_2

    Article  Google Scholar 

  21. Hahl J, Hamalainen H, Sintonen H, Simell T, Arinen S, Simell O (2002) Health-related quality of life in type 1 diabetes without or with symptoms of long-term complications. Qual Life Res 11:427–436 doi:10.1023/A:1015684100227

    Article  PubMed  CAS  Google Scholar 

  22. Maddigan S, Feeny D, Johnson J (2005) Health-related quality of life deficits associated with diabetes and comorbidities in a Canadian National Population Health Survey. Qual Life Res 14:1311–1320 doi:10.1007/s11136-004-6640-4

    Article  PubMed  Google Scholar 

  23. Lloyd C, Matthews K, Wing R, Orchard T (1992) Psychosocial factors and complications of IDDM. The Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes Care 15:166–172 doi:10.2337/diacare.15.2.166

    Article  PubMed  CAS  Google Scholar 

  24. Muñoz B, West S, Rubin G, Schein O, Quigley H, Bressler S, Bandeen-Roche K (2000) Causes of blindness and visual impairment in a population of older Americans: The Salisbury Eye Evaluation Study. Arch Ophthalmol 118:819–825

    PubMed  Google Scholar 

  25. Tielsch J, Javitt J, Coleman A, Katz J, Sommer A (1995) The prevalence of blindness and visual impairment among nursing home residents in Baltimore. N Engl J Med 332:1205–1209 doi:10.1056/NEJM199505043321806

    Article  PubMed  CAS  Google Scholar 

  26. Schotliff K, Duncan G (2005) Diabetes: chronic complications. In: Shaw KM, Cummings MH (Eds) Wiley, New York

  27. Chia E, Mitchell P, Rochtchina E, Foran S, Wang J (2003) Unilateral visual impairment and health related quality of life: the Blue Mountains Eye Study. Br J Ophthalmol 87:392–395 doi:10.1136/bjo.87.4.392

    Article  PubMed  Google Scholar 

  28. Unruh M, Yan G, Radeva M, Hays R, Benz R, Athienites N, Kusek J, Levey A, Meyer K (2003) Bias in assessment of health-related quality of life in a hemodialysis population: a comparison of self-administered and interviewer-administered surveys in the HEMO study. J Am Soc Nephrol 14:2132–2141 doi:10.1097/01.ASN.0000076076.88336.B1

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank two anonymous reviewers for their valuable comments on the paper. This research was supported by Lilly Germany GmbH, Bad Homburg.

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Correspondence to Lusine Breitscheidel.

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Davidov, E., Breitscheidel, L., Clouth, J. et al. Diabetic retinopathy and health-related quality of life. Graefes Arch Clin Exp Ophthalmol 247, 267–272 (2009). https://doi.org/10.1007/s00417-008-0960-y

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  • DOI: https://doi.org/10.1007/s00417-008-0960-y

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