Elsevier

Ophthalmology

Volume 113, Issue 10, October 2006, Pages 1846-1853
Ophthalmology

Original Article
Impact of Severity and Bilaterality of Visual Impairment on Health-Related Quality of Life

https://doi.org/10.1016/j.ophtha.2006.04.028Get rights and content

Objective

To assess the impact of unilateral and bilateral visual impairment (VI) and its severity on health-related quality of life (HRQOL) in Latinos 40 years and older.

Design

A cross-sectional population-based study, the Los Angeles Latino Eye Study (LALES).

Participants

Five thousand three hundred seventy-seven LALES participants.

Methods

Health-related quality of life was measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and the Medical Outcomes Study 12-Item Short Form Health Survey (SF-12). Visual acuity (VA) was measured by a standardized protocol. Based on the presenting VA, VI was classified as unilateral or bilateral impairment and as either mild (20/40–20/63) or moderate/severe (20/80 or worse).

Main Outcome Measures

National Eye Institute VFQ-25 and SF-12 composite and subscale scores.

Results

The NEI VFQ mean composite score decreased from no VI (86) to bilateral moderate/severe VI (66) (P<0.006). Relative to participants with no VI, those with unilateral or bilateral VI at any severity level had significantly lower NEI VFQ-25 scores for 10 of the 12 subscales (P<0.05). The largest mean score differences between participants with and without VI were observed for subscales related to driving difficulties (42.5 points), vision-related dependency (29.1 points), distance vision (27.0 points), and vision-related mental health (24.5 points). No differences in SF-12 scores were found between participants with and without VI (P>0.05).

Conclusion

Relative to persons with no VI, persons with bilateral mild and unilateral or bilateral moderate/severe VI report greater difficulties in performing most vision-dependent daily activities and experience vision-related dependency and poorer vision-related mental health. Because most visual function subscale scores were significantly lower in persons with bilateral mild and/or unilateral/bilateral moderate/severe VI, health care providers should consider intervention in these persons. Our findings provide further insight into the relationship between severity level, bilaterality of VI, and self-reported visual function. These data can be used to refine the determination of visual disability in persons with VI.

Section snippets

Design and Sample

Details of the study design, sampling plan, and baseline data are reported elsewhere.16 In brief, a door-to-door census of all residents within 6 census tracts in La Puente, California was conducted between February 2000 and May 2003 to identify eligible individuals. Demographic and socioeconomic characteristics of Latinos in the 6 census tracts of La Puente were similar to those of the Latino populations in Los Angeles County. All eligible participants (≥40 years old at the time of the census

Description of Study Cohort

Of the 7789 participants who were eligible for the LALES, 6357 (82%) completed an ophthalmic examination. Complete data on the SF-12, NEI VFQ-25, and unilateral and bilateral VAs were available for 5377 (85%) of the 6357 participants. The mean (SD) age of the participants was 55.1 (10.9) years (range, 40–95); the majority (n = 3177 [59%]) were female. Of the 5377 participants, 4272 (79%) had no VI, 465 (9%) and 207 (4%) had mild or moderate/severe unilateral VI, and 332 (6%) and 101 (2%) had

Discussion

Consistent with several previous studies, our analyses of the SF-12 scores (PCS and MCS) showed weak associations with VI.4, 35, 36, 37, 38, 39 With the NEI VFQ-25 measure, however, investigators consistently have reported that poorer VA is associated with worse vision-targeted HRQOL.3, 4, 8, 9, 10, 11, 12, 40 Clemons et al found that participants with vision worse than 20/20 in at least one eye had NEI VFQ scores for all the scales moderately lower than scores of participants with vision 20/20

Acknowledgment

The authors thank all the members of the LALES Group and the LALES Data Monitoring and Oversight Committee.

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    Manuscript no. 2005-828.

    Funding/support: National Eye Institute and National Center on Minority Health & Health Disparities, National Institutes of Health, Bethesda, Maryland (grant nos.: EY-11753, EY-03040), and Research to Prevent Blindness, New York, New York (unrestricted grant). Dr Varma is a Research to Prevent Blindness Sybil B. Harrington Scholar. Dr Hays also was supported by the UCLA/DREW Project EXPORT, National Center on Minority Health & Health Disparities, National Institutes of Health (grant no.: P20-MD00148-01).

    The authors have no proprietary or commercial interest in any materials discussed in the article.

    A complete list of the Study Group members can be found on page 1130 of Varma R, Paz SH, Azen SP, et al. The Los Angeles Latino Eye Study. Design, methods, and baseline data. Ophthalmology 2004;111:1121–31.

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