Visual Acuity Reductions Lower Quality Of Life

Diabetic Retinopathy Due To Diabetic Hyperglycemic Lesions On The Arterioles. Image Of The Back Of The Eye. (Photo By BSIP/UIG Via Getty Images)
The measure of visual functioning is more of a factor in quality of life than type of eye disease, according to a study.

Poor visual acuity (VA) is associated more strongly with low health-related quality of life (QOL) than the type of eye disease, according to research presented at the American Society of Retina Specialists 40th Annual Meeting, held in New York, New York, July 13-16, 2022.

Researchers sought to evaluate the effect of Early Treatment Diabetic Retinopathy Study (ETDRS) letter changes on health utility (HU) values, a measure of health-related QOL, in diabetic retinopathy (DR), wet age-related macular degeneration (AMD), and cataract. They conducted a cross-sectional survey of 309 participants (all aged 18 years or older) across 4 sites in Thailand between September 22, 2020 and April 2, 2021. Of the 309 participants, there were 141, 78, and 90 patients in the DR, cataract, and AMD groups, respectively. 

Investigators used a face-to-face interview approach to assess the HU among these patients. To obtain HU and vision-specific QOL, the team used time trade-off (DirectTTO), EQ-VT(EuroTTO), EQ-5D- 5L(including EQ-VAS), HUI3, and NEI-VFQ-25. They used simple randomization to allocate the sequence of HUI3 and EQ-5D-5L questionnaires. Multivariable regression analysis analyzed factors associated with HU and level of visual acuity (LogMar).

The overall mean utility score obtained from tTTO, cTTO, EQ-VAS, EQ-5D-5L, and HUI3 (mean±SD) were 0.66±0.20, 0.84±0.25, 0.73±0.15, 0.70±0.19, and 0.68±0.26, respectively, according to the study. The average VFQ-25 score was 70.71±17.76.

Researchers found that VA in the best-seeing eye was significantly associated with a negative change in the HU score in cTTO. They also found that VA in worse-seeing-eyes was associated with the HU in cTTO, EQ-5D-5L, and HUI3. 

HU from cTTO and HUI3 showed a significant response with severe visual impairment status or worse. HU from HUI3 (r=0.54, P <.01) and EQ-5D-5L (r=0.43, P <.01) showed a moderate correlation with the NEI VFQ-25 score.

When adjusted for VA levels and demographics, the team found no differences in HU among patients with DR, AMD, and cataract. They also found no significant differences in the mean HU among these diseases.

Factors associated with nontrader in tTTO can include older age, demographic region, Buddhist religion, and good VA, according to the researchers. 

“Using a universal health coverage care plan is associated with the risk of severe/blind visual impairment,” according to researchers. “A low level of VA is associated with low HU and QOL, while the type of eye disease has a lesser effect.” 


Pongsachareonnont PF, Sakthong Phantipa, Chaikitmongkol V, et al. Visual utility scores from attribute utility instruments and time trade-off in response to visual acuity: a multicenter survey. Poster presented at: the 40th Annual Meeting of the American Society of Retinal Specialists; July 13-16, 2022; New York. Poster 508.