In Black and White Populations, Similar Quality of Life Associated with Vision Loss

Patients experience similar changes in quality of life in conjunction with visual acuity loss whether they are Black or White.

Whatever their ethnicity, loss of visual acuity creates a similarly sized dent in patients’ quality of life, according to research published in the Canadian Journal of Ophthalmology. Time trade-off (TTO) vision utilities show that ophthalmology patients of Black and White ethnicity are alike at various levels of visual acuity, according to the study.

Researchers conducted a cross-sectional analysis to ascertain whether race is a differentiating factor confounding utilities related to vision. Data was obtained from ophthalmology outpatients with Black and White ethnicity who had participated in a long-standing TTO vision utility study from 1999 to 2016. The researchers interviewed each participant using a TTO vision utility acquisition instrument. Each participant was assigned to 1 of 5 vision categories according to acuity in the best-seeing eye. The researchers then compared utility outcomes using the 2-sides t test and the Mann-Whitney U test.

The study included 1125 consecutive patients and found that, for vision of 20/200-20/800, White/Black mean vision utilities were 0.58/0.59 (P =.84); for vision of 20/70-20/100, they were 0.72/0.70 (P =.85); for vision of 20/50-20/60, they were 0.78/0.79 (P =.86); for vision of 20/25-20/50, they were 0.84/0.88 (P =0.16); and for vision of 20/20, they were 0.91/0.90 (P =.43), respectively. 

The researchers explain that utilities measure total interventional value gain in quality-adjusted life years that can be integrated with costs in cost-utility analysis, depending on the intervention, in conjunction with length-of-life gain. Their findings that TTO vision utilities obtained from patients with Black and White ethnicity were similar at the same visual acuity levels suggests that the QOL associated with levels of vision in these cohorts is innate.

“It is our impression that TTO utilities are innate to human nature because time of life is shared by all humans, no matter their genetics, physiognomy, or culture,” according to the researchers.  “Whether people are willing to trade theoretical time of life primarily to see grandchildren, drive, read, perform self-care, or any different reason, vision of a select level seems to be of similar benefit to them.”

It is our impression that TTO utilities are innate to human nature because time of life is shared by all humans, no matter their genetics, physiognomy, or culture.

Study limitations include its focus on only Black and White patients; a lack of accounting for socioeconomic status and employment; and a lack of genetic analysis to confirm race in participants.


Brown GC, Brown MM, Sharma S. Preference-based comparison of the quality of life associated with vision loss in Black and White U.S. ophthalmic populations. Can J Ophthalmol. Published online November 22, 2022. doi:10.1016/j.jcjo.2022.11.003