The quality of life impact of peripheral versus central vision loss with a focus on glaucoma versus age-related macular degeneration

Figures & data

Table 1 Quality of life (QoL) instruments

Instrument	Description	Domains/dimensions assessed	Scale (relationship to QoL)
Generic QoL instruments
SF-36	well-validated generic instrument. Used clinically for policy-making and in general populations	8 scales. Physical component: physical functioning, role limitations-physical, bodily pain, general health. Mental component: social functioning, role limitations-emotional, vitality, mental health	0 to 100 (0 = worst; 100 = best)
SF-12	Can be used to compare patients with healthy individuals. Allows computation of physical and mental subscores	As for SF-36	0 to 100 (0 = worst; 100 = best)
EQ-5D	Standardized instrument used to measure health outcome	5 dimensions: mobility, self-care, usual activity, pain/discomfort, anxiety/depression	−0.6 to 1 (−0.6 = worst; 1 = best) often multiplied by 100 to enable comparisons with other instruments
		Global rating of current health using a visual analog scale	0 to 100 (0 = worst imaginable; 100 = best imaginable)
SIP	Frequently-used instrument that assesses the influence of disease and treatment on daily functioning	12 scales: sleep and rest, eating, work, home management, recreation and pastimes, ambulation, mobility, body care and movement, social interaction, alertness behavior, emotional behavior, communication	0 to 100 (0 = best; 100 = worst: 0 to 3 little or no disability; 4 to 9 mild disability; 10 to 19 moderate disability; >20 severe disability)
Vision-specific QoL instruments
NEI-VFQ-51	Targeted multidimensional survey that assesses the influence of vision problems on health-related QoL. The length of the instrument (51 items) limits its use in clinical settings	12 domains (general vision, ocular pain, near vision, distance vision, color vision, peripheral vision, driving, vision-specific role difficulties, vision-specific dependency, vision-specific social function, vision-specific mental health, vision-specific expectation) plus one item on general health	0 to 100 (0 = worst; 100 = best)
NEI-VFQ-39	NEI-VFQ-25 used with a 14-item appendix	12 domains (similar to NEI-VFQ-51)	0 to 100 (0 = worst; 100 = best)
NEI-VFQ-25	Shorter version of the NEI-VFQ-51. reliability and validity of the 2 versions are comparable. NEI-VFQ-25 preferred because of its brevity and higher internal consistency	12 domains (similar to NEI-VFQ-51)	0 to 100 (0 = worst; 100 = best)
IVI	Describes vision-specific restriction to participation (handicap) that is not captured in clinical measures (impairment), or self-reported or self-assessed performance (disability)	5 domains: leisure and work, consumer and social interaction, household and personal care, mobility, and emotional reaction to vision loss	0 to 5 (0 = best; 5 = worst)
VF-14	Brief questionnaire designed to measure functional impairment experienced by patients as a result of cataract	12 questions related to difficulty in general day-to-day functioning and 2 questions on driving	0 to 100 (0 = worst; 100 = best)

Abbreviations: EQ, EuroQoL; IVI, Impact of Vision Impairment; NEI-VFQ, National Eye Institute Visual Function Questionnaire; SF, short-form; SIP, Sickness Impact Profile;VF, Visual Function.

Table 2 Glaucoma and age-related macular degeneration (ARMD) publications by quality of life instrument

Instrument	Glaucoma publications (n)	ARMD publications (n)
SF-36	2	5
SF-12	0	4
EQ-5D	1	0
SIP	2	0
NEI-VFQ-51	3a	2a
NEI-VFQ-39	1	3
NEI-VFQ-25	8b	9b
IVI	1c	1c
VF-14	1	9
Total	19d	33

^a One publication reported both glaucoma and ARMD using NEI-VFQ-51.¹¹

^b One publication reported both glaucoma and ARMD using NEI-VFQ-25.⁶¹

^c One publication reported both glaucoma and ARMD using IVI.⁷⁶

^d Among the glaucoma publications, three publications reported more than one instrument: SF-36 and NEI-VFQ-51; ¹² SF-36, NEI-VFQ-51 and VF-14; ¹³ and NEI-VFQ-39 and −25.⁵¹ Each incidence is shown against the relevant instrument, therefore the number shown here is 19 not 15, the number of unique publications.

Abbreviations: EQ, EuroQoL; IVI, Impact of Vision Impairment; NEI-VFQ, National Eye Institute Visual Function Questionnaire; SF, short-form; SIP, Sickness Impact Profile; VF, Visual Function.

Table 3 Short-form-36 scores for glaucoma^12,13 and age-related macular degeneration (ARMD)^14,26–29

Domain	Glaucomaa	ARMDa
	Mean (SD)	Mean (SD)
Bodily pain	72.7 (25.4)	75.5 (6.0)
General health	69.7 (21.4)	64.5 (6.5)
Mental health	72.9 (19.7)	74.7 (3.3)
Physical function	70.6 (28.6)	68.2 (17.0)
Role limitation by physical problems	66.4 (40.3)	55.1 (25.4)
Role limitation by emotional problems	69.8 (39.9)	65.7 (30.0)
Social functioning	80.9 (23.4)	87.3 (6.5)
Vitality	57.8 (18.4)	60.2 (3.2)

^a weighted average across studies.

Table 4 Effects of glaucoma and age-related macular degeneration (ARMD) on quality of life using the National Eye institute visual Function Questionnaire (NEI-VFQ)-51 instrument^11–14

	Glaucoma	ARMD
	Weighted mean (SD)	Weighted mean (SD)
N	225	193
General health	67.3 (1.2)	62.6 (8.3)
General vision	66.3 (2.7)	49.0 (5.7)
Ocular pain	81.7 (5.3)	91.5 (5.1)
Near activities	75.6 (3.9)	47.5 (8.4)
Distance activities	76.3 (4.9)	52.1 (12.2)
Social functioning	86.8 (3.0)	71.3 (7.5)
Mental health	72.6 (6.1)	64.3 (1.4)
Expectations	48.3 (0.2)	40.6 (1.8)
Role difficulties	79.2 (5.7)	56.9 (8.0)
Dependency	85.9 (5.2)	65.2 (10.0)
Driving	75.0 (5.1)	50.3 (14.3)
Color vision	89.6 (2.5)	74.1 (12.3)
Peripheral vision	71.8 (3.1)	59.8 (19.4)

Table 5 Effect of glaucoma and age-related macular degeneration (ARMD) assessed using the National Eye institute visual Function Questionnaire (NEI-VFQ)-25 instrument^{37,38,51,55–67}

	Glaucoma	ARMD
	Weighted mean (SD)	Weighted mean (SD)
N	878	1775
General health	47.6 (7.2)	N = 1655 60.6 (9.0)
General vision	68.2 (7.9)	61.4 (21.4)
Ocular pain	75.1 (11.3)	88.5 (3.1)
Near activities	76.6 (7.8)	62.3 (27.8)
Distance activities	79.2 (7.5)	65.6 (25.1)
Social functioning	88.8 (5.9)	79.7 (21.3)
Mental health	70.0 (30.5)	67.3 (21.8)
Role difficulties	73.4 (10.9)	67.6 (25.5)
Dependency	82.4 (13.3)	75.2 (26.9)
Driving	73.1 (9.1)	53.7 (38.2)
Color vision	91.4 (3.9)	83.8 (14.9)
Peripheral vision	80.1 (8.0)	83.4 (14.7)
Mean composite score	N = 1482 75.9 (8.0)	N = 1617 75.1 (18.1)

Table 6 Effects of glaucoma and age-related macular degeneration (ARMD) on quality of life assessed using the impact of vision impairment instrument^9,76

Study	N	Emotion	Leisure	Mobility	Social	Household
Glaucoma
Mean score	11	1.93	2.38	1.77	2.79	1.18
SD		0.98	1.12	1.04	1.32	0.49
ARMD
Mean score	37	1.63	1.77	1.50	2.87	0.92
SD		0.92	1.04	0.61	0.76	0.34

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