Longitudinal changes in visual acuity and health-related quality of life: the Los Angeles Latino Eye study

Abstract

Purpose: To examine the association between longitudinal changes in visual acuity (VA) and health-related quality of life (HRQOL) in a population-based sample of adult Latinos.

Design: A population-based cohort study of eye disease in Latinos.

Participants: We included 3169 adult Latino participants who live in the city of La Puente, California.

Methods: Data for these analyses were collected for the Los Angeles Latino Eye Study (LALES). Distance VA was measured during a detailed ophthalmologic examination using the standard Early Treatment Diabetic Retinopathy Study protocol at baseline and a 4-year follow-up examination. We assessed HRQOL by the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and the Medical Outcomes Study 12-Item Short-Form Health Survey version 1 (SF-12).

Main outcome measures: Mean differences in HRQOL composite and subscale scores between baseline and follow-up were calculated for 3169 participants with complete clinical examination and HRQOL data at both time points. Mean differences and effect sizes (ES) for NEI-VFQ and SF-12 scores were calculated for 3 categories of VA change over the 4-year follow-up period (VA improved ≥ 2 lines, no change in VA or -2 < VA < 2, VA loss ≥ 2 lines).

Results: For participants with a 2-line loss in VA, we noted an approximate 5-point loss in the NEI-VFQ-25 composite score, with the greatest score changes found for the driving difficulties, vision-related mental health, and vision-related dependency subscales (-12.7, -11.5, and -11.3, respectively). For participants with a 2-line improvement in VA, we also noted an approximate 5-point gain in the NEI-VFQ-25 composite score. The greatest change (ES = 0.80) was observed for the driving difficulties subscale. No measurable differences in HRQOL were observed for individuals without change in VA from baseline to follow-up.

Conclusions: Clinically important, longitudinal changes in VA (≥ 2-line changes) were associated with significant changes in self-reported visual function and well-being. Both the size and direction of VA change influenced change in HRQOL scores.

Figure 1

Linear regression plot of the relationship between change in NEI-VFQ-25 composite scores (adjusted for co-variates including age, gender, education, employment status, income, acculturation, co-morbidities, health insurance, vision insurance, and baseline visual acuity (VA)) by change in best corrected visual acuity in the better seeing eye of participants in the Los Angeles Latino Eye Study. The adjusted NEI-VFQ-25 composite scores were obtained using the regression model conditioned on VA status (vision loss, no change, vision improvement). The mean change in NEI-VFQ composite score of all participants by each unit of mean change in VA were plotted. NEI-VFQ-25 = National Eye Institute Visual Function Questionnaire. VA = visual acuity.

Figure 2

Linear regression plot of the relationship between change in NEI-VFQ-25 driving difficulty scores (adjusted for co-variates including age, gender, education, employment status, income, acculturation, co-morbidities, health insurance, vision insurance, and baseline VA) by change in best corrected visual acuity in the better seeing eye of participants in the Los Angeles Latino Eye Study. The adjusted NEI-VFQ-25 composite scores were obtained using the regression model conditioned on VA status (vision loss, no change, vision improvement). The mean change in NEI-VFQ composite score of all participants by each unit of mean change in VA were plotted. NEI-VFQ-25 = National Eye Institute Visual Function Questionnaire. VA0020= visual acuity.