Measuring Health-Related Quality of Life for Patients with Diabetic Retinopathy [Internet]

Excerpt

Objectives: To identify and evaluate the psychometric properties of tools used to measure health-related quality of life (HRQL) in patients receiving treatment for diabetic retinopathy (DR), and to assess the effectiveness of interventions for DR to improve HRQL.

Data sources: We conducted a systematic and comprehensive search in six electronic databases and hand searched reference lists of reviews and included studies.

Review methods: Study selection, quality assessment, and data extraction were completed by reviewers independently and in duplicate. We included articles that presented data on HRQL outcomes following an intervention for DR (including diabetic macular edmema (DME). Mean differences and 95 percent confidence intervals were calculated for continuous outcomes. We did not conduct any meta-analyses due to heterogeneity.

Results: We identified four validated HRQL measures: 36–Item Short Form Health Survey (SF–36), National Eye Institute Visual Functioning Questionnaire (VFQ–25 and –51), Visual Function Index (VF–14), and Diabetes Treatment Satisfaction Questionnaire (DTSQ). We also identified two tools that are currently undergoing evaluation: the Retinopathy Treatment Satisfaction Questionnaire (RetTSQ) and the Retinopathy Dependent Quality of Life (RetDQoL).

Two randomized controlled trials (RCTs) reported on HRQL outcomes following anti-vascular endothelial growth factor (anti-VEGF) treatment for DME. Seven observational studies reported on HRQL outcomes following: laser photocoagulation (two), vitrectomy (two), panretinal photocoagulation versus vitrectomy (one), and phacoemulsification cataract surgery (two).

The RCT comparing pegaptanib sodium versus sham reported a statistically significant improvement from baseline for the composite score of the VFQ–25 at 2 years (but not at 1 year). The three-arm RCT comparing ranibizumab monotherapy versus ranibizumab plus laser versus laser showed a statisitically significant difference for the composite score of the VFQ–25 for both anti-VEGF arms versus laser at 1 year. The strength of evidence for anti-VEGF was assessed as low.

For the remaining interventions, the studies were at high risk of bias due to weak study designs (before-after and cohort studies) and poor implementation. There is insufficient evidence to determine whether one of these treatments for DR is more effective than another in improving HRQL in this patient population.

Conclusions: We identified few HRQL measurement instruments that have been used to assess the impact of treatment in patients with DR or DME; however, the tools that have been used have been adequately evaluated. Two tools developed specifically for patients with DR are currently undergoing evaluation. In general, HRQL was improved following interventions for DR. Further research on HRQL following anti-VEGF treatment for DME is needed to confirm the results of two RCTs. The current research on the impact of other interventions for DR on HRQL is insufficient to draw conclusions about the relative effect of one intervention versus another. RCTs that assess the impact of treatments for DR should include HRQL as an outcome.