Vision-Related Quality of Life in Patients with Ocular Graft-versus-Host Disease

Abstract

Purpose: To assess the vision-related quality of life (QOL) in a cohort of patients with ocular graft-versus-host disease (GVHD).

Design: Prospective study.

Participants: Eighty-four patients diagnosed with chronic ocular GVHD.

Methods: We assessed the vision-related QOL with the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). The symptoms of ocular GVHD were assessed using the Ocular Surface Disease Index (OSDI) and Symptom Assessment in Dry Eye (SANDE) questionnaires.

Main outcome measures: We assessed vision-related QOL with the NEI-VFQ-25 and compared the scores obtained from patients with ocular GVHD with those from a healthy population. In the ocular GVHD population, we also evaluated the associations between the NEI-VFQ-25 and the dry eye symptoms measured by the OSDI and SANDE questionnaires, age, duration of disease, best-corrected visual acuity (BCVA), corneal fluorescein staining (CFS), tear break-up time, and Schirmer test.

Results: The mean composite NEI-VFQ-25 score in patients with ocular GVHD was 76.5±17. Compared with healthy subjects, patients with ocular GVHD reported reduced scores on all NEI-VFQ-25 subscales (each P < 0.001) with the exception of color vision (P = 0.11). The NEI-VFQ-25 composite scores significantly correlated with OSDI (R = -0.81, P < 0.001), SANDE (R = -0.56, P < 0.001), CFS (R = -0.36, P = 0.001), and BCVA (R = -0.30, P = 0.004).

Conclusions: Patients with ocular GVHD experience measurable impairment of vision-related QOL. This study highlights the impact of ocular GVHD on the vision-related QOL, and thus the importance of comprehensive diagnosis and treatment of this condition.

Figure 1

Comparison of the mean National Eye Institute Visual Function Questionnaire-25 scores between ocular graft-versus-host disease patients (n = 84) and a healthy reference population from the article by Mangione et al. (n = 122). VS: vision-specific. P value was < 0.001 in all the subscales except for the color vision subscale (P = 0.11).

Figure 2

Correlations of the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) score with the clinical symptoms and signs. OSDI: Ocular Surface Disease Index; SANDE: Symptoms Assessment in Dry Eye; TBUT: tear break-up time; BCVA: best corrected visual acuity; LogMAR: logarithm of minimum angle of resolution; R: Spearman’s correlation coefficient. Higher scores in the NEI-VFQ-25 indicate better quality of life (note the negative correlations with OSDI, SANDE, corneal fluorescein staining, and BCVA).