Predicting quality of life in AMD patients-insights on the new NICE classification and on a bolt-on vision dimension for the EQ-5D

Abstract

Background/aims: Health-related quality of life (HRQoL) in age-related macular degeneration (AMD) is difficult to estimate as most generic tools underestimate vision. Our aim was to measure the effect of AMD on generic and visual quality of life and how it relates to handicap. We also aimed to validate the NG82 NICE AMD classification. Finally, we studied if a bolt-on visual domain increased the EQ-5D sensitivity to AMD.

Patients and methods: Ninety-six patients with AMD participated in this observational cross-sectional study. Visual (VF-14) and generic questionnaires (EQ-5D) with VIS, and the London handicap scale (LHS) was used to quantify HRQoL and handicap. ANOVA and regression analysis were used to identify significant associations.

Results: Visual dysfunction in AMD has a significant effect in VF-14 (P < 0.001), LHS (p < 0.001), and EQ-5D (p = 0.015). The EQ-5D was less sensitive than the VF-14 and LHS and was not significantly correlated with the VIS bolt-on domain (p = 0.608). On the other hand, VIS was significantly associated with visual acuity (p < 0.001), AMD diagnosis (p = 0.005), VF-14 (p < 0.001), and LHS (p < 0.001). The new AMD classification was a good predictor of visual HRQoL and had an excellent association with visual acuity in the best eye.

Conclusion: This article shows that visual impairment is associated with lower HRQoL and with an increased handicap. It also suggests that a visual dimension may increase the EQ-5D sensitivity in AMD. There was a relationship between visual impairment and handicap with the items of the new NICE AMD classification, which supports its use.

Fig. 1. VF-14 and LHS are highly associated with the VIS domain.

Box plots showing the spread of (A) VF-14, (B) EQ-5D, and (C) LHS values according to visual bolt-on dimension. 1: means no difficulties, 2: moderate difficulties, and 3: extreme difficulties. The bottom, middle and top lines in each box indicate the first quartile, median and third quartile, respectively. The bottom and top whiskers indicate the minimum and maximum value, respectively. Cross indicates mean.

Fig. 2. AMD has a significant detrimental effect in patients stopping to drive using the VF-14, LHS, but not the EQ-5D.

ANOVA analysis of patients who stopped driving due to AMD versus patients who stopped driving due to other reasons. A VF14. B EQ-5D. C LHS. Circle = mean; error bars = confidence intervals. ***p < 0.001.