Using Uniocular Visual Acuity Substantially Underestimates the Impact of Visual Impairment on Quality of Life Compared with Binocular Visual Acuity

Gan, Alfred Tau Liang; Fenwick, Eva; Thakur, Sahil; Gupta, Preeti; Teo, Zhen Ling; Cheng, Ching‐Yu; Wong, Tien Yin; Lamoureux, Ecosse L.

doi:10.1016/j.ophtha.2020.01.056

Cited by 15 publications

(9 citation statements)

References 30 publications

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“…A study looking at better and worse seeing eyes in patients having anti-VEGF treatment for DMO concluded uniocular VA underestimated the impact of vision loss on quality of life indices compared with binocular VA and suggested that researchers, clinicians and policy planners should consider using the patient's best overall VA in patient-reported outcome evaluation of vision loss [5]. A more recent study found that the level of binocular vision rather than vision from either the better or worse seeing eye had the biggest effect on quality of life measures [16]. We can see that for our cohort the mean VA of the better seeing eye was 70.8 letters, higher than the 61.5 letters for the treated eyes.…”

Section: Prioritizationmentioning

confidence: 99%

Macula service evaluation and assessing priorities for anti-VEGF treatment in the light of COVID-19

Stone

Devenport

Stratton

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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Purpose To assess the treatment position of all patients who have had an anti-VEGF injection in 2020, prior to the UK lockdown on 23 March. To assess methods of service quality evaluation in setting benchmarks for comparison after the situation stabilized. To consider what proportion could be delayed based on national guidelines and varying vision parameters. Finally, to measure how many patients actually attended. Method A retrospective analysis of data collected from our electronic medical record was performed. Age, sex, reason for injection, visual acuity (VA) for both treated and untreated eyes and number of injections were recorded. The proportion of patients and eyes with ≥ 70 letters were calculated as an assessment of quality of service provision. The proportion of patients that could be delayed was estimated based on published guidelines and varying the parameters of difference between treated and untreated eyes. Finally, the number of patients who actually attended was recorded. Results About 3364 eyes (2229 neovascular age-related macular degeneration (nAMD), 427 diabetic macular oedema (DMO), 599 retinal vein occlusion (RVO) and 109 other) from 2924 patients were analysed. At the last appointment with injection, 64.4% of patients achieved ≥ 70 letters in their better-seeing eye. Mean VA of the treated eye was 61.5 letters, and 36.9% achieved ≥ 70. The mean number of injections was 16, 90% with aflibercept. Of the patients receiving treatment to one eye, 57.6% was receiving treatment to their worse seeing eye. In 18.2% this eye was > 20 letters worse and in 5.07% > 40 letters worse than the untreated eye. Using Royal College of Ophthalmologists (RCOphth) guidelines, (treat nAMD 8 weekly, delay majority of RVO and DMO) 24.8% would be delayed. From 2738 appointments during the first 4 weeks of lockdown (booked prior to lockdown), doctors rescheduled 1025 and patients did not attend 820, leaving 893 who were seen (33%). Conclusions Assessing the treatment position of patients prior to COVID-19 lockdown enables objective stratification for prioritization for continued treatment. If RCOphth guidelines were followed 24.8% could be delayed and if treating the worse seeing eye up to 57.6%. Many scheduled patients elected not to attend, with 67% not seen in the first 4 weeks. The impact of non-attendance and delays may be evaluated later.

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Section: Prioritizationmentioning

confidence: 99%

Macula service evaluation and assessing priorities for anti-VEGF treatment in the light of COVID-19

Stone

Devenport

Stratton

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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“…Monocular acuity assessment would be better to uncover each eye's visual function and deficits for the purposes of diagnosis and intervention 19,20 . Some studies have also demonstrated similar findings that uniocular VA (better eye and worse eye) 16 or using only unilateral better-eye classification 15 seem to underestimate the impact of vision loss on VRQoL as compared with that of binocular VA and bilateral categorizations.…”

Section: Discussionmentioning

confidence: 71%

Impacts of monocular, binocular, and functional visual acuity on vision-related quality of life in patients with type 2 diabetes

Liao

Jang

et al. 2021

Sci Rep

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Although the association between visual acuity (VA) and vision-related quality of life (VRQoL) has been well reported in patients with type 2 diabetes mellitus (T2DM), little is known about how unilateral and bilateral VA affects daily performance in such patients. For this cross-sectional study, patients were recruited from the Diabetes Shared Care Network of the Division of Endocrinology and Metabolism, Zhong-Xiao Branch, Taipei City Hospital in Taiwan. Ninety patients with T2DM (51 men and 39 women) with a mean age of 60.3 ± 10.5 (standard deviation) years, 47% of whom had diabetic retinopathy, were included. The purposes were to compare the impacts of VA in the better eye, both eyes, and three forms of functional acuity scores (FAS) on VRQoL in patients with T2DM. VRQoL and corrected VA were assessed with the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and Early Treatment Diabetic Retinopathy Study (ETDRS) chart, respectively. Three FAS algorithms proposed by Colenbrander and the American Medical Association were used to assess FAS. Regression analyses were performed to determine the correlations among the five types of VA, the original composite scores, and the Rasch-calibrated composite scores of the NEI VFQ-25 on all patients with T2DM and on the same patients stratified by diabetic retinopathy (DR) and no-DR. The VA of both eyes had a higher impact on VRQoL and revealed a lower reduction estimated by the two forms of composite scores than did the VA of the better eye and three FAS algorithms (compared with binocular VA β estimates, − 14.5%, − 15.8%, − 29.3%, and − 11.8% for original composite scores, and − 16.1%, − 14.0%, − 24.6%, and 10.3% for Rasch-calibrated composite scores). When the T2DM group was stratified into DR and no-DR groups, significant associations between VA and VRQoL were observed only in the DR group. The VA of both eyes also had the greatest impact and reduction after stratification. The results indicated that unilateral better-eye VA and VA estimated by the three FAS algorithms seems to underestimate the impact of visual impairment on self-report VRQoL in patients with T2DM. This study provides empirical support for the importance of binocular VA assessment in regular clinical diabetes eye care.

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“…But none of these studies examined the presence of a VMT. [12][13][14] Recent, Menzler et al 15 has reported the prevalence of symptomatic vitreomacular adhesion, which is 1365 per 100,000 population. Symptomatic vitreomacular adhesion can occur in isolation as VMT, which has the symptoms of decreased visual acuity, metamorphopsia, micropsia, and even photopsia.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Associations of Vitreomacular Traction: The Beijing Eye Study

Shao¹,

Zhang²,

Dong³

et al. 2021

IJGM

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Purpose: To explore the prevalence and associations of vitreous macular traction (VMT) in Chinese population. Methods: A population-based cross-sectional study with 3468 individuals (mean age of 64.6 ± 9.8 years) based on Beijing Eye Study 2011. Participants underwent detailed ophthalmic examinations, including spectral domain optical coherence tomography (SD-OCT). VMT was defined as abnormal posterior vitreous detachment with anatomical deformation of the fovea, which may include pseudocyst, macular schisis, cystoid macular edema, and subretinal fluid. Main Outcome Measure: Prevalence of VMT. Results: A VMT was detected in 151 (2.3%) eyes (prevalence rate (mean ± SE): 2.3± 0.2%; 95% CI: 1.9%, 2.7%) of 80 (2.4%) subjects (prevalence rate: 2.4± 0.3%; 95% CI: 1.9%, 2.9%). Mean age of all subjects with VMT was 70.1± 8.7 years (median, 70.0 years; range, 50-90 years), mean refractive error was −0.22 ± 2.38D (median, 0.25 D; range, −15.00 to 5.25D). In multivariate analysis, prevalence of VMT was associated with elder age (P=0.001, OR 1.06), female gender (P = 0.036, OR 1.77), subfoveal retinal thickness (P = 0.005, OR 1.01), and subfoveal choroidal thickness (P = 0.026, OR 0.10). Conclusion:In adult Chinese in Greater Beijing, the prevalence of VMT was 2.3% for eyes or 2.4% for subjects. While it was associated with elder age, female gender, thicker subfoveal retinal thickness and thinner subfoveal choroidal thickness.

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Using Uniocular Visual Acuity Substantially Underestimates the Impact of Visual Impairment on Quality of Life Compared with Binocular Visual Acuity

Cited by 15 publications

References 30 publications

Macula service evaluation and assessing priorities for anti-VEGF treatment in the light of COVID-19

Macula service evaluation and assessing priorities for anti-VEGF treatment in the light of COVID-19

Impacts of monocular, binocular, and functional visual acuity on vision-related quality of life in patients with type 2 diabetes

Prevalence and Associations of Vitreomacular Traction: The Beijing Eye Study

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