Quality of life associated with no light perception vision

Published:April 23, 2022DOI:



      Time trade-off (TTO) utility analysis quantifies the quality of life associated with best-seeing-eye (BSE) vision. We compared the patient quality of life associated with unilateral and bilateral no light perception (NLP) with that of a control cohort without NLP.


      Cross-sectional interviews using a validated, reliable TTO vision utility analysis instrument.


      A total of 1598 consecutive ophthalmology patients from the authors’ practices.


      Patient records were reviewed in a case-control fashion The utilities of participants with unilateral or bilateral NLP vision were compared with those from patients without NLP vision.


      Among 99 NLP patients, 93 (94%) had unilateral NLP and 6 (6%) had bilateral NLP, for a total of 105 NLP eyes. Multiple regression analysis demonstrated the highest correlation between utility and BSE acuity (p = 0.001), with no correlation with age, ophthalmic disease, time of vision loss, race, or education. Mean unilateral NLP utility ranged from 0.55 in the counting fingers to light perception subcohort to 0.80 in the 20/20–20/25 subcohort. The 6-person bilateral NLP subcohort had a 0.54 utility. The 99-patient NLP cohort mean utility was 0.69, a 55% quality-of-life decrease versus a BSE vision–matched 0.80 in 1499 non-NLP patients (p < 0.001).


      TTO utility in unilateral NLP patients correlated with BSE vision at a lower utility than in patients with matched BSE vision without fellow-eye NLP. Decreased unilateral NLP patient quality of life should be considered in cost-utility analysis and clinical management. Bilateral NLP patient utility (0.54) was slightly less than that (0.55) in blind unilateral NLP patients with fellow-eye counting fingers to light perception vision, suggesting that more study is needed.
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        • Brown MM
        • Brown GC
        • Sharma S
        • et al.
        Utility values associated with blindness in an adult population.
        Br J Ophthalmol. 2001; 85: 327-331
        • Duncan PW
        • Lai SM
        • Keighley J.
        Defining post-stroke recovery: implications for design and interpretation of drug trials.
        Neuropharmacology. 2000; 39: 835-841
        • Lloyd A
        • Piglowska N
        • Ciulla T
        Estimation of impact of RPE65-mediated inherited retinal disease on quality-of-life and the potential benefits of gene therapy.
        Br J Ophthalmol. 2019; 103: 1610-1614
        • Yanagi Y
        • Ueta T
        • Obata R
        Utility values in Japanese patients with exudative age-related macular degeneration.
        Jpn J Ophthalmol. 2011; 55: 35-38
        • Zhu M
        • Yu J
        • Zhang J
        • et al.
        Evaluating vision-related quality of life in preoperative age-related cataract patients and analyzing its influencing factors in China: a cross-sectional study.
        BMC Ophthalmol. 2015; 15: 160
        • Zhu X
        • Sun Q
        • Zou H
        • Xu X
        • Zhang X.
        Disparities between ophthalmologists and patients in estimating quality of life associated with diabetic retinopathy.
        PLoS One. 2015; 10e0143678
        • Brown GC.
        Vision and quality of life.
        Trans Am Ophthalmol Soc. 1999; 97: 473-512
        • Brown MM
        • Brown GC
        • Sharma S
        A utility analysis correlation with visual acuity: methodologies and vision in the better and poorer eyes.
        Int Ophthalmol. 2001; 24: 123-127
        • Brown MM
        • Brown GC
        • Sharma S
        • Hollands H.
        Quality-of-life and systemic comorbidities in patients with ophthalmic disease.
        Br J Ophthalmol. 2002; 86: 8-11
        • Real FJ
        • Brown GC
        • Brown HC
        • Brown MM.
        The effect of comorbidities upon ocular and systemic health-related quality of life.
        Br J Ophthalmol. 2008; 92: 770-774
        • Hollands H
        • Lam M
        • Pater J
        • et al.
        Reliability of the time trade-off technique of utility assessment in patients with retinal disease.
        Can J Ophthalmol. 2001; 36: 202-209
        • Brown GC
        • Brown MM
        • Sharma S
        • Beauchamp G
        • Hollands H.
        The reproducibility of ophthalmic utility values.
        Trans Am Ophthalmol Soc. 2001; 99: 199-203
        • Sharma S
        • Brown GC
        • Brown MM
        • Hollands H
        • Robbins R
        • Shah G.
        Validity of the time trade-off and standard gamble methods of utility assessment in retinal patients.
        Br J Ophthalmol. 2002; 86: 493-496
        • Chun YS
        • Kyung RS
        • Park CK
        for the LIGHT (Life Quality of Glaucoma Patients Who Underwent Treatment) Study of the Korean Glaucoma Society. Factors influencing vision-related quality of life according to glaucoma severity.
        Acta Ophthalmol. 2019; 97: e216-e224
        • McClure TM
        • Choi D
        • Becker T
        The effect of visual impairment on vision-related quality of life in American Indian/Alaska Natives.
        Ophthalmic Epidemiol. 2009; 16: 128-135
        • Quinn GE
        • V Velma Dobson
        • Saigal S
        • Group for the CRYO-ROP Cooperative
        Health-related quality of life at age 10 years in very low-birth-weight children with and without threshold retinopathy of prematurity.
        Arch Ophthalmol. 2004; 122: 1659-1666
        • Sharma S
        • Oliver A
        • Bakal J
        • Hollands H
        • Brown GC
        • Brown MM.
        Utilities associated with diabetic retinopathy: results from a Canadian sample.
        Br J Ophthalmol. 2003; 87: 259-261
        • DiScala G
        • Brown GC
        • Brown MM.
        Vision utilities in Italy and the United States: are they similar?.
        Eur J Ophthalmol. 2020; 30: 253-257
        • Kobelt G
        • Jonsson B
        • Bergstrom A
        • Chen E
        • Linden C
        • Alm A.
        Cost-effectiveness analysis in glaucoma: what drives utility? Results from a pilot study in Sweden.
        Acta Ophthalmol Scand. 2006; 84: 363-371
        • Sanders GD
        • Neumann PJ
        • Basu A
        • et al.
        Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses. Second Panel on Cost-Effectiveness in Health and Medicine.
        JAMA. 2016; 316: 1093-1103
        • Kay S
        • Ferreira A.
        Mapping the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) to EQ-5D utility scores.
        Ophthalmic Epidemiol. 2014; 21: 66-78
        • Pearson I
        • Rycroft C
        • Irving A
        • et al.
        A systematic literature review of utility weights in wet age-related macular degeneration.
        J Med Econ. 2013; 16: 1307-1316
        • Espallargues M
        • Czoski-Murray CJ
        • Bansback NJ
        • et al.
        The impact of age-related macular degeneration on health status utility values.
        Invest Ophthalmol Vis Sci. 2005; 46: 4016-4023
        • Macedo AF
        • Ramos PL
        • Hernandez-Moreno L
        • et al.
        Visual and health outcomes, measured with the activity inventory and the EQ-5D, in visual impairment.
        Acta Ophthalmol. 2017; 95: e783-e791
      1. Health Utilities Inc. Health-related quality-of-life [Internet]. 2020 Sep 17. Available from:

      2. Benchmark Six Sigma. Sample size calculator for 2 sample t test [Internet]. 2022 Mar 6. Available from:

        • Torrance GC
        • Thomas WH
        • Sackett DL.
        A utility maximization model for evaluation of health care programs.
        Health Serv Res. 1972; 7: 118-133
        • Christ SL
        • Zheng DD
        • Swenor BK
        • et al.
        Longitudinal relationships among visual acuity daily functional status, and mortality. The Salisbury Eye Evaluation Study.
        JAMA Ophthalmol. 2014; 132: 1400-1406
        • Eong KGA
        • Chan EW
        • Luo EW
        Validity of EuroQol-5D, time trade-off, and standard gamble for age-related macular degeneration in the Singapore population.
        Eye (Lond). 2012; 26: 379-388
        • Chaudry I
        • Brown GC
        • Brown MM.
        Medical student perceptions of quality-of-life associated with vision loss.
        Can J Ophthalmol. 2015; 50: 217-224
        • Fryback DG
        • Dasbach EG
        • Klein R
        • et al.
        The Beaver Dam Outcomes Study: initial catalog of health state quality factors.
        Med Decis Making. 1993; 13: 89-102
        • Brown MM
        • Brown GC
        • Sharma S.
        Evidence-based to value-based medicine.
        AMA Press, Chicago2005: 151-233
      3. National Institute for Health and Care Excellence. Developing NICE guidelines: the manual [Internet]. 2020 Sep 11. Available from:

        • Brazier J
        • Ara R Azzabi I
        • et al.
        Identification, review, and use of health state utilities in cost-effectiveness models. An ISPOR Good Practices for Outcomes Research Task Force Report.
        Value in Health. 2019; 22: 267-275
        • Stein JD
        • Brown MM
        • Brown GC
        • Sharma S
        • Hollands H.
        Quality of life with macular degeneration: perceptions of patients, clinicians, and community members.
        Br J Ophthalmol. 2003; 87: 8-12
        • Brown GC
        • Brown MM
        • Sharma S.
        Difference between ophthalmologist and patient perceptions of quality-of-life associated with age-related macular degeneration.
        Can J Ophthalmol. 2000; 35: 127-133
      4. Tandvårds- Och Läkemedelförmånsverket. Health economics [Internet]. 2020 Sep 11. Available from:

        • Angel M.
        Patients’ preferences in randomized clinical trials.
        N Engl J Med. 1984; 310: 1385-1387
        • Kassirer JP.
        Incorporating patients’ preferences into medical decisions.
        N Engl J Med. 1994; 330: 1895-1986
        • Brown MM
        • Brown GC
        • Sharma S
        • Landy J.
        Quality of life with visual acuity loss from diabetic retinopathy and age-related macular degeneration.
        Arch Ophthalmol. 2002; 120: 481-484
        • Brown GC
        • Brown MM
        • Stein JD
        • Smiddy WE
        Ophthalmic Utility Research Study Group. Vision-related quality-of-life associated with unilateral and bilateral ocular conditions.
        Ophthalmology. 2018; 125: 965-971
        • He B
        • Tanya SM
        • Wang C
        • et al.
        The incidence of sympathetic ophthalmia after trauma: a meta-analysis.
        Am J Ophthalmol. 2021; (S0002-9394(21)00364-0)
        • Holmes CJ
        • McLaughlin A
        • Farooq T
        • et al.
        Outcomes of ocular evisceration and enucleation in the British Armed Forces from Iraq and Afghanistan.
        Eye (Lond). 2019; 33: 1748-1755
        • Shah-Desai SD
        • Tyers AG
        • Manners RM.
        Painful blind eye: efficacy of enucleation and evisceration in resolving ocular pain.
        Br J Ophthalmol. 2000; 84: 437-438
        • Rasmussen MLR
        • Ekholm O
        • Prause JU
        • Toft PB.
        Quality of life of eye amputated patients.
        Acta Ophthalmol. 2012; 90: 435-440
        • Chin K
        • Margolin CB
        • Finger PT.
        Early ocular prosthesis insertion improves quality of life after enucleation.
        Optometry. 2006; 77: 71-75