Abstract
Objective
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.
Design
Cross-sectional interviews using a validated, reliable TTO vision utility analysis
instrument.
Participants
A total of 1598 consecutive ophthalmology patients from the authors’ practices.
Methods
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.
Results
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).
Conclusions
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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of OphthalmologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Utility values associated with blindness in an adult population.Br J Ophthalmol. 2001; 85: 327-331
- Defining post-stroke recovery: implications for design and interpretation of drug trials.Neuropharmacology. 2000; 39: 835-841
- 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
- Utility values in Japanese patients with exudative age-related macular degeneration.Jpn J Ophthalmol. 2011; 55: 35-38
- 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
- Disparities between ophthalmologists and patients in estimating quality of life associated with diabetic retinopathy.PLoS One. 2015; 10e0143678
- Vision and quality of life.Trans Am Ophthalmol Soc. 1999; 97: 473-512
- A utility analysis correlation with visual acuity: methodologies and vision in the better and poorer eyes.Int Ophthalmol. 2001; 24: 123-127
- Quality-of-life and systemic comorbidities in patients with ophthalmic disease.Br J Ophthalmol. 2002; 86: 8-11
- The effect of comorbidities upon ocular and systemic health-related quality of life.Br J Ophthalmol. 2008; 92: 770-774
- Reliability of the time trade-off technique of utility assessment in patients with retinal disease.Can J Ophthalmol. 2001; 36: 202-209
- The reproducibility of ophthalmic utility values.Trans Am Ophthalmol Soc. 2001; 99: 199-203
- Validity of the time trade-off and standard gamble methods of utility assessment in retinal patients.Br J Ophthalmol. 2002; 86: 493-496
- 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
- The effect of visual impairment on vision-related quality of life in American Indian/Alaska Natives.Ophthalmic Epidemiol. 2009; 16: 128-135
- 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
- Utilities associated with diabetic retinopathy: results from a Canadian sample.Br J Ophthalmol. 2003; 87: 259-261
- Vision utilities in Italy and the United States: are they similar?.Eur J Ophthalmol. 2020; 30: 253-257
- Cost-effectiveness analysis in glaucoma: what drives utility? Results from a pilot study in Sweden.Acta Ophthalmol Scand. 2006; 84: 363-371
- 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
- Mapping the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) to EQ-5D utility scores.Ophthalmic Epidemiol. 2014; 21: 66-78
- A systematic literature review of utility weights in wet age-related macular degeneration.J Med Econ. 2013; 16: 1307-1316
- The impact of age-related macular degeneration on health status utility values.Invest Ophthalmol Vis Sci. 2005; 46: 4016-4023
- Visual and health outcomes, measured with the activity inventory and the EQ-5D, in visual impairment.Acta Ophthalmol. 2017; 95: e783-e791
Health Utilities Inc. Health-related quality-of-life [Internet]. 2020 Sep 17. Available from: www.healthutilities.com/hui3.htm.
Benchmark Six Sigma. Sample size calculator for 2 sample t test [Internet]. 2022 Mar 6. Available from: www.benchmarksixsigma.com/calculators/sample-size-calculator-for-2-sample-t-test/.
- A utility maximization model for evaluation of health care programs.Health Serv Res. 1972; 7: 118-133
- Longitudinal relationships among visual acuity daily functional status, and mortality. The Salisbury Eye Evaluation Study.JAMA Ophthalmol. 2014; 132: 1400-1406
- 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
- Medical student perceptions of quality-of-life associated with vision loss.Can J Ophthalmol. 2015; 50: 217-224
- The Beaver Dam Outcomes Study: initial catalog of health state quality factors.Med Decis Making. 1993; 13: 89-102
- Evidence-based to value-based medicine.AMA Press, Chicago2005: 151-233
National Institute for Health and Care Excellence. Developing NICE guidelines: the manual [Internet]. 2020 Sep 11. Available from: www.nice.org.uk/process/pmg20/resources/developing-nice-guidelines-the-manual-pdf-72286708700869.
- 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
- Quality of life with macular degeneration: perceptions of patients, clinicians, and community members.Br J Ophthalmol. 2003; 87: 8-12
- Difference between ophthalmologist and patient perceptions of quality-of-life associated with age-related macular degeneration.Can J Ophthalmol. 2000; 35: 127-133
Tandvårds- Och Läkemedelförmånsverket. Health economics [Internet]. 2020 Sep 11. Available from: www.tlv.se/in-english/medicines/health-economics.html.
- Patients’ preferences in randomized clinical trials.N Engl J Med. 1984; 310: 1385-1387
- Incorporating patients’ preferences into medical decisions.N Engl J Med. 1994; 330: 1895-1986
- Quality of life with visual acuity loss from diabetic retinopathy and age-related macular degeneration.Arch Ophthalmol. 2002; 120: 481-484
- Ophthalmic Utility Research Study Group. Vision-related quality-of-life associated with unilateral and bilateral ocular conditions.Ophthalmology. 2018; 125: 965-971
- The incidence of sympathetic ophthalmia after trauma: a meta-analysis.Am J Ophthalmol. 2021; (S0002-9394(21)00364-0)
- Outcomes of ocular evisceration and enucleation in the British Armed Forces from Iraq and Afghanistan.Eye (Lond). 2019; 33: 1748-1755
- Painful blind eye: efficacy of enucleation and evisceration in resolving ocular pain.Br J Ophthalmol. 2000; 84: 437-438
- Quality of life of eye amputated patients.Acta Ophthalmol. 2012; 90: 435-440
- Early ocular prosthesis insertion improves quality of life after enucleation.Optometry. 2006; 77: 71-75
Article Info
Publication History
Published online: April 23, 2022
Accepted:
March 9,
2022
Received in revised form:
March 7,
2022
Received:
June 4,
2021
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
