Preference-based comparison of the quality of life associated with vision loss in Black and White U.S. ophthalmic populations

  • Gary C. Brown
    Correspondence to Gary C. Brown, MD, Center for Value-Based Medicine, Box 3417, Hilton Head, SC 29928.
    Center for Value-Based Medicine, Hilton Head, SC

    Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa

    Department of Ophthalmology, Emory University School of Medicine, Atlanta, Ga
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  • Melissa M. Brown
    Center for Value-Based Medicine, Hilton Head, SC

    Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa

    Department of Ophthalmology, Emory University School of Medicine, Atlanta, Ga
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  • Sanjay Sharma
    Department of Ophthalmology, Hotel Dieu Hospital, Kingston, Ont.
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Published:November 22, 2022DOI:



      Utilities are preference-based estimates, typically ranging from 1.00 (normal health) to 0.00 (death), that quantify the quality-of-life improvement associated with a health care intervention. In conjunction with length-of-life gain, depending on the intervention, they measure total interventional value gain in quality-adjusted life years that can be integrated with costs in cost-utility analysis. We believed it relevant to ascertain whether race was a differentiating factor confounding utilities related to vision.


      An analysis of cross-sectional data obtained from consecutive Black and White ophthalmic outpatients from the Wills Eye Hospital (Philadelphia, Pa.) practices who participated in a long-standing time trade-off (TTO) vision utility study from 1999 to 2016 was undertaken. Each participant was interviewed by a researcher using a previously validated and reliable TTO vision utility acquisition instrument and assigned to 1 of 5 vision categories according to acuity in the best-seeing eye. Utility outcomes were compared using both the 2-sided t test and the Mann–Whitney U test.


      Eleven hundred and twenty-five consecutive patients able to successfully answer the questions were included. For vision of 20/200–20/800, White/Black mean vision utilities were, respectively, 0.58/0.59 (p = 0.84); for vision of 20/70–20/100, they were, respectively, 0.72/0.70 (p = 0.85); for vision of 20/50–20/60, they were, respectively, 0.78/0.79 (p = 0.86); for vision of 20/25–20/50, they were, respectively, 0.84/0.88 (p = 0.16); and for vision of 20/20, they were, respectively, 0.91/0.90 (p = 0.43).


      TTO vision utilities in Black and White ophthalmic patient cohorts were alike at various levels of visual acuity. This suggests a similar quality of life and that TTO vision utilities used in cost-utility analysis do not require adjustment for race in Black and White U.S. ophthalmic populations.
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