Impact of Glaucoma, Lens Opacities, and Cataract Surgery on Visual Functioning and Related Quality of Life: The Barbados Eye Studies

Abstract

purpose. To determine the relationship of open-angle glaucoma (OAG) and lens opacities to visual functioning and related quality of life (QOL), by using the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) in a population of African origin.

methods. The study included 962 black participants of the Barbados Eye Studies with known glaucoma, prior cataract surgery, visual acuity (VA) ≤20/200, or self-reported fair to poor vision and consecutive participants without these conditions. Standardized examinations and protocols were used to define OAG and lens opacities. Associations with VFQ scores were evaluated by multiple regression analyses.

results. After adjustment for age, additional demographic variables, and comorbidities, the presence of OAG was significantly associated with lower scores for distance activities, mental health, and color and peripheral vision, with an overall adjusted mean difference of approximately three points in composite scores. Significantly lower scores were found with PSC opacities, with an overall adjusted mean difference of 6 points (95% CI: 3.3–8.8) for the composite score. Persons who had undergone cataract extraction without intraocular lens implantation reported generally lower scores in many domains than those with pseudophakia and those without cataract surgery, with significantly lower adjusted mean scores for distance activities, social functioning, and color vision.

conclusions. Inferior vision-related QOL was associated with OAG, PSC, and aphakic cataract surgery, as assessed by the NEI-VFQ-25 in this African-origin population. Findings highlight the importance of targeting public health policy, patient care strategies, and social policy, to assist patients with glaucoma, cataract, and surgical aphakia in better coping with the impact of these conditions on QOL.

Age-related cataract, followed by glaucoma, are the two leading causes of visual impairment worldwide. ¹ In the predominantly African-origin population of the Barbados Eye Studies (BESs), the prevalence of visual acuity impairment was higher than in European-derived populations, with both eye conditions collectively accounting for more than 60% of existing blindness. ² Although clinical indicators, such as visual acuity impairment and visual field defects, have been standard measures to describe visual disabilities associated with cataract and glaucoma, self-perceived vision-related quality of life (QOL) has emerged as another important outcome measure that can reflect the impact of these eye diseases. To date, most such investigations involve European-derived and Indian populations, with limited data available for populations of African origin. ^{3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21} Intended to gain better understanding of the perceived vision-related QOL among high-risk groups of this population, the 25-item version of the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) was administered to a subsample of participants during the second phase of the BESs. The NEI-VFQ-25 was designed to evaluate vision-targeted, health-related QOL and has been shown to be reliable and valid in individuals with various eye diseases. ²² The objective of the current report is to determine the relationship of OAG and lens opacities to vision functioning and related QOL, using the NEI-VFQ-25, in this population. 

Methods

The BESs are a series of large population-based investigations of the prevalence, incidence, and risk factors for major eye diseases in the predominantly black population of Barbados, West Indies. ^{23 24 25} The studies were funded by the National Eye Institute and included a Coordinating Center (Stony Brook University, Stony Brook, NY), a Data Collection Center (Ministry of Health, Bridgetown, Barbados, West Indies), and a Fundus Photography Reading Center (The Johns Hopkins University, Baltimore, MD). The BESs cohort was identified from a prevalence study, based on a simple random sample of the Barbados population, 40 to 84 years. ²³ A subsequent phase of the studies, the Barbados Incidence Study of Eye Diseases II (BISED II, 1997–2003) re-examined 2793 surviving members of the original cohort 9-years after the initial baseline prevalence study, with a participation of 81%. ²⁵  

As described previously, standardized protocols used in BISED II ²⁵ included a comprehensive interview on demographics, medical and family history, and other factors, with an added component on quality of life; anthropometric and blood pressure measurements; refraction (Humphrey refractor) and presenting and best corrected visual acuity; Humphrey perimetry and applanation tonometry readings; lens gradings at the slit lamp; and stereo fundus photographs of the disc and macula. Persons in a 10% systemic sample and/or with positive findings such as visual field defects, IOP >21 mm Hg, best corrected VA <20/30, or history of major eye diseases, were referred for a comprehensive ophthalmic examination, repeat tonometry, and perimetry. The research adhered to the tenets of the Declaration of Helsinki. The study was approved by the institutional review board (IRB) of participating institutions, and informed consent was obtained from all study participants. 

The classification of glaucoma was described in detail elsewhere. ^{23 24 26} In brief, OAG was based on the presence of both visual field defects (abnormal visual field tests by Humphrey perimetry, with ophthalmic interpretation as definite or suspected glaucomatous field loss) and optic disc damage (disc abnormalities in masked gradings of fundus photographs at the study’s Reading Center and/or the ophthalmic examination) in either eye, after the exclusion of other possible causes by the study ophthalmologists. IOP was not considered in the glaucoma definition. Analyses involving OAG in this report excluded persons with secondary and other types of glaucoma. Lens gradings were based on the Lens Opacities Classification System II (LOCS II) ²⁷ at the slit lamp under maximum dilatation with 1% tropicamide. LOCS II employs photographic standards to grade opacities into five nuclear (N0–N4), seven cortical (C0, trace, C1–C5), and five posterior subcapsular (PSC, P0–P4) ordinal grades of increasing severity. The presence of lens opacities, by type, was defined by a LOCS II score ≥2 in either eye. Cataract surgery was based on the surgical removal of a lens in at least one eye, with or without intraocular lens implantation, as identified at the study examination. 

The NEI-VFQ-25 was administered throughout BISED II to assess vision-related QOL in the high-risk groups with known glaucoma, prior cataract surgery, VA ≤20/200, or self-reported fair or poor vision. Interviewers were trained according to a detailed protocol, with regular monitoring until adequate performance was achieved and certification awarded. Postcertification quality control involved periodic replication of selected questionnaire items during the study period. From December 1999 to March 2001, all consecutive participants, regardless of their vision and eye disease status, were interviewed with the questionnaire, thus constituting a comparison group that included persons without the mentioned conditions. A total of 1044 participants completed the NEI-VFQ at the study site. Because of the small number of participants with other self-reported ancestries, this report focused on the 962 participants of African origin only. These individuals had various ocular conditions that were not mutually exclusive. For example, 53 of the 962 participants had the combination of OAG, lens opacities, and visual acuity worse than 20/40, and 137 had both OAG and lens opacities. The questionnaire consists of 25 vision-targeted questions representing one general-health–rating question and 11 vision-related subscales. The latter comprised the following dimensions: global vision rating, difficulties with near and distance vision activities, limitations in social functioning, role limitations, dependency, mental health symptoms attributable to visual problems, driving difficulties, limitations with peripheral and color vision, and ocular pain. A total of 12 subscale scores and a composite score (unweighted average of all subscale scores, excluding the general health rating question) ranging from 0 to 100 were evaluated, with higher scores representing better-vision–targeted QOL. ²²  

Analyses were conducted on computer (SAS, ver. 9.1; SAS Institute Inc., Cary NC). Multiple regression analyses using the General Linear Model procedure in SAS were conducted to evaluate associations with VFQ scores. The analyses adjusted for potential confounding variables on demographics and medical comorbidities, including age, sex, years of education, lifetime occupation, hypertension, history of diabetes and cardiovascular disease (including myocardial infarction [MI], other heart conditions, and stroke). The reference group for each ocular condition of interest included persons without that condition, while adjusting for other ocular comorbidities. Results were presented as adjusted means (least square) and P-values were based on the Tukey-Kramer test for multiple comparisons. 

Results

Among the 962 black participants completing the NEI-VFQ at the study site, the mean age was 68.6 years (SD = 10.5) and 56% were females. As seen in Table 1 , 19% of persons in this high-risk group had OAG and more than 70% had lens opacities. Overall composite scores were lower in participants with older age, visual impairment, and OAG, compared with their counterparts (P < 0.05). Mean scores were similar for males and females. Although a lower mean composite score was observed in persons with any lens opacities than those without, the difference was not significant after adjusting for age (Table 1) . 

Table 2presents multivariate adjusted mean scores according to the presence of OAG for the composite and all subscales. Scores for distance activities, social function, mental health, and color and peripheral vision were significantly lower in participants with OAG than in those without, after adjustment for demographic and nonocular comorbidities, visual acuity, and lens opacity status. The adjusted mean score differences between the two groups were modest, approximately 3 to 7 points, the highest being for peripheral vision. Overall, the adjusted mean (SE) composite scores were 86.8 (0.6) for no OAG and 84.1 (0.9) for OAG. Persons with OAG also reported more driving difficulty with a borderline significance level of P = 0.06, which was based on a smaller sample size (n = 32) because 70% of the participants never drove. Differences in scores were also suggested for the domains of general vision (P = 0.08) and role difficulties (P = 0.06). In additional analyses, participants were further categorized into nonglaucoma (n = 682), suspected or probable OAG (n = 88; having some, but not all the strict optic disc and visual field criteria for OAG), and definite OAG (n = 181) groups. For most of the subscales, results yielded lowest adjusted mean scores for the definite OAG group, highest for the non-OAG group, and intermediate for the suspected or probable group, with adjusted mean (SE) composite scores being 84.1 (0.9), 87.0 (0.6), and 85.4 (1.2), respectively, although significant differences were seen only between non-OAG and definite OAG groups. 

When the relationship was evaluated by type of lens opacities, significant associations were mainly seen with any PSC, but not with nuclear or cortical opacities. Table 3presents the multivariate adjusted mean scores for persons with and without PSC opacities. Even with the relatively small sample size, persons with PSC opacities had lower scores than others for almost all subscales. Significant differences were most noticeable for limitations with peripheral vision, role difficulties, and distance activities (∼9-point difference for each of these subscales), followed by social functioning, near activities, dependency, and mental health (∼5–7 points). The overall mean difference for the composite scores was 6 points (95% CI: 3.3–8.8) (i.e., scores were 80.9 and 87.0 for persons with and without PSC opacities, respectively). Additional analyses categorizing PSC opacities into moderate (P = 2 or 3, n = 50) and severe (P > 3, n = 23) indicated a gradient of VFQ scores in subscales such as social functioning, role difficulties, dependency, and peripheral vision, with adjusted mean (SE) composite scores decreasing from 87.6 (1.1) in persons without PSC opacities to 83.1 (1.9) in persons with moderate PSC and 78.3 (2.5) with severe PSC opacities. 

For all subscales, lower unadjusted mean scores were found for persons with any nuclear opacities (n = 523) than those without. After adjustment for age, however, significantly lower scores were noted only for subscales, including general health, mental health, role difficulties, and peripheral vision. Additional adjustment for other demographic and comorbidities resulted in no significant associations with any subscale, regardless of adjustment for visual acuity. There were no significant differences between persons with and without any cortical opacities (n = 429) in any of the subscales, before or after age or multivariate adjustment. When persons with any type of lens opacities were considered as one group, their unadjusted mean scores were lower than their unaffected counterparts on all subscales. However, age-adjusted differences were significant only for general health and role difficulties, with no associations noted after further adjustment. Further analyses defining any lens changes to include persons with any lens opacities or with cataract surgery (n = 124) also did not reveal any significant associations with the VFQ scores. 

Of the 124 persons who had undergone cataract surgery, 73% were pseudophakic and 27% were aphakic in either eye. As shown in Table 4 , adjusted mean scores for most subscales were generally similar between persons without cataract surgery and those with pseudophakia, but tended to be lower in persons with aphakia. Despite the small number of participants with aphakia (n = 34), these differences reached significance at the 5% level for distance activities, social functioning, and color vision in multivariate adjustment that included visual acuity. Of the cataract surgeries, 82 (66%) were unilateral and 42 (34%) were bilateral. While unadjusted mean scores in some subscales were lower in participants with unilateral surgery than persons without cataract surgery, no significant differences were found either between persons with versus without cataract surgery or between unilateral versus bilateral surgery, after age or additional adjustment. 

Discussion

This study provides new data on the relationship of OAG and lens opacities to various aspects of QOL, as characterized by the NEI-VFQ-25, in a population of African origin. The presence of OAG, independent of VA, was associated with significantly lower scores for subscales including distance activities, social functioning and mental health, color and peripheral vision (∼3–7 points), and with lower composite scores (mean difference: 2.7, 95% CI: 0.9–4.5). Although persons with lens opacities, particularly those with nuclear and PSC opacities, had generally lower unadjusted mean scores than persons without such conditions, significantly lower scores were found only with PSC opacities after multivariate adjustment. These results suggested more difficulties with general vision, near and distance activities, peripheral vision, and limitations on psychosocial functioning and dependency, with an adjusted mean difference in composite score of 6 points lower (95% CI: 3.3–8.8). In this cross-sectional evaluation, persons who had undergone cataract extraction without intraocular lens (IOL) implantation, reported generally lower scores in many domains of the vision-related QOL assessment than those with pseudophakia and those without cataract surgery, demonstrated by significantly lower adjusted mean scores for distance activities, social functioning, and color vision. 

OAG and Vision-Related QOL

Based on a standardized definition of OAG that required the presence of both visual field defects and optic disc damage, BESs participants with OAG reported worse vision-related QOL overall and in multiple dimensions, compared with nonglaucomatous participants, with or without accounting for the impact of visual impairment. Our results are generally consistent with those of other studies (in which various instruments were used) that reported a lower perceived functional status and well-being in persons with diagnosed glaucoma than in others. ^{8 9 11 17 21} In addition, some investigators found a decrease in vision-related QOL as glaucomatous visual field defects became worse. ^{5 6 8 16 20} While direct comparisons between different studies should consider their variations in design, definitions, and instruments used, comparable results were reported in two other studies that used the NEI-VFQ-25. In testing the psychometric properties of the 25-item questionnaire, Mangione et al. ²² demonstrated significant differences in scores between persons with glaucoma and a reference group in all subscales, except general health and ocular pain. Data from the Mexican-American population-based study of Proyecto VER also found that participants with glaucoma had lower scores, independent of visual acuity, in all subscales but general health, with most declines in scores relating to driving. ¹¹ In the BESs, predominant differences between persons with and without OAG were found in scores relating to peripheral vision and driving (∼7 points), as expected. A modest difference (∼3–5 points) in scores was also noted for vision-related social functioning and mental health, as well as distance activities. These studies found the associations between glaucoma and vision-related QOL (measured by NEI-VFQ-25) in almost the same domains, except that the difference in activities related to near vision was not noted in the BESs. While glaucoma usually affects peripheral vision, central vision may also be lost at an advanced stage. Although analyses including suspected or probable OAG suggested a trend toward lower scores as disease status worsened, further investigations may better clarify the impact of severity, such as the degree of visual field defect, on QOL. Results from this study suggest that disabilities related to OAG extend beyond clinically measurable vision defects. Participants with OAG also perceived limitations of daily activities and social/mental functions. 

Lens Opacities and Vision-Related QOL

The association between lens opacities and vision-related QOL was found in participants with PSC, but not with nuclear or cortical opacities. Although persons with nuclear opacities had lower unadjusted mean scores in almost all subscales than those without such opacities, these differences were no longer significant after adjustment for age. Participants with nuclear opacities were much older than their counterparts (mean age: 74 versus 60 years for nuclear, 74 versus 67 for PSC, and 71 versus 64 for cortical opacities) and this may explain the lack of independent association. In the Age-Related Eye Disease Study (AREDS), the only other study (to our best knowledge) evaluating associations by lens opacity types, the NEI-VFQ scores for participants with severe nuclear opacities were significantly lower in many subscales than in those without nuclear opacities, after adjusting for age, sex, and race. PSC opacities were not considered in that study because they were uncommon. ¹³ Our study used the standardized classification system of LOCS II, which categorized lens opacities by anatomic region and severity, independent of visual acuity. Several studies have examined the relationship between cataract and vision-related QOL, also using a similar type of definition to classify lens opacities without requiring a visual acuity criterion. While their results have varied, most reported significant associations before accounting for the effect of visual acuity. In an adult population from southern India, aged 40 years and older, participants with cataract had significantly lower scores with the WHO-QOL instrument than those without cataract. This association was no longer significant after adjusting for visual acuity. ²¹ Another study conducted in rural south India found that participants with age-related cataract had difficulty across all domains of QOL, which persisted after adjustment for visual acuity. ¹⁷ Data from Proyecto VER showed that those with cataract had associated decrements in QOL, although low acuity explained most of the low scores. ¹¹ Mangione et al. ²² reported significant between-group differences in scores for persons with cataract in all domains except ocular pain, after adjusting for age, sex, race, and medical comorbidities. In the BESs, additional analyses combining all types of lens opacities did not show significant differences in QOL scores compared to no opacities, before and after age or additional multivariate adjustment. This result may be affected by the infrequency of PSC opacities, which was the only opacity type associated with vision-related QOL in this report. Also, anecdotal reports suggest that vision loss due to age-related cataract is often viewed as an accepted and inevitable concomitant of aging in this population, and this is supported by the low frequency of cataract surgery. ²⁵ Therefore, cultural issues could also contribute to the weak influence of lens opacities in general, and nuclear opacities in particular, on self-perceived vision-targeted, health-related QOL. Nonetheless, the association between PSC opacities and QOL corroborated the validity of the NEI-VFQ-25 in discriminating many aspects of QOL between those with and without this condition. 

Cataract Surgery and Vision-Related QOL

Although there was an increasing trend to more cataract surgery during the follow-up period of the BESs (1987–2002), the frequency of cataract extraction, particularly with IOL implantation, remained relatively low compared with European-derived populations. ²⁵ Data from the cross-sectional investigation of AREDS showed that, according to the 39-item NEI-VFQ, participants with unilateral aphakia or pseudophakia (n = 244) had significantly lower age, ethnicity, and sex-adjusted mean scores for all subscales except general health, than those without cataract surgery. ¹³ Although similar patterns were suggested by the unadjusted mean scores, results from the BESs could not confirm these findings, probably due to the small sample size of the cataract surgery group. Studies investigating the effects of cataract surgery before and after the procedure have reported improved vision-related QOL after cataract extraction. ^{28 29 30 31} In a randomized controlled trial in an Indian population, cataract extraction with and without IOL implantation was associated with substantial improvements in visual functioning and QOL, with those who received IOLs reporting greater benefits and fewer problems with vision than those who received aphakic glasses. ³⁰ Such a conclusion is not possible from the observational design of the BES, where details on surgical performance and its outcomes, which could be relevant to our findings, were not readily available. Relatively short-term (within 1 year) postsurgical effects of cataract surgery were evaluated in these studies. Although direct comparisons with those findings were not possible given the cross-sectional design of the present study, it is interesting to note that even with the small number of surgery cases, self-perceived visual functioning and related QOL were similar in persons with IOLs as in those without surgery. In addition, persons with aphakia generally reported lower scores, with significantly more difficulties in subscales such as distance activities and social functioning, after adjustment for visual acuity. Although compliance with aphakic spectacle use may be one possible explanation, our results support the favorable influence of cataract surgery with IOLs, versus an aphakic procedure, in achieving better QOL. 

Strengths and Limitations

A major strength of this study was the large number of African-origin participants with glaucoma and lens opacities, with classification by standardized protocols and specific criteria. However, the low frequency of those who underwent cataract extraction limited the power to detect significant findings with surgery. Other potential limitations relate to the cross-sectional design of the present study that did not allow evaluations of QOL changes over time, as well as the sampling scheme that restricted the generalizability of the study findings. 

In conclusion, the NEI-VFQ-25 showed that self-perceived QOL in multiple domains differed between persons with and without OAG in this African-Caribbean population. No significant relationship was found between QOL and combined types of lens opacities or cortical and nuclear opacities considered separately, possibly reflecting a general acceptability of decreased vision as part of the normal aging process. In contrast, inferior QOL was associated with PSC opacities in various subscales. Furthermore, differences in some subscales between persons with aphakic cataract surgery and those with IOLs or without cataract surgery were measurable with the instrument. These findings support the need for more targeted public health policy and patient care management strategies, emphasizing earlier detection and optimal management of OAG and cataract, particularly PSC opacities, as cataract surgery with IOL implantation is likely to reduce visual disability. Broad social policies to counter poor QOL could also be beneficial in decreasing the functional dependence and impaired social and mental functioning of persons with glaucoma and cataract. 

Appendix 1

The Barbados Eye Studies Group

Principal Investigator: M. Cristina Leske 

Coordinating Center

Stony Brook University, Stony Brook, NY: M. Cristina Leske, Barbara Nemesure, Suh-Yuh Wu, Leslie Hyman, Xiaowei Li, Lixin Jiang, Ling Yang, Kasthuri Sarma, Karen Kelleher, and Melinda Santoro 

Data Collection Center

Ministry of Health, Bridgetown, Barbados, West Indies: Anthea M. S. Connell (deceased), Anselm Hennis, Ann Bannister, Muthu A. Thangaraj, Coreen Barrow, Patricia Basdeo, Kim Bayley, and Anthanette Holder 

Fundus Photography Reading Center

The Johns Hopkins University, Baltimore, MD: Andrew P. Schachat, Judith A. Alexander, Cheryl J. Hiner, Noreen B. Javornik, Deborah A. Phillips, Reva W. Strozykowski, and Terry W. George 

Advisory Committee

Trevor Hassell, (Department of Cardiology), Henry Fraser, (Chronic Diseases Research Centre), Clive Gibbons, (Department of Ophthalmology), School of Clinical Medicine and Research, University of the West Indies; Queen Elizabeth Hospital, Barbados, West Indies 

 Supported by Grants EY07625, EY07617, and EY014921 from the National Eye Institute, Bethesda, Maryland.

 Submitted for publication September 25, 2007; revised November 9, 2007; accepted February 18, 2008.

 Disclosure: S.-Y. Wu, None; A. Hennis, None; B. Nemesure, None; M.C. Leske, None

 The publication costs of this article were defrayed in part by page charge payment. This article must therefore be marked “advertisement” in accordance with 18 U.S.C. §1734 solely to indicate this fact.

 

Table 1.

 

Composite NEI-VFQ Scores by Age, Sex, and Ocular Condition

	n	Mean ± SD	P *
Age (y)
<70	506	91.3 ± 11.6
≥70	456	80.0 ± 17.6	<0.0001
Sex
Female	542	86.5 ± 14.1
Male	420	85.2 ± 17.6	0.3
Visual acuity impairment, †
No impairment	690	91.4 ± 8.4
Impairment	196	77.3 ± 15.2	<0.0001
Blindness	67	56.9 ± 25.7	<0.0001
OAG
No	770	87.6 ± 13.6
Yes	181	78.9 ± 21.5	<0.0001
Lens opacities
No	246	93.1 ± 10.1
Yes	660	84.0 ± 16.0	0.2
Cataract surgery
No	829	86.7 ± 15.2
Yes	124	81.1 ± 18.5	0.7
Pseudophakia	90	84.5 ± 14.0	0.3
Aphakia	34	71.9 ± 24.9	0.002

*  Age-adjusted differences for variables other than age were based on regression models.

†  Based on presenting visual acuity (VA). Low vision, 6/60 < VA < 6/12; blindness, VA ≤ 6/60.

Table 2.

 

NEI-VFQ-25 and OAG

Subscale	OAG
		No (n = 770)	Yes (n = 181)
General health	40.5 (1.1)	39.5 (1.6)
General vision	68.1 (0.8)	66.1 (1.2)*
Ocular pain	88.4 (1.1)	88.3 (1.6)
Near activities	84.9 (1.0)	83.6 (1.5)
Distance activities	87.2 (1.0)	82.8 (1.6), †
Social functioning	92.1 (0.8)	88.7 (1.2), †
Mental health	91.7 (0.7)	89.0 (1.1), †
Role difficulties	82.6 (1.2)	79.4 (1.8), ‡
Dependency	92.6 (0.8)	92.2 (1.3)
Driving	87.9 (2.4)	81.2 (3.6), ‡
Color vision	96.4 (0.6)	94.1 (0.9), †
Peripheral vision	86.1 (1.1)	79.2 (1.7), †
Composite score	86.8 (0.6)	84.1 (0.9), †

 Data are the mean (SE) NEI-VFQ Score adjusted for age, sex, education, occupation, hypertension, history of diabetes and cardiovascular disease, lens opacities, and visual acuity.

*   P = 0.08.

†   P < 0.05.

‡   P = 0.06.

Table 3.

 

NEI-VFQ-25 and PSC Opacities

Subscale	PSC
		No (n = 765)	Yes (n = 73)
General health	40.3 (1.2)	43.6 (2.6)
General vision	68.6 (0.8)	64.4 (1.9)*
Ocular pain	88.4 (1.2)	84.7 (2.6)
Near activities	86.1 (1.1)	79.3 (2.4)*
Distance activities	86.9 (1.1)	78.2 (2.4)*
Social functioning	92.4 (0.9)	85.3 (1.8)*
Mental health	91.2 (0.8)	86.1 (1.8)*
Role difficulties	82.8 (1.3)	73.7 (2.8)*
Dependency	94.1 (0.9)	87.9 (2.0)*
Driving	84.3 (2.9)	78.1 (9.3)
Color vision	96.1 (0.6)	95.7 (1.4)
Peripheral vision	85.6 (1.2)	76.3 (2.5)*
Composite score	87.0 (0.7)	80.9 (1.4)*

 Data are the mean (SE) NEI-VFQ scores adjusted for age, sex, education, occupation, hypertension, history of diabetes and cardiovascular disease, presence of cortical and nuclear opacities, presence of OAG, and visual acuity.

*   P < 0.05.

Table 4.

 

NEI-VFQ-25 and Cataract Surgery

	No (n = 829)	Aphakia (n = 34)	Pseudophakia (n = 90)
General health	39.8 (1.0)	40.7 (3.5)	40.1 (2.1)
General vision	66.6 (0.8)	63.3 (2.6)	66.6 (1.6)
Ocular pain	87.3 (1.1)	92.4 (3.6)	83.7 (2.2)
Near activities	83.3 (1.0)	78.6 (3.4)	83.9 (2.1)
Distance activities	84.1 (1.0)*	74.0 (3.4)	84.2 (2.1)*
Social functioning	89.7 (0.8)	84.2 (2.6)	91.9 (1.6)*
Mental health	89.7 (0.7)	90.7 (2.5)	89.8 (1.5)
Role difficulties	79.8 (1.2)	77.7 (3.9)	79.6 (2.4)
Dependency	91.9 (0.9)	86.8 (3.0)	93.7 (1.8), †
Driving	84.3 (2.4)	70.6 (10.6)	88.8 (5.6)
Color vision	94.4 (0.7)*	86.9 (2.2)	95.1 (1.4)*
Peripheral vision	82.1 (1.1)	79.7 (3.6)	83.5 (2.3)
Composite	84.7 (0.6)	81.3 (2.1)	84.9 (1.3)

 Data are the mean (SE) NEI-VFQ scores adjusted for age, sex, education, occupation, hypertension, history of diabetes and heart disease (MI, other heart, stroke), presence of OAG, and visual acuity

*   P < 0.05, based on Tukey-Kramer multiple comparisons test. Reference group, aphakia.

†   P = 0.097.

The authors thank the Barbados Eye Studies participants and the Ministry of Health, Barbados, West Indies, for their role in the study.