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R. Varma, K. Mazhar, F. Choudhury, C. Shtir, R. McKean-Cowdin, S. Azen, LALES Group; The association of Diabetic Retinopathy (DR) with Health-Related Quality of Life (HRQOL). Invest. Ophthalmol. Vis. Sci. 2009;50(13):3905.
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To assess whether moderate non-proliferative DR (NPDR) is associated with lower health-related quality of life (HRQOL).
As part of the Los Angeles Latino Eye Study (LALES), a population-based sample of adult Latinos with type 2 diabetes mellitus (T2DM) underwent a detailed interview (including an assessment of HRQOL) and a detailed ophthalmic examination. Both general and vision-specific HRQOL were assessed utilizing the Short Form 12-item Health Survey (SF-12) and the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) respectively. The detailed examination included obtaining stereoscopic fundus photographs of the 7 standard fields. These photographs were graded in a masked manner using the modified Airlie house classification. The severity levels were: no DR (levels 10 through 13), NPDR (levels 14 through 53) and proliferative DR (PDR; levels 60 through 85). These levels were further classified into a 15 step scale by combining the severity levels for the two eyes but giving greater weight to the eye with higher level. This 15-step scale were (10/10, 21/<21, 21/21, 31/<31, 31/31, 37/<37, 37/37, 43/<43, 43/43, 47/<47, 47/47, 53/<53, 53/53, ≥60/<60, ≥60/≥60). Multivariate regression analyses and spline functions were performed to determine if the relationship between severity of DR and HRQOL is linear across the DR severity scale or varies depending on the severity of DR.
Of the 1263 participants identified as having T2DM 1064 (84%) participants were included in this analysis as they had a gradable fundus photograph and completed the HRQOL questionnaires. While the overall relationship was that HRQOL scores were lower in persons with more severe DR, the slope between levels 21/,21 and 43/43 was minimal ( slope -0.23-0.40). However, there was a greater than six-fold sharp and consistent increase in the slope for NEI VFQ-25 and SF-12 between DR levels 43/43 and 47/<47 (moderate NPDR) and ≥60/≥60 (PDR)(slope -1.8-2.55). These differences were statistically significant (P<0.05).
Our data suggests that HRQOL is minimally impacted by severity of DR until a person develops moderate NPDR (level 47/<47). However, DR severity levels worse than moderate NPDR (level 47/<47) have a significant impact on a person’s HRQOL. If a goal of treatment of DR is to prevent impacting a person’s quality of life, clinicians should consider intervening earlier to prevent the development of moderate NPDR in persons with T2DM.
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