May 2008
Volume 49, Issue 13
ARVO Annual Meeting Abstract  |   May 2008
A Systematic Literature Review of Utilities Associated With Visual Acuity in Retinal Diseases
Author Affiliations & Notes
  • J. C. Hornberger
    Cedar Associates LLC, Menlo Park, California
    Medicine, Stanford University School of Medicine, Stanford, California
  • A. Shewade
    Cedar Associates LLC, Menlo Park, California
  • J. W. Doberne
    Cedar Associates LLC, Menlo Park, California
  • J. Kowalski
    Allergan, Inc., Irvine, California
  • H. Nguyen
    Allergan, Inc., Irvine, California
  • Footnotes
    Commercial Relationships  J.C. Hornberger, Allergan, Inc., F; A. Shewade, Allergan, Inc., F; J.W. Doberne, Allergan, Inc., F; J. Kowalski, Allergan, Inc., E; H. Nguyen, Allergan, Inc., E.
  • Footnotes
    Support  Allergan, Inc.
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 4478. doi:
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      J. C. Hornberger, A. Shewade, J. W. Doberne, J. Kowalski, H. Nguyen; A Systematic Literature Review of Utilities Associated With Visual Acuity in Retinal Diseases. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4478.

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      © ARVO (1962-2015); The Authors (2016-present)

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Assessment of illness on patient well-being, grounded in expected-utility theory, is a routine component of new technology appraisals weighing costs and benefits. A systematic literature review cataloged utilities related to visual acuity (VA) in retinal diseases.


The peer-reviewed literature was searched using PubMed and SciSearch on terms, such as retina, visual acuity, macular degeneration, macular edema, and retinal vein occlusion, time trade-off (TTO), standard gamble (SG), EQ-5D, and SF-6D. Eliminating studies for conditions other than retinal diseases, 19 studies were identified and abstracted. Six categories of visual acuity states were defined. Descriptive statistics were performed to assess the relationship of utilities with different levels of visual acuity, type of disease, assessment method, and whether assessment examined best-seeing eye (BSE) or worst-seeing eye (WSE).


All nineteen studies reported TTO utilities. Six studies reported SG utilities, and two studies reported Health utility Index Mark 3 (HUI-3). Visual Analog Scale (VAS), EQ-5D, SF-6D, Quality of Well-being (QWB), and conjoint analysis utilities were reported by one study each. Utilities were derived from patients in all studies; one study also reported utilities assessed from clinicians and community members. TTO utilities were generally lower than SG utilities. Mean utility declined as VA declined. A large variation was observed in utility score when VA < 20/200. Utilities for BSE tended to be lower than for WSE, adjusting for VA; there was no significant difference in utilities across the types of retinal diseases.


A sizable body of literature has emerged, using utility-based survey methods, on the importance of visual acuity to a patient’s overall well-being. These studies reveal significant decrements in well-being as visual acuity declines; thus, providing an evidence base for use in appraising the importance of new technologies to prevent or restore visual acuity.  

Keywords: retina • visual acuity • quality of life 

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