Impact of Diabetic Retinopathy on Visual Function and Health–Related Quality of Life in Latinos With Type 2 Diabetes: The Los Angeles Latino Eye Study (LALES)

Abstract

Abstract: : Purpose:To assess the impact of diabetic retinopathy (DR) of varying severity on self–reported visual function and health–related quality of life (HRQOL) in Latinos with type 2 diabetes (T2DM). Methods:The LALES is a population–based prevalence study to assess the presence of eye disease and HRQOL in Latinos aged 40 yrs or older. Participants underwent a complete ophthalmologic examination including stereoscopic fundus photography. Photographs were graded in a masked manner using a modified Airlie House Grading System to assess presence and severity of DR. Participants also completed a standardized interview including the NEI 25–Item Visual Function Questionnaire (VFQ–25) to measure visual function and the Medical Outcome Study 12–Item Short Form (SF–12) to measure HRQOL. Both VFQ–25 and SF–12 subscale scores (high score represents better function) were calculated using standard algorithms. Analysis of covariance was used to compare mean QOL scores among the different levels of DR: no DR, unilateral nonproliferative DR (NPDR), bilateral NPDR, unilateral proliferative DR (PDR), and bilateral PDR. A 5 point difference in subscale scores was considered to be clinically meaningful. Covariates included standard sociodemographic factors, comorbidities, and health insurance. Results: 1,090 participants with T2DM were included. After adjusting for covariates, all 12 mean VFQ–25 subscale scores were clinically and statistically significantly lower for those with unilateral or bilateral PDR compared to unilateral or bilateral NPDR, or no DR (P<0.05). There were no clinically meaningful differences between unilateral NPDR and no DR, and bilateral NPDR and no DR. The mean scores of the SF–12 physical component summary were clinically and statistically significantly lower for those with bilateral PDR compared to those with bilateral NPDR, unilateral NPDR, and no DR (P<0.03). No other clinically meaningful differences were noted in SF–12 scores. Conclusions: Latinos with T2DM having unilateral or bilateral PDR self reported poorer visual function compared to those with less severe DR or no DR. However, only those with bilateral PDR reported poorer general HRQOL, possibly reflecting more severe systemic disease. Persons with NPDR did not report poorer visual function or HRQOL. The impact of PDR on visual function and HRQOL suggests the need for closely monitoring and potentially intervening to prevent/reduce the risk of development of PDR in Latinos.

Keywords: diabetic retinopathy • quality of life • clinical (human) or epidemiologic studies: outcomes/complications