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E. Chia, P. Mitchell, W. Smith, E. Rochtchina, J. Wang, Blue Mountains Eye Study; Visual Impairment and Health-Related Quality of Life: The Blue Mountains Eye Study . Invest. Ophthalmol. Vis. Sci. 2003;44(13):984.
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Purpose: This paper aims to assess the impact of visual impairment on health-related quality of life (HRQOL) using the validated, multidimensional Short-Form 36 health survey (SF-36), and to compare its impact with that from major medical conditions. Methods: Participants of the second cross-sectional Blue Mountains Eye Study (BMES, n=3508, mean age 66.7 years) were invited to complete the self-administered SF-36 and underwent a comprehensive eye examination, including detailed refraction and medical interview. The sample included 2334 (72.5%) 5-year follow-up study participants and 1174 (85.2%) new age-eligible participants. Visual impairment (VI) was defined as visual acuity of worse than 6/12. Age- and sex-adjusted data were derived for individual domains and for summary Physical and Mental Component Scores (PCS, MCS). The SF-36 scores were age- and sex-standardised to the BMES population to permit comparison with other medical conditions. Results: Adjusting for the effects of age and sex, there was a significant trend for worsening SF-36 profiles with increasing severity of bilateral VI, from correctable to non-correctable levels (PCS, p=0.047; MCS, p=0.006). Increasing severity of non-correctable unilateral VI also correlated with poorer SF-36 profiles (significant in the domains ‘social functioning’ and ‘role limitations due to emotional problems’, p for trend 0.048 and 0.026, respectively). In our study, a decreasing adverse impact on SF-36 profiles from medical conditions was ranked as follows: angina, non-correctable bilateral visual impairment, heart attack, stroke, diabetes, asthma, arthritis and any cancer. The major impact from visual impairment was on mental rather than physical domains, reflected by the summary scores (mean MCS and PCS, 46.2 and 41, respectively). The VI impact on mental domains was substantially greater than from the other medical conditions used for comparison (age and sex adjusted multivariate odds ratio 2.4, 95% confidence interval 1.2-5.2). Conclusions: Bilateral non-correctable visual impairment was associated with reduced functional status and well-being, with a magnitude comparable to that from major medical conditions. Its impact was stronger on mental than physical domains. These data have implications for disability weights such as those developed by the Global Burden of Disease study.
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