Abstract
Purpose :
Vision related quality of life (VRQOL) attempts to measure the impact of impaired vision on daily living. Despite the growing emphasis on the importance of patient reported outcomes, longitudinal analyses of VRQOL on patients with chronic eye disease such as uveitis are limited. This study explores the longitudinal patterns of VRQOL for patients assigned to receive systemic or implant therapy in the Multicenter Uveitis Steroid Treatment Trial and Follow-up Study (MUST).
Methods :
VRQOL was measured using the National Eye Institute Visual Functioning Questionnaire (VFQ25) at baseline and at six-month intervals for 3 years. Best–corrected visual acuity (VA) in the better eye was measured using logarithmic charts following a standardized protocol. Mean deviation was used to summarize visual field sensitivity. Analyses were stratified by treatment due to differences in the pattern (but not magnitude) of change in VFQ25 for the two treatments. Generalized estimating equations were used to longitudinally model the VFQ25 and to evaluate potential baseline risk factors.
Results :
Individuals in both arms improved significantly by a similar amount by 3 years (p = 0.21). In the systemic therapy group, VFQ25 scores improved by 1.6 points (95% CI: 1.04, 2.1, p < 0.001) every six months throughout follow-up. Individuals with VA worse than 20/40, moderate or severe visual field impairment started with significantly worse VFQ25 scores at baseline and throughout follow-up (p < 0.01). In the implant group, all individuals improved by 10.6 points (95% CI: 7.9, 13.3, p < 0.001) during the first 6 months of follow-up. VFQ25 was stable thereafter for individuals with baseline VA 20/40 or better. Those who started with a VA worse than 20/40 had worse VFQ25 at baseline (-14 points, p < 0.001) but also had an additional 8.0-point gain (95% CI: 3.1, 13.0, p = 0.001) between 6 months and 12 months before stabilizing. Moderate and severe mean deviation impairment and older age were associated with significantly lower VRQ25 scores (p ≤ 0.01) and men had significantly higher scores than women (p = 0.002) at all timepoints.
Conclusions :
Both treatment groups demonstrated similar improvement in VFQ25 by 3 years; however, the longitudinal patterns differed. Differences in improvement based upon baseline visual function were only seen in the implant group and were not sufficient for eyes with poor vision to catch up to eyes with good vision.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.