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Tasanee Braithwaite, Henry Bailey, Debra R Bartholomew, Konrad Pesudovs, Rupert R A Bourne, Alastair Gray; The impact of vision loss on health related quality of life in Trinidad and Tobago. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1349. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Little is known about the impact of vision impairment on quality of life (QoL) in the Caribbean. This study aimed to quantify the utility and quality adjusted life year (QALY) loss associated with vision impairment identified in the 2013-2014 National Eye Survey of Trinidad and Tobago (NESTT).
The EQ5D-5 level (L) health-related QoL instrument was included in NESTT, a population-based, nationally-representative, cross-sectional survey of adults aged > 40 years. Respondents rated their level of impairment across five dimensions (mobility, self-care, usual activities, discomfort/pain and depression/anxiety). Utility scores were derived using a newly-developed TT general population-based algorithm for the EQ5D-3L, with cross walk from the EQ5D-5L scores. Relationships between utility, presenting vision category, socio-demographic and medical factors were explored using multivariate regression analysis, with robust standard error estimation.
2634 adults participated (61.8% response rate). Mean age was 58.4 (sd 11.8, range 40 to 103) years and 56% were female. Mean utility ranged from 0.94 (sd 0.08) in those with normal vision (LogMAR <=0.0), to 0.73 (sd 0.23) in those who were blind (LogMAR >1.32). In a multivariate model, utility loss was predicted by older age, female sex, fewer qualifications, previous stroke, elevated body mass index, arthritis, and diabetes (p<0.05). After adjustment, in comparison to those with no vision impairment (<0.48 LogMAR), moderate or severe vision impairment (MSVI) was associated with -0.02 reduction in utility, and blindness with -0.12 reduction in utility. The odds of reporting mobility difficulty were increased by MSVI (Odds Ratio (OR) 2.3, 95% confidence interval (CI) 1.9 to 3.8) and blindness (OR 7.8,, 95% CI 2.0 to 31.1). The odds of self-care difficulty were also increased by MSVI (OR 2.2, 95% CI 1.2 to 3.8) and blindness (OR 30.5, 95% CI 4.5 to 206.7). The QALY loss resulting from MSVI and blindness amongst adults over 40 years in Trinidad and Tobago was estimated to be 209 per 100,000 population per year.
This first study on the impact of vision loss on QoL in the Caribbean reveals utility loss in Trinidad and Tobago consistent with levels identified elsewhere. The QALY loss reflects a substantial health burden among visually impaired adults and highlights the potential value of strategies to prevent avoidable vision loss.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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