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Mohith Shamdas, Kerolos Bassilious, Philip Ian Murray; Health related quality of life in uveitis patients. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1136.
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© ARVO (1962-2015); The Authors (2016-present)
To measure health related quality of life (HRQOL) in uveitis patients using time trade-off (TTO), standard gamble (SG) and EQ5D-5L utility valuation instruments to compare HRQOL associated with vision in uveitis versus any other health state.
Patients with various types of uveitis completed TTO, SG and EuroQOL EQ5D-5L questionnaires. Our TTO model asked patients how many years they expect to live and then asks how many of those remaining years they would be willing to give up if they could be guaranteed perfect vision in both eyes for the remainder of life. Our SG model presented a hypothetical situation where the patient is offered a treatment that will restore perfect vision to both eyes but there is a risk of immediate death. The patient is asked what the highest risk of death they would be willing to take if accepting treatment. Utility values were recorded from 0.0 to 1.0 with 0 representing death and 1 perfect health. A standardised EQ5D-5L questionnaire was also administered.
174 uveitis patients (106 F, 68 M; aged 16-90 years) were included. Overall mean TTO utility was 0.837 [95% CI 0.807-0.867]; mean SG utility was 0.870 [95% CI 0.841-0.899] and mean EQ5D-5L utility was 0.735 [95% CI 0.692-0.778]. Stratifying by visual acuity (VA) in the better seeing eye demonstrated a linear relationship between VA and mean HRQOL across all three health utility valuation instruments (p<0.001): (a) 6/12 or better: TTO 0.865, SG 0.890, EQ5D 0.780 (b) 6/15 to 6/60: TTO 0.747, SG 0.804, EQ5D 0.526 (c) worse than 6/60: TTO 0.577, SG 0.673, EQ5D 0.385. There was significant correlation between TTO and SG utilities (Spearman’s R=0.559, p<0.001). No statistically significant correlation was found for HRQOL with respect to anatomical classification or duration of uveitis. Amongst uveitic sub-types, ocular sarcoidosis (TTO 0.783) and HLA-B27 acute anterior uveitis (TTO 0.795) had the lowest HRQOL, whilst Fuchs’ uveitis (TTO 0.924) and herpes simplex virus anterior uveitis (TTO 0.878) had the highest HRQOL.
Uveitis comprises a group of potentially blinding diseases, often with systemic health associations, that can have a marked impact on quality of life. Uveitis patients with poor vision have a TTO that is worse than patients with symptomatic metastatic prostate cancer or AIDS. EQ5D-5L utilities were consistently lower than corresponding TTO/SG utilities, indicating health burdens beyond vision in these patients.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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