A Review of Generic Preference-Based Measures of Health-Related Quality of Life in Visual Disorders

Abstract

ObjectiveThis review examines generic preference-based measures and their ability to reflect health-related quality of life in patients with visual disorders.MethodsA systematic search was undertaken to identify clinical studies of patients with visual disorders where health state utility values were measured and reported. Data were extracted to assess the validity and responsiveness of the measures. A narrative synthesis of the data was undertaken due to the heterogeneity between different studies.ResultsThere was considerable heterogeneity in the 31 studies identified in terms of patient characteristics, visual disorders, and outcomes reported. Vision loss was associated with a reduction in scores across the preference-based measure, but the evidence on validity and responsiveness was mixed. The EQ-5D health-related assessment instrument's performance differed according to condition, with poor performance in age-related macular degeneration (AMD) and diabetic retinopathy. The more limited evidence on the HUI-3 instrument found it performed best in differentiating between severity groups of patients with glaucoma, AMD, cataracts, and diabetic retinopathy. One study reported data on the SF-6D instrument and showed it was able to differentiate between patients with AMD.ConclusionsThe performance of the EQ-5D in visual disorders was mixed. The HUI-3 seemed to perform better in some conditions, but the evidence on this and SF-6D is limited. More head to head comparisons of these three measures are required. The new five-level version of EQ-5D may do better at the milder end of visual function.

Visual and health outcomes, measured with the activity inventory and the EQ‐5D, in visual impairment

“…Lloyd obtained lower scores for patients with acuity 6/12 to 6/18 than for patients with acuity 6/24 to 6/36. As suggested by Tosh et al, the association of EQ-5D-3L utility indices with visual impairments might depend on the visual disorder studied (Tosh et al 2012). …”

“…For example, Malkin and colleagues recently conducted one of the few studies to use a generic health state instrument, the EQ-5D-3L, to assess both the health utility of visual impairment and the impact of low vision rehabilitation (Malkin et al 2013). The authors concluded that the EQ-5D-3L was unresponsive to low vision rehabilitation, a conclusion supported by the results summarized by Tosh and colleagues who concluded that the EQ-5D-3L might have limited ability to distinguish between groups of patients, stratified by acuity, suffering from age-related macular degeneration or diabetic retinopathy (Tosh et al 2012;Malkin et al 2013). These studies demonstrate that the use of health utility …”

“…The assigned utility values then can be used to estimate qualityadjusted life-years (QALYs) (Rein et al 2007). However, it often has been suggested that the EQ-5D-3L can have unreliable and unresponsive outcomes in the case of visual disorders (Tosh et al 2012;Malkin et al 2013). …”

[Cost-effectiveness analysis of ocriplasmin in the treatment of vitreomacular traction in Italy]

“…L'analisi prende in considerazione anche le utilità ed essendo queste ultime direttamente correlate alla VA possono essere influenzate negativamente o positivamente, a seconda degli eventi avversi (metamorfopsia, vitrectomia e cataratta) o della risoluzione della patologia. Utilità e disutilità utilizzate nell'analisi sono state ricavate dalla letteratura disponibile [13][14][15] e i dati clinici non direttamente rilevabili da fonti pubblicate sono stati stimati attraverso l'opinione di esperti. È stato adottato un orizzonte temporale pari a tutta la vita del paziente, con cicli della durata di un mese (per i primi 6 mesi), di 3 mesi (per i successivi 5 anni) e di 1 anno (per il tempo di sopravvivenza rimanente), fino ad un massimo di 37,5 anni.…”

“…Alcuni pazienti inizialmente trascurano questi sintomi considerandoli una normale componente del processo di invecchiamento, consentendo, inconsapevolmente, alla malattia di progredire fino ad un livello grave di compromissione funzionale. È ben nota la correlazione tra qualità visiva e qualità di vita/benessere psico-fisico dei pazienti: la perdita visiva infatti è qualcosa di più del non essere in grado di leggere un paio di righe su una tabella, il danneggiamento della vista è associato con il declino delle funzioni fisiche, depressione ed incremento della mortalità [14].…”