The Impact of Visual Impairment and Eye Disease on Vision-related Quality of Life in a Mexican-American Population: Proyecto VER

Purpose: To describe the relationship of visual acuity impairment and eye disease on vision-related quality of life, as measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25), in a cross-sectional, population-based study of older Hispanic persons living in Arizona.

Methods: A random sample of block groups with Hispanic residents in Nogales and Tucson, Arizona, were selected for study. Participants were interviewed at home with a questionnaire that included the NEI-VFQ-25, an instrument measuring vision-related quality of life. Acuity was obtained with Early Treatment Diabetic Retinopathy Study (ETDRS) charts and standard protocol. Cataract was determined by clinical examination, diabetic retinopathy was diagnosed on stereo fundus photographs, and glaucoma was diagnosed on the basis of clinical examination and visual field results. Analyses were done to determine the degree of association between subscale scores and acuity in the better-seeing eye, monocular visual impairment, and specific eye diseases, with adjustment for acuity.

Results: Of the 4774 participants in the study, 99.7% had completed questionnaires that were not completed by proxy. Participants with visual impairment had associated decrements in scores on all subscales, with a decrease in presenting acuity associated with a worse score (P < 0.05), after adjustment for demographic variables. Monocular impairment was also associated with lower scores in several subscales. In those with cataract, low acuity explained most of the low scores, but those with glaucoma or diabetic retinopathy had low scores independent of acuity.

Conclusions: In this study of Mexican-American persons aged 40 or more, monocular impairment and better-eye acuity was associated with a decrease in most domains representing quality of life. Subjects with uncorrected refractive error, cataract, diabetic retinopathy, and glaucoma had associated decrements in quality of life, many not explained by loss of acuity. Further work on the specific measures of vision associated with reported decreases in quality of life, such as visual field or contrast sensitivity, is warranted.