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Progression to bilateral DR linked to sharp decline in quality of life
Ophthalmology. 2011;118:649-655.
Disease progression from unilateral to bilateral diabetic retinopathy diminished health-related quality of life to a greater extent than did less severe disease, a study found.
"Our data suggest that earlier intervention should be considered to prevent the development of bilateral moderately severe [nonproliferative diabetic retinopathy] because it is at this severity level that the impact on a person's [health-related quality of life] begins to decline at a more rapid trajectory than those with less severe or no DR," the study authors said.
Data were culled from the Los Angeles Latino Eye Study, an ongoing cross-sectional population-based cohort analysis. The study on diabetic retinopathy and health-related quality of life (HRQOL) included 1,064 patients with type 2 diabetes.
Presence of diabetic retinopathy correlated significantly with age, number of comorbidities and unemployment (P < .05).
The 25-item National Eye Institute Vision Specific Questionnaire and the 12-item Short Form Health Survey were used to measure HRQOL.
Masked grading of stereoscopic photographs from seven standard fields was used to assess diabetic retinopathy. Severity scores from each eye were adjusted to arrive at a single grade for each subject. A grade of 1 denoted no diabetic retinopathy in either eye; a grade of 15 signified bilateral proliferative diabetic retinopathy.
Study results showed a statistically significant correlation between severity of diabetic retinopathy and low HRQOL scores on both instruments (P < .05). Subjects with diabetic retinopathy from grade 2 to grade 8 had moderately diminished HRQOL. However, data showed a dramatically steeper downturn in HRQOL between grade 8 disease and grade 9 to 15 disease.
Vision-related daily activities, dependency and mental health were most adversely affected by diabetic retinopathy severity, the authors reported.
This study evaluates the relationship between severity of diabetic retinopathy (DR) and health-related quality of life (HRQOL). As expected, the take-home message is that greater severity of DR and bilaterality of DR are associated with lower HRQOL. Interestingly, this relationship is not linear. The progression to moderate DR in both eyes is the turning point for a steady decline in HRQOL. This suggests that therapy should be targeted to prevent the development of bilateral moderate DR. Such therapy could include optimal diabetic and hypertension control, timely laser treatment or retinal pharmacotherapy. As medical therapy transitions to a value-based perspective, this information will be useful in the development of new clinical trials to prevent or retard the progression of DR.
– George A. Williams, MD
OSN
Retina/Vitreous Board Member
Disclosure: No products or companies are
mentioned that would require financial disclosure.