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Study: Impact of presbyopia on quality of life modest
Most patients were not willing to trade much of their remaining lifetime for freedom from glasses.
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Patients who were corrected for presbyopia with spectacles had a modest decrease in quality of life, comparable with that associated with hypertension, according to a study.
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The time trade-off utility analysis showed, on average, patients were willing to sacrifice half a year of expected remaining lifetime for freedom from glasses. Melissa M. Brown, MD, MN, MBA, and colleagues published their findings in the American Journal of Ophthalmology.
The results showed that patients with presbyopia fare much better than those with diabetic retinopathy and other debilitating ocular diseases, Dr. Brown said in a telephone interview with Ocular Surgery News.
“There is very little quality-of-life change for the majority of people that have presbyopia. Relative to other life problems, wearing of glasses for reading is not a big concern,” she said.
Standardization
The study authors interviewed patients using a standardized quality-of-life questionnaire approved by the Wills Eye Hospital Institutional Review Board.
Utility analysis is a reliable, rigorous measurement tool, Dr. Brown said.
The study group included 110 patients (78 women, 32 men) with a mean age of 59.8 years. On average, patients wore glasses for 29 years.
Patients were deemed presbyopic if their near vision prescription was +0.5 D or greater for distance vision and required reading glasses.
Inclusion criteria were presence of presbyopia and corrected distance visual acuity of 20/40 or better in both eyes. Patients with Alzheimer’s disease or other forms of dementia or an unwillingness or inability to understand the questions were excluded from the study.
The patients were assigned to three subgroups based on degrees of presbyopia.
Utility analysis was used to measure the quality of life associated with a health condition. Utilities ranged from 0 for death to 1 for perfect health or perfect vision.
To determine time trade-off utility, researchers asked: “How many additional years do you expect to live?”
They also presented a hypothetical scenario: “Suppose there was a technology that could permanently make your reading vision normal without glasses. The technology always works but decreases your survival. What is the maximum amount of time, if any, you would be willing to give up if you could receive this technology for your near vision?”
The equation to determine individual utility was 1, less the amount of time traded and divided by the expected remaining lifetime. For example, a patient who expected to live an additional 20 years and was willing to trade 1 year to be free of reading glasses had a presbyopia-related utility of 0.95 (1 – 1/20, or 0.05), the authors said.
Modest trade-offs
Patients’ mean expected remaining lifetime was 23.4 years. The mean trade-off was 0.46 years, or 2%, of the average expected remaining lifetime. The mean utility was 0.98. The lowest utility was 0.33, the authors reported.
“That is unusual,” Dr. Brown told OSN. “That’s why, in general, when we look at utilities, we try to look at means on fairly large numbers, so we aren’t skewed by one or two people that have very different needs.”
The first subgroup, composed of patients with a prescription less than or equal to 1.75 D, had a mean utility of 0.997. The second subgroup, composed of patients with prescriptions between 1.75 D and 2.25 D, had a mean utility of 0.959. The third subgroup, consisting of patients with prescriptions greater than 2.25 D, had a mean utility of 0.989.
Differences between the three groups’ mean utilities were not statistically significant (P = .13), the authors said.
Ten percent of presbyopes were willing to trade at least 5% of their expected remaining lifetimes to be free of presbyopia. Those patients may be candidates for intervention to correct presbyopia, the authors noted.
Trade-off utilities for presbyopia compared favorably with those for other ocular diseases. For example, the authors cited a study in which patients with diabetic retinopathy had a utility of 0.84.
To determine the duration of an improvement in quality of life, researchers used a quality-adjusted life-year, which assigns total value offered by an intervention.
Comparative effectiveness
Quality of life will factor into values assigned to specific treatment options, Dr. Brown said.
“There’s no question that this country is moving in the direction, from a political standpoint, of taking a look at this,” she said. “Practically every other industrial country already does this. … This is probably long overdue. It is coming here. The question [a decade ago] was ‘when?’ The answer that we now know is, ‘sooner than later.’”
For more information:
- Melissa M. Brown, MD, MN, MBA, can be reached at the Center for Value-Based Medicine, P.O. Box 335, Flourtown, PA 19031; 215-353-6249; fax: 215-233-3222; e-mail: mbrown@valuebasedmedicine.com.
Reference:
- Luo BP, Brown GC, Luo SC, Brown MM. The quality of life associated with presbyopia. Am J Ophthalmol. 2008;145:618-622.
- Matt Hasson is an OSN Staff Writer who covers all aspects of ophthalmology. He focuses on regulatory, legislative and practice management topics.