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Lower visual acuity predicts worse utility values among patients with type 2 diabetes

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Abstract

Objective

We estimated the quality of life impact of vision loss in a community-based population with diabetes.

Design and methods

We randomly surveyed 4,000 members of a large health maintenance organization with type 2 diabetes to assess quality of life using the EQ-5D instrument. Visual acuity was obtained by automated text processing of clinical notes recorded during the two years preceding subjects’ surveys. Natural language processing was used to collect data from electronic medical records and to read clinical notes to determine the stage of retinopathy. Linear regression was used to model quality of life scores.

Results

Of the 4,000 surveys sent, approximately 55% of patients responded. Patients with ≥20/20 acuity reported the highest mean utility (mean = 0.82), which declined as the visual angle doubled to 20/40 (mean = 0.75), and then doubled again to ≤20/80 (mean = 0.71). Perfect utility (1.0) was reported by 28% of the sample. Only 7% of patients suffered visual impairment (≤20/40), and lower levels of visual acuity rarely occurred. Compared with patients with ≥20/20 acuity, the first doubling of the visual angle (20/40) lowered utility by three points (95% confidence interval [CI], −0.05 to −0.01), and the second doubling of the visual angle (≤20/80) lowered utility by six points (95%CI, −0.10 to −0.02).

Conclusions

This study aimed to estimate disutility associated with visual loss in patients with diabetes using a community-based sample and controlled for many characteristics associated with quality of life. We found a smaller utility decrement compared to other studies, suggesting that visual acuity’s impact on the quality of life for patients with diabetes in the community setting differs from more selected populations.

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Acknowledgments

We thank Ms. Kim Olson of the Center for Health Research for performing the chart abstractions. We are grateful to Dr. William Borok of Kaiser Permanente Northwest for his clinical advice. Drs. Matthew Rousculp and Honjun Kan—who were employed by Eli Lilly and Company at the time of the study—provided helpful comments on earlier versions of the manuscript.

While this research does not contain evaluations of any products, Eli Lilly and Company supported the research through a contract to the Center for Health Research, Kaiser Permanente Northwest. The contract between Eli Lilly and Company and the Center for Health Research protected the Center for Health Research’s right to publish the findings.

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Authors and Affiliations

  1. Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA

    David H. Smith, Eric S. Johnson, Allen Russell, Brian Hazlehurst, Gregory A. Nichols & Jonathan Betz-Brown

  2. Department of Optometry, Kaiser Permanente Northwest, Portland, OR, USA

    Cecilia Muraki

  3. Eli Lilly and Company, Indianapolis, IN, USA

    Allen Oglesby

Authors
  1. David H. Smith
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  2. Eric S. Johnson
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  3. Allen Russell
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  4. Brian Hazlehurst
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  5. Cecilia Muraki
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  6. Gregory A. Nichols
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  7. Allen Oglesby
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  8. Jonathan Betz-Brown
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Correspondence to David H. Smith.

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Smith, D.H., Johnson, E.S., Russell, A. et al. Lower visual acuity predicts worse utility values among patients with type 2 diabetes. Qual Life Res 17, 1277–1284 (2008). https://doi.org/10.1007/s11136-008-9399-1

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  • DOI: https://doi.org/10.1007/s11136-008-9399-1

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