Original article
Impact of Age-Related Macular Degeneration on Vision-Specific Quality of Life: Follow-up from the 10-Year and 15-Year Visits of The Study of Osteoporotic Fractures

https://doi.org/10.1016/j.ajo.2010.05.030Get rights and content

Purpose

To assess vision-specific quality of life (QOL), based on abbreviated surveys derived from the National Eye Institute Visual Function Questionnaire (NEI-VFQ), in a cohort of United States women who participated in the Study of Osteoporotic Fractures.

Design

Prospective, observational cohort study.

Methods

Age-related macular degeneration (AMD) status, based on a 3-level classification (no AMD, early AMD, late AMD), and vision-specific QOL, based on abbreviated NEI-VFQ surveys, were calculated for 1674 women enrolled in the Study of Osteoporotic Fractures at 4 centers within the United States who had gradable fundus photographs at both the 10-year and 15-year follow-up visits. The associations among 5-year changes in NEI-VFQ composite scores, change in AMD status, and distance visual acuity were examined.

Results

Compared with study participants without AMD at both visits, study participants with late AMD at both visits and those who progressed from early AMD to late AMD demonstrated the greatest declines in adjusted NEI-VFQ composite scores, up to a mean decrease of 16.2 from a scale of 100. Visual acuity declines also were most prominent for patients with late AMD at both visits and for those who progressed from early AMD to late AMD. Change in visual acuity was found to correlate significantly with change in vision-specific QOL.

Conclusions

The abbreviated NEI-VFQ surveys provide reliable assessments of vision-specific QOL in AMD patients. The decline in vision-specific QOL associated with the progression of AMD is clinically meaningful.

Section snippets

Methods

Details of the design and methods of the IAMD sub-study29 and the SOF30 appear elsewhere. Only the major features of the IAMD and SOF studies relevant to the participant status at the time of the 10-year follow-up clinic visit are presented here. Subjects selected for the SOF were white women aged ≥65 years at original study enrollment (1986–1988) and black women aged ≥65 years at the 10-year follow-up visit (1997–1998). The participants were recruited from four centers in the United States

Results

The results from analyses with and without attrition weights were similar. Except for the descriptive tables, in which both results are presented, only attrition weight-adjusted results are presented. Characteristics of the study participants at the 10-year visit are presented in Table 2. There were 1674 female participants in the study with a mean age of 78 years. Eighty-eight percent of participants were white, and the large majority of participants were at least high school graduates (83%)

Discussion

This study demonstrated that patients progressing from early AMD to late AMD and patients who had established late AMD at the 10-year visit have greater declines in vision-specific QOL over the 5-year longitudinal study period than patients whose AMD did not progress. Furthermore, the change in vision-specific QOL (i.e., NEI-VFQ-8) attributable to change in AMD status, after controlling for potential confounders, was approximately a 13-point decline in adjusted composite scores for patients

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