Impact of severity and bilaterality of visual impairment on health-related quality of life

Objective: To assess the impact of unilateral and bilateral visual impairment (VI) and its severity on health-related quality of life (HRQOL) in Latinos 40 years and older. Design: A cross-sectional population-based study, the Los Angeles Latino Eye Study (LALES). Participants: Five thousand three hundred seventy-seven LALES participants. Methods: Health-related quality of life was measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and the Medical Outcomes Study 12-Item Short Form Health Survey (SF-12). Visual acuity (VA) was measured by a standardized protocol. Based on the presenting VA, VI was classified as unilateral or bilateral impairment and as either mild (20/40-20/63) or moderate/severe (20/80 or worse). Main Outcome Measures: National Eye Institute VFQ-25 and SF-12 composite and subscale scores. Results: The NEI VFQ mean composite score decreased from no VI (86) to bilateral moderate/severe VI (66) (P < 0.006). Relative to participants with no VI, those with unilateral or bilateral VI at any severity level had significantly lower NEI VFQ-25 scores for 10 of the 12 subscales (P < 0.05). The largest mean score differences between participants with and without VI were observed for subscales related to driving difficulties (42.5 points), vision-related dependency (29.1 points), distance vision (27.0 points), and vision-related mental health (24.5 points). No differences in SF-12 scores were found between participants with and without VI (P > 0.05). Conclusion: Relative to persons with no VI, persons with bilateral mild and unilateral or bilateral moderate/severe VI report greater difficulties in performing most vision-dependent daily activities and experience vision-related dependency and poorer vision-related mental health. Because most visual function subscale scores were significantly lower in persons with bilateral mild and/or unilateral/bilateral moderate/severe VI, health care providers should consider intervention in these persons. Our findings provide further insight into the relationship between severity level, bilaterality of VI, and self-reported visual function. These data can be used to refine the determination of visual disability in persons with VI. (c) 2006 by the American Academy of Ophthalmology.