Variability of Visual Field Loss and Vision Quality of Life
To examine the association of visual field loss (VFL) and self-reported vision-specific quality of life (VSQOL) in a multiethnic cohort of Americans.
The Multiethnic Ophthalmology Cohorts of California Study (MOCCaS) is a pooled analysis of three population-based, cross-sectional studies of Latino, Chinese American, and African American residents of Los Angeles County. 17,071 adults aged 40 years and older completed comprehensive interviews and ophthalmic exams from 2000-18. VSQOL was assessed using the NEI-VFQ-25, which was scored by item response theory (IRT)—producing task and well-being composites—and classical test theory (CTT)—producing 11 subscales. VFL was measured using the Humphrey SITA Standard 24-2 test. VFL was measured as decibels (dB) of mean deviation (MD). Multivariable linear regression was used to determine the relationship between VSQOL and VFL in the better-seeing eye overall and stratified by race.
12,941 participants (5,020 Latino, 3,758 Chinese American, 4,163 African American) had complete data.
Adults were more likely to have VFL if they were female, unemployed, born outside the US, reported annual income ≤ $20,000, did not complete high school, or had presenting visual acuity 20⁄40 or worse. Older age, greater number of comorbidities, and higher self-reported depression were significantly associated with worse VFL.
VFL was correlated with lower VSQOL for all NEI-VFQ-25 domains (p < 0.001). Overall, every 1 dB MD of VFL was associated with 0.75 lower task (βt) and 0.62 lower well-being (βwb) composite scores. Associations were similar for Latinos (βt = 0.73, βwb = 0.70) and Chinese Americans (βt = 0.83, βwb = 0.68), but weaker in African Americans (βt = 0.60, βwb = 0.41). For CTT subscales, driving difficulties (β = 1.22) and mental health (β = 0.90) had the strongest associations with VFL. The next strongest associations varied by race: dependency for Latinos, role function for Chinese Americans, and near vision for African Americans.
A 5-point loss in VSQOL score has been shown to impact patients clinically. In this multiethnic cohort, 6.7 and 8.1 dB of VFL was associated with a 5-point loss in task and well-being composites, respectively. Clinically meaningful losses in driving difficulties (4.1 dB) and mental health (5.6 dB) may arise even earlier. Providers should know how VFL may affect patients’ VSQOL.
As people lose their vision, they may be unable to complete normal daily tasks and they may feel unwell. This study suggests that people are affected after only a small amount of vision loss. Study participants who lost part of their vision had the most difficulty with driving and lower mental health. They reported they had difficulty driving both at night and during the day. People reported they were more worried about their eyesight and felt frustrated, had less control, and worried of embarrassing themselves due to their vision. These findings apply to a multiethnic, US population because a large number of Latinos, Chinese Americans, and African Americans participated in this study.
Knights Templar Eye Foundation (Domestic) Travel Grant