Visual Field Loss Impacts Vision-Specific Quality of Life by Race, Ethnicity: The Multiethnic Ophthalmology Cohorts of California Study

Publication

Purpose

To assess the impact of Visual Field Loss (VFL) on Vision-Specific Quality of Life (VSQOL) by race, ethnicity and age

Design

Pooled analysis of cross-sectional data from three population-based, prospective cohort studies

Participants

The Multiethnic Ophthalmology Cohorts of California Study (MOCCaS) participants included 6,142 Latinos, 4,582 Chinese Americans, and 6,347 African Americans from Los Angeles County.

Methods

17,071 adults 40 years and older completed comprehensive interviews and ophthalmic examinations from 2000 to 2018. VFL was measured using the Humphrey SITA Standard 24-2 test as decibels (dB) of mean deviation (MD). Multivariable linear regression was used to evaluate the impact of VFL in the better-seeing eye on self-reported VSQOL scores, adjusting for sociodemographic and clinical covariables. Hierarchical modeling was performed to determine the best-fit model after considering main effects and interactions by race, ethnicity and age.

Main Outcome Measures

VSQOL scores were measured using the 25 Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25). Item response theory (IRT) was used to model vision-related task and well-being composite scores, while classical test theory (CTT) was used to calculate 11 vision subscales.

Results

The impact of VFL on VSQOL varied by race and ethnicity. 5-point reductions in task and well-being scores were reached after mild-to-moderate VFL for Latinos (6.7 dB and 7.5 dB), mild-to-moderate VFL for Chinese Americans (7.0 dB and 8.7 dB), and moderate-to-severe VFL for African Americans (10.1 dB and 12.9 dB), respectively. Differences met statistical significance when comparing Latinos and African Americans (P < 0.01). VFL had the largest effect on driving among all participants. Driving difficulties was the only VSQOL outcome modified by age; participants 65 years and older scored 0.487 lower points per MD of VFL (P < 0.01). Subscales most affected by VFL included role function, mental health, and dependency.

Conclusions

Race and ethnicity modified the impact of VFL on VSQOL, even after adjusting for sociodemographic covariates. In MOCCaS, Latinos and Chinese Americans reported a greater change in VSQOL than African Americans for the same level of VFL. Future work should assess whether findings were due to socioeconomic or cultural differences in perception of visual function.

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Dom Grisafe
MD Candidate | PhD Epidemiology

Epidemiologist studying chronic disease in population-based cohort studies

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