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Original Investigation
June 2018

Vision Preference Value Scale and Patient Preferences in Choosing Therapy for Symptomatic Vitreomacular Interface Abnormality

Author Affiliations
  • 1Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Editor, JAMA Ophthalmology
  • 3Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  • 4Medical Retina Department, National Institute for Health Research Moorfields Biomedical Research Centre, London, United Kingdom
  • 5Retina Division, Department of Ophthalmology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
  • 6Department of Retina, Centro Brasileiro da Visao, Brasília, DF, Brazil
  • 7Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
JAMA Ophthalmol. 2018;136(6):658-664. doi:10.1001/jamaophthalmol.2018.1272
Key Points

Question  What preference value do individuals across 3 continents with vitreomacular interface abnormalities assign to their visual states, and what are their treatment preferences?

Findings  In this cross-sectional questionnaire study including 213 participants, with 1 indicating perfect health and 0 indicating death, the mean (SD) preference value was 0.76 (0.15), with no difference across continents identified. Most participants (171 [81.0%]) were enthusiastic about being treated; 150 (71.1%) were enthusiastic about vitrectomy and 120 (56.9%) about intravitreal injections.

Meaning  These data suggest vitreomacular interface abnormalities affect preference-related quality of life similarly across continents at a level slightly better than reported for common retinal diseases, such as retinal vein occlusions; there may be a slight preference for surgical treatment over injections.


Importance  While symptomatic vitreomacular interface abnormalities (VIAs) are common, assessment of vision preference values and treatment preferences of these may guide treatment recommendations by physicians and influence third-party payers.

Objective  To determine preference values that individuals with VIA assign to their visual state and preferences of potential treatments.

Design, Setting, and Participants  In this cross-sectional one-time questionnaire study conducted between December 2015 and January 2017, 213 patients from tertiary care referral centers in Thailand, the United Kingdom, and the United States were studied. Patients with symptomatic VIA diagnosed within 1 year of data collection, visual acuity less than 20/20 OU, and symptoms ascribed to VIAs were included. Data were analyzed from January 2017 to November 2017.

Main Outcomes and Measures  The primary end points were overall mean preference value that individuals with VIA assigned to their visual state and patients’ preferences for potential treatments. Preference values were graded on a scale from 0 to 1, with 0 indicating death and 1 indicating perfect health with perfect vision.

Results  Of the 213 included patients, 139 (65.3%) were women, and the mean (SD) age was 65.6 (7.7) years. Diagnoses included epiretinal membrane (n = 100 [46.9%]), macular hole (n = 99 [46.5%]), and vitreomacular traction (n = 14 [6.6%]). The mean (SD) vision preference value was 0.76 (0.15), without differences identified among the 3 VIA types. More participants were enthusiastic about vitrectomy (150 [71.1%]) compared with intravitreal injection (120 [56.9%]) (difference, 14.2%; 95% CI, 5.16-23.3; P = .002). Adjusted analyses showed enthusiasm for vitrectomy was associated with fellow eye visual acuity (odds ratio, 10.99; 95% CI, 2.01-59.97; P = .006) and better-seeing eye visual acuity (odds ratio, 0.03; 95% CI, 0.001-0.66; P = .03). Overall enthusiasm for treatment was associated with fellow eye visual acuity (odds ratio, 7.22; 95% CI, 1.29-40.40; P = .02). Overall, most participants (171 [81.0%]) were enthusiastic about surgery, injection, or both.

Conclusions and Relevance  Study participants reported similar preference values among 3 types of VIAs. The data suggest that most patients with these conditions would be enthusiastic about undergoing vitrectomy or an injection to treat it, likely because of the condition’s effect on visual functioning, although there may be a slight preference for vitrectomy at this time.