Extent of Exacerbation of Chronic Health Conditions by Visual Impairment in Terms of Health-Related Quality of Life | Depressive Disorders | JAMA Ophthalmology | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Resnikoff  S, Pascolini  D, Etya’ale  D,  et al.  Global data on visual impairment in the year 2002.  Bull World Health Organ. 2004;82(11):844-851.PubMedGoogle Scholar
Vitale  S, Cotch  MF, Sperduto  RD.  Prevalence of visual impairment in the United States.  JAMA. 2006;295(18):2158-2163.PubMedGoogle ScholarCrossref
Wong  HB, Machin  D, Tan  SB, Wong  TY, Saw  SM.  Visual impairment and its impact on health-related quality of life in adolescents.  Am J Ophthalmol. 2009;147(3):505-511.e1.PubMedGoogle ScholarCrossref
Renaud  J, Levasseur  M, Gresset  J,  et al.  Health-related and subjective quality of life of older adults with visual impairment.  Disabil Rehabil. 2010;32(11):899-907.PubMedGoogle ScholarCrossref
Pascolini  D, Mariotti  SP.  Global estimates of visual impairment: 2010.  Br J Ophthalmol. 2012;96(5):614-618.PubMedGoogle ScholarCrossref
Thylefors  B, Négrel  AD, Pararajasegaram  R, Dadzie  KY.  Global data on blindness.  Bull World Health Organ. 1995;73(1):115-121.PubMedGoogle Scholar
Swenor  BK, Muñoz  B, West  SK.  Does visual impairment affect mobility over time? the Salisbury Eye Evaluation Study.  Invest Ophthalmol Vis Sci. 2013;54(12):7683-7690.PubMedGoogle ScholarCrossref
Zwerling  C, Whitten  PS, Davis  CS, Sprince  NL.  Occupational injuries among older workers with visual, auditory, and other impairments: a validation study.  J Occup Environ Med. 1998;40(8):720-723.PubMedGoogle ScholarCrossref
Hayman  KJ, Kerse  NM, La Grow  SJ, Wouldes  T, Robertson  MC, Campbell  AJ.  Depression in older people: visual impairment and subjective ratings of health.  Optom Vis Sci.2007;84(11):1024-1030. PubMedGoogle ScholarCrossref
Giloyan  A, Harutyunyan  T, Petrosyan  V.  Visual impairment and depression among socially vulnerable older adults in Armenia.  Aging Ment Health. 2015;19(2):175-181.PubMedGoogle ScholarCrossref
Berdeaux  G, Brézin  AP, Fagnani  F, Lafuma  A, Mesbah  M.  Self-reported visual impairment and mortality: a French nationwide perspective.  Ophthalmic Epidemiol. 2007;14(2):80-87.PubMedGoogle ScholarCrossref
Li  Z, Sun  D, Liu  P, Zhang  L, Bai  J, Cui  H.  Visual impairment and mortality in a rural adult population (the Southern Harbin Eye Study).  Ophthalmic Epidemiol. 2011;18(2):54-60.PubMedGoogle ScholarCrossref
Christ  SL, Zheng  DD, Swenor  BK,  et al.  Longitudinal relationships among visual acuity, daily functional status, and mortality: the Salisbury Eye Evaluation Study.  JAMA Ophthalmol. 2014;132(12):1400-1406.PubMedGoogle ScholarCrossref
Garin  N, Olaya  B, Lara  E,  et al.  Visual impairment and multimorbidity in a representative sample of the Spanish population.  BMC Public Health. 2014;14:815.PubMedGoogle ScholarCrossref
Langelaan  M, de Boer  MR, van Nispen  RM, Wouters  B, Moll  AC, van Rens  GH.  Impact of visual impairment on quality of life: a comparison with quality of life in the general population and with other chronic conditions.  Ophthalmic Epidemiol. 2007;14(3):119-126.PubMedGoogle ScholarCrossref
Chia  EM, Wang  JJ, Rochtchina  E, Smith  W, Cumming  RR, Mitchell  P.  Impact of bilateral visual impairment on health-related quality of life: the Blue Mountains Eye Study.  Invest Ophthalmol Vis Sci. 2004;45(1):71-76.PubMedGoogle ScholarCrossref
Varma  R, Wu  J, Chong  K, Azen  SP, Hays  RD; Los Angeles Latino Eye Study Group.  Impact of severity and bilaterality of visual impairment on health-related quality of life.  Ophthalmology. 2006;113(10):1846-1853.PubMedGoogle ScholarCrossref
Wang  X, Lamoureux  E, Zheng  Y, Ang  M, Wong  TY, Luo  N.  Health burden associated with visual impairment in Singapore: the Singapore Epidemiology of Eye Disease Study.  Ophthalmology. 2014;121(9):1837-1842.PubMedGoogle ScholarCrossref
Hong  T, Mitchell  P, Burlutsky  G, Fong  CS, Rochtchina  E, Wang  JJ.  Visual impairment and subsequent use of support services among older people: longitudinal findings from the Blue Mountains Eye Study.  Am J Ophthalmol. 2013;156(2):393-399.e1.PubMedGoogle ScholarCrossref
Schmier  JK, Halpern  MT, Covert  D, Delgado  J, Sharma  S.  Impact of visual impairment on use of caregiving by individuals with age-related macular degeneration.  Retina. 2006;26(9):1056-1062.PubMedGoogle ScholarCrossref
Schmier  JK, Halpern  MT, Covert  DW, Delgado  J, Sharma  S.  Impact of visual impairment on service and device use by individuals with age-related macular degeneration (AMD).  Disabil Rehabil. 2006;28(21):1331-1337.PubMedGoogle ScholarCrossref
Roberts  CB, Hiratsuka  Y, Yamada  M,  et al.  Economic cost of visual impairment in Japan.  Arch Ophthalmol. 2010;128(6):766-771.PubMedGoogle ScholarCrossref
Köberlein  J, Beifus  K, Schaffert  C, Finger  RP.  The economic burden of visual impairment and blindness: a systematic review.  BMJ Open. 2013;3(11):e003471.PubMedGoogle ScholarCrossref
Yoon  KC, Mun  GH, Kim  SD,  et al.  Prevalence of eye diseases in South Korea: data from the Korea National Health and Nutrition Examination Survey 2008-2009.  Korean J Ophthalmol. 2011;25(6):421-433.PubMedGoogle ScholarCrossref
Kweon  S, Kim  Y, Jang  MJ,  et al.  Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES).  Int J Epidemiol. 2014;43(1):69-77.PubMedGoogle ScholarCrossref
Park  SJ, Lee  JH, Woo  SJ,  et al; Epidemiologic Survey Committee of the Korean Ophthalmologic Society.  Age-related macular degeneration: prevalence and risk factors from Korean National Health and Nutrition Examination Survey, 2008 through 2011.  Ophthalmology. 2014;121(9):1756-1765.PubMedGoogle ScholarCrossref
Park  SJ, Lee  JH, Woo  SJ, Kang  SW, Park  KH; Epidemiologic Survey Committee of Korean Ophthalmologic Society.  Five heavy metallic elements and age-related macular degeneration: Korean National Health and Nutrition Examination Survey, 2008-2011.  Ophthalmology. 2015;122(1):129-137.PubMedGoogle ScholarCrossref
Jin  YH.  A new LogMAR vision chart: Jins Vision Chart.  J Korean Ophthalmol Soc.1997;38(11):2036-2044.Google Scholar
World Health Organization.  ICD-10: International Statistical Classification of Diseases and Related Health Problems. Geneva, Switzerland: World Health Organization; 2004.
Rubin  GS, West  SK, Muñoz  B,  et al.  A comprehensive assessment of visual impairment in a population of older Americans: the SEE Study: Salisbury Eye Evaluation Project.  Invest Ophthalmol Vis Sci. 1997;38(3):557-568.PubMedGoogle Scholar
Kim  MH, Cho  YS, Uhm  WS, Kim  S, Bae  SC.  Cross-cultural adaptation and validation of the Korean version of the EQ-5D in patients with rheumatic diseases.  Qual Life Res. 2005;14(5):1401-1406.PubMedGoogle ScholarCrossref
Lee  YK, Nam  HS, Chuang  LH,  et al.  South Korean time trade-off values for EQ-5D health states: modeling with observed values for 101 health states.  Value Health.2009;12(8):1187-1193. PubMedGoogle ScholarCrossref
EuroQol Group.  EuroQol: a new facility for the measurement of health-related quality of life.  Health Policy. 1990;16(3):199-208.PubMedGoogle ScholarCrossref
Kang  EJ, Ko  SK.  A catalogue of EQ-5D utility weights for chronic diseases among noninstitutionalized community residents in Korea.  Value Health.2009;12 Suppl 3:S114-S117.Google Scholar
Centers for Disease Control and Prevention (CDC).  Reasons for not seeking eye care among adults aged ≥40 years with moderate-to-severe visual impairment: 21 States, 2006-2009.  MMWR Morb Mortal Wkly Rep. 2011;60(19):610-613.PubMedGoogle Scholar
Agborsangaya  CB, Lau  D, Lahtinen  M, Cooke  T, Johnson  JA.  Health-related quality of life and healthcare utilization in multimorbidity: results of a cross-sectional survey.  Qual Life Res. 2013;22(4):791-799.PubMedGoogle ScholarCrossref
McCann  RM, Jackson  AJ, Stevenson  M, Dempster  M, McElnay  JC, Cupples  ME.  Help needed in medication self-management for people with visual impairment: case-control study.  Br J Gen Pract.2012;62(601):e530-e537. PubMedGoogle ScholarCrossref
Keeffe  JE, Jin  CF, Weih  LM, McCarty  CA, Taylor  HR.  Vision impairment and older drivers: who’s driving?  Br J Ophthalmol. 2002;86(10):1118-1121.PubMedGoogle ScholarCrossref
Rowe  F, Brand  D, Jackson  CA,  et al.  Visual impairment following stroke: do stroke patients require vision assessment?  Age Ageing. 2009;38(2):188-193.PubMedGoogle ScholarCrossref
Sand  KM, Midelfart  A, Thomassen  L, Melms  A, Wilhelm  H, Hoff  JM.  Visual impairment in stroke patients: a review.  Acta Neurol Scand Suppl. 2013;(196):52-56.PubMedGoogle Scholar
Rovner  BW, Ganguli  M.  Depression and disability associated with impaired vision: the MoVies Project.  J Am Geriatr Soc. 1998;46(5):617-619.PubMedGoogle ScholarCrossref
Carrière  I, Delcourt  C, Daien  V,  et al.  A prospective study of the bi-directional association between vision loss and depression in the elderly.  J Affect Disord. 2013;151(1):164-170.PubMedGoogle ScholarCrossref
Wang  CW, Chan  CL, Ho  AH, Xiong  Z.  Social networks and health-related quality of life among Chinese older adults with vision impairment.  J Aging Health. 2008;20(7):804-823.PubMedGoogle ScholarCrossref
Holmén  K, Andersson  L, Ericsson  K, Rydberg  L, Winblad  B.  Visual impairment related to cognition and loneliness in old age.  Scand J Caring Sci. 1994;8(2):99-105.PubMedGoogle ScholarCrossref
Brown  RL, Barrett  AE.  Visual impairment and quality of life among older adults: an examination of explanations for the relationship.  J Gerontol B Psychol Sci Soc Sci. 2011;66(3):364-373.PubMedGoogle ScholarCrossref
Cuperus  N, Vliet Vlieland  TP, Mahler  EA, Kersten  CC, Hoogeboom  TJ, van den Ende  CH.  The clinical burden of generalized osteoarthritis represented by self-reported health-related quality of life and activity limitations: a cross-sectional study.  Rheumatol Int. 2015;35(5):871-877.PubMedGoogle ScholarCrossref
Simó  R, Hernández  C, Genescà  J, Jardí  R, Mesa  J.  High prevalence of hepatitis C virus infection in diabetic patients.  Diabetes Care. 1996;19(9):998-1000.PubMedGoogle ScholarCrossref
Emamian  MH, Zeraati  H, Majdzadeh  R, Shariati  M, Hashemi  H, Fotouhi  A.  The gap of visual impairment between economic groups in Shahroud, Iran: a Blinder-Oaxaca decomposition.  Am J Epidemiol. 2011;173(12):1463-1467.PubMedGoogle ScholarCrossref
Wang  D, Ding  X, He  M,  et al.  Use of eye care services among diabetic patients in urban and rural China.  Ophthalmology. 2010;117(9):1755-1762.PubMedGoogle ScholarCrossref
Liao  PA, Chang  HH, Yang  FA.  Does the universal health insurance program affect urban-rural differences in health service utilization among the elderly? evidence from a longitudinal study in Taiwan.  J Rural Health.2012;28(1):84-91. PubMedGoogle ScholarCrossref
Anderson  GF.  Universal health care coverage in Korea.  Health Aff (Millwood). 1989;8(2):24-34.PubMedGoogle ScholarCrossref
Finger  RP, Fenwick  E, Hirneiss  CW,  et al.  Visual impairment as a function of visual acuity in both eyes and its impact on patient reported preferences.  PLoS One. 2013;8(12):e81042.PubMedGoogle ScholarCrossref
Au Eong  KG, Chan  EW, Luo  N,  et al.  Validity of EuroQOL-5D, time trade-off, and standard gamble for age-related macular degeneration in the Singapore population.  Eye (Lond). 2012;26(3):379-388.PubMedGoogle ScholarCrossref
Espallargues  M, Czoski-Murray  CJ, Bansback  NJ,  et al.  The impact of age-related macular degeneration on health status utility values.  Invest Ophthalmol Vis Sci. 2005;46(11):4016-4023.PubMedGoogle ScholarCrossref
Original Investigation
November 2015

Extent of Exacerbation of Chronic Health Conditions by Visual Impairment in Terms of Health-Related Quality of Life

Author Affiliations
  • 1Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
  • 2Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
  • 3Medical Research Collaborating Center, Division of Statistics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
JAMA Ophthalmol. 2015;133(11):1267-1275. doi:10.1001/jamaophthalmol.2015.3055

Importance  Visual impairment (VI) causes a considerable public health burden and substantial deterioration in health-related quality of life (HRQoL). However, the relative effect of VI on HRQoL compared with other chronic health conditions is unknown as is the additive effect of VI with other conditions.

Objective  To investigate whether the impact of chronic health conditions on HRQoL varies according to VI presence.

Design, Setting, and Participants  Cross-sectional study involving 29 639 participants aged 19 years and older and using a multistage, probability-cluster survey, which can produce nationally representative estimates. We analyzed data from the 2008-2012 Korean National Health and Nutrition Examination Survey, which included results for vision assessment and HRQoL, measured using the European Quality of Life–5 Dimensions Questionnaire (EQ-5D). All analyses were conducted in October and November 2014. Visual impairment was defined as the presenting distance best-corrected visual acuity of less than decimal 0.32 (approximate Snellen equivalent 20/63). Linear regression models accounting for sample weights were used to examine interactions between VI and each of 14 chronic health conditions on the EQ-5D index score, adjusted for demographic and socioeconomic covariates.

Main Outcomes and Measures  The EQ-5D index score for participants with VI or 14 chronic health conditions, as well as the effect of the interactions between VI and each condition on the EQ-5D index score.

Results  The EQ-5D index score with VI was substantially lower than without VI (mean difference, −0.158; 95% CI, −0.186 to −0.130; P < .001). In most conditions, the comorbidity with VI resulted in lower EQ-5D index scores; furthermore, participants with stroke, osteoarthritis or rheumatic arthritis, hepatitis B or C, and depression showed lower EQ-5D index scores than expected when they were comorbid with VI, indicating an interaction between VI and each condition. The estimated β coefficients for interaction terms were −0.256 (95% CI, −0.480 to −0.032) for stroke, −0.124 (95% CI, −0.223 to −0.026) for osteoarthritis or rheumatic arthritis, −0.183 (95% CI, −0.327 to −0.038) for hepatitis B or C, and −0.130 (95% CI, −0.229 to −0.032) for depression.

Conclusions and Relevance  These results suggest that VI has a substantial effect on HRQoL, even in the presence of concurrent chronic health conditions, and the combined effect of VI and stroke, osteoarthritis/rheumatic arthritis, hepatitis, or depression on HRQoL was greater. However, because this study group was a representative sampling of South Koreans, generalization to other races/ethnicities and countries should be approached with caution.