Quality of Life with Age-Related Macular Degeneration: Perceptions of Patients and Optometrists

Patricia Hrynchak; Tammy Labreche

doi:10.65636/cjo.v88i1.6189

Authors

Patricia Hrynchak University of Waterloo, School of Optometry and Vision Science
Tammy Labreche University of Waterloo, School of Optometry and Vision Science

DOI:

https://doi.org/10.65636/cjo.v88i1.6189

Keywords:

quality of life, age-related macular degeneration, time trade-off, utility value

Abstract

Objective
Understanding the impact of eye diseases on quality of life is vital when implementing policies. Studies have demonstrated that physicians poorly predict the effects of age-related macular degeneration (AMD) on patients’ quality of life. This study explored how well optometrists who are trained in optics, disease, and low vision rehabilitation can estimate this impact. Quality of life can be measured using questionnaires and utility assessment methods. Knowing how visual impairment affects quality of life will inform policy-makers on how health funds should be distributed.
Methods
We used the time trade-off (TTO) utility assessment of quality of life. Individuals with AMD were separated into three groups based on the severity of the condition. Level 1 had a visual acuity in the better eye of 20/30 (6/9) or better, Level 2 had a visual acuity of 20/40 to 20/100 (6/12 to 6/30), and Level 3 had a visual acuity of 20/200 (6/60) or worse. They were asked to rate how many years of life they would give up if AMD was cured. Optometrists were also asked to imagine that they had AMD at these three levels and to respond to the same question. The ratios were calculated and compared.
Results
Our study included 72 patients with AMD and 47 optometrists. We calculated the mean TTO values of patients with AMD, compared with those done by optometrists, and completed nonparametric analysis. The results demonstrated that there was no statistical difference between the two participant groups (P = .700, .986, and .704) for levels 1, 2, and 3, respectively.
Conclusions
The findings suggest optometrists may be good predictors of the impact of AMD on patients’ quality of life as compared with the patients themselves. Optometrists could be consulted as part of a team process about decisions regarding policies for individuals with vision loss due to AMD.

Author Biography

Tammy Labreche, University of Waterloo, School of Optometry and Vision Science

Clinical Associate Professor, Director of the Centre for Sight Enhancement

References

1. Knauer C, Pfeiffer N. The value of vision. Graefes Arch Clin Exp Ophthalmol. 2008;246(4):477-82. https://doi.org/10.1007/s00417-007-0668-4

2. Brown MM, Brown GC. Update on value-based medicine. Curr Opin Ophthalmol. 2013;24(3):183-189. https://doi.org/10.1097/ICU.0b013e32835ff189

3. Ellwein LB, Fletcher A, Negrel AD, Thulasirai RD. Quality of life assessment in blindness prevention interventions. Int Ophthalmol. 1994;18(5):263-268. https://doi.org/10.1007/BF00917828

4. Goldberg I, Clement C, Chiang T, et al. Assessing quality of life in patients with glaucoma using the Glaucoma Quality of Life-15 (GQL-15) questionnaire. J Glaucoma. 2009;18(1):6-12. https://doi.org/10.1097/IJG.0b013e3181752c83

5. Pesudovs K, Garamendi E, Elliott DB. The Quality of Life Impact of Refractive Correction (QIRC) Questionnaire: Development and validation. Optom Vis Sci. 2004;81(10):769-777. https://doi.org/10.1097/00006324-200410000-00009

6. Stein JD. Disparities between ophthalmologists and their patients in estimating quality of life. Curr Opin Ophthalmol. 2004;15(3):238-243. https://doi.org/10.1097/01.icu.0000120712.35941.ad

7. Buchholz P, Steeds CS, Stern LS, et al. Utility assessment to measure the impact of dry eye disease. Ocul Surf. 2006;4(3):155-161. https://doi.org/10.1016/s1542-0124(12)70043-5

8. Brown GC, Brown MM, Sharma S. Value-based medicine: Evidence-based medicine and beyond. Ocul Immunol Inflamm. 2003;11(3):157-170. https://doi.org/10.1076/ocii.11.3.157.17355

9. Sharma S, Brown GC, Brown MM, Hollands H, Robins R, Shah GK. Validity of the time trade-off and standard gamble methods of utility assessment in retinal patients. Br J Ophthalmol. 2002;86(5):493-496. https://doi.org/10.1136/bjo.86.5.493

10. Aspinall PA, Hill AR, Dhillon B, et al. Quality of life and relative importance: A comparison of time trade-off and conjoint analysis methods in patients with age-related macular degeneration. Br J Ophthalmol. 2007;91(6):766-772. https://doi.org/10.1136/bjo.2006.104679

11. Brown GC, Brown MM. Health care stakeholder perceptions of vision loss. Surv Ophthalmol. 2019;64(3):345-352. https://doi.org/10.1016/j.survophthal.2018.11.001

12. Pearson I, Rycroft C, Irving A, Ainsworth C, Wittrup-Jensen K. A systematic literature review of utility weights in wet age-related macular degeneration. J Med Econ. 2013;16(11):1307-1316. https://doi.org/10.3111/13696998.2013.839946

13. Briesen S, Roberts H, Finger, RP. The impact of visual impairment on health-related quality of life in rural Africa. Ophthalmic Epidemiol. 2014;21(5):297-306. https://doi.org/10.3109/09286586.2014.950281

14. Sankaridurg P, Tahhan N, Kandel H, et al. IMI Impact of Myopia. Invest Ophthalmol Vis Sci. 2021;62(5):2. https://doi.org/10.1167/iovs.62.5.2

15. Lundberg, D. J. Disability and health state utility values: a framework for assessing ableism and equity. Value and Outcomes Spotlight. 2023;9(4), 32-35. https://www.ispor.org/publications/journals/value-outcomes-spotlight/vos-archives/issue/view/global-threats-from-climate-change/disability-and-health-state-utility-values-a-framework-for-assessing-ableism-and-equity

16. Tuttle, DW. Aging and vision loss, a personal perspective: A postscript to self-esteem and adjusting To Blindness. The New RE:view 2023;1(2), 3-11. https://doi.org/10.56733/TNR.23.007

17. Cruess AF, Gordon KD, Bellan L, Mitchell S, Pezzullo ML. The cost of vision loss in Canada. 2 Results. Can J Ophthalmol. 2011;46(4): 315-318. https://doi.org/10.1016/j.jcjo.2011.06.006

18. Brown GC, Brown MM, Sharma S. Difference between ophthalmologists’ and patients’ perceptions of quality of life associated with age-related macular degeneration. Can J Ophthalmol. 2000;35(3):127-133. https://doi.org/10.1016/s0008-4182(00)80005-8

19. Association of Schools and Colleges of Optometry. Entry-level competencies and learning objectives for low vision rehabilitation. 2025 accessed April 8, 2025. https://optometriceducation.org/wp-content/uploads/2025/04/Low-Vision-Entry-Level-Competencies-REVISED-clean.pdf

20. Macnamara A, Chen CS, Davies A, Sloan C, Loetscher T. Low vision devices for age-related macular degeneration: A systematic review. Disabil Rehabil Assist Technol. 2023;18(7):998-1010. https://doi.org/10.1080/17483107.2021.1966523

21. Stein JD, Brown MM, Brown GC, Hollands H, Sharma S. Quality of life with macular degeneration: Perceptions of patients, clinicians, and community members. Br J Ophthalmol. 2003;87(1):8-12. https://doi.org/10.1136/bjo.87.1.8

22. Stevens W, Brown GC, Brown MM, Stein JD, Sharma S. Vision-related quality-of-life estimates in adolescent youths. Can J Ophthalmol. 2021;56(6):385-390. https://doi.org/10.1016/j.jcjo.2021.01.012

23. van Nispen RM, Virgili G, Hoeben M, et al. Low vision rehabilitation for better quality of life in visually impaired adults. Cochrane Database Syst Rev. 2020;1(1):CD006543. https://doi.org/10.1002/14651858.CD006543.pub2