Date Published:
2022 Oct 11
Abstract:
Objective: To assess the effect of diabetic retinopathy (DR) on vision-related quality of life (VRQoL) in patients with type 2 diabetes. Methods: In this cross-sectional study, patients with type 2 diabetes residing in 15 residency communities in Fushun, Liaoning province were enrolled from July 2012 to May 2013. We measured the VRQoL by the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Patients were grouped according to their age, gender, presence of visual impairment, and affected eyes. NEI-VFQ-25 scores were compared between/among groups using the Wilcoxon rank-sum test or Kruskal-Wallis H test. The severity of DR in the eyes was graded into no DR, mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, and proliferative diabetic retinopathy (PDR). Severity scores from both eyes were then summarized to create a single per-person grade ranging from 1 (no DR in either eye) to 7 (bilateral PDR). Generalized linear models were used to assess the linear relationship between NEI-VFQ-25 scores and DR severity. Locally weighted scatterplot smoothing plots were generated to evaluate the possible nonlinear associations between concatenated severity of DR and VRQoL. Results: A total of 1 537 patients were recruited, including 836 (54.4%) with no DR, 479 (31.2%) with mild NPDR, 90 (5.9%) with moderate NPDR, 72 (4.7%) with severe NPDR and 60 (3.9%) with PDR. Compared with patients with unilateral DR, bilaterally involved subjects were statistically significantly compromised in general vision [70.2 (66.5, 72.5)
vs. 68.9 (63.9, 71.6),
Z=90.222,
P=0.038], near activities [90.5 (85.8, 94.0)
vs. 88.8 (84.5, 92.5),
Z=114.942,
P=0.005], dependency [91.1 (85.6, 96.5)
vs. 89.3 (83.8, 94.5),
Z=91.934,
P=0.033], mental health [80.0 (73.4, 84.9)
vs. 77.5 (70.8, 82.0),
Z=118.388,
P=0.003], role difficulties [76.8 (70.1, 82.4)
vs. 74.5 (67.6, 80.6),
Z =90.791,
P=0.036] and NEI-VFQ-25 composite [88.3 (84.2, 91.0)
vs. 86.9 (82.8, 90.1),
Z=96.207,
P=0.024]. Scores on general vision (
χ2=85.665), near activities (
χ2=78.462), distance activities (
χ2=145.489), social function (
χ2=53.629), dependency (
χ2=86.710), mental health (
χ2=68.281), role difficulties (
χ2=45.357), color vision (
χ2=68.176), peripheral vision (
χ2=116.179) and NEI-VFQ-25 composite (
χ2=133.291) decreased gradually as DR severity increased (all
P<0.001). On role difficulties, locally weighted scatterplot smoothing plots showed significant"turning points"from bilateral mild NPDR to mild NPDR/>mild NPDR (slope m=-4.7) and from moderate NPDR/≥moderate NPDR to severe NPDR/≥severe NPDR (slope m=-12.6). Conclusion: Both greater severity and bilaterality of DR were associated with lower vision-specific VRQoL, particularly role difficulties and mental health.
