Disparities between Ophthalmologists and Patients in Estimating Quality of Life Associated with Diabetic Retinopathy

BackgroundThis study aimed to evaluate and compare the utility values associated with diabetic retinopathy (DR) in a sample of Chinese patients and ophthalmologists.MethodsUtility values were evaluated by both the time trade-off (TTO) and rating scale (RS) methods for 109 eligible patients with DR and 2 experienced ophthalmologists. Patients were stratified by Snellen best-corrected visual acuity (BCVA) in the better-seeing eye. The correlations between the utility values and general vision-related health status measures were analyzed. These utility values were compared with data from two other studies.ResultsThe mean utility values elicited from the patients themselves with the TTO (0.81; SD 0.10) and RS (0.81; SD 0.11) methods were both statistically lower than the mean utility values assessed by ophthalmologists. Significant predictors of patients’ TTO and RS utility values were both LogMAR BCVA in the affected eye and average weighted LogMAR BCVA. DR grade and duration of visual dysfunction were also variables that significantly predicted patients’ TTO utility values. For ophthalmologists, patients’ LogMAR BCVA in the affected eye and in the better eye were the variables that significantly predicted both the TTO and RS utility values. Patients’ education level was also a variable that significantly predicted RS utility values. Moreover, both diabetic macular edema and employment status were significant predictors of TTO and RS utility values, whether from patients or ophthalmologists. There was no difference in mean TTO utility values compared to our American and Canadian patients.ConclusionsDR caused a substantial decrease in Chinese patients’ utility values, and ophthalmologists substantially underestimated its effect on patient quality of life.背景 本研究旨在针对中国患者与眼科医师样本，评估并比较与糖尿病视网膜病变（diabetic retinopathy, DR）相关的效用值。 方法 本研究采用时间权衡法（time trade-off, TTO）与等级评分法（rating scale, RS），对109名符合纳入标准的糖尿病视网膜病变患者及2名资深眼科医师的效用值进行评估。研究按患者优势眼的斯内伦最佳矫正视力（best-corrected visual acuity, BCVA）进行分层。此外，分析了效用值与通用视力相关健康状况评估指标间的相关性，并将本次获取的效用值与另外两项研究的数据进行对比。 结果 患者通过时间权衡法（均值0.81；标准差0.10）与等级评分法（均值0.81；标准差0.11）自评所得的平均效用值，均经统计学检验显著低于眼科医师评估所得的平均效用值。影响患者TTO与RS效用值的显著预测因子均包括患眼对数最小分辨角（LogMAR）最佳矫正视力以及加权平均LogMAR BCVA。糖尿病视网膜病变分期与视力障碍时长同样为患者TTO效用值的显著预测变量。对于眼科医师而言，患者患眼与优势眼的LogMAR BCVA均为可显著预测其TTO与RS效用值的变量；患者受教育程度则为显著预测RS效用值的变量。此外，无论基于患者还是眼科医师的评估结果，糖尿病黄斑水肿与就业状态均为TTO及RS效用值的显著预测因子。本次研究所得平均TTO效用值，与此前针对美国及加拿大患者的研究结果无统计学差异。 结论 糖尿病视网膜病变可显著降低中国患者的效用值，而眼科医师对该病对患者生活质量的影响存在显著低估。