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Diabetes Care 29:1506-1511, 2006
DOI: 10.2337/dc05-2150
© 2006 by the American Diabetes Association
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Epidemiology/Health Services/Psychosocial Research
Original Article

Assessing the Impact of Visual Acuity on Quality of Life in Individuals With Type 2 Diabetes Using the Short Form-36

Philip M. Clarke, PHD1,2,3, Judit Simon, MD2, Carole A. Cull, PHD1 and Rury R. Holman, FRCP1

1 Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, U.K.
2 Health Economics Research Centre, Division of Public Health and Primary Care, University of Oxford, Oxford, U.K.
3 School of Public Health, University of Sydney, New South Wales, Australia

Address correspondence and reprint requests to Dr. Philip Clarke, Health Economics Research Centre, Old Road Campus, University of Oxford, Headington, Oxford OX3 7LF, U.K. E-mail: philip.clarke{at}dphpc.ox.ac.uk

OBJECTIVE—We sought to ascertain quality-of-life measures and utility values associated with visual acuity in type 2 diabetes.

RESEARCH DESIGN AND METHODS—The Medical Outcome Study Short Form with 36 items (SF-36) was administered to 4,051 individuals with type 2 diabetes who were enrolled in the Lipids in Diabetes Study, and their best attainable vision was determined using an Early Treatment of Diabetic Retinopathy Study chart, expressed as a LogMAR score. Eight domain scores and a utility value representing an overall quality-of-life score were calculated using predefined algorithms. The associations between quality of life measured and best-eye visual acuity were assessed graphically and by regression analysis.

RESULTS—All eight SF-36 domain scores were negatively associated with reduced visual acuity. The impact of lower levels of visual acuity ranged from a decline of 1.3 units for a 0.1-LogMAR increase for physical functioning and 0.6 units in mental health. Regression analysis indicated a negative association (P < 0.001) between utility and reduced visual acuity after controlling for sex, BMI, smoking status, and history of diabetes complications. Patients whose LogMAR scores equated to legally blind had, on average, 0.054 (95% CI 0.034–0.074) lower utility compared with patients with normal visual acuity.

CONCLUSIONS—Reduced visual acuity is negatively associated with quality of life. The utility scores estimated here should inform studies quantifying the burden of diabetes and those evaluating potential therapies for treating or preventing diabetic eye diseases.

Abbreviations: HRQOL, health-related quality of life • LDS, Lipids in Diabetes Study • SF-36, Medical Outcome Study Short Form with 36 items • SF-6D, Short Form with six dimensions


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