准分子激光手术术后视觉质量评价

准分子激光手术不仅要改善屈光不正患者术后的裸眼视力及最佳矫正视力,同时也要保证患者术后的视觉质量。视觉质量主要是通过近视患者手术后的客观视力、像差、对比敏感度与眩光敏感度、非球面参数(Q值)、主观视觉生活质量、优势眼改变以及双眼视功能等方面来评价,本文就此几个方面进行综述。     

视系统CSF测定对青光眼诊断的评价

一、序言视功能状态常以视力和视野测量的数值表示;而青光眼患者的视功能水平,习惯上也是以视力和视野作为定量标准.目前,常规的视力检测法是以浓淡分明的Snellen字母表作为视标,并以受检者所能识别这种字母表最小到何种程度为依据判定视功能状态.Snellen视力检查法的优点是操作简便,无损伤,易被受检者所接受,在一定条件下对特定能力的比较和评价具有重要的实用价值.     

青光眼视觉康复研究现状与展望

青光眼在当今世界不可逆性致视觉损伤的眼病中位居前列,其所引起的视觉障碍严重影响患者的日常生活及社会心理功能,导致患者生活质量大幅度下降。通过利用患者残余视功能进行视觉损伤康复可有效改善患者生活质量,但目前社会各界对青光眼所致视觉障碍以及视功能康复的重视程度尚显不足。本文总结国内外相关领域的研究进展,从青光眼视觉损伤的流...     

天津市蓟县桑梓村40岁及以上人群中青光眼患病率调查

目的 调查天津蓟县桑梓村40岁及以上人群中青光眼的患病率。方法 2003年1～3月，对天津蓟县桑梓村1987人进行青光眼的普查，每一位受检者接受了问卷调查、视力、色觉、眼前节检查、前房深度、眼压测量及眼底检查，部分接受了倍频视野仪、Goldmann前房角镜及中心视野检查。结果 1701人完成了检查，受检率为85.61％。青光眼患病率为1．59％，原发性闭角型青光眼为1．12％，原发性开角型青光眼为0．35％，继发性青光眼为0.12％；高龄、有青光眼家族史者原发性青光眼患病率较高。所检出的27例青光眼患者中，有19例视功能有一定程度的损伤，其中6例双眼盲，5例单眼盲，4例双眼低视力，4例单眼低视力；19例视力损伤中13例患者年龄≥70岁。结论 青光眼引起的视功能损伤是十分严重的，高龄伴有青光眼家族史的人群应定期随访。     

脑卒中患者视觉受损的调查

目的探讨脑卒中患者视功能障碍的类型和发病情况。方法经神经内科确诊为脑卒中的患者147例,平均年龄（71．7±13．3）岁,仔细检查其眼科疾病和视功能状态,如视力、眼位和眼球运动、视知觉和视野缺损等方面的内容。结果147例患者中,46．9％的患者有斜视／眼球运动受损,34．0％的患者有视野受损,19．7％的患者有视力受损,19．0％的患者有视知觉缺陷。结论72．1％的脑卒中患者都有不同程度的视功能受损。这不仅影响患者的独立生活能力,还直接影响整个临床康复效果。临床医生应重视脑卒中患者视功能的治疗和康复。     

LVC程序视野检查在白内障手术中的应用

目的　探讨中央低视力(lowvisioncenter ,LVC)程序视野检查在术前评估白内障低视力患者视功能的价值。方法　白内障低视力患者共30例30眼,其中合并青光眼、入院后行青白联合术者2 1例2 1眼;无青光眼史、单纯行白内障手术者9例9眼。术前1日及术后3月内行LVC程序视野检查。术前同时行视网膜潜视力测定。结果　所有患者在术后总的平均阈值敏感度(meansensi tivity,MS)均有显著提高(P <0. 0 1) ,而颞侧的MS值较鼻侧的MS值改善更为明显。术前视野已有绝对暗点形成的区域,术后仍存在。与视网膜潜视力测定相比,LVC程序视野检查的MS值与术后最佳矫正视力间存在更好的对应关系。结论　术前LVC程序视野检查对于白内障尤其是合并青光眼低视力患者有特殊价值,有助于术者判断该类患者术后的视力、视野的情况,可作为术前估计其潜在视功能的新方法之一     

多焦点人工晶状体与非球面人工晶状体植入术后视觉质量的临床研究

目的客观与主观检测结合评价非球面设计的多焦点与单焦点人工晶状体植入术后的视觉质量。方法132例（207只眼）白内障患者分别植入非球面的多焦点人工晶状体AcrySof IQ ReSTOR IOL和单焦点人工晶状体AcrySof IQ IOL。记录患者手术后的裸眼远、近视力,矫正远、近视力。术后3个月检测患者明视、暗视和暗视眩光状态的对比敏感度。采用VF-14（Visual function-14）视功能和生存质量调查问卷评价患者主观的视觉质量。结果术后两组裸眼远视力（t=0．61,P〉0．05）最佳矫正近视力（t=1．877,P〉0．05）差异无统计学意义。非矫正近视力多焦点组优于单焦点组（t=11．38,P〈0．001）,单焦点组在明光、暗光、暗光眩光条件下各空间频率对比敏感度均高于多焦点组,明光条件下3cpd和6cpd空间频率差异有统计学意义（P〈0．05）,暗光眩光条件下中高频率差异有统计学意义（P〈0．05）,两组无患者存在严重的视觉干扰现象。两组术后视远时脱镜率均大于98％,视近时脱镜率多焦点组为78．9％,单焦点组为10．9％。结论与单焦点人工晶状体相比,除了对比敏感度下降,多焦点人工晶状体能提供令人满意的术后视功能和生活质量,患者能获得较高的视觉质量。     

原发性急性闭角型青光眼高眼压水平及持续时间对视力影响

为了探讨原发性急性闭角型青光眼高眼压对视功能的损害程度及影响视功能恢复的因素, 我们对 １０１ 例原发性急性闭角型青光眼急性发作期患者进行研究。结果表明急性发作期患者的视力损害程度与年龄、眼压水平, 高眼压持续时间呈线性关系, 眼压越高、持续时间越长、年龄越大、视力损害越严重。视盘凹陷的形成与高眼压持续时间成正相关。患者术后视力的恢复受术前高眼压的持续时间、年龄、术前视力、术后眼压、 Ｃ／ Ｄ等综合因素的影响。结果提示对急性闭角型青光眼患者应进行紧急降眼压治疗, 缩短高眼压的持续时间以挽救和保护患者的视功能。     

北京两个社区低视力人群流行病学调查

目的 了解北京社区中符合曼谷-马德里标准的低视力人群的视功能状况、致病原因、视觉相关生存质量及康复需求。方法 横断面调查研究。于2013年9月至2015年4月选取北京市西城区德胜街道和朝阳区酒仙桥街道2个社区登记在册的视力残疾者388人作为研究对象。采用入户方式进行问卷调查,进行视功能和眼科检查及视觉相关生存质量评估。依据诊断标准,判定研究对象是否属于低视力患者,并对其视功能状况、致病原因、生存质量进行进一步分析。数据采用χ²检验、t检验、秩和检验进行分析,并采用Logistic多因素回归分析影响生存质量评分高低的相关因素。结果 入户访视单纯视力残疾者共151人,占登记人数的39.0%。访视到的患者中,确诊符合曼谷-马德里低视力标准的视力残疾者110人,占受访者的74.3%,其中66人（60.0%）双眼矫正视力均小于0.05或视野半径小于10°。110例低视力患者视功能损伤的主要病因为视网膜或葡萄膜病变[55例（50.0%）],青光眼[15例（13.6%）],遗传或先天发育异常[15例（13.6%）],他们的主要康复需求是独自外出和读书看报,2项需求相加占到81.8%。低视力患者应用低视力者生活质量量表的得分为47.3±26.7,其得分高低与性别、年龄、身体健康状况或视功能损伤程度无相关性。资料完整的148例受访者的Logistic多因素分析显示年龄和残存视野大小（P<0.001）是影响生活质量得分的主要因素。结论 低视力患者在北京2个社区视力残疾患者中占了大多数,其视功能损伤严重,致病原因主要为不可逆性眼病,其生存质量显著下降。在生活中最主要的康复需求是独自外出和读书看报2项。     

晚期原发性青光眼治疗的我见

晚期青光眼指的是因青光眼而视功能严重障碍而言。关于视功能严重障碍到何种程度才是晚期青光眼,至今并无统一标准。视功能严重障碍可有两种情况。一种是中心视力显著减退(0.02以下者),另一种是视野明显的向心性缩小(中心视野或岛视野只剩15°以内,而中心视力尚可达1.0者)。这样的视功能严重障碍,可谓之晚期青光眼(急性发     

Converting visual acuity to utilities

BACKGROUND: Utility theory can be used to quantify dysfunction associated with various diseases and thus can represent a "hard" measure of quality of life. By determining utility values, one can compare the quality of life of patients with ocular disease to that of patients with non-ophthalmic problems. We performed a study to determine whether utility values from patients with ocular disease are associated with clinical variables, including visual acuity in the better-seeing eye, and to develop a mathematical method for converting visual acuity to utility value, if there is an association between the two. METHODS: Cross-sectional study. A total of 239 patients from a tertiary care retinal practice with various ocular conditions, including macular degeneration, cataract, glaucoma and diabetic retinopathy, were interviewed under standardized conditions to determine their utility values by the time trade-off technique. Visual acuity, duration of visual loss and number of concomitant conditions were also determined. Multiple linear regression was performed to determine which variables were associated with utility values. RESULTS: The mean acuity in the better-seeing eye was 0.479 (near 20/40 vision). The mean utility value was 0.72. Accordingly, the average patient in our series was willing to trade 2.8 of every 10 remaining years of life to obtain perfect vision in both eyes. Utility value was significantly associated with visual acuity in the better-seeing eye (F = 69.1, p < 0.001). Other variables were not significantly associated with utility value. The association with duration of visual loss approached statistical significance (p = 0.075). Utility values (U) for patients with ocular disease can be derived from the following formula: U = (0.374)(visual acuity in better-seeing eye) + 0.514. INTERPRETATION: Utility values from patients with ocular disease were strongly associated with visual acuity and could be estimated mathematically.     

Utility values among glaucoma patients: an impact on the quality of life

AIM: To ascertain utility values and associated quality of life with different severity and duration of glaucoma among Indian patients. METHODS: Utility values of 105 consecutive patients with primary glaucoma of at least 12 months' duration were evaluated in a cross sectional study. Utility values were ascertained in five groups using both the time-trade off and standard gamble methods: group 1 (best corrected visual acuity in the better eye of 6/9 or better), group 2 (best corrected visual acuity in the better eye of 6/18 to 6/12), group 3 (best corrected visual acuity in the better eye of 6/36 to6/24), group 4 (best corrected visual acuity in the better eye of 3/60 to 6/60), and group 5 (best corrected visual acuity in the better eye of 3/60 or worse). RESULTS: The mean utility value for the glaucoma group as a whole was 0.64 (SD 0.69; 95% confidence interval (CI), 0.58 to 0.70) with the time-trade off method and 0.86 (SD 1.00; 95% CI, 0.81 to 0.90) with the standard gamble method for a gamble of death and 0.97 (SD 1.00; 95% CI, 0.94 to 0.99) for a gamble of blindness. The mean utility results by the time-trade off method were as follows: group 1 = 0.66, group 2 = 0.66, group 3 = 0.62, group 4 = 0.55, and group 5 = 0.61. The utility value was much lower (0.46) in those with no formal education or only primary education compared to those with postgraduate education (0.75) (p = 0.038). Those patients with glaucoma of less than 5 years' duration had a utility score of 0.62 while those with glaucoma for more than 10 years had a score of 0.74 (p = 0.40). CONCLUSIONS: Visual acuity loss occurring secondary to glaucoma is associated with a substantial decrease in patient utility value (and quality of life) in a developing country like India. The utility value is directly dependent on the degree of visual acuity loss associated with the disease and educational status and not on the duration of disease, the number of medications, or the visual field indices.     

Utility values in patients with acquired anophthalmus

Background: Loss of an eye can be supposed to lead to reduced health-related quality of life. This can be due to monophthalmia in acquired anophthalmus and/or because of cosmetic impairment. Meanwhile several methods exist to evaluate the quality of life and the impairment in utility values in patients with ophthalmological diseases.

Methods: Twenty-three patients who underwent enucleation of one eye with good visual acuity of the fellow eye (>20/30) were included. All patients were asked to complete a standardized time trade-off (TTO) utility assessment form as well as the self-administered National Eye Institute Visual Function Questionnaire 25 (VFQ 25). TTO was assessed for restoring vision (TTO-A) and for restoring cosmetic appearance (TTO-B).

Results: The mean TTO value for visual function (TTO-A) was 0.87, the mean TTO value for cosmetic restoration (TTO-B) was 0.90 with a significant correlation. These values are surprisingly high compared to current TTO data. Visual acuity of the last eye and utility values were not correlated. TTO was not influenced by the underlying diagnosis. Patients older than 50 years were willing to trade off relatively more years than younger patients. TTO values were independent from the duration of the acquired anophthalmus. The mean VFQ-25 composite score was 81.0 and significantly lower than in the normal population. There was no significant correlation between TTO and the VFQ-25 composite score or any of the 12 subscales of the VFQ-25.

Conclusion: Utility of patients with acquired anophthalmus and good vision of the last eye is very similar to patients with two eyes of which one is worse and good binocular vision. The VFQ-25 is no predictor for time trade-off.     

Visual function and quality of life in Korean patients with glaucoma

The relationship between visual acuity, the level of visual field impairment, visual functioning, and the quality of life was evaluated in Korean patients with glaucoma. Forty-three consecutive glaucoma patients from the glaucoma service at Severance Eye and Ear Hospital were included in this study. Each subject underwent a vision-specific functional status questionnaire (VF-14), a modified VF-14 (VF'-14) and general quality-of-life questionnaires of the Medical Outcomes Study 36-Items Short Form Health Survey (SF-36). The visual acuity and visual field measurements with a Humphrey automated perimeter were taken within one month of the initial visit. The mean age of the subjects was 57.9 +/- 17.8. Among these patients, there were 23 males and 20 females. The mean deviation (MD) and the corrected pattern standard deviation (CPSD) by the automated perimeter in the eye with the better visual acuity were -5.87 +/- 5.16 dB and 3.92 +/- 2.74 dB respectively. The VF-14 and SF-36 scores were 41.28 +/- 14.56 and 52.39 +/- 6.61 respectively. There were significant correlations between the VF-14, VF'-14, and the MD of the better eye (p < 0.05). In Korean patients with glaucoma, the VF-14 and VF'-14 have significant relationship with the MD of the better eye in the visual field.     

Utility assessment to measure the impact of dry eye disease

Utility assessment is a formal method for quantifying and understanding the relative impact of a given health state or disease on patients. In this article, methodology of utility assessment is explained and illustrated, and results of an original study are reported. The study was conducted to determine utility values (patient preferences) associated with dry eye disease and compare them to other disease utilities, as well as to compare patient and physician assessments of disease. Forty-four patients in the United Kingdom with moderate to severe dry eye were surveyed via interactive utility assessment software. Utility values were measured by the Time Trade-Off (TTO) and Standard Gamble (SG) methods and adjusted to scores from 1.0=perfect health to 0.0=death. Patients reported utilities for: self-reported current dry eye status, self-reported current comorbidities, various dry eye severities, and binocular and monocular painful blindness. Patient's dry eye severity was independently classified by patient and physician assessments. Correlation analyses (Pearson) were performed between patients' current dry eye utilities and the physician-assessed severity. Agreement between self-reported and physician-reported patient severity was analyzed (Kappa). Patients reported higher utilities for their current dry eye condition than for monocular and binocular blindness (SG:0.84>0.60>0.51; TTO:0.67>0.43>0.38). Using TTO, the mean score for asymptomatic dry eye (0.68) was similar to that for "some physical and role limitations with occasional pain" and severe dry eye requiring surgery scored (0.56) similarly to hospital dialysis (0.56-0.59) and severe angina (0.5). Utilities described for scenarios of dry eye severity levels were slightly higher for patients self-reported as mild-to-moderate versus those self-reported as severe. For current dry eye condition, mean utilities for these groups were 0.72 for self-reported mild-to-moderate and 0.61 for self-reported severe. Utilities for dry eye were in the range of conditions accepted as lowering health utilities. Severe dry eye utilities were similar to those reported for dialysis and severe angina, highlighting the impact of dry eye disease on patients.     

Utility Values Associated with Diabetic Retinopathy in Chennai,India

Abstract

Purpose: The aim of this study was to estimate utility values associated with different severity stages of diabetic retinopathy (DR) in India by a direct elicitation method (time-trade off, TTO) and indirectly by questionnaire.

Methods: People with diabetes aged 40 years and over were recruited from an on-going DR epidemiology study and a laser clinic in Chennai, India. Utility values were elicited using the direct TTO method and indirectly through a validated questionnaire (EQ-5D).

Results: Of 249 participants, 30 had no DR, 73 had non-proliferative DR, 114 had sight-threatening DR, and 32 were blind from DR (bilateral visual acuity <6/60). The mean TTO utility value was 0.73 (standard deviation, SD, 0.31). TTO utility values decreased with increasing severity of DR (p?<?0.001) and were significantly lower among participants with sight threatening DR (0.70, SD 0.33) and blindness (0.55, SD 0.24) compared to those with no DR (0.89, SD 0.25) after adjustment for sociodemographic and clinical factors. Blindness from DR was independently associated with a lower EQ-5D utility value. The utility value derived from EQ-5D (0.06) associated with being blind from DR was substantially lower than that of the TTO utility value (0.55).

Conclusions: This study provides estimates of utility values that can be used in economic evaluations of DR screening strategies in India. The relatively low utility values associated with blindness highlights the importance of screening programs for early detection of the sight-threatening stages to prevent vision loss from DR in this setting.     

Impact of impaired vision and eye disease on quality of life in Andhra Pradesh

PURPOSE: To determine the impact of visual impairment and eye diseases on quality of life (QOL) in an older population of Andhra Pradesh in southern India. METHODS: The World Health Organization (WHO) QOL (WHOQOL) instrument was adapted as a health-related quality of life (HRQOL) instrument for administration to adults participating in the Andhra Pradesh Eye Disease Study. Participants aged 40 years and older (n = 3702), 99.4% of the 3723 eligible, who underwent interview and detailed dilated ocular eye evaluation by trained professionals were included in this study. Psychometric properties of the HRQOL instrument were evaluated among visually impaired people. Relationships among overall QOL scores and presenting visual acuity in the better eye, specific eye diseases, and demographic variables were examined. RESULTS: Internal consistency was high for the entire questionnaire (alpha = 0.94). Each item of the QOL scale had an adequate item-total correlation (range, 0.25-0.77) greater than 0.2. After adjusting for demographic variables and ocular disease, Subjects with blindness had significantly lower QOL scores. Subjects with glaucoma or corneal disease independent of visual acuity had lower scores than subjects without those eye diseases. Subjects with cataract or retinal disease had significantly lower scores than those without cataract or retinal disease in the model without visual acuity but not when visual acuity was added to the model. CONCLUSIONS: Decreased QOL was associated with the presence of glaucoma or corneal disease independent of visual acuity and with cataract or retinal disease as a function of visual acuity. Visual impairment from uncorrected refractive errors was not associated with decreased QOL.     

Quality of life evaluation of age-related macular degeneration

PURPOSE: To evaluate quality of life (QOL) characteristics and ophthalmic factors influencing QOL in age-related macular degeneration (AMD) patients. SUBJECTS AND METHODS: The subjects were 80 patients with AMD. An eye-disease specific QOL questionnaire, The 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25), was administered. Results were compared with those of glaucoma or cataract patients and those of individuals without eye diseases. The VFQ-25 score was assessed according to visual acuity, absolute scotoma size, and disease type. Multiple regression analysis was used to evaluate ophthalmic factors influencing the QOL score. RESULTS: VFQ-25 scores were significantly lower in AMD patients than in all other groups. Scores of patients with visual acuity less than 0.1, with large absolute central scotoma, and bilateral exudative AMD were lower, for several items, than those of patients with visual acuity of 0.4 or more, those of patients without absolute scotoma, and those of bilateral atrophic AMD patients, respectively. Visual acuity and absolute central scotoma size influenced social functioning and mental health. The exudative form influenced mental health and critical print size influenced dependency. CONCLUSION: The VFQ-25-assessed QOL of AMD patients was lower than that of glaucoma or cataract patients. Visual acuity, absolute central scotoma and the existence of exudative AMD influenced the QOL in AMD patients.     

Contribution of multiple glaucoma medications to visual function and quality of life in patients with glaucoma.

BACKGROUND: Previous studies examining the correlation between medical treatment and overall quality of life in patients with glaucoma assessed differences between a glaucoma population and a matched group (without glaucoma) and were not aimed specifically at detecting a relation between visual acuity, visual field status and medication use, and visual function and quality of life. We performed a study to determine this relation in patients with chronic open-angle glaucoma (COAG). METHODS: The study was cross-sectional. Of 235 English-speaking patients with a diagnosis of COAG, normal-pressure glaucoma or suspected glaucoma (receiving therapy) seen in a university-based glaucoma practice between Feb. 1 and Apr. 30, 1998, 224 (95.3%) agreed to participate. All subjects completed two questionnaires: the Visual Function Assessment and the EQ-5D, assessing health status (quality of life). Visual acuity, diagnosis, age, sex, country of birth, type and number of medications for topical and for oral use, dosage, and history of laser treatment and surgery were extracted from the medical record. Pearson rank correlation and multivariate analyses were performed. RESULTS: On univariate analysis visual function was correlated with age, visual acuity, number of glaucoma medications, number of applications of eyedrops, mean deviation in better eye, mean deviation in worse eye, and lower hemifield involvement in both eyes. On multivariate analysis only visual acuity and visual field status were independently associated with visual function. Univariate analysis showed that health status was correlated with age, visual function and number of medications for oral use; however, age failed to retain statistical significance in the regression analysis. INTERPRETATION: Our results suggest that the number of glaucoma medications is not predictive of quality of life.