Central Visual Function and the NEI-VFQ-25 Near and Distance Activities Subscale Scores in People with Type 1 and 2 Diabetes

doi:10.1016/j.ajo.2005.01.008

American Journal of Ophthalmology

Volume 139, Issue 6, June 2005, Pages 1042-1050

Presented at the Association for Research in Vision and Ophthalmology Annual Meeting, Fort Lauderdale, Florida, May 2001.

https://doi.org/10.1016/j.ajo.2005.01.008 Get rights and content

Purpose

To investigate relationships between clinical measures of central visual function and NEI-VFQ-25 Near and Distance Activities subscales in patients with diabetic retinopathy.

Design

Clinic-based, cross-sectional, observational study.

Methods

The NEI-VFQ-25 was administered to 170 people with type 1 or 2 diabetes before an ocular examination that included visual acuity, contrast sensitivity, and central visual fields. Multiple linear regression and exact multiple logistic regression were used to assess the relationship between poor acuity (<69 letters), poor contrast sensitivity (<1.5 log units), and abnormal visual fields (mean deviation ≤ −5dB) and NEI-VFQ-25 subscale scores.

Results

Final multivariable linear models explained a β = 4.7 letter difference (P ≤ .001) for each 25-point Near Activities subscale score difference. Similar effects were observed for the Distance Activities subscale, although the magnitudes of regression and partial correlation coefficients were lower (β = 3.3 letters, P ≤ .01). Final logistic regression models on abnormal clinical categories of central visual function demonstrated relationships only with the Near Activities subscale. For a 1-point change in Near Activities subscale score, the odds of obtaining a poor score for visual acuity, central visual fields, and contrast sensitivity changed by 0.08 (P ≤ .001), 0.07 (P ≤ .05), and 0.12 (P ≤ .001), respectively.

Conclusions

NEI-VFQ-25 Near and Distance Activities subscales demonstrate utility as measures of central visual function in persons with type 1 or 2 diabetes. Low scores on the NEI-VFQ-25 may reflect poor central visual fields and contrast sensitivity in addition to poor visual acuity.

Section snippets

Subjects

The study population consisted of 170 subjects with either type 1 or type 2 diabetes. Subjects were enrolled in any of three clinical protocols at the National Eye Institute (NEI) Clinical Center between the years of 1997 and 2000. Two protocols were designed to assess the natural history of diabetic retinopathy in patients with (n = 67) or without (n = 34) a history of treatment with focal or scatter laser photocoagulation. The third protocol was designed as a long-term follow-up of subjects

Results

One hundred seventy patients were included in this study. The mean age was 56 years (SEM 1.0; range 34 to 85 years), 44% of the patients were female, and approximately 91% identified themselves as white. More than half of the patients had type 1 diabetes (53%), and the majority of patients used insulin (82%) and had over a 20-year history of diabetes (78%). Data on glycosylated hemoglobin (HbA1c) levels at the time of NEI-VFQ-25 were available for 98 of 170 subjects. The mean HbA1c was 7.9

Discussion

The NEI-VFQ-25 is a valid and reliable vision-specific quality-of-life instrument that has been used to supplement the clinical assessment of various eye diseases. In this study, we chose to assess the subscale scores of Near and Distance Activities, as they are most related to central visual function.⁵ The results of our investigation demonstrate that the relationships of ETDRS acuity, Humphrey 10 to 2 visual fields, and Pelli-Robson contrast sensitivity with the NEI-VFQ-25 Near Activities

Dr. Michael Cusick is a guest researcher at the National Eye Institute, National Institutes of Health, where he was previously a Howard Hughes Medical Institute Research Scholar. He will be a resident at The Wilmer Eye Institute, The Johns Hopkins Hospital, from 2005–2008. His research interests include the epidemiology of retinal diseases.

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Cited by (57)

Assessment of quality of life of the patients with diabetic retinopathy using National Eye Institute Visual Functioning Questionnaire (VFQ-25)
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Citation Excerpt :
No significant difference was observed in the scores of patients based on the duration of DR. Turkish version of NEI-VFQ-25 was studied for measuring VR QoL in 93 DR patients. Composite NEI-VFQ-25 score was found to be significantly higher in patients with shorter duration of DM and who had a better visual acuity.6 The patients prescribed with sulfonylureas + gliptins + biguanides showed significantly highest QoL as compared to patients using other medications for diabetes management.
Diabetes affects most of the organs causing macrovascular and microvascular complications. Diabetic retinopathy (DR) results from the prolonged uncontrolled hyperglycemia which causes impairment of vision. Quality of life (QoL) of patients with DR is affected due to vision loss. National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) is the questionnaire used to study the effect of DR on QoL.
To assess the QoL of the patients with DR.
The study enrolled 149 (male-104 and female 45) patients with DR. The previous translated and validated version of NEI-VFQ-25 questionnaire was used in the study.
Cronbach alpha for internal consistency was between 0.6 and 0.8. The male patient showed significantly higher (p < 0.05) QoL scores (60.73 ± 1.63) as compared to the female patients (53.15 ± 2.84). Hypertensive patients showed poor QoL as compared to non-hypertensive patients. The patients with a history of diabetes for 16–30 yrs. showed better QoL as compared to other patients.
DR affects the QoL of life of patients. Routine assessment of QoL using NEI-VFQ-25 questionnaire would be useful for physicians and health care team.
La diabetes afecta a la mayoría de los órganos provocando complicaciones macrovasculares y microvasculares. La retinopatía diabética (RD) es el resultado de la hiperglucemia incontrolada prolongada que causa deterioro de la visión. La calidad de vida (CdV) de los pacientes con RD se ve afectada debido a la pérdida de visión. El Cuestionario de funcionamiento visual (VFQ-25) es el cuestionario que se utiliza para estudiar el efecto de la RD en la calidad de vida.
Evaluar la CV de los pacientes con RD.
El estudio reclutó a 149 (hombres-104 y mujeres 45) pacientes con RD. En el estudio se utilizó la versión anterior traducida y validada del cuestionario VFQ-25. Resultados El alfa de Cronbach para la consistencia interna estuvo entre 0,6 y 0,8. El paciente masculino mostró puntuaciones de calidad de vida significativamente más altas (p <0,05) (60,73 ± 1,63) en comparación con las mujeres (53,15 ± 2,84). Los pacientes hipertensos mostraron una calidad de vida deficiente en comparación con los pacientes no hipertensos. Los pacientes con antecedentes de diabetes de 16 a 30 años. mostró una mejor calidad de vida en comparación con otros pacientes.
El cuestionario VFQ-25 sería útil para que los médicos y el equipo de atención médica evalúen y mejoren la calidad de vida de los pacientes con RD.
A critical review: Psychophysical assessments of diabetic retinopathy
2021, Survey of Ophthalmology
Citation Excerpt :
For many years, psychophysical assessments, especially visual acuity, have served as functional outcomes in clinical DR research. Previous studies have reported decreased visual acuity and contrast sensitivity, impaired color vision, loss of visual field, and slowed dark adaptation in people with DR. These visual impairments corresponded with self-reported symptoms, including cloudy or blurred vision, impaired color vision, reduced peripheral vision, and poor night vision.5,45,87 The subjects also reported poor driving ability and significant emotional distress.37,53
Diabetic retinal disease remains a leading cause of vision loss despite currently available screening methods, ocular treatments, and efforts to control metabolic dysfunction. It is now understood that diabetes damages the entire retina and the cellular components of the neurovascular unit. Multiple studies have demonstrated impairment of various aspects of retinal function across the spectrum of retinopathy severity. Here we review these tests, the principles underlying their use, clinical data from multiple publications, the strengths and limitations of the studies, and prospects for their application to understand the pathophysiology of diabetic retinal disease and monitor its response to therapy. We focus on visual acuity, contrast sensitivity, color vision, visual field, and dark adaptation and their use to understand the pathophysiology of diabetic retinopathy and as potential endpoints for clinical trials.
Crosscultural adaptation and validation into Spanish of the questionnaire National Eye Institute Visual Function Questionnaire 25
2018, Archivos de la Sociedad Espanola de Oftalmologia
Los avances en medicina han contribuido al aumento del promedio de vida, existiendo un mayor número de pacientes crónicos. Esto hace que la evaluación de la calidad de vida de los pacientes en varios aspectos, entre ellos el relacionado con su visión, haya adquirido una especial importancia.
Validación de la traducción y adaptación cultural al castellano de uno de los cuestionarios de calidad de vida relacionada con la visión más ampliamente empleados. Se ha buscado que el cuestionario en castellano sea equivalente semántica y conceptualmente, así como de contenido técnico y de criterio que el ya validado en inglés.
Estudio observacional analítico de una cohorte de pacientes en los que se ha analizado la calidad de vida relacionada con la visión. El estudio se ha desarrollado en 2 fases, una primera de traducción y adaptación cultural al castellano del cuestionario NEI VFQ-25 y, la segunda, de estudio psicométrico de la fiabilidad y validez de la escala en la versión en castellano.
El análisis de fiabilidad y validez refleja que la traducción y adaptación cultural cumple con los requisitos esperados y ha sido bien aceptada por los usuarios.
Se puede disponer de un cuestionario validado en castellano para evaluar la calidad de vida en pacientes con enfermedades crónicas como la degeneración macular asociada a la edad.
Advances in medicine have contributed to a higher average life expectancy, as well as an increasing number of chronic diseases patients. This longevity means that the assessment of the quality of life, particularly that related to vision, has become very relevant.
The validation of the translation and cross-cultural adaptation into Spanish of one of the most widely used vision-related quality of life questionnaires. It has sought to ensure that the Spanish version of the questionnaire was equivalent in semantic, conceptual, and technical content and criteria level, compared to its already validated English version.
An analytical observational study was conducted using a cohort of patients, in whom their quality of life related to vision was analysed. The study was developed in two steps; the first was the translation and cross-cultural adaptation to Spanish of the NEI VFQ-25 questionnaire. The second one was the psychometric study of the reliability and validity of the scale of the Spanish version.
The analysis of the terms of reliability and validity showed that the translation and cross-cultural adaptation met the expected requirements and was well accepted by users.
There is now a possibility of having a Spanish validated questionnaire available to assess the quality of life related to vision in patients with chronic diseases, such as age-related macular degeneration.
Diabetic Retinopathy and Quality of Life: A Systematic Review and Meta-Analysis
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Endpoints for microvascular complications: Clinical outcomes, patient reported outcomes and surrogate endpoints, methodology for validating surrogate parameters
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Distance and near vision changes after intravitreal anti-vascular endothelial growth factor injection in eyes with center-involving diabetic macular edema
2023, Indian Journal of Ophthalmology

View all citing articles on Scopus

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Original articleCentral Visual Function and the NEI-VFQ-25 Near and Distance Activities Subscale Scores in People with Type 1 and 2 Diabetes

Purpose

Design

Methods

Results

Conclusions

Section snippets

Subjects

Results

Discussion

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Causes and prevalence of visual impairment among adults in the United States

Arch Ophthalmol

Centers for Disease Control and Prevention. Blindness caused by diabetesMassachusetts, 1987–1994

Morb Mortal Wkly Rep

The impact of diabetic retinopathy on participation in daily living

Arch Ophthalmol

Development of the 25-item National Eye Institute Visual Function Questionnaire

Arch Ophthalmol

National Eye Institute Visual Function Questionnaire in the Age-Related Eye Disease Study (AREDS)AREDS Report No. 10

Arch Ophthalmol

Relative contributions of reduced vision and general health to NEI-VFQ scores in patients with neovascular age-related macular degeneration

Arch Ophthalmol

Responsiveness of the National Eye Institute Visual Function Questionnaire to changes in visual acuityfindings in patients with subfoveal choroidal neovascularization-SST Report No

1. Arch Ophthalmol

The NEI-VFQ-25 in people with long-term type 1 diabetes mellitusthe Wisconsin Epidemiologic Study of Diabetic Retinopathy

Arch Ophthalmol

Original article
Central Visual Function and the NEI-VFQ-25 Near and Distance Activities Subscale Scores in People with Type 1 and 2 Diabetes