[The impact of diabetic retinopathy on vision-related quality of life]

Zhonghua Yan Ke Za Zhi. 2022 Oct 11;58(10):760-768. doi: 10.3760/cma.j.cn112142-20211210-00581.
[Article in Chinese]

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.

目的: 了解2型糖尿病伴糖尿病视网膜病变(DR)患者的视觉相关生活质量(VRQoL)。 方法: 横断面研究。纳入2012年7月至2013年5月辽宁省抚顺市将军街道15个社区已确诊为2型糖尿病的居民1 537例,男性623例,女性914例,年龄(61.1±8.4)岁。采用美国国立眼科研究院视功能量表(NEI-VFQ-25)中文版来评估受检者的VRQoL。受检者分别按年龄、性别、有无视力损伤、受累眼进行分析。不同人群间量表分数的比较采用Wilcoxon秩和检验或Kruskal-Wallis H检验。将每只眼分为无DR、轻度非增生期糖尿病性视网膜病变(NPDR)、中度NPDR、重度NPDR和增生性糖尿病视网膜病变(PDR)。判断受检者双眼DR严重程度,按7级DR综合等级进行分级。采用广义线性模型评估DR严重程度与量表分数的线性关系;采用局部加权回归来评估DR综合严重程度与量表分数之间可能存在的非线性关系。 结果: 1 537例受检者中无DR者836例(54.4%),轻度NPDR 479例(31.2%),中度NPDR 90例(5.9%),重度NPDR 72例(4.7%),PDR 60例(3.8%)。与单眼受累患者相比,双眼受累患者总体视力[70.2(66.5,72.5)分和68.9(63.9,71.6)分,Z=90.222,P=0.038]、近距离活动[90.5(85.8,94.0)分和88.8(84.5,92.5)分,Z=114.942,P=0.005]、依赖性[91.1(85.6,96.5)分和89.3(83.8,94.5)分,Z =91.934,P=0.033]、心理健康[80.0(73.4,84.9)分和77.5(70.8,82.0)分,Z=118.388,P=0.003]、社会角色限制[76.8(70.1,82.4)分和74.5(67.6,80.6)分,Z =90.791,P=0.036]和总分[88.3(84.2,91.0)分和86.9(82.8,90.1)分,Z =96.207,P=0.024]的分数均低于单眼DR者,差异有统计学意义。随着DR严重程度的增加,总体视力(χ2=85.665)、近距离活动(χ2=78.462)、远距离活动(χ2=145.489)、社会功能(χ2=53.629)、依赖性(χ2=86.710)、心理健康(χ2=68.281)、社会角色限制(χ2=45.357)、色觉(χ2=68.176)、周边视野(χ2=116.179)、NEI-VFQ-25总分(χ2=133.291)分数逐渐降低(均P<0.001)。局部加权回归曲线显示社会角色限制项存在2处分数显著下降的转折点,分别在双眼轻度NPDR与轻度NPDR/>轻度NPDR之间(斜率为-4.7)和中度NPDR/≥中度NPDR与重度NPDR/≥重度NPDR之间(斜率为-12.6)。 结论: DR严重程度和受累眼都与视觉相关生活质量显著相关,尤其在社会角色限制和心理健康方面最为明显。.

MeSH terms

  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2* / complications
  • Diabetic Retinopathy* / complications
  • Humans
  • Quality of Life / psychology
  • Surveys and Questionnaires
  • Visual Acuity