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Original Investigation |

Age-Related Macular Degeneration and Quality of Life in Latinos The Los Angeles Latino Eye Study

Farzana Choudhury, MBBS, MS, PhD1; Rohit Varma, MD, MPH1; Ronald Klein, MD, MPH2; W. James Gauderman, PhD3; Stanley P. Azen, PhD3; Roberta McKean-Cowdin, PhD3 ; for the Los Angeles Latino Eye Study Group
[+] Author Affiliations
1Department of Ophthalmology, USC Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles
2Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison
3Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
JAMA Ophthalmol. 2016;134(6):683-690. doi:10.1001/jamaophthalmol.2016.0794.
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Importance  This study found evidence of a threshold effect in which the presence of bilateral soft drusen and depigmentation of retinal pigment epithelium was associated with substantially low health-related quality of life (HRQoL) in adult Latinos from the United States.

Objective  To assess the association of general and vision-specific HRQoL with age-related macular degeneration (AMD), overall and by bilaterality and severity, in adult Latinos.

Design, Setting, and Participants  This cross-sectional, population-based study included 4876 participants from the general urban community in 6 US Census tracts in La Puente, California. The data for these analyses were collected as part of a population-based study of ocular diseases in adult Latinos in the Los Angeles Latino Eye Study from February 1, 2000, through May 31, 2003. The analysis was performed from November 2010 to February 2011. Additional analyses were performed in June 2014.

Main Outcomes and Measures  Mean-adjusted HRQoL scores and effect sizes.

Results  Of the 4876 participants included in the analysis, 4402 (90.3%) had no AMD, and 474 (9.7%) had any AMD, with 453 having early (9.3%) and 21 (0.4%) having late stages of the disease. The mean (SD) age of the cohort was 54.8 (10.7) years. Of the 4876 participants, 2001 (41.0%) were male and 2875 (59.0%) were female. In this cohort of Latinos, participants with AMD had lower vision-specific HRQoL scores. General HRQoL was assessed by the Medical Outcomes Study 12-Item Short-Form Health Survey and self-reported vision-related HRQoL by the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25). Composite NEI-VFQ-25 scores were 59.5 (95% CI, 50.8-68.1) for those with late-stage AMD and 79.4 (95% CI, 72.5-86.1) for those with early-stage AMD, compared with participants without AMD 80.7 (95% CI, 73.9-82.4); P < .001. Several lesions of early AMD were associated with lower NEI-VFQ-25 composite scores and 8 to 10 individual scales. Large effect sizes and lower mean scores were observed for those with late AMD lesions, overall and specifically for geographic atrophy and neovascular AMD, compared with those without AMD. With the use of concatenated bilateral severity levels for AMD, decreases in the NEI-VFQ-25 composite and individual scale scores were observed at the transition from a unilateral to bilateral severity level of 40, which corresponds to having bilateral soft drusen (>125 μm in diameter with drusen area ≥196 350 μm2) and depigmentation of retinal pigment epithelium (slope of −19.17 for the NEI-VFQ-25 composite score). Measures of general health, as assessed by the Medical Outcomes Study 12-Item Short-Form Health Survey, were not affected in this cohort.

Conclusions and Relevance  In this study of adult Latinos, early AMD lesions are associated with lower self-reported, vision-specific HRQoL but not general HRQoL. Severity and bilaterality of AMD are associated with measurably lower HRQoL scores, with the largest difference in scores occurring for individuals with both eyes affected. A concatenated approach to incorporate bilateral severity might be more useful and provide better insight into the association of AMD and HRQoL.

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Figure 1.
Age-Related Macular Degeneration (AMD) Severity and Composite National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) Score in Worse and Better Eye

Locally weighted scatterplot smoothing plot illustrating the association between the NEI-VFQ-25 composite health-related quality-of-life (HRQoL) score and severity of AMD for the worse and better eyes.

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Place holder to copy figure label and caption
Figure 2.
Comparison of Generic and Vision-Specific Health-Related Quality of Life (HRQoL) for Bilateral Age-Related Macular Degeneration (AMD) Severity Levels

Locally weighted scatterplot smoothing plot between the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) composite score and the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) Physical component summary score and concatenated bilateral severity of AMD.

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