To improve understanding and awareness of the impact of subfoveal choroidalneovascularization (CNV) on health-related quality of life, we sought to measurethe preference value that patients with subfoveal CNV assigned to their healthand vision status.
Patients and Methods
Patients with subfoveal CNV completed telephone interviews about theirquality of life prior to enrollment and random treatment assignment in theSubmacular Surgery Trials, a set of multicenter randomized controlled trialsevaluating outcomes of submacular surgery compared with observation. The interviewersasked patients to rate their current vision on a scale from 0 (completelyblind) to 100 (perfect vision). The interviewers also asked them to rate completeblindness and then perfect vision, assuming their health otherwise was thesame as it was at the time of the interview, on a scale from 0 (dead) to 100(perfect health with perfect vision). Scores were converted to a 0 to 1 preferencevalue scale for health and vision status, where 0 represents death and 1 representsperfect health and vision.
Of 1015 participants enrolled in the Submacular Surgery Trials, 996completed interviews that included the rating questions, and 792 (80%) answeredall 3 rating questions in a manner permitting calculation of a single overallpreference value for their current health and vision status on a scale from0 (dead) to 1 (perfect). The mean preference value was 0.64 (median, 0.68;interquartile range, 0.51-0.80). The preference values correlated with age(Pearson correlation coefficient, –0.11; P = .002),patients’ self-rated perception of overall health (Spearman correlationcoefficient, 0.36; P<.001), and self-reportedperception of vision (Spearman correlation coefficient, 0.47; P<.001). The preference values were significantly lower with poorervisual acuity in the better eye and greater evidence of dysfunction on eitherthe Hospital Anxiety and Depression Scale or the Physical or Mental ComponentSummary scales of the Short Form-36 Health Survey but did not differ significantlyby gender or other baseline characteristics such as race, treatment assignment,or size of the CNV lesion.
Vision loss from subfoveal CNV is associated with patient preferencevalues that are as low as or lower than values previously reported for otherserious medical conditions such as dialysis-dependent renal failure and AIDS,indicating that both unilateral and bilateral CNV have a profound impact onhow patients feel about their overall health-related quality of life.