Academic journal article Iranian Journal of Public Health

Impact of Diabetic Retinopathy on Health-Related Quality of Life in Iranian Diabetics

Academic journal article Iranian Journal of Public Health

Impact of Diabetic Retinopathy on Health-Related Quality of Life in Iranian Diabetics

Article excerpt


Diabetic retinopathy (DR) is an ocular manifestation and serious microvascular complication of diabetes mellitus that often affects working-aged adults (1). Almost all patients with type I diabetes and more than 60% of type II diabetics will have some degree of retinopathy 15-20 years after diagnosis. In developed countries, diabetic eye disease represents the leading reason for visual impairment in adults less than 75 years (2). In Iran, DR prevalence has reached 24-37% among diabetics (3).

Visual impairment because of DR has a significant negative impact on patients' life span and their quality of life (QoL) (4). QoL is an abstract concept, which exists only in the mind of the person, whose life is affected, and intrinsically, it cannot be directly observed; instead, an individual's preferences should be elicited (5). Preferences can be measured using either direct diseasespecific Standard Gamble (SG) or Time TradeOff (TTO) instruments, whereby patients themselves value their own health state (6) or indirect multi-attribute ones that attach societal preferences derived from the general population to the health states of patients using general questionnaires, such as the EuroQol-5D (EQ-5D), Short Form-6D (SF-6D) and Health Utility Index (HUI) (7). SG and TTO are two choice-based methods with incontestable reliability, acceptability, and validity in Western sociocultural contexts, valuing the weight of any health state on a numeric scale from 0.00 (death) to 1.00 (perfect quality of life) (8). Economists refer to these values as the utility; a cardinal function also known as the "policy scale" due to its application in value-based policy-making (9). Both SG and TTO have established theoretical underpinnings. The TTO has been developed to be an easy alternative for the SG with empirical properties similar to the standard gamble and overcomes the problems of explaining probabilities to respondents (10). Another less popular direct instrument to elicit utility is the Visual Analogue Scale (VAS) which is a type of rating scale that asks a respondent to indicate his or her current health state on a scale with finish points of death (0) and ideal health (100) (11).

With the advent of new methods for costeffectiveness evaluation in the 1970s and 1980s, utility assessment techniques have frequently been used to quantify the impact of medical interventions (12). One effectiveness criterion is the Quality Adjusted Life Year (QALY), which is a combination of the quantity and quality of obtained life years attributable to an intervention (13). . .

In this perspective, for the first time in a middleincome country, we aimed to measure the impact of DR along its spectrum and its clinical pictures on patients' health-related QoL (HRQoL) using the single-attribute Standard Gamble, TTO, and VAS based on the policy and the perfect vision scales.


Patient Selection

During the winter of 2015, patients were recruited consecutively from those visited at Farabi Eye Hospital, a tertiary referral hospital in the Iranian health care system. Eligible subjects were Persian-speaking Iranians at least 22 yr of age who had diabetes with some degree of untreated DR, were willing and able to participate and lived independently. Patients with Alzheimer's or another form of dementia were not included. For those who for any reason such as significant hearing or cognitive problems were not able to speak or understand our questions and scenarios, we asked their first-degree relatives as their proxy.

Data collection Examinations

For all participants, visual acuity was tested by an optometrist using the standard Snellen chart, and they were examined by a senior vitreoretinal subspecialist at the Retina Consultation Unit to assess DR. The macular and optic disc were viewed at the slit lamp using a 90 diopter widefield lens (Volk Inc., O'Fallon, MO) or Goldman 3 mirror (Volk), if needed, and imaged by fluorescein angiography and optical coherence tomography (OCT) (Heidelberg Engineering, HeidelbergGermany) to evaluate DME. …

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