Visual function and patient-reported outcomes across ophthalmic diseases: An exploratory cross-sectional study

Purpose To explore how disease category, visual function, and severe visual impairment are associated with patient-reported outcomes (PROs) in ophthalmology. Design Exploratory cross-sectional study. Subjects, Participants, and/or Controls A total of 262 patients with major ophthalmic diseases were included, comprising patients with glaucoma, age-related macular degeneration, diabetic retinopathy, retinitis pigmentosa, cataract, and a separate group with severe visual impairment certified under the Japanese physical disability certification system. Methods, Intervention, or Testing PROs were assessed using the 12-Item Short Form Health Survey (SF-12) and the National Eye Institute Visual Function Questionnaire-25 (VFQ-25). Disease-group differences were evaluated using nonparametric comparisons and multivariable regression models. Because the severe visual impairment group was defined by disability status rather than by a single diagnosis, analyses involving this group were interpreted descriptively and were further evaluated using sensitivity analyses excluding this group. A glaucoma subgroup analysis examined the association between visual field loss and VFQ-25 scores. Results Physical component scores did not differ significantly among disease groups. Mental and role/social component scores differed across groups, but these differences were largely attenuated after exclusion of the severe visual impairment group. In descriptive group comparisons, the severe visual impairment group showed lower role/social functioning and higher mental component scores; however, these findings should be interpreted cautiously because this group was heterogeneous and defined by functional disability rather than disease category. In the glaucoma subgroup, better mean deviation was independently associated with higher VFQ-25 composite scores, whereas visual acuity was not. Conclusions In this exploratory cohort, differences in generic PROs across ophthalmic disease groups appeared to be influenced by the inclusion of patients with severe visual impairment. The findings do not establish that disease category is unimportant, but they suggest that functional visual impairment should be carefully considered when interpreting PROs across ophthalmic diseases. In glaucoma, visual field loss may provide clinically relevant information regarding vision-related quality of life beyond visual acuity alone.