Showing papers by "Gary C. Brown published in 2022"

Preference-based comparison of the quality of life associated with vision loss in Black and White U.S. ophthalmic populations.

Abstract: Utilities are preference-based estimates, typically ranging from 1.00 (normal health) to 0.00 (death), that quantify the quality-of-life improvement associated with a health care intervention. In conjunction with length-of-life gain, depending on the intervention, they measure total interventional value gain in quality-adjusted life years that can be integrated with costs in cost-utility analysis. We believed it relevant to ascertain whether race was a differentiating factor confounding utilities related to vision.An analysis of cross-sectional data obtained from consecutive Black and White ophthalmic outpatients from the Wills Eye Hospital (Philadelphia, PA.) practices who participated in a long-standing time trade-off (TTO) vision utility study from 1999 to 2016 was undertaken. Each participant was interviewed by a researcher using a previously validated and reliable TTO vision utility acquisition instrument and assigned to 1 of 5 vision categories according to acuity in the best-seeing eye. Utility outcomes were compared using both the 2-sided t test and the Mann-Whitney U test.Eleven hundred and twenty-five consecutive patients able to successfully answer the questions were included. For vision of 20/200-20/800, White/Black mean vision utilities were, respectively, 0.58/0.59 (p = 0.84); for vision of 20/70-20/100, they were, respectively, 0.72/0.70 (p = 0.85); for vision of 20/50-20/60, they were, respectively, 0.78/0.79 (p = 0.86); for vision of 20/25-20/50, they were, respectively, 0.84/0.88 (p = 0.16); and for vision of 20/20, they were, respectively, 0.91/0.90 (p = 0.43).TTO vision utilities in Black and White ophthalmic patient cohorts were alike at various levels of visual acuity. This suggests a similar quality of life and that TTO vision utilities used in cost-utility analysis do not require adjustment for race in Black and White ophthalmic populations in the US.

Quality of life associated with no light perception vision.

Abstract: Time trade-off (TTO) utility analysis quantifies the quality of life associated with best-seeing-eye (BSE) vision. We compared the patient quality of life associated with unilateral and bilateral no light perception (NLP) with that of a control cohort without NLP.Cross-sectional interviews using a validated, reliable TTO vision utility analysis instrument.A total of 1598 consecutive ophthalmology patients from the authors' practices.Patient records were reviewed in a case-control fashion The utilities of participants with unilateral or bilateral NLP vision were compared with those from patients without NLP vision.Among 99 NLP patients, 93 (94%) had unilateral NLP and 6 (6%) had bilateral NLP, for a total of 105 NLP eyes. Multiple regression analysis demonstrated the highest correlation between utility and BSE acuity (p = 0.001), with no correlation with age, ophthalmic disease, time of vision loss, race, or education. Mean unilateral NLP utility ranged from 0.55 in the counting fingers to light perception subcohort to 0.80 in the 20/20-20/25 subcohort. The 6-person bilateral NLP subcohort had a 0.54 utility. The 99-patient NLP cohort mean utility was 0.69, a 55% quality-of-life decrease versus a BSE vision-matched 0.80 in 1499 non-NLP patients (p < 0.001).TTO utility in unilateral NLP patients correlated with BSE vision at a lower utility than in patients with matched BSE vision without fellow-eye NLP. Decreased unilateral NLP patient quality of life should be considered in cost-utility analysis and clinical management. Bilateral NLP patient utility (0.54) was slightly less than that (0.55) in blind unilateral NLP patients with fellow-eye counting fingers to light perception vision, suggesting that more study is needed.