Diabetic retinopathy and quality of life: a systematic review and meta-analysis

Mohammed G. Zayed*, Waseem Karsan, Tunde Peto, Ponnusamy Saravanan*, Gianni Virgili, David Preiss

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Importance
The association between diabetic retinopathy (DR) and quality of life (QoL) has not been thoroughly investigated.

Objective
To investigate the association between DR and both vision-related QoL (VRQoL) and general health-related QoL (HRQoL).

Data Sources
MEDLINE, EBSCO, Embase, and Web of Science were searched from their inception to April 2022.

Study Selection
Studies included adults with DR and a measure of QoL.

Data Extraction and Synthesis
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Two assumption-free meta-analyses were conducted. Analysis 1 included studies with participants without DR as the referent group to which QoL scores of participants with DR, grouped according to DR severity, were compared. Analysis 2 included all studies with participants with DR and a measure of QoL. QoL scores were pooled within categories of DR severity, and comparisons were made between these categories.

Main Outcome and Measures
QoL measured using HRQoL and VRQoL scales.

Results
A total of 93 articles were included: 79 in the meta-analyses and 14 in the narrative results. VRQoL was recorded in 54 studies, HRQoL in 26, and both in 13 studies. The most commonly used scales were the National Eye Institute 25-item Visual Function Questionnaire (VFQ-25) (n = 49) for VRQoL and the Short Form (SF) Health Survey (n = 18) for HRQoL. Thirty-five studies reported VFQ-25 composite scores. Analysis 1 consisted of 8 studies including 1138 participants with DR and 347 participants without DR. Compared with participants without DR, the composite VFQ-25 score was 3.8 (95% CI, 1.0-6.7) points lower in those with non–vision-threatening DR (NVTDR), 12.5 (95% CI, 8.5-16.5) lower in those with any DR, and 25.1 (95% CI, 22.8-27.2) lower in VTDR (P < .001 for trend). Analysis 2 consisted of 35 studies including 6351 participants with DR. The pooled mean VFQ-25 composite score was 91.8 (95% CI, 91.0-92.7) for participants with NVTDR, 77.6 (95% CI, 76.9-78.3) for any DR, and 73.2 (95% CI, 72.6-73.7) for VTDR (P < .001 for trend). HRQoL scores had weak or no associations with NVTDR and strong associations with VTDR.

Conclusions and Relevance
This study found that VRQoL declined with the presence and severity of DR. Interventions to reduce progression of DR at both early and more advanced stages could improve VRQoL.

Original languageEnglish
Pages (from-to)199-207
JournalJAMA Ophthalmology
Volume142
Issue number3
Early online date01 Feb 2024
DOIs
Publication statusPublished - 01 Mar 2024

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