Purpose

Although the impact of vision-related quality of life (VRQoL) is assessed optimally using binocular visual acuity (VA), uniocular VA remains the preferred measurement method in clinic-based and epidemiologic studies. We compared the impact of distance presenting binocular VA and uniocular VA in the better-seeing (better-eye VA) and worse-seeing (worse-eye VA) eye on VRQoL.

Design

The Singapore Chinese Eye Study 2 (2015–2017), a population-based, cross-sectional study.

Participants

One thousand eight hundred twenty-two individuals (mean age, 66.2 years [standard deviation, 8.9 years]; 51.1% women) were included.

Methods

Presenting uniocular VA and binocular VA were assessed using a logarithm of the minimum angle of resolution number chart at a distance of 4 m under standard lighting by trained and certified study optometrists. Multiple linear regression models were constructed to determine the independent associations between binocular VA, better-eye VA, and worse-eye VA and the outcome (VRQoL), adjusted for potential confounders, including age, gender, socioeconomic status, and presence of comorbidities. In addition, a cluster sandwich estimator was used to determine if any differences in β estimates between the associations were statistically significant.

Main Outcome Measures

Vision-related quality of life was measured using Rasch-transformed scores from the emotional, mobility, and reading domains of the Impact of Visual Impairment (IVI) questionnaire.

Results

Although every 2-line increase (worsening) in binocular VA and uniocular VA was associated independently with decrements in emotional, mobility, and reading IVI scores (P < 0.05 for all), the reductions in all VRQoL domains were substantially lower (P < 0.1) when using either the better-eye VA (compared with binocular VA β-estimates, –27.8%, –19.4%, and –24.2% difference in emotional, mobility, and reading IVI scores, respectively) or worse-eye VA (compared with binocular VA β estimates, –38.9%, –58.1%, and –57.5% reduction in emotional, mobility, and reading IVI scores, respectively) to quantify vision loss.

Conclusions

Uniocular VA seems to underestimate the impact of vision loss on VRQoL indices compared with binocular VA. Our data suggest that researchers, clinicians, and policy planners should consider using binocular instead of uniocular measures of VA in patient-reported outcome evaluation of vision loss because it may better reflect its impact on VRQoL.

中文翻译：

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与双眼视力相比，使用单眼视力实质上低估了视力障碍对生活质量的影响。

目的

尽管使用双眼视敏度（VA）可以最佳地评估与视觉有关的生活质量（VRQoL）的影响，但单眼VA仍然是基于临床和流行病学研究的首选测量方法。我们比较了远视呈现双眼VA和单眼VA对VRQoL的视力较好（视力较佳）和视力较差（视力较差）的影响。

设计

《新加坡华人眼睛研究2》（2015-2017年）是一项基于人群的横断面研究。

参加者

其中包括182个个体（平均年龄66.2岁（标准偏差8.9岁）；女性51.1％）。

方法

在训练条件下，由经过培训和认证的研究验光师在4 m的距离下，使用最小分辨角数字图表的对数评估单眼VA和双眼VA。构建了多个线性回归模型来确定双眼VA，视力较好的VA和视力不良的VA与结果（VRQoL）之间的独立关联，并针对潜在的混杂因素进行了调整，包括年龄，性别，社会经济地位和合并症。另外，使用群集三明治估计器来确定关联之间的β估计值之间的任何差异是否具有统计显着性。

主要观察指标

视觉相关的生活质量是使用视觉障碍影响（IVI）问卷的情感，行动能力和阅读领域的Rasch转换得分来衡量的。

结果

尽管双眼VA和单眼VA每增加2行（恶化）与情绪，活动能力和阅读IVI得分的降低独立相关（所有P均<0.05），但所有VRQoL域的降低均较低（P <0.1 ），或者使用视力较差的VA（与双眼VAβ估计相比，情绪，行动和阅读IVI评分分别降低–27.8％，– 19.4％和–24.2％）或估计双眼VAβ可使情绪，行动和阅读IVI得分分别降低–38.9％，– 58.1％和–57.5％，以量化视力丧失。

结论

与双眼VA相比，单眼VA似乎低估了视力丧失对VRQoL指数的影响。我们的数据表明，在患者报告的视力丧失结果评估中，研究人员，临床医生和政策制定者应考虑使用双眼VA而非单眼VA测量，因为它可能更好地反映其对VRQoL的影响。