Umbrella Review Highlights Global Scope of Vision Impairment, Reduced Quality of Life

A global analysis of 9 systematic reviews found a consistent association between vision impairment, eye diseases, and reduced quality of life, findings which support the continued pursuit of ophthalmic interventions where indicated. Results of the cross-sectional study of systematic reviews were published in JAMA Ophthalmology.

Around the world, at least 2.2 billion people are estimated to suffer vision impairment, while more than 1 billion “have moderate or severe vision impairment or blindness from a preventable or potentially correctable cause, including refractive error, presbyopia, and cataract,” researchers wrote.

Although quality-of-life measures have gained traction in ophthalmology research in recent years, there has yet to be a global synthesis of the evidence on quality of life and eye health. To examine this association and the outcome of ophthalmic interventions on quality of life globally and across the life span, investigators conducted a systematic review of systematic reviews, or umbrella review.

The study, which consisted of searching electronic databases MEDLINE, Ovid, Embase, Cochrane Database of Systematic Reviews, ProQuest Dissertations and Theses Global, forms part of the work for the upcoming Lancet Global Health Commission on Global Eye Health. All databases were searched from inception through June 29, 2020. Of the 685 relevant full-text articles assessed for eligibility, 9 reviews on vision impairment or eye diseases and 60 reviews on ophthalmic interventions were included in the final analysis.

Out of the 9 reviews (5 on quantitative observational studies, 3 on qualitative studies, and 1 on qualitative and quantitative studies) researchers investigated the association between quality of life and vision impairment, age-related macular degeneration, glaucoma, diabetic retinopathy, or mendelian eye conditions (including retinitis pigmentosa and Usher syndrome), specifically. “All found an association between vision impairment and lower quality of life,” authors wrote.

The studies were published between 2010 and 2020 and represented authors from the United Kingdom, United States, the Netherlands, Taiwan, China and Singapore. Data showed “people with vision impairment had poorer scores on quality-of-life subscales, such as mental health, psychosocial functioning, and fatigue (odds ratio, 2.61 [95% CI, 1.69-4.04]).”

In addition, of the 60 reviews on interventions published from 2005 to 2020, “33 unique interventions were investigated, of which 25 were found to improve quality of life compared with baseline measurements or a group receiving no intervention. These interventions included timely cataract surgery, anti–vascular endothelial growth factor (VEGF) therapy for age-related macular degeneration (AMD), and macular edema,” authors said. The reviews included authors from a variety of countries including the United Kingdom, the United States, China, Italy, brazil, Canada, Australia, and Uruguay, among others.

Of the ophthalmic interventions evaluated, 75% exhibited evidence of a positive outcome on quality of life, researchers found. “Most notably, cataract surgery and the use of anti-VEGF therapy for AMD, diabetic macular edema, and macular edema secondary to other causes resulted in improved quality of life.”

However, gaps in evidence available on outcomes of leading causes of visual impairment were apparent among children, people from racial/ethnic minorities, and in low- and middle-income countries. Many systematic reviews were also excluded from the review due to a lack of a unified definition for quality of life.

Publication bias among reviews and overlaps in primary studies included mark limitations to the current analysis. “Reviews and primary studies addressing underrepresented diseases and reviews focusing on specific populations, such as people from low- and middle-income countries, are needed to expand generalizable knowledge on the association between eye health and quality of life,” researchers wrote.

“Scaling up interventions, such as cataract surgery, refractive error correction, and anti-VEGF therapy at a global level, has the potential to improve the quality of life of millions of people worldwide,” they concluded.

Reference

Assi L, Chamseddine F, Ibrahim P, et al. A global assessment of eye health and quality of life. JAMA Ophthalmol. Published online February 12, 2021. doi:10.1001/jamaophthalmol.2021.0146