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Gary C. Brown, MD, MBA; Sanjay Sharma, MD, MSc(Epid); Melissa M. Brown, MN, MD, MBA; Jonathan Kistler, MD

Arch Ophthalmol. 2000;118:47-51.

Objective  To ascertain the utility values associated with age-related macular degeneration and varying degrees of visual loss.

Design  A cross-sectional study.

Participants  Eighty white patients with unilateral or bilateral age-related macular degeneration in 1 or both eyes, and visual loss to a minimum of the 20/40 level in at least 1 eye.

Main Outcome Measures  Utility values were measured in 5 groups according to the visual acuity in the better-seeing eye, 1 (20/20 to 20/25), 2 (20/30 to 20/50), 3 (20/60 to 20/100), 4 (20/200 to 20/400), and 5 (counting fingers to light perception), using the time trade-off and the standard gamble methods. Conventionally assigned anchor utility values were 1.0 for perfect health and 0.0 for death.

Results  The mean utility value for the total group with age-related macular degeneration was 0.72 (95% confidence interval [CI], 0.66-0.78) using the time trade-off method and 0.81 (95% CI, 0.76-0.86) using the standard gamble method. Using the time trade-off method correlated with the visual acuity in the better-seeing eye, the results were as follow: group 1, 0.89 (95% CI, 0.82-0.96), group 2, 0.81 (95% CI, 0.73-0.89), group 3, 0.57 (95% CI, 0.47-0.67), group 4, 0.52 (95% CI, 0.38-0.66), and group 5, 0.40 (95% CI, 0.29-0.50). Thus, those patients in group 1 were willing to trade 11% of their remaining lifetime in return for perfect vision in each eye, whereas those in group 5 were willing to trade 60% of their remaining lifetime in return for perfect vision in each eye.

Conclusion  Age-related macular degeneration causes a substantial decrease in patient utility values and is highly dependent on the degree of visual loss in the better-seeing eye.

From the Retina Vascular Unit (Drs G. C. Brown and Kistler) and the Cataract and Primary Eye Care Service (Dr M. M. Brown), Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pa; the Departments of Ophthalmology and Epidemiology, Queens Medical College, Kingston, Ontario (Dr Sharma); and the Center for Evidence-Based Healthcare, Flourtown, Pa (Drs G. C. Brown, Sharma, and M. M. Brown).

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