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The NEI-VFQ-25 in People With Long-term Type 1 Diabetes Mellitus
The Wisconsin Epidemiologic Study of Diabetic Retinopathy
Arch Ophthalmol. 2001;119:733-740.
Objectives To examine the association of the 25-item National Eye Institute Visual
Function Questionnaire (NEI-VFQ-25) overall and specific scale scores with
visual acuity, diabetic retinopathy, and other characteristics, in a cohort
of persons with type 1 diabetes.
Design Population-based cohort study.
Setting An 11-county area in southern Wisconsin.
Participants Six hundred two persons with diabetes whose conditions were diagnosed
when they were younger than 30 years and who were currently taking insulin
participated in baseline, 4-year, 10-year, and 14-year follow-up examinations.
Main Outcome Measures An interview that consisted of the 25-item NEI-VFQ was completed. Visual
acuity was measured by the Early Treatment of Diabetic Retinopathy Study (ETDRS)
protocol and the presence and severity of retinopathy and macular edema were
detected by masked grading of stereoscopic color fundus photographs using
the modified Airlie House classification and the ETDRS retinopathy severity
scheme.
Results Univariate analyses revealed that the total NEI-VFQ-25 score was lower
in persons who were older, had a longer duration of diabetes, higher glycosylated
hemoglobin, were in renal failure, had a history of cardiovascular disease,
hypertension, or amputation of a lower limb, had poorer visual acuity, more
severe diabetic retinopathy, macular edema, glaucoma, cataract, abnormalities
in tactile sensation or temperature sensitivity, smoked more total pack-years,
led a more sedentary lifestyle, and had poor peak expiratory flow. In multivariate
analyses, while controlling for the physical and mental component scores from
the Medical Outcomes Survey 36-Item Short-Form Health Survey as measures of
comorbidity, lower total NEI-VFQ-25 scores were independently associated with
poorer visual acuity, more severe retinopathy, older age, history of loss
of tactile sensation, and more total pack-years of cigarettes smoked.
Conclusions In this cross-sectional study, the 25-item NEI-VFQ seems to be strongly
associated with vision, independent of severity of retinopathy and other complications
associated with type 1 diabetes. It may be a useful measure of health-related
quality of life as it relates to vision in epidemiological studies and clinical
trials in persons with diabetes.
Ronald Klein, MD, MPH;
Scot E. Moss, MA;
Barbara E. K. Klein, MD;
Peter Gutierrez, MA;
Carol M. Mangione, MD
From the Department of Ophthalmology and Visual Sciences, University
of Wisconsin Medical School, Madison (Drs R. Klein and B. E. K. Klein and
Mr Moss); and the Department of Medicine, University of California School
of Medicine, Los Angeles (Mr Gutierrez and Dr Mangione).
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