American Journal of Ophthalmology, December 2019
Niemeyer et al. set out to determine the time trade-off (TTO) utility values associated with noninfectious uveitis. They found that noninfectious uveitis is linked to modestly reduced quality of life (QoL), which correlated with long-term use of oral corticosteroids and poor visual acuity (VA) in the worse eye.
For this study, the researchers enrolled 104 consecutively treated adults with noninfectious uveitis. TTO utility values were calculated from responses to an interviewer-guided survey on QoL. The researchers also collected information about general health, ocular symptoms, and religion. Medical records were reviewed to determine anatomic location of uveitis, disease activity, VA, and treatments provided. Multivariable regression analysis with backward selection was used to identify factors associated with TTO scores.
Findings showed a median TTO value of 0.975 for the study population (interquartile range [IQR], 0.8-1.0), which corresponded to trading 1.28 years (median) of remaining life for healthy eyes (IQR, 0-6.29). According to regression analysis, controlled for age and sex, lower TTO scores were linked to poorer VA in the worse eye, taking oral corticosteroids for more than six months, and current use of antidepressants (p = .008, p = .006, and p = .008, respectively). Patients who had been taking oral corticosteroids for more than six months, regardless of the dose, were 10.5 times more likely to trade 20% or more years of remaining life (TTO ≤ 0.8) than were those who did not take oral corticosteroids (p = .002). Patients who were legally blind in at least one eye had a median TTO score of 0.8 and were willing to trade a median of 4.3 years of remaining life.
Overall, 73% of patients were willing to trade time from their life for healthy eyes. The backward stepwise analysis showed that the greatest contributors to this willingness were college education (odds ratio [OR], 5.12; p = .008) and Catholic religion (OR, 0.27; p = .03).
To the authors’ knowledge, this study is the first to investigate TTO utility values among patients with noninfectious uveitis. The results highlight the negative effect of long-term use of corticosteroids on QoL, regardless of dosage. The TTO tool had favorable test-retest reliability and thus may be useful to study QoL for patients with ocular disease, the authors concluded.
The original article can be found here.