Vision Preference Value Scale and Patient Preferences in Choosing Therapy for Symptomatic Vitreomacular Interface Abnormality
Vision Preference Value Scale and Patient Preferences in Choosing Therapy for Symptomatic Vitreomacular Interface Abnormality
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DOI：
10.1001/jamaophthalmol.2018.1272
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发表时间：
2018-06-01
影响因子：
8.1
通讯作者：
Scott, Adrienne W.
中科院分区：
文献类型：
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作者：
Linz, Marguerite O.;Bressler, Neil M.;Scott, Adrienne W.
重要提示：虽然有症状的玻璃体黄斑界面异常（VIAs）是常见的，但对视力偏好值和治疗偏好的评估可能会指导医生的治疗建议，并影响第三方payer.Objective：确定VIA患者对其视觉状态和潜在治疗偏好的偏好值。在这项于2015年12月至2017年1月进行的一次性横断面问卷调查中，对来自泰国、英国和美国三级医疗转诊中心的213名患者进行了研究。纳入了在数据收集后1年内诊断出症状性VIA、视力低于20/20 mm和症状归因于VIA的患者。主要结果和指标：主要终点为VIA患者对视觉状态的总体平均偏好值和患者对潜在治疗的偏好。偏好值按0到1的等级进行分级，0表示死亡，1表示完全健康和完美视力。结果：在纳入的213名患者中，139名（65.3%）为女性，平均（SD）年龄为65.6（7.7）岁。诊断包括视网膜前膜（n = 100 [46.9%]）、黄斑裂孔（n = 99 [46.5%]）和玻璃体黄斑牵引（n = 14 [6.6%]）。平均（SD）视力偏好值为0.76（0.15），在3种VIA类型之间未发现差异。与玻璃体内注射（120 [56.9%]）相比，更多的参与者热衷于玻璃体切除术（150 [71.1%]）（差异，14.2%; 95% CI，5.16-23.3; P = 0.002）。校正分析显示，玻璃体切除术的热情与对侧眼视力（比值比，10.99; 95%CI，2.01-59.97; P = 0.006）和更好的视力（比值比，0.03; 95%CI，0.001-0.66; P = 0.03）相关。总体治疗热情与对侧眼视力相关（比值比，7.22; 95%CI，1.29-40.40; P = .02）。总体而言，大多数参与者（171 [81.0%]）热衷于手术，注射，或both.CONCLUSIONS AND RELEVANCE：研究参与者报告3种类型的VIA之间的相似的偏好值。数据表明，大多数患有这些疾病的患者会热衷于接受玻璃体切除术或注射治疗，可能是因为这种情况对视觉功能的影响，尽管此时可能会稍微倾向于玻璃体切除术。
IMPORTANCE: While symptomatic vitreomacular interface abnormalities (VIAs) are common, assessment of vision preference values and treatment preferences of these may guide treatment recommendations by physicians and influence third-party payers.OBJECTIVE: To determine preference values that individuals with VIA assign to their visual state and preferences of potential treatments.DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional one-time questionnaire study conducted between December 2015 and January 2017, 213 patients from tertiary care referral centers in Thailand, the United Kingdom, and the United States were studied. Patients with symptomatic VIA diagnosed within 1 year of data collection, visual acuity less than 20/20 OU, and symptoms ascribed to VIAs were included. Data were analyzed from January 2017 to November 2017.MAIN OUTCOMES AND MEASURES: The primary end points were overall mean preference value that individuals with VIA assigned to their visual state and patients' preferences for potential treatments. Preference values were graded on a scale from 0 to 1, with 0 indicating death and 1 indicating perfect health with perfect vision.RESULTS: Of the 213 included patients, 139 (65.3%) were women, and the mean (SD) age was 65.6 (7.7) years. Diagnoses included epiretinal membrane (n = 100 [46.9%]), macular hole (n = 99 [46.5%]), and vitreomacular traction (n = 14 [6.6%]). The mean (SD) vision preference value was 0.76 (0.15), without differences identified among the 3 VIA types. More participants were enthusiastic about vitrectomy (150 [71.1%]) compared with intravitreal injection (120 [56.9%]) (difference, 14.2%; 95% CI, 5.16-23.3; P = .002). Adjusted analyses showed enthusiasm for vitrectomy was associated with fellow eye visual acuity (odds ratio, 10.99; 95% CI, 2.01-59.97; P = .006) and better-seeing eye visual acuity (odds ratio, 0.03; 95% CI, 0.001-0.66; P = .03). Overall enthusiasm for treatment was associated with fellow eye visual acuity (odds ratio, 7.22; 95% CI, 1.29-40.40; P = .02). Overall, most participants (171 [81.0%]) were enthusiastic about surgery, injection, or both.CONCLUSIONS AND RELEVANCE: Study participants reported similar preference values among 3 types of VIAs. The data suggest that most patients with these conditions would be enthusiastic about undergoing vitrectomy or an injection to treat it, likely because of the condition's effect on visual functioning, although there may be a slight preference for vitrectomy at this time.