Visual Field Loss Impacts Vision-Specific Quality of Life by Race and Ethnicity: The Multiethnic Ophthalmology Cohorts of California Study.

PURPOSE: To assess the impact of visual field loss (VFL) on vision-specific quality of life (VSQOL) by race, ethnicity, and age. DESIGN: Pooled analysis of cross-sectional data from 3 population-based, prospective cohort studies. PARTICIPANTS: The Multiethnic Ophthalmology Cohorts of California Study (MOCCaS) participants included 6142 Latinos, 4582 Chinese Americans, and 6347 Black Americans from Los Angeles County. METHODS: A total of 17 071 adults aged 40 years and older completed comprehensive interviews and ophthalmic examinations from 2000 to 2018. VFL was measured using the Humphrey Swedish Interactive Threshold Algorithm Standard 24-2 test as decibels (dB) of mean deviation (MD). Multivariable linear regression was used to evaluate the impact of VFL in the better-seeing eye on self-reported VSQOL scores, adjusting for sociodemographic and clinical covariables. Hierarchical modeling was performed to determine the best-fit model after considering main effects and interactions by race, ethnicity, and age. MAIN OUTCOME MEASURES: The VSQOL scores were measured using the 25 Item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Item response theory was used to model vision-related task and well-being composite scores, and classical test theory was used to calculate 11 vision subscales. RESULTS: The impact of VFL on VSQOL varied by race and ethnicity. Five-point reductions in task and well-being scores were reached after mild-to-moderate VFL for Latinos (6.7 dB and 7.5 dB), mild-to-moderate VFL for Chinese Americans (7.0 dB and 8.7 dB), and moderate-to-severe VFL for Black Americans (10.1 dB and 12.9 dB), respectively. Differences met statistical significance when comparing Latinos and Black Americans (P < 0.001). Visual field loss had the largest effect on driving among all participants. Driving difficulties were the only VSQOL outcome modified by age; participants aged 65 years and older scored 0.487 lower points per MD of VFL (P < 0.001). Subscales most affected by VFL included role function, mental health, and dependency. CONCLUSIONS: Race and ethnicity modified the impact of VFL on VSQOL, even after adjusting for sociodemographic covariates. In MOCCaS, Latinos and Chinese Americans reported a greater change in VSQOL than Black Americans for the same level of VFL. Future work should assess whether findings were due to socioeconomic or cultural differences in perception of visual function.

Self-reported Use of Eye Care Among Adult Chinese Americans: The Chinese American Eye Study.

PURPOSE: To identify the prevalence and determinants of self-reported eye care use among Chinese Americans. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: A total of 4582 Chinese Americans 50 years and older residing in Monterey Park, California. METHODS: Multivariable logistic regression analyses based on Andersen's Behavioral Model of Health Services Use were conducted to identify predisposing, enabling, and need variables associated with self-reported eye care use. MAIN OUTCOME MEASURES: Prevalence of self-reported use assessed as eye care visit in the past 12 months, dilated eye examination in the past 12 months, and ever having had a dilated examination, and odds ratios for factors associated with these measures. RESULTS: Overall, 36% of participants reported an eye care visit and 21% reported a dilated examination in the past 12 months. Forty-eight percent reported ever having had a dilated eye examination. Older age, female sex, preference for English, more education, health and vision insurance, a usual place for health care, currently driving, a greater number of comorbidities, and lower vision-specific quality-of-life (NEI VFQ-25) scores were associated with higher odds of reporting use of eye care. CONCLUSIONS: Use of eye care among Chinese Americans was found to be as low as what is reported for African Americans and Hispanics, and lower than what is reported for whites. Multiple modifiable factors are associated with use of eye care among the rapidly growing Chinese American population. Culturally sensitive interventions targeting these factors should be a priority. Further research is needed to investigate how findings from this group of Chinese Americans reflect other Asian Americans that are different in language and ethnicity.

Vision assessment using the NIH Toolbox.

Vision is a sensation that is created from complex processes and provides us with a representation of the world around us. There are many important aspects of vision, but visual acuity was judged to be the most appropriate vision assessment for the NIH Toolbox for Assessment of Neurological and Behavioral Function, both because of its central role in visual health and because acuity testing is common and relatively inexpensive to implement broadly. The impact of visual impairments on health-related quality of life also was viewed as important to assess, in order to gain a broad view of one's visual function. To test visual acuity, an easy-to-use software program was developed, based on the protocol used by the E-ETDRS. Children younger than 7 years were administered a version with only the letters H, O, T, and V. Reliability and validity of the Toolbox visual acuity test were very good. A 53-item vision-targeted, health-related quality of life survey was also developed.

Longitudinal changes in visual acuity and health-related quality of life: the Los Angeles Latino Eye study.

PURPOSE: To examine the association between longitudinal changes in visual acuity (VA) and health-related quality of life (HRQOL) in a population-based sample of adult Latinos. DESIGN: A population-based cohort study of eye disease in Latinos. PARTICIPANTS: We included 3169 adult Latino participants who live in the city of La Puente, California. METHODS: Data for these analyses were collected for the Los Angeles Latino Eye Study (LALES). Distance VA was measured during a detailed ophthalmologic examination using the standard Early Treatment Diabetic Retinopathy Study protocol at baseline and a 4-year follow-up examination. We assessed HRQOL by the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and the Medical Outcomes Study 12-Item Short-Form Health Survey version 1 (SF-12). MAIN OUTCOME MEASURES: Mean differences in HRQOL composite and subscale scores between baseline and follow-up were calculated for 3169 participants with complete clinical examination and HRQOL data at both time points. Mean differences and effect sizes (ES) for NEI-VFQ and SF-12 scores were calculated for 3 categories of VA change over the 4-year follow-up period (VA improved ≥ 2 lines, no change in VA or -2 < VA < 2, VA loss ≥ 2 lines). RESULTS: For participants with a 2-line loss in VA, we noted an approximate 5-point loss in the NEI-VFQ-25 composite score, with the greatest score changes found for the driving difficulties, vision-related mental health, and vision-related dependency subscales (-12.7, -11.5, and -11.3, respectively). For participants with a 2-line improvement in VA, we also noted an approximate 5-point gain in the NEI-VFQ-25 composite score. The greatest change (ES = 0.80) was observed for the driving difficulties subscale. No measurable differences in HRQOL were observed for individuals without change in VA from baseline to follow-up. CONCLUSIONS: Clinically important, longitudinal changes in VA (≥ 2-line changes) were associated with significant changes in self-reported visual function and well-being. Both the size and direction of VA change influenced change in HRQOL scores.

Ethnic differences in the use of regular mammography: the multiethnic cohort.

Women's regular use of mammography over a 6 year interval was examined among women aged 45-75 in the Hawaii and Los Angeles Multiethnic Cohort (MEC). The analyses included 81,722 African American, Japanese, Latina, Native Hawaiian, and White females using self-reported mammography history from 1993 to 1998. Ninety-one percent of MEC women reported ever having a mammogram, however only 36% reported regular annual and 48% reported regular biennial mammography over the interval. Mammography was lowest among women who were obese, had a high school education or less, or who were aged 70 and over. Regular mammography use during follow-up was low compared to prior studies reporting on recent mammography. African American, Latina, and Native Hawaiian women had significantly lower annual and biennial mammography use compared to White women even after controlling for age, education, family history, body mass index and hormone therapy indicating that gaps exist in mammography that remain unexplained by known predictors of screening behavior.