Assessment of vision-related quality of life in patients with homonymous visual field defects
- 591 Downloads
Background and purpose
Homonymous visual field defects (HVFDs) are among the most common disorders that occur in the elderly after vascular brain damage and can have a major impact on quality of life (QOL). Aims of this study were to describe the vision-targeted, health-related QOL in patients with HVFDs after cerebrovascular lesion, and to determine the relationship between patients’ self-reported difficulties and the characteristics of HVFDs in the binocular visual field.
The German version of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) was used. NEI-VFQ-25 scores for patients were compared to reference values of healthy German subjects from Franke (Z Med Psychol 7:178–184, 1999). Extent and location of absolute HVFDs were assessed by binocular semi-automated kinetic perimetry (SKP) within the 90° visual field. Correlations of the NEI-VFQ-25 scores of patients with the area of sparing within the affected hemifield (A-SPAR) were estimated by Spearman’s r s.
The mean NEI-VFQ-25 composite score for 33 patients (time span after brain injury at least 6 months) was 77.1, which was significantly lower (p < 0.0001) than the reference value for 360 healthy subjects (composite score = 90.6), and this was also the case for general vision, near activities, vision specific mental health, driving, colour, and peripheral vision. The score for general health was also significantly lower in patients than in reference subjects (p < 0.0001). A weak correlation of the composite score with A-SPAR (r s = 0.38) was observed.
Our findings indicate that detectable decrements in vision-targeted, health-related QOL are observed in patients with homonymous visual field loss. A relationship of the perceived visual functioning with objective parameters is by definition difficult; however, understanding what components of visual function affect certain visual tasks, would help in developing more efficient, clinical assessment strategies. The results reveal a tendency for increasing QOL with advancing size of the area of sparing within the affected hemifield (A-SPAR). The lack of a strong correlation between NEI-VFQ-25 subscales and A-SPAR suggests that an assessment of the visual field may not accurately reflect patients’ perceived difficulty in visual tasks. Additional consideration of visual exploration via eye and head movements may improve the correlation between visual function and its perception.
KeywordsHomonymous hemianopia Homonymous visual field defect Vascular brain damage Questionnaire Exploration Visual exploration Quality of life (QOL)
The authors thank the Rehabilitation Centre Bad Urach, European Union (PERACT- Marie Curie Early Stage Training MEST-CT-2004-504321) and RAND Health Corporation for their support for this study. The authors are also indebted to one of the referees of this manuscript for providing some control values and to PD Dr. Anne Kurtenbach for helpful comments on the manuscript.
- 1.Adler M, Naskar R, Thanos S, Groppe M (2004) Validation of German-language versions of visual function indexes (VF-14 and VFQ-25). 102. Annual meeting of the German Ophthalmological Society, BerlinGoogle Scholar
- 9.Franke G, Esser J, Voigtlaender A, Maehner N (1998) Erste Ergebnisse zur psychometrischen Prüfung des NEI-VFQ (National Eye Institute Visual Function Questionnaire), eines psychodiagnostischen Verfahrens zur Erfassung der Lebensqualität bei Sehbeeinträchtigten. Z Med Psychol 7:178–184Google Scholar
- 10.Franke GH (1999) Handbuch zum National Eye Institute Visual Function Questionnaire (NEI-VFQ) - ein psychodiagnostisches Verfahren zur Erfassung der Lebensqualität bei Sehbeeinträchtigten. Eigendruck, EssenGoogle Scholar
- 11.Franke GH, Esser J, Reimer J, Maehner N (2002) Vision targeted quality of life under different degrees of visual impairment. Rev Port Psicossom 4:39–49Google Scholar
- 12.Franke GH, Maehner N, Reimer J, Voigtlaender-Fleiss A, Esser J (2003) Ein psychodiagnostischer Zugang zur Erfassung der EinbuBen an gesundheitsbezogener Lebensqualität bei verringerter Sehkraft. Z Med Psychol 12:57–62Google Scholar
- 13.Gauthier L, Dehaut F, Joannette Y (1989) The bells test: a quantitative and qualitative test for visual neglect. Int J Clin Neuropsychol 11:49–54Google Scholar
- 19.Karnath HO (2002) Anosognosie. In: Hartje W, Poeck K (eds) Klinische Neuropsychologie, 5th edn. Thieme, Stuttgart, pp 361–371Google Scholar
- 34.R Development Core Team (2005) A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. http://www.R-project.org
- 41.Rijn LJ (Ed) (2005) New standards for the visual functions of drivers. Report of the Eyesight Working Group, http://ec.europa.eu/transport/home/drivinglicence/fitnesstodrive/index_en.htm
- 45.Zangemeister WH, Utz P (2002) An increase in a virtual hemianopic field defect enhances the efficiency of secondary adaptive gaze strategies. Curr Psychol Cogn 21:281–303Google Scholar
- 49.Zihl J (2000) Rehabilitation of visual disorders after brain injury. Psychology Press, Hove, East SussexGoogle Scholar