Effects of Visual Field Loss on Vision-Specific Quality of Life in Minority Groups

Did I do all that I could?
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Patients of Chinese and Latino ethnicity have a different experience with vision loss than other groups, according to researchers.

Patients of Hispanic and Chinese backgrounds report a greater change in vision-specific quality of life (VSQOL) for the same level of visual field loss (VFL) than participants who self-reported as Black, according to research published in Ophthalmology.

Researchers analyzed data from 14,570 participants (mean age 59 years, 61% women) enrolled in the Multiethnic Ophthalmology Cohorts of California Study (MOCCaS), which includes 17,071 participants from a combination of the Los Angeles Latino Eye Study (LALES), the Chinese American Eye Study (CHES), and the African American Eye Disease Study (AFEDS).

They measured VFL using the Swedish Interactive Threshold Algorithm (SITA) Standard C2-4 test to determine mean deviation (MD) from age-adjusted population. VSQOL was measured with the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25). Researchers included item response theory (IRT) composite domains and classical test theory (CTT) subscales for the NEI-VFQ-25.

Participants of Chinese ethnicity had the greatest differences in VSQOL at baseline (18.5 points) compared with those who were either Black (13.7 points) or Hispanic (12.2 points). Participants who were Black reported a significantly smaller change in VFQOL compared with patients in the Hispanic group who experienced the same degree of VFL.

Participants with self-reported Hispanic ethnicity experienced a 0.750 loss in VSQOL score per decibel (dB) decrease of MD for VFL. Those who reported Chinese ethnicity experienced a 0.719 loss. Participants in the Black group experienced a 0.496 loss with the IRT task model. Task composite VSQOL decreased 5 points following a VFL of 6.7 dB for those in the Hispanic group, 7.0 dB for those in the Chinese group, and 10.1 dB for participants in the Black group.

Participants in the Hispanic group reported a 0.666 loss in VSQOL per dB decrease of MD for VFL for the IRT well-being model, Chinese patients experienced a 0.575 loss, and participants in the Black group experienced a 0.387 loss. A 5-point decrease in well-being composite VSQOL resulted from a VFL of 6.7 dB among participants in the Hispanic group, a 7.0 dB VFL among those in the Chinese group, and a 10.1 dB among those in the Black group.

Individuals who were at least 65 years old experienced a VSQOL point loss of 0.487 per dB of MD in VFL for driving challenges, compared with individuals aged younger than 65 years (P <.001). VFL produced the greatest impact on the CTT subscale of driving for participants in the Hispanic and Black groups. Participants in the Chinese group older than 65 years were most affected by that subscale; however, patients in the Chinese group who were younger than 65 years experienced greater CTT loss with respect to vision-related role function and mental health.

Variation between ethnic groups was more likely among US born men younger than 65 years who were high school graduates, employed, insured, not experiencing depression, and not visually impaired.

Limitations of the study included overadjustment of separated covariates due to participants having mixed ancestry and differences in socioeconomic status among races.


Grisafe DJ II, McKean-Cowdin R, Burkemper BS, Xu BY, Torres M, Varma R. Visual field loss impacts vision-specific quality of life by race, ethnicity: the multiethnic ophthalmology cohorts of California study. Ophthalmol. Published online January 9, 2022. doi:10.1016/j.ophtha.2022.01.001