Lower Quality of Life Reported by Individuals With Unilateral No Light Perception

Retina of diabetic - diabetic retinophaty
Retina of diabetic – diabetic retinopathy
Patients with a unilateral lack of light perception report a better quality of life with improved acuity of the best seeing eye, according to a study.

Patients with unilateral no light perception (NLP) report a lower quality of life than individuals with similar visual acuity (VA) in their best seeing eye who do not lack light perception in their fellow eye, according to research published in the Canadian Journal of Ophthalmology. However, patients with NLP who have a prosthesis in the eye with NLP were an exception to this finding. 

Researchers enrolled 1598 participants (mean age 60±17, 62% women) consisting of patients with NLP (n=99) and a control group (n=1499) in the investigation. Among participants with NLP, 93 experienced it unilaterally, while 6 experienced it bilaterally. The team interviewed participants, asking them how many years they believed they would live, and how many years of life they would trade for an interventional therapy that would guarantee normal bilateral vision. Participant answers were expressed as a time trade-off (TTO) utility ratio, with higher values representing a willingness to trade fewer years of life. 

The investigators also sought correlations between TTO and ophthalmic disease, race, age, and education. In their participants, the most common causes of NLP vision were proliferative diabetic retinopathy (34%), rhegmatogenous retinal detachment (18%), and end stage glaucoma (17%). A total of 27% of eyes with NLP underwent enucleation with prosthetic replacement. 

The researchers calculated mean TTO as 0.69 for patients with NLP vs 0.80 for the control group (P <.001). Patients in the bilateral cohort had a mean TTO of 0.54, and those whose vision ranged from counting fingers to NLP had a mean TTO of 0.55. The team also noted that patients who underwent enucleation and received a prosthetic implant had a TTO utility equal to the control group (0.80). They found no significant correlations between TTO and ophthalmic disease, race, age, or education. 

The team was uncertain as to why individuals with bilateral NLP had a similar TTO utility compared with individuals whose vision ranged from counting fingers to NLP. “These data suggest that those who have bilateral NLP may lose the burden of concern about further vision loss, with that improving QoL,” according to the researchers. “They might also be more accepting than people who still have remaining unilateral vision.”

Study limitations include failure to differentiate between light perception with and without accurate projection, reliance on self-reporting with respect to time of vision loss, and a small sample size of patients with NLP compared with the control group.


Brown GC, Brown MM, Stein JD, Sharma S. Quality of life associated with no light perception vision. Can J Ophthalmol. Published online April 23, 2022. doi:10.1016/j.jcjo.2022.03.002