Difference between ophthalmologists' and patients' perceptions of quality of life associated with age-related macular degeneration

Background: There may be a wide disparity between the perceptions of patien ts and those of their treating physicians concerning the quality of life as sociated with a given state of health. Because of this potential for differ ence of opinion, we performed a study to evaluate patients' and ophthalmolo gists' perceptions of quality of life, as measured by utility analysis, ass ociated with visual loss secondary to age-related macular degeneration (AMD ). Methods: Cross-sectional study. Utilities were assessed, by means of both t he time trade-off method and the standard gamble method, for various degree s of theoretical visual loss secondary to AMD for ophthalmologists-in-train ing and graduate ophthalmologists. These were compared to utilities for a k nown population of patients with actual visual loss due to AMD. A utility o f 1.0 is associated with perfect health, whereas a utility of 0.0 is associ ated with death. Results: With both the time trade-oft and standard gamble methods, the pati ents had lower mean utilities than did the ophthalmologists for the same de grees of visual loss secondary to AMD. The ophthalmologists were significan tly less willing than the patients to trade years of remaining life for per fect vision with the time tradeoff method (p less than or equal to 0.01), a nd with the standard gamble method they were less willing than the patients to take the risk of dying in return for perfect vision. Given the scenario of counting fingers or worse vision in both eyes, the ophthalmologists wer e willing to trade 3.3 of every 10 years of remaining life for perfect visi on in both eyes, whereas the patients with actual vision of counting finger s or worse in both eyes were willing to trade 6.0 of every 10 years of rema ining life for this result. Interpretation: When presented with the scenario of visual loss secondary t o AMD, ophthalmologists substantially underestimated its effect on patients ' quality of life.