The NEI-VFQ-25 in people with long-term type 1 diabetes mellitus - The Wisconsin Epidemiologic Study of Diabetic Retinopathy

Objectives: To examine the association of the 25-item National Eye Institut e Visual Function Questionnaire (NEI-VFQ-25) overall and specific scale sco res with visual acuity, diabetic retinopathy, and other characteristics, in a cohort of persons with type 1 diabetes. Design: Population-based cohort study. Setting: An 11-county area in southern Wisconsin. Participants: Six hundred two persons with diabetes whose conditions were d iagnosed when they were younger than 30 years and who were currently taking insulin participated in baseline, 4-year, 10-year, and 14-year follow-up e xaminations. Main Outcome Measures: An interview that consisted of the 25-item NEI-VFQ w as completed. Visual acuity was measured by the Early Treatment of Diabetic Retinopathy Study (ETDRS) protocol and the presence and severity of retino pathy and macular edema were detected by masked grading of stereoscopic col or fundus photographs using the modified Airlie House classification and th e ETDRS retinopathy severity scheme. Results: Univariate analyses revealed that the total NEI-VFQ-25 score was l ower in persons who were older, had a longer duration of diabetes, higher g lycosylated hemoglobin, were in renal failure, had a history of cardiovascu lar disease, hypertension, or amputation of a lower limb, had poorer visual acuity, more severe diabetic retinopathy, macular edema, glaucoma, catarac t, abnormalities in tactile sensation or temperature sensitivity, smoked mo re total pack-years, led a more sedentary lifestyle, and had poor peak expi ratory flow. In multivariate analyses, while controlling for the physical a nd mental component scores from the Medical Outcomes Survey 36-Item Short-F orm Health Survey as measures of comorbidity, lower total NEI-VFQ-25 scores were independently associated with poorer visual acuity, more severe retin opathy, older age, history of loss of tactile sensation, and more total pac k-years of cigarettes smoked. Conclusions: In this cross-sectional study, the 25-item NEI-VFQ seems to be strongly associated with vision, independent of severity of retinopathy an d other complications associated with type 1 diabetes. It may be a useful m easure of health-related quality of life as it relates to vision in epidemi ological studies and clinical trials in persons with diabetes.