Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Dr. Monali Malvankar

2nd Supervisor

Dr. Shehzad Ali

Abstract

Background: Health-related Quality of Life (HRQoL) values determined using direct elicitation methods and generic preference-based measures are important for economic evaluations of healthcare interventions. The ophthalmology clientele is vulnerable to psychological stressors in the context of the coronavirus disease 2019 (COVID-19) pandemic.

Objectives: To systematically identify and summarize the quality of life (QoL) of eye disease patients in general in North America and seniors with eye diseases during the COVID-19 pandemic.

Methods: A systematic review identified North American studies that quantified HRQoL of eye disease patients. A cross-sectional study was conducted among seniors with eye diseases and backwards stepwise regression models were built.

Results: The systematic review revealed that HRQoL across patients with glaucoma, age-related macular degeneration (ARMD), diabetic retinopathy (DR), cataracts, uveitis, and dry eye disease (DED) was similar using the SF-12 and SF-36. Utility values across patients with ARMD, DR, cataracts, uveitis, and DED appear to be similar while values in patients with glaucoma appear to be higher. The cross-sectional survey revealed that HRQoL, vision-related QoL (VRQoL), and sleep quality appeared to be good. Depression and anxiety symptoms appeared to be low, while community integration and social support were moderate. The presence of retinal disease and the number of non-ocular comorbidities negatively impacted VRQoL and social support and community integration. Education impacted social support and community integration negatively. of mobility aids appeared to negatively affect depressive symptoms and sleep quality.

Conclusion: Overall QoL among North American patients and seniors with eye diseases appeared to be generally good.

Summary for Lay Audience

Eye diseases have been associated with numerous negative impacts on a patient’s quality of life (QoL) and overall wellbeing. This thesis investigates the QoL of patients with eye diseases from two different angles. The first angle is through a systematic review of literature that looks at QoL from a health economics point of view. In particular, the review focuses on the values produced by standardized questionnaires and techniques from previous studies to quantify the overall QoL of North American patients with eye diseases. This review revealed that the QoL across patients with glaucoma, age-related macular degeneration, diabetic retinopathy, cataracts, uveitis, and dry eye disease appeared to be similar. However, there may be evidence that the QoL of patients with glaucoma is higher than in patients with other diseases.

The second angle in which QoL of eye disease patients is investigated is through conducting a survey that specifically focuses on seniors with eye diseases to see how their QoL has been during the recent coronavirus disease 2019 (COVID-19) pandemic. This survey looked at QoL using many different measures. The results of this survey revealed that the QoL and sleep quality of seniors with eye diseases appeared to be good. Depression and anxiety appeared to be low, while community integration and social support were moderate. More specifically, having retinal disease and more non-eye diseases negatively affected visual aspects of QoL and community integration and social support. Having a greater education also appeared to negatively affect community integration and social support. Finally, the use of a mobility aid appeared to negatively affect sleep quality and depression. The findings revealed by these studies are important because they could provide necessary information for making economic assessments and evaluations for many different eye diseases. Furthermore, the findings help potentially quantify the effects of COVID-19 beyond the direct impact of the virus. This, in turn, may help to improve the future quality of care during non-COVID-19 conditions and during potential future pandemic situations. Overall, the findings from this thesis may be used to improve patients' overall care for eye diseases in the future.

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