QOL Surveys Provide Better Emotional, Social Insight of Patients with DR than VA

In this study, type 2 diabetes patients with DR development or progression over a four-year period had worsened health-related quality of life compared with those who remained stable over time. Visual acuity at baseline was not associated with quality-of-life measures at year four, demonstrating the weakness of this objective measurement in assessing participants’ well-being. Photo: Rami Aboumourad, OD. Click image to enlarge. Although diabetic retinopathy (DR) can be a progressive and debilitating disease, there has been little research that evaluates change in quality of life (QOL) over time. A recent study published in American Journal of Ophthalmology, conducted by researchers from the National Eye Institute, used data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial to compare quality of life scores between patients with type 2 diabetes with vs. without diabetic retinopathy development or progression over a four-year follow-up period. They determined that visual acuity (VA) may not capture patients’ psychosocial distress and impairments in daily functioning that may be secondary to DR development and progression.“Providers should instead rely on the results of subjective, validated surveys to understand the social and emotional impact of DR on their patients, as well as identify patients who may benefit from additional emotional or psychiatric management,” the study authors suggested in their paper.The ACCORD multicenter study included 10,251 participants with type 2 diabetes and a glycated hemoglobin level of at least 7.5%. Participants in ACCORD had either established cardiovascular disease or known cardiovascular risk factors at baseline. The ACCORD Eye consisted of a subset of ACCORD participants without a history of PDR that had previously been treated with focal laser photocoagulation or vitrectomy.Among the health-related QOL measures the researchers included were the feeling thermometer (self-assessment of general health), the Health Utilities Index Mark (HUI) 2 (aggregate score of sensation, mobility, cognition, self-care, emotion, pain and fertility), the HUI-3 (aggregate score of vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain), the Patient Health Questionnaire-9 (PHQ-9) for depression and the Short Form-36 that included the Brazier Index derived from physical health and emotional problems.Among ACCORD participants, those self-reporting DR development had a significantly lower score on the feeling thermometer by 3.68 points, the HUI-2 by 0.02 points, the HUI-3 by 0.04 points and the Brazier Index by 0.03 points compared with those who did not report developing DR. Among ACCORD Eye substudy participants, those with DR progression had a significantly lower score on HUI-3 (0.05 points) compared with those who did not experience DR progression.The researchers suggested that individuals who self-report DR development may be likely to report worse QOL because of concerns regarding possible future vision loss.“Individuals with DR development may be perceiving higher levels of interference in their daily life from their physical and emotional problems and may benefit from counseling and other forms of psychosocial support.Click here for the journal source. Prasad M, Agrón E, Vitale S, et al. Diabetic retinopathy incidence, progression and health-related quality of life from the ACCORD trial. Am J Ophthalmol. July 23, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.