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Editors Selection IGR 11-1

Health and Quality of Life: Health literacy

Comment by David Garway-Heath on:

21328 Health literacy and vision-related quality of life, Muir KW; Santiago-Turla C; Stinnett SS et al., British Journal of Ophthalmology, 2008; 92: 779-782

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Vision is the sense that provides the most important interface between the individual and their environment. Clinicians tend to focus on the eye, rather than on the patient, and use sophisticated instruments to measure aspects of vision in detail. However, such tests fail to measure the ability of individuals to function in everyday environments. The consequence is that the effects of vision loss on the interaction of individuals with the visual environment are poorly understood. Impaired vision can have a significant and detrimental impact on a patient's quality of life. One approach to identifying the impact of vision loss on the individual is through quality of life questionnaires ('instruments'). Many instruments have been investigated in glaucoma patients,¹ including generic (not disease-specific) instruments, vision-specific instruments, and glaucoma-specific instruments. The National Eye Institute 25-Item Vision Function Questionnaire (VFQ-25) is an example of a vision-specific instrument, and contains sub-scales relating to general health, general vision, near vision, distance vision, driving, peripheral vision, color vision, ocular pain, role limitations, dependency, social function and mental health.

Patient-centered outcomes should drive clinicians' management of glaucoma

Many non-vision factors may influent a patient's response to questions and these include general health, personality and mental well-being, age, and socio-economic and cultural considerations.
Muir et al. (481) undertook a study to investigate the impact of health literacy on responses of 195 glaucoma patients to the VFQ-25. Health literacy is the ability to comprehend written material in a healthcare setting. Other variables considered were race, gender, age, visual field, visual acuity, education, and general health (mental and physical). Whereas worse health literacy was associated with lower VFQ-25 scores in a univariate analysis, it was not in the multivariate model, suggesting that other (related) factors could account for the association. Interestingly, worse health literacy remained un-associated with VFQ-25 score in a multivariate model with education level excluded. The only factors associated with worse VFQ-25 score were older age (p < 0.001) and worse visual field (P = 0.051). Worse health literacy was associated with the dependency sub-scale of the VFQ-25 in the multivariate model. As lower literacy is strongly related to lower socio-economic status in the United States, it is not possible to distinguish between the effect of patients' ability to understand and use available services and the effect of lack of economic resources.

Patient-centered outcomes should drive clinicians' management of glaucoma. This study provides important data helping to clarify the influence non-vision patient factors on responses to a vision-related quality of life questionnaire.

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