Gender-specific changes in vision-related quality of life over time – results from the population-based Gutenberg Health Study
Authors: Hartmann Alica , Grabitz Stephanie D. , Wild Philipp S. , Lackner Karl J. , Münzel Thomas , Kerahrodi Jasmin Ghaemi , Singer Susanne , Geschke Katharina , Schattenberg Jörn M. , Konstantinides Stavros , Pfeiffer Norbert , Schuster Alexander K. 
Published: February 2025

Abstract

Purpose
To investigate potential gender- and age-specific changes over time in vision-related quality of life (VRQoL) on a population-based level. Further, factors associated with changes in VRQoL will be explored.

Methods
The Gutenberg Health Study is a population-based, prospective, observational, single-center cohort study in Germany. VRQoL was quantified at baseline and 5-year follow-up using the visual function scale (VFS) and socio-emotional scale (SES-VRQoL). VFS and SES-VRQoL are calculated using the “National Eye Institute 25-Item Visual Functioning Questionnaire” (NEI-VFQ-25). Both scales range from 0 to 100, 0 corresponds to the sum that would be achieved if a participant had answered all items with the worst performance, and 100 corresponds to the sum of all items answered with the best possible performance. Distance-corrected visual acuity was measured in both eyes. Univariable and multivariable linear regression analyses were conducted to identify ophthalmic and sociodemographic predictors of VRQoL.

Results
A total of 10,152 participants (mean age 54.2 years; 49.2% female) were included in the analysis. The mean visual functioning decreased from 89.6 (IQR: 81.3, 95.1) at baseline to 85.9 (IQR: 79.2, 92.6) at 5-year follow-up in the VFS (p < 0.001). Participants' socio-emotional well-being remained the same from baseline to 5-year follow-up in the SES-VRQoL. In multivariable linear regression analysis, older age (0.03, p = 0.002) and female gender (-1.00, p < 0.001) were associated with a VFS change. Higher baseline socioeconomic status was associated with a slightly positive increase in VFS (0.07, p = 0.001). Deterioration of visual acuity in the better and worse-seeing eye was associated with negative VFS change over 5 years (better-seeing eye: -5.41, p < 0.001, worse-seeing eye: -7.35, p < 0.001). Baseline socioeconomic status was associated with SES-VRQoL change (0.06, p < 0.001). The negative change in visual acuity showed an association with negative SES-VRQoL in the better (-4.15, p < 0.001) and worse-seeing eye (-3.75, p < 0.001). Stratification of the regression models by age and gender showed greater reductions in VFS scores with visual acuity changes in participants aged 65 years or older and a more pronounced decrease in female participants over 5 years.

Conclusions
This study demonstrated an association between visual acuity change and change in VRQoL over 5 years, with a greater decrease in female participants and participants aged 65 years or older. The better-seeing eye and the worse-seeing eye both had an impact on changes in VRQoL.

Key messages

What is known

Previous studies have predominantly used cross-sectional designs to investigate the correlation between visual acuity and vision-related quality of life, with limited insights into how visual acuity changes over time affect vision-related quality of life in a large cohort.

What is new

This study demonstrates that visual acuity changes significantly impact VRQoL over a 5-year period, with a notable decrease observed in female participants and those aged 65 years or older.

Analysis reveals both the better-seeing and worse-seeing eye contribute to changes in VRQoL, highlighting the necessity of comprehensive visual assessments in both eyes for a more accurate understanding of VRQoL outcomes.