title: Determinants of health related quality of life and health state utility in patients with age related macular degeneration: the association of contrast sensitivity and visual acuity.
abstract: BACKGROUND
  There has been increasing interest in the use of measures of health related quality of life (HRQoL) and health state utility values in Age Related Macular Degeneration (ARMD). Visual acuity has been found to be an important determinant of such measures in previous studies. More recently, another measure of visual impairment, contrast sensitivity has received considerable attention. We designed a study to examine whether the contribution of contrast sensitivity in explaining HRQoL and health utilities over and above that of visual acuity.
  
  
  METHODS
  209 patients with unilateral or bilateral ARMD were recruited into a cross-sectional study of patients from a large teaching hospital. Patients underwent visual tests (near and distant visual acuity, contrast sensitivity) and completed a vision function questionnaire, the VF-14, HUI3, and time trade-off.
  
  
  RESULTS
  Using multivariate regression analysis, the study revealed that contrast sensitivity remained a statistically significant predictor of all outcome measures even when visual acuity was included. This result was supported by the correlation coefficients between measures.
  
  
  CONCLUSIONS
  The measurement of contrast sensitivity appears to be better related to a person's HRQoL and health utility. Future studies should consider incorporating contrast sensitivity in addition to visual acuity. Studies, in particular economic evaluations, may underestimate the effect of treatment unless contrast sensitivity is considered.
authors.affiliation: Health Economics and Decision Science, ScHARR (School of Health and Related Research), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. n.j.bansback@sheffield.ac.uk
authors.forename: N
authors.initials: N
authors.lastname: Bansback
authors.forename: C
authors.initials: C
authors.lastname: Czoski-Murray
authors.forename: J
authors.initials: J
authors.lastname: Carlton
authors.forename: G
authors.initials: G
authors.lastname: Lewis
authors.forename: L
authors.initials: L
authors.lastname: Hughes
authors.forename: M
authors.initials: M
authors.lastname: Espallargues
authors.forename: C
authors.initials: C
authors.lastname: Brand
authors.forename: J
authors.initials: J
authors.lastname: Brazier
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015350:Contrast Sensitivity / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008268:Macular Degeneration / Q000503:physiopathology / Q000523:psychology*; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011594:Psychometrics / Q000295:instrumentation; D011788:Quality of Life / Q000523:psychology*; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014787:Vision Tests; D014792:Visual Acuity / Q000502:physiology*