title: The impact of visual impairment on health-related quality of life in rural Africa.
abstract: OBJECTIVE
  To assess the impact of visual impairment (VI) on utility values in Sub-Saharan Africa and compare findings with other studies from low- and high-income countries.
  
  
  METHODS
  Patients with normal vision and various levels of VI were recruited from a secondary eye clinic in rural Kenya and interviewed using time trade-off (TTO). VI was classified using the World Health Organization definition of (normal vision, visual acuity ≥20/60, VI 20/80-20/200, severe VI 20/240-20/400, and blindness <20/400).
  
  
  RESULTS
  Mean age of the total sample (N = 303) was 50.3 years (standard deviation, SD, ±18.17 years), and 51.5% of patients were male. Most were small-scale farmers and illiteracy was high at 40%. Mean TTO scores per group were: normal vision 0.93 (SD ± 0.10), VI 0.88 (SD ± 0.14), severe VI 0.86 (SD ± 0.13), blindness 0.73 (SD ± 0.17; p ≤ 0.001). Lower TTO scores were independently associated with worse visual acuity (p ≤ 0.001), longer duration of disease (p ≤ 0.001) and illiteracy (p = 0.011), but not with cause of VI, age, sex, marital status, socioeconomic status, or systemic comorbidities in multivariate analyses. Overall, TTO scores were considerably higher than those reported from high-income countries at similar levels of VI.
  
  
  CONCLUSIONS
  In this rural African population, duration and extent of vision loss, rather than cause, socioeconomic factors and comorbidities affected vision-related quality of life. Our findings underline the importance of providing sight-restoring treatment as timely as possible and the necessity of enhancing rehabilitation efforts for those with non-curable eye diseases.
authors.affiliation: MVZ Jung-Stilling Hospital , Siegen , Germany .
authors.forename: Sebastian
authors.initials: S
authors.lastname: Briesen
authors.forename: Helen
authors.initials: H
authors.lastname: Roberts
authors.forename: Robert P
authors.initials: RP
authors.lastname: Finger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics / Q000295:instrumentation; D011788:Quality of Life / Q000523:psychology*; D012424:Rural Population / Q000706:statistics & numerical data*; D018434:Sickness Impact Profile; D013019:South Africa / Q000453:epidemiology; D014786:Vision Disorders / Q000523:psychology*; D014792:Visual Acuity / Q000502:physiology; D019987:Persons with Visual Disabilities / Q000523:psychology*
keywords: Africa; Kenya; time trade-off; utilities; visual impairment