title: Risk factors for low vision related functioning in the Mycotic Ulcer Treatment Trial: a randomised trial comparing natamycin with voriconazole.
abstract: OBJECTIVE
  The Mycotic Ulcer Treatment Trial I (MUTT I) was a double-masked, multicentre, randomised controlled trial, which found that topical natamycin is superior to voriconazole for the treatment of filamentous fungal corneal ulcers. In this study, we determine risk factors for low vision-related quality of life in patients with fungal keratitis.
  
  
  METHODS
  The Indian visual function questionnaire (IND-VFQ) was administered to MUTT I study participants at 3 months. Associations between patient and ulcer characteristics and IND-VFQ subscale score were assessed using generalised estimating equations.
  
  
  RESULTS
  323 patients were enrolled in the trial, and 292 (90.4%) completed the IND-VFQ at 3 months. Out of a total possible score of 100, the average VFQ score for all participants was 81.3 (range 0-100, SD 23.6). After correcting for treatment arm, each logMAR line of worse baseline visual acuity in the affected eye resulted in an average 1.2 points decrease on VFQ at 3 months (95% CI -1.8 to 0.6, p<0.001). Those who required therapeutic penetrating keratoplasty had an average of 25.2 points decrease on VFQ after correcting for treatment arm (95% CI -31.8 to -18.5, p<0.001). Study participants who were unemployed had on average 28.5 points decrease on VFQ (95% CI -46.9 to -10.2, p=0.002) after correcting for treatment arm.
  
  
  CONCLUSIONS
  Monocular vision loss from corneal opacity due to fungal keratitis reduced vision-related quality of life. Given the relatively high worldwide burden of corneal opacity, improving treatment outcomes of corneal infections should be a public health priority.
  
  
  BACKGROUND
  Clinicaltrials.gov Identifier: NCT00996736.
authors.affiliation: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA.|Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA.|Department of Optometry, University of California Berkeley.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rose-Nussbaumer
authors.affiliation: Aravind Eye Care System at Madurai, Pondicherry and Coimbatore.
authors.forename: N Venkatesh
authors.initials: NV
authors.lastname: Prajna
authors.affiliation: Aravind Eye Care System at Madurai, Pondicherry and Coimbatore.
authors.forename: Tiruvengada
authors.initials: T
authors.lastname: Krishnan
authors.affiliation: Aravind Eye Care System at Madurai, Pondicherry and Coimbatore.
authors.forename: Jeena
authors.initials: J
authors.lastname: Mascarenhas
authors.affiliation: Aravind Eye Care System at Madurai, Pondicherry and Coimbatore.
authors.forename: Revathi
authors.initials: R
authors.lastname: Rajaraman
authors.affiliation: Aravind Eye Care System at Madurai, Pondicherry and Coimbatore.
authors.forename: Muthiah
authors.initials: M
authors.lastname: Srinivasan
authors.affiliation: Aravind Eye Care System at Madurai, Pondicherry and Coimbatore.
authors.forename: Anita
authors.initials: A
authors.lastname: Raghavan
authors.affiliation: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Oldenburg
authors.affiliation: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA.
authors.forename: Kieran S
authors.initials: KS
authors.lastname: O'Brien
authors.affiliation: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Ray
authors.affiliation: Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA.|Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
authors.forename: Travis C
authors.initials: TC
authors.lastname: Porco
authors.affiliation: Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: McLeod
authors.affiliation: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA.|Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA.
authors.forename: Nisha R
authors.initials: NR
authors.lastname: Acharya
authors.affiliation: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA.|Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Keenan
authors.affiliation: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA.|Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA.|Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Lietman
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage; D003320:Corneal Ulcer / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D015821:Eye Infections, Fungal / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010866:Natamycin / Q000008:administration & dosage*; D009883:Ophthalmic Solutions; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D015354:Vision, Low / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D014792:Visual Acuity; D065819:Voriconazole / Q000008:administration & dosage*
chemical_list: D000935:Antifungal Agents; D009883:Ophthalmic Solutions; D010866:Natamycin; D065819:Voriconazole
keywords: Cornea; Infection