Validation of a novel diabetic retinopathy utility index using discrete choice experiments

Background/aims To validate a preference-based Diabetic Retinopathy Utility Index (DRU-I) using discrete choice experiment (DCE) methods and assess disutilities associated with vision-threatening DR (VTDR: severe non-proliferative DR, proliferative DR and clinically significant macular oedema) and associated vision impairment. Methods The DRU-I comprises five quality-of-life dimensions, including Visual symptoms, Activity limitation/mobility, Lighting and glare, Socio-emotional well-being and Inconvenience, each rated as no, some, or a lot of difficulty. The DRU-I was developed using a DCE comprising six blocks of nine choice sets which, alongside the EuroQoL-5D (EQ-5D-3L) and Vision and Quality of Life (VisQoL) utility instruments, were interviewer-administered to participants. To ensure the DRU-I was sensitive to severe disease, we oversampled patients with VTDR. Data were analysed using conditional logit regression. Results Of the 220 participants (mean +/-SD age 60.1+/-11.3 years; 70.9% men), 57 (29.1%) and 139 (70.9%) had non-VTDR and VTDR, respectively, while 157 (71.4%), 20 (9.4%) and 37 (17.3%) had no, mild or moderate/severe vision impairment, respectively. Regression coefficients for all dimensions were ordered as expected, with worsening levels in each dimension being less preferred (theoretical validity). DRU-I utilities decreased as DR severity (non-VTDR=0.87; VTDR=0.80; p=0.021) and better eye vision impairment (none=0.84; mild=0.78; moderate/severe=0.72; p=0.012) increased. DRU-I utilities had low (r=0.39) and moderate (r=0.58) correlation with EQ-5D and VisQoL utilities, respectively (convergent validity). Discussion The DRU-I can estimate utilities associated with vision-threatening DR and associated vision impairment. It has the potential to assess the cost effectiveness of DR interventions from a patient perspective and inform policies on resource allocation relating to DR.Eva K Fenwick, Nick Bansback, Alfred Tau Liang Gan, Julie Ratcliffe, Leonie Burgess, Tien Yin Wong, Ecosse Luc Lamoureu

Prevalence, determinants and association of unawareness of diabetes, hypertension and hypercholesterolemia with poor disease control in a multi-ethnic Asian population without cardiovascular disease

10.1186/s12963-019-0197-5Population Health Metrics1711

Microsieve lab-chip device for rapid enumeration and fluorescence in situ hybridization of circulating tumor cells

10.1039/c2lc20750hLab on a Chip - Miniaturisation for Chemistry and Biology12214388-4396LCAH

The Relationship between Generalized and Abdominal Obesity with Diabetic Kidney Disease in Type 2 Diabetes: A Multiethnic Asian Study and Meta-Analysis

10.3390/nu10111685Nutrients101

Retinal vasculature and 5-year metabolic syndrome among women with gestational diabetes mellitus

10.1016/j.metabol.2017.10.004Metabolism: Clinical and Experimental83216-224METAAGUSTO (Growing up towards Healthy Outcomes

Prevalence, risk factors, and impact of undiagnosed visually significant cataract: The Singapore epidemiology of eye diseases study

10.1371/journal.pone.0170804PLoS ONE121e017080

Selective laser trabeculoplasty versus topical medication as initial glaucoma treatment: the glaucoma initial treatment study randomised clinical trial

Published Online First 5 September 2019BACKGROUND/AIMS:To determine if selective laser trabeculoplasty (SLT) is superior to topical medication as a first-line treatment for glaucoma on quality of life (QoL) and clinical outcomes. METHODS:In this international, longitudinal, multisite randomised controlled trial, treatment naïve mild-to-moderate primary open angle or exfoliation glaucoma patients were randomised 1:1 to SLT or topical medication. Glaucoma-specific QoL (primary outcome) was measured using the Glaucoma Outcomes Assessment Tool (GOAT; 342 items, 12 domains). Secondary outcomes included rate of successful intraocular pressure (IOP) reduction (>25% reduction from baseline) and presence of ocular surface disease including conjunctival hyperaemia and eyelid erythema. Our intention-to-treat analysis was performed at months 12 and 24. RESULTS:Of 167 enrolled patients, 83 and 84 were randomised to SLT and topical medication, respectively; and 145 (n=75 SLT, n=70 medication) completed 24-month follow-up. While both treatment arms achieved significant within-group gains in GOAT outcomes at both endpoints, SLT patients reported a greater between-group improvement in 'social well-being' compared with medication patients (mean±SE=0.28±0.13; p=0.034) at 24 months. At month 24, the rate of successful IOP reduction was 18.6% (95% CI 3.0% to 34.3%, p=0.022) higher (absolute difference) in the medication compared with SLT group. More individuals in the medication group had conjunctival hyperaemia and eyelid erythema compared with SLT at 24 months. CONCLUSION:Overall, we did not find evidence that SLT was superior to medication in improving glaucoma-specific QoL. While we found superior IOP reduction in the medication arm, eyelid erythema and conjunctival hyperaemia were more prevalent in these patients compared with the SLT group. TRIAL REGISTRATION:ACTRN12611000720910.Ghee Soon Ang, Eva K Fenwick , Marios Constantinou, Alfred Tau Liang Gan, Ryan Eyn Kidd Man, Robert J Casson ... et al

Rationale and methodology of the population health and eye disease profile in elderly singaporeans study [PIONEER]

10.14336/AD.2020.0206Aging and Disease1161444-145