Difference between ophthalmologists' and patients' perceptions of quality of life associated with age-related macular...

There may be a wide disparity between the perceptions of patients and those of their treating physicians concerning the quality of life associated with a given state of health. Because of this potential for difference of opinion, we performed a study to evaluate patients' and ophthalmologists' perceptions of quality of life, as measured by utility analysis, associated with visual loss secondary to age-related macular degeneration (AMD).

Cross-sectional study. Utilities were assessed, by means of both the time trade-off method and the standard gamble method, for various degrees of theoretical visual loss secondary to AMD for ophthalmologists-in-training and graduate ophthalmologists. These were compared to utilities for a known population of patients with actual visual loss due to AMD. A utility of 1.0 is associated with perfect health, whereas a utility of 0.0 is associated with death.

With both the time trade-off and standard gamble methods, the patients had lower mean utilities than did the ophthalmologists for the same degrees of visual loss secondary to AMD. The ophthalmologists were significantly less willing than the patients to trade years of remaining life for perfect vision with the time tradeoff method (p < or = 0.01), and with the standard gamble method they were less willing than the patients to take the risk of dying in return for perfect vision. Given the scenario of counting fingers or worse vision in both eyes, the ophthalmologists were willing to trade 3.3 of every 10 years of remaining life for perfect vision in both eyes, whereas the patients with actual vision of counting fingers or worse in both eyes were willing to trade 6.0 of every 10 years of remaining life for this result.

When presented with the scenario of visual loss secondary to AMD, ophthalmologists substantially underestimated its effect on patients' quality of life.