Low Vision Services Are Underutilized by Patients with Vision Loss from Corneal Disease

This study evaluated the rate at which patients with visual impairment primarily from corneal disease were referred for low vision (LV) services and assessed the visual outcomes from completed evaluations.

This 1-year retrospective, cross-sectional study included patients with corneal disease limiting best-corrected visual acuity (BCVA) to ≤ 20/40. Outcome measures included the change in BCVA achieved after distance refraction by a LV specialist. Incremental costs per quality-adjusted life years (QALY) gained were calculated upon the better-seeing eye, by using a willingness-to-pay threshold of USD 50,000/QALY.

Of 3230 patients, 143 (4.4%) had visual impairment from corneal disease. The median age of those patients was 80 years (IQR: 66-88 years) and 64.3% were male. Just over half were referred for LV evaluations (53.2%), and most completed appointments (96.1%). Patients more likely to be referred had better vision in their worse-seeing eye (0.961 logMAR vs. 1.451 logMAR, P = 0.002) and were more frequently diagnosed with corneal dystrophies, degenerations, or ectatic disease (51.3% vs. 26.9%, P = 0.003) compared with other corneal conditions, but they were less likely to have immunologic conditions (2.6% vs. 13.4%, P = 0.016). In total, two-thirds of patients achieved improved BCVA for their better-seeing eye, with 32% gaining ≥ 2 lines. This translated into an average gain of 0.04 QALYs/patient at a cost of USD 3128/QALY. The estimated net monetary benefit was USD 1923/LV evaluation completed.

Referring patients with corneal disease to LV services resulted in significant improvements in visual function at a reasonable cost.