Medical student and patient perceptions of quality of life associated with vision loss

• Published in: Canadian journal of ophthalmology 2015-06, Vol.50 (3), p.217-224
• Main Authors: Chaudry, Imtiaz, MD, Brown, Gary C., MD, MBA, Brown, Melissa M., MD, MN, MBA
• Format: Article
• Language: English
• Subjects: Adult; Blindness - psychology; Cross-Sectional Studies; Female; Health Status; Humans; Internal Medicine; Male; Middle Aged; Ophthalmology; Patients - psychology; Psychometrics - instrumentation; Quality of Life - psychology; Quality-Adjusted Life Years; Students, Medical - psychology; Vision, Low - psychology; Visually Impaired Persons - psychology; Young Adult
• ISSN: 0008-4182; 1715-3360
• DOI: 10.1016/j.jcjo.2015.02.004

Abstract Objective Because most medical schools in the United States and Canada require no formal ophthalmology training, the authors queried medical student and ophthalmic patients to compare their perceptions of the quality of life (QOL) associated with vision loss. Design Cross-sectional comparative study of consecutive medical students and patients with vision loss using a validated, reliable, time trade-off utility instrument. Participants Consecutive Jefferson Medical College medical students (cohort 1: 145 second-year student; cohort 2: 112 third-year/fourth-year students) and 283 patients with vision loss (patient cohort). Methods Time trade-off vision utilities with anchors of 0.0 (death) to 1.0 (normal vision permanently) were used to quantify the QOL associated with vision loss. Students were asked to assume they had: ( i ) mild vision loss (20/40 to 20/50 vision in the better-seeing eye), ( ii ) legal blindness (20/200 in the better-seeing eye), and ( iii ) absolute blindness (no light perception bilaterally). Results Mean utilities for cohort 1/cohort 2 were 0.96/0.95 ( p = 0.20) for mild vision loss, 0.88/0.84 for legal blindness ( p = 0.009), and 0.80/0.67 ( p < 0.0001) for absolute blindness. Medical student/patient mean utilities were 0.96/0.79 ( p < 0.0001) for mild vision loss, 0.85/0.62 for legal blindness ( p < 0.0001), and 0.74/0.26 ( p < 0.0001) for absolute blindness. Overall, medical students underestimated the QOL associated with vision loss referent to patients with vision loss by 153%–425%. Conclusions Medical students dramatically underestimated the impact of vision loss on patient QOL. Clinical training slightly improved medical student perceptions. Trivialization of vision loss could result in systemic health harm, less ophthalmic research dollars, loss of the finest medical students entering ophthalmology, and overall adverse financial effects for the field.