Predicting quality of life in AMD patients—insights on the new NICE classification and on a bolt-on vision dimension for the EQ-5D

Background/aims Health-related quality of life (HRQoL) in age-related macular degeneration (AMD) is difficult to estimate as most generic tools underestimate vision. Our aim was to measure the effect of AMD on generic and visual quality of life and how it relates to handicap. We also aimed to validate the NG82 NICE AMD classification. Finally, we studied if a bolt-on visual domain increased the EQ-5D sensitivity to AMD. Patients and methods Ninety-six patients with AMD participated in this observational cross-sectional study. Visual (VF-14) and generic questionnaires (EQ-5D) with VIS, and the London handicap scale (LHS) was used to quantify HRQoL and handicap. ANOVA and regression analysis were used to identify significant associations. Results Visual dysfunction in AMD has a significant effect in VF-14 ( P < 0.001), LHS ( p < 0.001), and EQ-5D ( p = 0.015). The EQ-5D was less sensitive than the VF-14 and LHS and was not significantly correlated with the VIS bolt-on domain ( p = 0.608). On the other hand, VIS was significantly associated with visual acuity ( p < 0.001), AMD diagnosis ( p = 0.005), VF-14 ( p < 0.001), and LHS ( p < 0.001). The new AMD classification was a good predictor of visual HRQoL and had an excellent association with visual acuity in the best eye. Conclusion This article shows that visual impairment is associated with lower HRQoL and with an increased handicap. It also suggests that a visual dimension may increase the EQ-5D sensitivity in AMD. There was a relationship between visual impairment and handicap with the items of the new NICE AMD classification, which supports its use.