Brown G C, Brown M M, Sharma S
Retina Vascular Unit, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pa., USA.
Can J Ophthalmol. 2000 Apr;35(3):127-33. doi: 10.1016/s0008-4182(00)80005-8.
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.
在与特定健康状况相关的生活质量方面，患者及其治疗医生的认知可能存在很大差异。由于存在这种意见分歧的可能性，我们进行了一项研究，以评估通过效用分析衡量的、与年龄相关性黄斑变性（AMD）继发视力丧失相关的患者和眼科医生对生活质量的认知。
横断面研究。通过时间权衡法和标准博弈法，对接受培训的眼科医生和眼科专科医生就AMD继发的各种理论视力丧失程度进行效用评估。将这些结果与已知的因AMD实际视力丧失患者群体的效用进行比较。效用值为1.0表示完全健康，而效用值为0.0表示死亡。
采用时间权衡法和标准博弈法时，对于AMD继发相同程度的视力丧失，患者的平均效用值低于眼科医生。在时间权衡法中，眼科医生比患者明显更不愿意用剩余寿命来换取完美视力（p≤0.01）；在标准博弈法中，他们也比患者更不愿意为了完美视力而冒死亡风险。在双眼只能数指或视力更差的情况下，眼科医生愿意用每10年剩余寿命中的3.3年换取双眼完美视力，而双眼实际只能数指或视力更差的患者愿意用每10年剩余寿命中的6.0年换取这样的结果。
面对AMD继发视力丧失的情况时，眼科医生大大低估了其对患者生活质量的影响。
