角膜疾病导致视力丧失的患者对低视力服务的利用率较低。

Usta Güldeniz, Ramsey David J

Division of Ophthalmology, Department of Surgery, UMass Chan - Lahey School of Medicine, Burlington, MA.

Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Cornea. 2025 Mar 11. doi: 10.1097/ICO.0000000000003847.

PURPOSE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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

目的

本研究评估了主要因角膜疾病导致视力障碍的患者被转诊至低视力（LV）服务机构的比例，并评估了完成评估后的视觉效果。

方法

这项为期1年的回顾性横断面研究纳入了因角膜疾病导致最佳矫正视力（BCVA）≤20/40的患者。结果指标包括低视力专家进行远距离验光后BCVA的变化。通过使用每质量调整生命年（QALY）50,000美元的支付意愿阈值，计算较好视力眼每获得一个QALY的增量成本。

结果

在3230名患者中，143名（4.4%）因角膜疾病导致视力障碍。这些患者的中位年龄为80岁（四分位间距：66 - 88岁），64.3%为男性。略超过一半的患者被转诊进行低视力评估（53.2%），且大多数完成了预约（96.1%）。与其他角膜疾病相比，更有可能被转诊的患者较差视力眼的视力更好（0.961对数最小分辨角对数视力表 [logMAR] 对比1.451 logMAR，P = 0.002），且更频繁地被诊断为角膜营养不良、角膜变性或角膜扩张性疾病（51.3%对比26.9%，P = 0.003），但他们患免疫性疾病的可能性较小（2.6%对比13.4%，P = 0.016）。总体而言，三分之二的患者较好视力眼的BCVA得到改善，32%的患者提高了≥2行。这转化为每位患者平均获得0.04个QALY，成本为每QALY 3128美元。估计完成每次低视力评估的净货币效益为1923美元。