TY - JOUR
T1 - Inter-relationship between visual symptoms, activity limitation and psychological functioning in patients with diabetic retinopathy
AU - Fenwick, Eva K.
AU - Cheng, Grand H.L.
AU - Man, Ryan E.K.
AU - Khadka, Jyoti
AU - Rees, Gwyn
AU - Wong, Tien Y.
AU - Pesudovs, Konrad
AU - Lamoureux, Ecosse Luc
PY - 2018/6/24
Y1 - 2018/6/24
N2 - Aims: We explored the direct and indirect impact of restrictions in daily living activities on the relationship between perceived visual symptoms associated with diabetic retinopathy (DR) and psychological functioning. Methods: In this prospective, cross-sectional study, 514 tertiary patients with DR (mean age±SD, 60.4±12.6 years; 64% male) answered questions related to nine domains of DR-specific quality of life. These were classified into the following predictor, mediating and outcome variables: visual symptoms (predictor variable); activity limitation, driving, lighting, social restriction, inconvenience, mobility (mediating variables); and emotional distress and concerns (outcome variables). Direct and indirect relationships between study variables were assessed using path analysis, using interval-level person measures derived from Rasch analyses of the study questionnaires. Results: We found no direct effect of DR-related visual symptoms on emotional distress or concerns. Rather, the association between visual symptoms and emotional distress was mediated (all p<0.05) by mobility (indirect effect=0.07), inconvenience (indirect effect=0.28), activity limitation (indirect effect=0.13) and social restriction (indirect effect=0.11). Similarly, the relationship between DR-related visual symptoms and concerns was mediated by inconvenience (indirect effect=0.36) and social restriction (indirect effect=0.11). Lighting and driving did not have a mediating role. Conclusions: The link between vision and psychological functioning outcomes such as emotional distress and concern is complex in patients with DR and mediated by limitations in daily living activities and social factors. Interventions to enhance daily functioning and social interaction may be effective in reducing emotional distress associated with DR-related vision impairment.
AB - Aims: We explored the direct and indirect impact of restrictions in daily living activities on the relationship between perceived visual symptoms associated with diabetic retinopathy (DR) and psychological functioning. Methods: In this prospective, cross-sectional study, 514 tertiary patients with DR (mean age±SD, 60.4±12.6 years; 64% male) answered questions related to nine domains of DR-specific quality of life. These were classified into the following predictor, mediating and outcome variables: visual symptoms (predictor variable); activity limitation, driving, lighting, social restriction, inconvenience, mobility (mediating variables); and emotional distress and concerns (outcome variables). Direct and indirect relationships between study variables were assessed using path analysis, using interval-level person measures derived from Rasch analyses of the study questionnaires. Results: We found no direct effect of DR-related visual symptoms on emotional distress or concerns. Rather, the association between visual symptoms and emotional distress was mediated (all p<0.05) by mobility (indirect effect=0.07), inconvenience (indirect effect=0.28), activity limitation (indirect effect=0.13) and social restriction (indirect effect=0.11). Similarly, the relationship between DR-related visual symptoms and concerns was mediated by inconvenience (indirect effect=0.36) and social restriction (indirect effect=0.11). Lighting and driving did not have a mediating role. Conclusions: The link between vision and psychological functioning outcomes such as emotional distress and concern is complex in patients with DR and mediated by limitations in daily living activities and social factors. Interventions to enhance daily functioning and social interaction may be effective in reducing emotional distress associated with DR-related vision impairment.
KW - Retina
KW - Vision
KW - Visual perception
KW - Diabetic retinopathy (DR)
KW - Psychological distress
UR - http://www.scopus.com/inward/record.url?scp=85049142436&partnerID=8YFLogxK
UR - http://purl.org/au-research/grants/nhmrc/529923
UR - http://purl.org/au-research/grants/nhmrc/1072987
UR - http://purl.org/au-research/grants/nhmrc/1061801
U2 - 10.1136/bjophthalmol-2017-310915
DO - 10.1136/bjophthalmol-2017-310915
M3 - Article
C2 - 28928266
AN - SCOPUS:85049142436
SN - 0007-1161
VL - 102
SP - 948
EP - 953
JO - British Journal of Ophthalmology
JF - British Journal of Ophthalmology
IS - 7
ER -