Journal List > J Korean Ophthalmol Soc > v.54(1) > 1009621

Rim, Lee, and Chung: Visual Acuity and Quality of Life: KNHANES IV



To evaluate the health-related quality of life (QOL) in Koreans according to visual acuity.


The fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) is a nationwide survey. The present study included 11,022 Koreans who completed the KNHANES IV. The relation of visual acuity and QOL was verified, and EuroQoL 5D (EQ-5D) was identified using the adjusted mean based on linear regression analysis.


As visual acuity decreased, QOL decreased. QOL in mobility, usual activities, and pain/discomfort were affected by the vision gradient, while self-care and anxiety/depression were less influenced by the vision gradient. In particular, QOL in usual activities was significantly affected by the visual gradient. Subjects with a visual acuity of 1.6–3.0 were less likely to have a low QOL in usual activities compared to subjects with a visual acuity of 0.0–0.5 as a reference group (adjusted Odds Ratio = 23.6, 95% CI, 4.8–115.5). QOL in usual activities was statistically low in subjects older than 65 years of age, with low household monthly income, low education, and living without a spouse.


As visual acuity decreased, QOL in the aspect of mobility, usual activities, and pain/discomfort decreased severely, which resulted from activity limitation. Considering that the risk group with increasing age, low income, low education, and living without a spouse had lower QOL, the most important is to increase activity, which can induce the improvement of QOL in Koreans who have low visual acuity and related risk factors is.


1. Janca A, Prilipko L, Costa e Silva JA. The World Health Organization's global initiative on neurology and public health. J Neurol Sci. 1997; 145:1–2.
2. The Children's Vaccine Initiative and the Global Programme for Vaccines and Immunization. Recommendations from the Special Advisory Group of Experts. Part 1. Wkly Epidemiol Rec. 1997; 72:237–43.
3. Resnikoff S, Pascolini D, Etya'ale D, et al. Global data on visual impairment in the year 2002. Bull World Health Organ. 2004; 82:844–51.
4. Murray McGavin DD. Global initiative for the elimination of avoidable blindness. Community Eye Health. 1998; 11:3.
5. Park JH, Lee JY, Kim Y, Moon NJ. Epidemiological analysis and low vision rehabilitation of the visually impaired registered in Seoul. J Korean Ophthalmol Soc. 2009; 50:572–9.
6. Zou H, Zhang X, Xu X, et al. Vision-related quality of life and self-rated satisfaction outcomes of rhegmatogenous retinal abdominal surgery: three-year prospective study. PLoS One. 2011; 6:e28597.
7. Lau J, Michon JJ, Chan WS, Ellwein LB. Visual acuity and quality of life outcomes in cataract surgery patients in Hong Kong. Br J Ophthalmol. 2002; 86:12–7.
8. Yoon KC, Mun GH, Kim SD, et al. Prevalence of eye diseases in South Korea: data from the Korea national health and nutrition abdominal survey 2008–2009. Korean J Ophthalmol. 2011; 25:421–33.
9. Sung Nam Hae, Yuep Kim Kun, Suk Kwon Soon, et al. Research Report for estimated weight for Quality of Life Survey(EQ-5D). Korea Centers for Disease Control and Prevention 2007.
10. Bansback N, Tsuchiya A, Brazier J, Anis A. Canadian valuation of EQ-5D health states: preliminary value set and considerations for future valuation studies. PLoS One. 2012; 7:e31115.
11. Cleemput I, Kesteloot K, Moons P, et al. The construct and abdominal validity of the EQ-5D in a renal transplant population. Value Health. 2004; 7:499–509.
12. Gerding MN, Terwee CB, Dekker FW, et al. Quality of life in abdominals with Graves' ophthalmopathy is markedly decreased: abdominal by the medical outcomes study instrument. Thyroid. 1997; 7:885–9.
13. Egle UT, Kahaly GJ, Petrak F, et al. The relevance of physical and psychosocial factors for the quality of life in patients with abdominal-associated orbitopathy (TAO). Exp Clin Endocrinol Diabetes. 1999; 107(Suppl 5):S168–71.
14. Lee H, Roh HS, Yoon JS, Lee SY. Assessment of quality of life and depression in Korean patients with Graves' ophthalmopathy. Korean J Ophthalmol. 2010; 24:65–72.
15. Nah YS, Seong GJ, Kim CY. Visual function and quality of life in Korean patients with glaucoma. Korean J Ophthalmol. 2002; 16:70–4.
16. Leung JC, Kwok TC, Chan DC, et al. Visual functioning and abdominal of life among the older people in Hong Kong. Int J Geriatr Psychiatry. 2012; 8:807–15.

Figure 1.
Association between quality of life and visual acuity (log MAR) using LOWESS fit line. Gray line and triangle mean unadjusted mean of quality of life, black line and circle mean adjusted mean of quality of life after adjusting age, sex, income, education, occupation, residential area, and spouse. Vertical axis mean degree of quality of life; 1 no problem, 2 some/moder-ate problem, and 3 extreme problem. In terms of “6. EuroQOL index”, maximum score is 1 that mean the best quality of life. Horizontal axis mean visual acuity by log MAR. 2.5, 3.0, and 0 mean light perception, no light perception, and 1.0 as a decimal unit of visual acuity repectively.
Table 1.
Characteristics of study population (n = 11,022)   
    Number Percentage (%)
Sociodemographic factors      
Age (yrs) 19–29 1,544 14.0
  30–39 2,143 19.4
  40–49 2,205 20.0
  50–59 1,851 16.8
  60–69 1,786 16.2
  70- 1,493 13.6
Sex Men 4,728 42.9
  Women 6,294 57.1
Monthly household income Lowest quintile 2,171 20.0
  2nd–4th quintile 6,497 59.8
  Highest quintile 2,191 20.2
Education Elementary school 3,097 28.3
  Middle school 1,229 11.2
  High school 3,834 35.0
  University or higher 2,800 25.6
Occupation Administrator, Management, Professional 1,200 11.0
  Business and financial operations occupations? 827 7.6
  Sales and related occupations 1,410 12.9
  Farming, fishing, and foresty occupations 1,062 9.7
  Installation, maintenance, and repair occupations, technicians 1,013 9.3
  Laborer 975 8.9
  Unemployed 4,441 40.6
Residential area Rural 2,868 26.0
  Urban 8,154 74.0
Spouse With 7,840 83.6
Without 1,541 16.4
Table 2.
Factors associated with quality of life in usual activities – multivariate logistic regression analysis (n = 11,022)
    Multivariate OR 95% CI p-value
Visual acuity [log MAR (decimal form)] 0.0–0.5 (0.32–1.0) 1.0 (ref)    
  0.6–0.8 (0.16–0.25) 2.8 (1.1 – 7.0) <0.05
  0.9–1.5 (0.025–0.125) 3.4 (1.0 – 12.2) 0.058
  1.6–3.0 (CF-no LP) 23.6 (4.8 – 115.5) <0.05
Sociodemographic factors        
Age (yrs) 19–39 1.0 (ref)    
  40–64 1.9 (0.6 – 5.8) 0.245
  65- 6.0 (2.0 – 18.5) <0.05
Sex Men 1.0 (ref)    
  Women 0.8 (0.5 – 1.2) 0.219
Monthly household income Lowest quintile 1.0 (ref)    
  2nd–4th quintile 0.6 (0.4 – 0.8) <0.05
  Highest quintile 0.1 (0.0 – 0.4) <0.05
Education Elementary school 1.0 (ref)    
  Middle school 0.8 (0.5 – 1.4) 0.503
  High school 0.5 (0.3 – 0.9) <0.05
  University or higher 0.3 (0.1 – 0.8) <0.05
Residential area Rural 1.0 (ref)    
  Urban 0.7 (0.5 – 1.0) 0.088
Spouse With spouse 1.0 (ref)    
Without spouse 1.6 (1.1 – 2.4) <0.05

CF = count finger; LP = light perception; ref = reference.

Similar articles