Inter-relationship between visual symptoms, activity limitation and psychological functioning in patients with diabetic retinopathy
Abstract
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.
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DR patients are prone to adverse emotional reactions such as anxiety and depression.
“It is reported that DR patients are prone to adverse emotional reactions such as anxiety and depression.[6–8]”
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- Authors
- Fenwick, E. K., Cheng, G. H.-L., Man, R. E. K., Khadka, J., Rees, G., Wong, T. Y., Pesudovs, K., & Lamoureux, E. L.
- Affiliations
- The University of Melbourne (AU)
- National University of Singapore (SG)
- Singapore National Eye Center (SG)
- Flinders University (AU)
- Corresponding author
- Lamoureux, Ecosse Luc
- ORCID
- Venue
- British Journal of Ophthalmology
- Publisher
- BMJ
- Published
- 2017-09-19
- Volume
- 102
- Issue
- 7
- Pages
- 948-953
- ISSN
- 0007-1161 (ISSN-L)
- 1468-2079
- OpenAlex
- W2755582624
- Cited by
- 23
- References
- 39
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2023: 6 · 2022: 3 · 2021: 3 · 2020: 1 · 2019: 2 · 2018: 1 · 2017: 1
- FWCI
- 1.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- British Journal of Ophthalmology (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Health and Medical Research Council
- Royal Victorian Eye and Ear Hospital
- Novartis Pharmaceuticals Corporation
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Epidemiology › Ophthalmology and Visual Impairment Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- diabetic retinopathy, visual disturbances, activity limitation, psychological functioning, emotional distress, concern, quality of life, mobility (physical function), social restrictions, inconvenience, driving, lighting, mediation, visual impairment
- MeSH terms
- Activities of Daily Living, Aged, Cross-Sectional Studies, Diabetic Retinopathy, Female, Humans, Male, Middle Aged, Prospective Studies, Psychometrics, Quality of Life, Surveys and Questionnaires, Vision Disorders, Visual Acuity, Sickness Impact Profile
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