{"paper_id":"11b8188a-ffd6-4aad-80f0-23e4a0392d2b","body_text":"Evaluation of the Importance of Quality of Life in Terms of Vision | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of the Importance of Quality of Life in Terms of Vision André Castro, Hélio Alves, Mariana Cura, Ângela Carneiro, José Paulo Andrade This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6106931/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Previous studies have demonstrated that visual impairment impacts individuals' overall quality of life. Given the lack of research on this topic in Portugal, the primary objective of the present study is to collect the public’s opinion on the importance of vision. Methods A questionnaire of 36 questions was made, categorized into the following groups: Personal data (Q1-Q3), General Health (Q4-Q17), Knowledge (Q18-Q25) and Lifestyle (Q26-Q36). Quantitative statistical methods were used to analyze the responses. Results There were 575 respondents with ages 18 or older. Most respondents answered that losing their vision would significantly impact their quality of life, more so than losing their hearing, memory, speech, or limb. As for the worst loss of sense, most participants said blindness, with respondents over 40 years old considering this more than their younger counterparts (92.9–93.0% vs. 82.8–87.6%, p = 0.035), followed by loss of speech (4.9%), hearing loss (4.2%) and loss of smell or taste (0.2%). Conclusions It is considered that the loss of vision would lead to losing independence, decreased productivity and a lower quality of life. The results also show that the population is often uninformed, or even ill-informed, about the prevalence of and risk factors for ocular diseases, including those leading to irreversible blindness. It is important to raise awareness and improve education amongst the general population about eye health and diseases. Eye Disease Quality of Life Survey Age-related macular degeneration Diabetic retinopathy Figures Figure 1 Figure 2 Figure 3 Figure 4 Contributions to the literature This study addresses the limited research on public perception of visual health in Portugal. It demonstrates that the majority of respondents consider vision loss to have the most significant impact on quality of life compared to other sensory impairments. The findings highlight a general lack of awareness about common eye diseases and their associated risk factors. Results suggest the need for increased public education and awareness campaigns regarding ocular health and preventative measures. The study reinforces the importance of routine eye examinations and the role of healthcare providers in promoting ocular health. Introduction Like many other ailments, eye function deterioration comes with age and is an increasing concern as the population ages [ 1 , 2 ]. When considerable loss of visual acuity and visual field occurs, patients’ ability to carry out day-to-day activities, such as reading, writing, driving and walking, starts to suffer [ 1 ] and profoundly influences the quality of life [ 1 , 3 – 8 ]. The connection between vision loss and reduced quality of life [ 2 , 6 ] related to cataracts, diabetic eye disease, and age-related macular degeneration (AMD) has been shown to be detrimental [ 9 ]. According to findings from a longitudinal clinical study that incorporated patients with sensory loss, the most significant decrease in quality of life was observed in individuals experiencing moderate to severe sight and tact sensation loss [ 10 ]. Hearing loss, followed by taste and smell, reduced quality of life less significantly [ 10 ]. It has also been demonstrated that severe vision loss may have a comparable to or worse health-related quality of life than other major chronic illnesses, like stroke or metastasized solid tumors [ 2 ]. The Beaver Dam Eye Study demonstrated that poor visual acuity, contrast sensitivity and differing vision between the two eyes serve as biomarkers for aging and feebleness and are correlated with a risk of falling [ 1 ] and an independent mortality risk factor [ 1 ]. Overall, blindness and visual impairment are rising [ 8 , 11 ], predominantly in industrialized countries with an older population [ 8 ]. According to the World Health Organization 2019 World Report on Vision, a minimum of 2.2 billion individuals worldwide experience a form of visual impairment [ 12 ] and at least one billion individuals possess a preventable or untreated visual impairment [ 12 ]. These conditions frequently develop from age-related eye conditions less amenable to correction with glasses or contact lenses, such as glaucoma, cataract, AMD and diabetic retinopathy [ 3 ]. Several studies reveal how visual impairment affects activity limitations and the availability of financial, social and psychological resources reveal various factors contributing to older people’s lower quality of life [ 3 , 4 ]. Within the United Kingdom (UK), the burden of disease attributed to loss of sight and blindness has demonstrated an upward trajectory [ 13 ]. Demographic aging substantially increases the prevalence of age-related sight-impairing conditions [ 6 ] and the associated cost rises [ 13 ]. Although prevalence rates change depending on the definition that is applied, present population estimates indicate that about one-fifth of adults over 60 experience some degree of visual impairment [ 3 ]. The financial aspect of visual disability is also relevant. In 2022, the economic burden of vision loss in the USA was estimated at $ 134.2 billion: $ 98.7 billion in direct costs and $ 35.5 billion in indirect costs [ 14 ]. Scott et al. conducted an extensive survey of individuals within the USA, across ethnic and racial groups, and aimed to understand the importance of eye and vision health by examining individual’s attitudes toward eye health, vision loss, expenses related to vision research and knowledge of several eye diseases and their risk factors [ 9 ]. They found that every ethnic and racial group defined losing their eyesight as having the greatest impact on their daily life when ranked against other disorders, including loss of a limb, memory, hearing or speech [ 9 ]. Considering the lack of studies in Portugal concerning public perception and attitudes about eye and vision health, the primary aim of the current study is to gather the public’s opinions regarding the significance of vision, both in the professional environment and in the daily lives of individuals. This investigation intends to highlight the importance vision has on quality of life and ascertain its perceived value within a sample of the Portuguese population. Methods A questionnaire using Google Forms was made based on some of the questions of Scott et al. poll [ 9 ] and adjusted to the Portuguese reality and health system. A 36-question questionnaire was created (Q1-Q36), categorized into the following groups: Personal data (Q1-Q3), General Health (Q4-Q17), Knowledge (Q18-Q25) and Lifestyle (Q26-Q36). The questionnaire was distributed via web link to the general population via email, social networks and word of mouth. The questionnaire was written in Portuguese and distributed from October 2022 to December 2022. An English-translated copy can be found in the supplementary material. All answers to the questionnaire were anonymized. Through their individual responses to the invitation, each participant consented to take part in the poll. All participants were 18 years old or over. Descriptive statistics of the most relevant questions for the aims of this paper are presented as absolute counts and proportions. For the purpose of hypothesis testing, re-categorization of the answers was decided a priori to guarantee representativeness for each category, grouping together the “totally agree/slightly agree” and the “totally disagree/slightly disagree” options. The chi-square test was used to compare the results of the most relevant questions across age categories. The significance level was set at α = 0.05. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp). Results The questionnaire yielded 575 responses. The sociodemographic characteristics of the study sample are presented in Table 1 - Sample characterization. More than half of the respondents were female, and the age of the respondents was balanced. Most respondents generally consider themselves in good (60.3%) or excellent (17%) health. Nearly all respondents (95.5%) had their eyes checked by an ophthalmologist. The main reasons for eye examination were for a periodical check-up (27.8%), the need for glasses or lenses (35.3%) and difficulty seeing (13.6%). Of our sample, 57.9% of people wear glasses, 33.7% wear reading glasses, 18.6% wear contact lenses and 22.1% do not use glasses or lenses. When participants were asked if they would go for an eye examination after being suggested to them by someone, 82.6% said they were likely to go if suggested by a primary care provider, 59.1% if by another health professional, 46.4% if by a family member, 40.2% if by a co-worker/employer and 25.4% if a friend suggested it (Table 2 - “If any of the following people said your eyes should be examined, would you go?” – Q12 – n (%)). Concerning the knowledge of ophthalmologic diseases, 92.7% answered that they have heard of cataracts, 80.3% of glaucoma, 76.5% of diabetic retinopathy, 51.8% of AMD and 5.4% never heard about any of these health conditions. Respondents were asked which conditions they believe have the most significant impact on the percentage of Portuguese people who will develop irreversible blindness from eye disease (Table 3 - “Which of the following conditions do you think has the greatest impact on…” - n (%); and Figure 1 - Results in what respondents think has the \"most impact on the percentage of Portuguese people who will develop blindness from eye disorders in Portugal\" (Q20) and \"greatest impact on health costs related to eye disorders\" (Q21)). The majority (44.3%) responded diabetic retinopathy, 20.0% said glaucoma, 18.8% said cataracts and 14.1% answered AMD. As for which of these diseases they believe has the biggest impact on health costs, diabetic retinopathy was the most answered (46.4%), followed by cataracts (27.5%), glaucoma (15.1%), AMD (8.5%) and none of these diseases (2.4%). When participants were asked what is the worst disease one could have (Figure 2 - Results in “worst disease that could happen\" (Q22)), 27.8% answered Alzheimer’s disease, 24.3% said cancer, 20.5% blindness, 6.1% mentioned other diseases and 21.2% were not sure. As for the worst loss of sense (Figure 3 - Results in “worst loss of sense that could happen” (Q23)), 80.0% said blindness (with respondents over 40 years old considering this more than their younger counterparts [92.9-93.0% vs. 82.8-87.6%, p =0.035]), 4.9% said the loss of speech, 4.2% hearing loss, 0.2% loss of smell or taste and 10.8% are not sure. Losing eyesight was described as potentially having the greatest effect on the day-to-day life of respondents, followed in order of frequency by memory loss, hearing loss, speech loss and losing a limb (Figure 4 - Ability loss that would impact the most in daily life, 1 having the smallest impact and 5 greatest impact (Q24)). When questioned about the impact of vision in their lives, 99.3% said sight is important for their profession, with people considering the loss of independence (97.4%), productivity (96.5%) and lower quality of life (98.3%) if they lost their eyesight. Most participants (85.7%) are worried about changes in eyesight as they age, with participants aged 25 years or above more concerned than their younger counterparts (91.1-97.6% vs. 79.6%, p <0.001) and most also agree (89.7%) that good eye health is important to overall health. Respondents generally agree that there is an increased risk of eye disease if it is associated with smoking, obesity, excess exposure to sunlight/ultraviolet rays and family incidence (Table 4 - Knowledge on risk factors for ocular disease). Younger respondents (ages 18-25) agree more than their older counterparts that smoking (81.2% vs. 61.1-67.9%) and obesity (91.9% vs. 64.3-85.3%) can be major risk factors for ocular disease ( p =0.003 and <0.001 respectively). As for family incidence, participants aged 61 or older were less likely to agree that this is a major risk factor (79.4% vs. 89.0-96.6%, p <0.001) for developing ocular diseases. Discussion To our knowledge, this is the first study in Portugal that sheds light on the level of awareness of visual health and its importance amongst the general population. One of the main conclusions of this study is that, according to 80% of the respondents, losing their vision was the worst health issue related to senses that could befall them. Losing eyesight could mean losing people’s freedom and a decrease in quality of life, possibly compromising their jobs and careers. Social exclusion, a decline in social integration and an increase in social avoidance are all linked to visual impairment, including blindness [ 1 , 3 – 8 ]. The respondents of the questionnaire value eye health, with 89.7% regarding good eye health important for their overall health, while 99.3% emphasize the significance of vision in their profession. If they were to lose their eyesight, most believe they would experience a loss of independence, decreased productivity and a lower quality of life. These findings suggest that using vision is critical not only for daily life but also in a professional context. The findings from this questionnaire align with the extensive collection of previously published information that demonstrates the significant worth placed on vision [ 9 , 10 , 15 – 18 ]. For example, vision was the most valuable sense among a cross-section of the UK public [ 16 ]. In another study of UK adults, it was reported that individuals would, on average, choose 4.6 years of perfect health over ten years of life with complete blindness [ 17 ]. Also, a cohort of older African American individuals reported prioritizing eye care and placing a high value on good vision for overall well-being [ 15 ]. People with more significant visual impairments have been shown to have a decreased quality of life, linked to a perception of having less control over their environment [ 3 ], validating the finding that most of our respondents listed blindness high among their most-feared ailments. According to the questionnaire responses, compared to conditions such as loss of memory, hearing, speech or a limb, most respondents perceive losing their eyesight as having the most significant impact on their daily lives. Scott et al. [ 9 ] obtained comparable results, which reported that visual impairment was more worrisome than the loss of memory, speech, hearing or limb, and chronic health conditions such as cancer, rheumatic disease, cardiac disease and AIDS/HIV. In our questionnaire, Alzheimer’s disease was considered the worst disease (35.3%), followed by cancer (30.9%) and blindness (26%). Notably, in the survey of Scott et al., the number one concern throughout all races and ethnic conditions was blindness, followed by cancer and Alzheimer’s disease. However, Asian (15%) and Hispanic (15%) respondents ranked blindness behind cancer (18% and 22%, respectively) [ 9 ]. Among White respondents, Alzheimer’s disease was considered the worst condition (24%), followed by blindness (20%) [ 9 ]. The questionnaire results revealed that AMD is not well known and there is no knowledge that this disease leads to irreversible blindness in more individuals than diabetic retinopathy and glaucoma [ 13 , 19 , 20 ]. In developed countries, diabetic retinopathy and glaucoma blindness can be avoided with early detection and timely intervention [ 19 , 20 ]. In reality, the burden of disease across conditions associated with vision loss is much higher in AMD than in other conditions leading to irreversible blindness [ 13 ]. There are considerable financial burdens for patients with AMD and the healthcare system treating them, and these costs are projected to increase as the population ages [ 13 , 19 – 21 ]. The responses to the questionnaire indicate that numerous individuals are unaware of the actual contribution of modifiable and hereditary risk factors. Although respondents have identified smoking as an important risk factor for eye diseases, they ranked it last. This was primarily observed in the 24–40 and 61 years old or over individuals. This is a very worrying finding as, for example, concerning AMD pathogenesis, the most prominent modifiable risk factor is smoking, which increases the risk by 2.5 to 4.5 and is cumulative with time [ 22 ]. There are also some genetic variants related to AMD, that together with cigarette smoking, increase the odds of developing AMD [ 23 ]. In contrast, it is not possible to establish strong causality between sunlight exposure and AMD [ 24 ]. The relationship with obesity is also not strong and there are conflicting results in the current literature [ 22 ]. These findings underscore the importance of educating the public on eye health and preventing eye diseases like AMD. Consequences of poor vision include an increased risk of falls, depression and the need for long-term care if a patient finds themselves unable to perform daily activities, such as dressing, eating and working [ 21 ]. Patients and primary care providers could benefit from familiarizing themselves with age-related vision threats to reduce morbidity and death by identifying them sooner during their disease and seeking suitable expert ophthalmic care [ 1 ]. These findings underscore the importance of educating the public on eye health, how to prevent eye diseases and when to consult an ophthalmologist. Its been shown that when advised to see an ophthalmologist, individuals are more likely to take the recommendation seriously if it comes from other healthcare professionals, family members, friends, and colleagues, with a particular emphasis on their general practitioner [ 3 ], which is supported by our findings. Education is important as a lack of knowledge about eye care and ocular diseases could present barriers to seeking treatment that could prevent vision loss [ 25 , 26 ]. This knowledge is vital because early interventions improve outcomes in numerous eye conditions, including glaucoma, AMD or diabetic retinopathy [ 26 ]. This study has some limitations. A sampling bias may exist, and the results may not represent the entire population’s opinions. This is a voluntary questionnaire and there can be a possible bias related to motivation to participate in the study. Another bias can be associated with the population sample, as there is a high proportion of teachers and students who may have some medical knowledge, including vision health. As a result, care must be used when extrapolating poll respondents’ opinions to represent the Portuguese population. However, with its high sample size, this study attempts to mitigate bias. Moreover, some questions may have been prejudiced due to wording or impacted by questions before them. To reduce bias, participants were first asked general health questions, before being asked specific questions about their eyesight. Conclusion According to the study, most respondents believe that losing their eyesight would have a greater impact on their daily lives than losing their memory, hearing, speech or a limb. Many people lack knowledge about significant eye conditions such as AMD and the behavioural and genetic risk factors that lead to them. These results highlight the importance of raising awareness and improving education amongst the general population about eye health and diseases. This new data can also be used to help guide public health strategies to preserve vision. Abbreviations Q: question; AMD: age-related macular degeneration; UK: United Kingdom Declarations Ethics approval and consent to participate Informed consent was obtained from all participants involved in this study. The study was analyzed, reviewed and approved by the Ethics Committee of the Centro Hospitalar Universitário de São João (CHUSJ) and the Faculty of Medicine of the University of Porto. Consent for publication Not applicable. Availability of data and materials All data gathered for this review is presented in the manuscript or as supplementary files. Competing interests The authors declare no competing interests. Funding This research was supported by National Funds through FCT—Fundação para a Ciência e a Tecnologia, I.P., within CINTESIS, R&D Unit (reference UIDB/4255/2020) and within the scope of the project RISE, Associated Laboratory (reference LA/P/0053/2020). Authors’ contributions AC, HA, MC, ÂC and JPA made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. Acknowledgments The authors would like to thank all participants who contributed to this study, as well all colleagues and institutions for their support throughout the research process. References Voleti VB, Hubschman J-P (2013) Age-related eye disease. Maturitas 75: 29-33 DOI https://doi.org/10.1016/j.maturitas.2013.01.018 Köberlein J, Beifus K, Schaffert C, Finger RP (2013) The economic burden of visual impairment and blindness: a systematic review. 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Am J Ophthalmol 173: vii-viii DOI 10.1016/j.ajo.2016.10.003 Irving EL, Sivak AM, Spafford MM (2018) \"I can see fine\": patient knowledge of eye care. Ophthalmic Physiol Opt 38: 422-431 DOI 10.1111/opo.12566 Tables Tables 1 to 4 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.docx Table2.docx Table3.docx Table4.docx InquritoaccINGLSV2.6.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6106931\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":423811845,\"identity\":\"630106fd-4f70-48a7-be29-e619adcb18ce\",\"order_by\":0,\"name\":\"André 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people who will develop blindness from eye disorders in Portugal\\\" (Q20) and \\\"greatest impact on health costs related to eye disorders\\\" (Q21)\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6106931/v1/ad8a2230f339ab90eee81f76.png\"},{\"id\":78244331,\"identity\":\"bc8195f5-8c19-4039-9da7-d153bd25b930\",\"added_by\":\"auto\",\"created_at\":\"2025-03-11 09:17:49\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":17861,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eResults in “worst disease that could happen\\\" (Q22)\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6106931/v1/7fa3b99a390f9d7d20e94550.png\"},{\"id\":78244293,\"identity\":\"66b80b58-9240-43da-bdf5-b1fd6f51a4af\",\"added_by\":\"auto\",\"created_at\":\"2025-03-11 09:17:43\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":19849,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eResults in “worst loss of sense that could happen” (Q23)\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6106931/v1/cc60d289994985412994d8d3.png\"},{\"id\":78244291,\"identity\":\"0e09394e-0c01-435f-b2c3-4b4b76ba2e3e\",\"added_by\":\"auto\",\"created_at\":\"2025-03-11 09:17:43\",\"extension\":\"png\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":28577,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eAbility loss that would impact the most in daily life, 1 having the smallest impact and 5 greatest impact (Q24)\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"4.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6106931/v1/83567148639d1594eb28443f.png\"},{\"id\":78248983,\"identity\":\"f2c51b54-e747-4a08-aafd-7708d0643305\",\"added_by\":\"auto\",\"created_at\":\"2025-03-11 09:41:43\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":500521,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6106931/v1/df746e3d-45da-42fe-be68-e817677620ae.pdf\"},{\"id\":78246831,\"identity\":\"69e821bc-e79a-4bbf-817e-76b37fbc6b36\",\"added_by\":\"auto\",\"created_at\":\"2025-03-11 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09:17:48\",\"extension\":\"docx\",\"order_by\":6,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":26487,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Table3.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6106931/v1/e1299247e7b44c6e3c07d447.docx\"},{\"id\":78244297,\"identity\":\"0a4bc465-b797-4af8-a935-2c590be7a7b5\",\"added_by\":\"auto\",\"created_at\":\"2025-03-11 09:17:43\",\"extension\":\"docx\",\"order_by\":8,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":27421,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Table4.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6106931/v1/5a9c9dbdd3e89a10518c61d2.docx\"},{\"id\":78244300,\"identity\":\"395933e3-cf58-496e-b9b9-056f7494a7a5\",\"added_by\":\"auto\",\"created_at\":\"2025-03-11 09:17:43\",\"extension\":\"docx\",\"order_by\":9,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":33475,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"InquritoaccINGLSV2.6.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6106931/v1/d46529bdafcd3bcec62745ea.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"\\u003cp\\u003eEvaluation of the Importance of Quality of Life in Terms of Vision\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Contributions to the literature\",\"content\":\"\\u003cp\\u003eThis study addresses the limited research on public perception of visual health in Portugal.\\u003c/p\\u003e\\n\\u003cp\\u003eIt demonstrates that the majority of respondents consider vision loss to have the most significant impact on quality of life compared to other sensory impairments.\\u003c/p\\u003e\\n\\u003cp\\u003eThe findings highlight a general lack of awareness about common eye diseases and their associated risk factors.\\u003c/p\\u003e\\n\\u003cp\\u003eResults suggest the need for increased public education and awareness campaigns regarding ocular health and preventative measures.\\u003c/p\\u003e\\n\\u003cp\\u003eThe study reinforces the importance of routine eye examinations and the role of healthcare providers in promoting ocular health.\\u003c/p\\u003e\"},{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eLike many other ailments, eye function deterioration comes with age and is an increasing concern as the population ages [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. When considerable loss of visual acuity and visual field occurs, patients\\u0026rsquo; ability to carry out day-to-day activities, such as reading, writing, driving and walking, starts to suffer [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e] and profoundly influences the quality of life [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR4 CR5 CR6 CR7\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. The connection between vision loss and reduced quality of life [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e] related to cataracts, diabetic eye disease, and age-related macular degeneration (AMD) has been shown to be detrimental [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. According to findings from a longitudinal clinical study that incorporated patients with sensory loss, the most significant decrease in quality of life was observed in individuals experiencing moderate to severe sight and tact sensation loss [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. Hearing loss, followed by taste and smell, reduced quality of life less significantly [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. It has also been demonstrated that severe vision loss may have a comparable to or worse health-related quality of life than other major chronic illnesses, like stroke or metastasized solid tumors [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. The Beaver Dam Eye Study demonstrated that poor visual acuity, contrast sensitivity and differing vision between the two eyes serve as biomarkers for aging and feebleness and are correlated with a risk of falling [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e] and an independent mortality risk factor [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eOverall, blindness and visual impairment are rising [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e], predominantly in industrialized countries with an older population [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. According to the World Health Organization 2019 World Report on Vision, a minimum of 2.2\\u0026nbsp;billion individuals worldwide experience a form of visual impairment [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e] and at least one billion individuals possess a preventable or untreated visual impairment [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. These conditions frequently develop from age-related eye conditions less amenable to correction with glasses or contact lenses, such as glaucoma, cataract, AMD and diabetic retinopathy [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eSeveral studies reveal how visual impairment affects activity limitations and the availability of financial, social and psychological resources reveal various factors contributing to older people\\u0026rsquo;s lower quality of life [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Within the United Kingdom (UK), the burden of disease attributed to loss of sight and blindness has demonstrated an upward trajectory [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Demographic aging substantially increases the prevalence of age-related sight-impairing conditions [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e] and the associated cost rises [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Although prevalence rates change depending on the definition that is applied, present population estimates indicate that about one-fifth of adults over 60 experience some degree of visual impairment [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. The financial aspect of visual disability is also relevant. In 2022, the economic burden of vision loss in the USA was estimated at \\u003cspan\\u003e$\\u003c/span\\u003e134.2\\u0026nbsp;billion: \\u003cspan\\u003e$\\u003c/span\\u003e98.7\\u0026nbsp;billion in direct costs and \\u003cspan\\u003e$\\u003c/span\\u003e35.5\\u0026nbsp;billion in indirect costs [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eScott et al. conducted an extensive survey of individuals within the USA, across ethnic and racial groups, and aimed to understand the importance of eye and vision health by examining individual\\u0026rsquo;s attitudes toward eye health, vision loss, expenses related to vision research and knowledge of several eye diseases and their risk factors [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. They found that every ethnic and racial group defined losing their eyesight as having the greatest impact on their daily life when ranked against other disorders, including loss of a limb, memory, hearing or speech [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eConsidering the lack of studies in Portugal concerning public perception and attitudes about eye and vision health, the primary aim of the current study is to gather the public\\u0026rsquo;s opinions regarding the significance of vision, both in the professional environment and in the daily lives of individuals. This investigation intends to highlight the importance vision has on quality of life and ascertain its perceived value within a sample of the Portuguese population.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003eA questionnaire using Google Forms was made based on some of the questions of Scott et al. poll [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e] and adjusted to the Portuguese reality and health system. A 36-question questionnaire was created (Q1-Q36), categorized into the following groups: Personal data (Q1-Q3), General Health (Q4-Q17), Knowledge (Q18-Q25) and Lifestyle (Q26-Q36). The questionnaire was distributed via web link to the general population via email, social networks and word of mouth. The questionnaire was written in Portuguese and distributed from October 2022 to December 2022. An English-translated copy can be found in the supplementary material. All answers to the questionnaire were anonymized. Through their individual responses to the invitation, each participant consented to take part in the poll. All participants were 18 years old or over.\\u003c/p\\u003e \\u003cp\\u003eDescriptive statistics of the most relevant questions for the aims of this paper are presented as absolute counts and proportions. For the purpose of hypothesis testing, re-categorization of the answers was decided \\u003cem\\u003ea priori\\u003c/em\\u003e to guarantee representativeness for each category, grouping together the \\u0026ldquo;totally agree/slightly agree\\u0026rdquo; and the \\u0026ldquo;totally disagree/slightly disagree\\u0026rdquo; options. The chi-square test was used to compare the results of the most relevant questions across age categories. The significance level was set at α\\u0026thinsp;=\\u0026thinsp;0.05. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp).\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eThe questionnaire yielded 575 responses. The sociodemographic characteristics of the study sample are presented in Table 1 - Sample characterization. More than half of the respondents were female, and the age of the respondents was balanced. Most respondents generally consider themselves in good (60.3%) or excellent (17%) health. \\u003c/p\\u003e\\n\\u003cp\\u003eNearly all respondents (95.5%) had their eyes checked by an ophthalmologist. The main reasons for eye examination were for a periodical check-up (27.8%), the need for glasses or lenses (35.3%) and difficulty seeing (13.6%). Of our sample, 57.9% of people wear glasses, 33.7% wear reading glasses, 18.6% wear contact lenses and 22.1% do not use glasses or lenses. \\u003c/p\\u003e\\n\\u003cp\\u003eWhen participants were asked if they would go for an eye examination after being suggested to them by someone, 82.6% said they were likely to go if suggested by a primary care provider, 59.1% if by another health professional, 46.4% if by a family member, 40.2% if by a co-worker/employer and 25.4% if a friend suggested it (Table 2 - “If any of the following people said your eyes should be examined, would you go?” – Q12 – n (%)).\\u003c/p\\u003e\\n\\u003cp\\u003eConcerning the knowledge of ophthalmologic diseases, 92.7% answered that they have heard of cataracts, 80.3% of glaucoma, 76.5% of diabetic retinopathy, 51.8% of AMD and 5.4% never heard about any of these health conditions.\\u003c/p\\u003e\\n\\u003cp\\u003eRespondents were asked which conditions they believe have the most significant impact on the percentage of Portuguese people who will develop irreversible blindness from eye disease (Table 3 - “Which of the following conditions do you think has the greatest impact on…” - n (%); and Figure 1 - Results in what respondents think has the \\\"most impact on the percentage of Portuguese people who will develop blindness from eye disorders in Portugal\\\" (Q20) and \\\"greatest impact on health costs related to eye disorders\\\" (Q21)). The majority (44.3%) responded diabetic retinopathy, 20.0% said glaucoma, 18.8% said cataracts and 14.1% answered AMD. As for which of these diseases they believe has the biggest impact on health costs, diabetic retinopathy was the most answered (46.4%), followed by cataracts (27.5%), glaucoma (15.1%), AMD (8.5%) and none of these diseases (2.4%). \\u003c/p\\u003e\\n\\u003cp\\u003eWhen participants were asked what is the worst disease one could have (Figure 2 - Results in “worst disease that could happen\\\" (Q22)), 27.8% answered Alzheimer’s disease, 24.3% said cancer, 20.5% blindness, 6.1% mentioned other diseases and 21.2% were not sure. As for the worst loss of sense (Figure 3 - Results in “worst loss of sense that could happen” (Q23)), 80.0% said blindness (with respondents over 40 years old considering this more than their younger counterparts [92.9-93.0% vs. 82.8-87.6%, \\u003cem\\u003ep\\u003c/em\\u003e=0.035]), 4.9% said the loss of speech, 4.2% hearing loss, 0.2% loss of smell or taste and 10.8% are not sure. Losing eyesight was described as potentially having the greatest effect on the day-to-day life of respondents, followed in order of frequency by memory loss, hearing loss, speech loss and losing a limb (Figure 4 - Ability loss that would impact the most in daily life, 1 having the smallest impact and 5 greatest impact (Q24)).\\u003c/p\\u003e\\n\\u003cp\\u003eWhen questioned about the impact of vision in their lives, 99.3% said sight is important for their profession, with people considering the loss of independence (97.4%), productivity (96.5%) and lower quality of life (98.3%) if they lost their eyesight. Most participants (85.7%) are worried about changes in eyesight as they age, with participants aged 25 years or above more concerned than their younger counterparts (91.1-97.6% vs. 79.6%, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026lt;0.001) and most also agree (89.7%) that good eye health is important to overall health.\\u003c/p\\u003e\\n\\u003cp\\u003eRespondents generally agree that there is an increased risk of eye disease if it is associated with smoking, obesity, excess exposure to sunlight/ultraviolet rays and family incidence (Table 4 - Knowledge on risk factors for ocular disease). Younger respondents (ages 18-25) agree more than their older counterparts that smoking (81.2% vs. 61.1-67.9%) and obesity (91.9% vs. 64.3-85.3%) can be major risk factors for ocular disease (\\u003cem\\u003ep\\u003c/em\\u003e=0.003 and \\u0026lt;0.001 respectively). As for family incidence, participants aged 61 or older were less likely to agree that this is a major risk factor (79.4% vs. 89.0-96.6%, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026lt;0.001) for developing ocular diseases.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eTo our knowledge, this is the first study in Portugal that sheds light on the level of awareness of visual health and its importance amongst the general population. One of the main conclusions of this study is that, according to 80% of the respondents, losing their vision was the worst health issue related to senses that could befall them. Losing eyesight could mean losing people\\u0026rsquo;s freedom and a decrease in quality of life, possibly compromising their jobs and careers. Social exclusion, a decline in social integration and an increase in social avoidance are all linked to visual impairment, including blindness [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR4 CR5 CR6 CR7\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. The respondents of the questionnaire value eye health, with 89.7% regarding good eye health important for their overall health, while 99.3% emphasize the significance of vision in their profession. If they were to lose their eyesight, most believe they would experience a loss of independence, decreased productivity and a lower quality of life. These findings suggest that using vision is critical not only for daily life but also in a professional context.\\u003c/p\\u003e \\u003cp\\u003eThe findings from this questionnaire align with the extensive collection of previously published information that demonstrates the significant worth placed on vision [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR16 CR17\\\" citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. For example, vision was the most valuable sense among a cross-section of the UK public [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. In another study of UK adults, it was reported that individuals would, on average, choose 4.6 years of perfect health over ten years of life with complete blindness [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. Also, a cohort of older African American individuals reported prioritizing eye care and placing a high value on good vision for overall well-being [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003ePeople with more significant visual impairments have been shown to have a decreased quality of life, linked to a perception of having less control over their environment [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e], validating the finding that most of our respondents listed blindness high among their most-feared ailments. According to the questionnaire responses, compared to conditions such as loss of memory, hearing, speech or a limb, most respondents perceive losing their eyesight as having the most significant impact on their daily lives. Scott et al. [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e] obtained comparable results, which reported that visual impairment was more worrisome than the loss of memory, speech, hearing or limb, and chronic health conditions such as cancer, rheumatic disease, cardiac disease and AIDS/HIV. In our questionnaire, Alzheimer\\u0026rsquo;s disease was considered the worst disease (35.3%), followed by cancer (30.9%) and blindness (26%). Notably, in the survey of Scott et al., the number one concern throughout all races and ethnic conditions was blindness, followed by cancer and Alzheimer\\u0026rsquo;s disease. However, Asian (15%) and Hispanic (15%) respondents ranked blindness behind cancer (18% and 22%, respectively) [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. Among White respondents, Alzheimer\\u0026rsquo;s disease was considered the worst condition (24%), followed by blindness (20%) [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe questionnaire results revealed that AMD is not well known and there is no knowledge that this disease leads to irreversible blindness in more individuals than diabetic retinopathy and glaucoma [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]. In developed countries, diabetic retinopathy and glaucoma blindness can be avoided with early detection and timely intervention [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]. In reality, the burden of disease across conditions associated with vision loss is much higher in AMD than in other conditions leading to irreversible blindness [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. There are considerable financial burdens for patients with AMD and the healthcare system treating them, and these costs are projected to increase as the population ages [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR20\\\" citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe responses to the questionnaire indicate that numerous individuals are unaware of the actual contribution of modifiable and hereditary risk factors. Although respondents have identified smoking as an important risk factor for eye diseases, they ranked it last. This was primarily observed in the 24\\u0026ndash;40 and 61 years old or over individuals. This is a very worrying finding as, for example, concerning AMD pathogenesis, the most prominent modifiable risk factor is smoking, which increases the risk by 2.5 to 4.5 and is cumulative with time [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]. There are also some genetic variants related to AMD, that together with cigarette smoking, increase the odds of developing AMD [\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. In contrast, it is not possible to establish strong causality between sunlight exposure and AMD [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]. The relationship with obesity is also not strong and there are conflicting results in the current literature [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]. These findings underscore the importance of educating the public on eye health and preventing eye diseases like AMD.\\u003c/p\\u003e \\u003cp\\u003eConsequences of poor vision include an increased risk of falls, depression and the need for long-term care if a patient finds themselves unable to perform daily activities, such as dressing, eating and working [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]. Patients and primary care providers could benefit from familiarizing themselves with age-related vision threats to reduce morbidity and death by identifying them sooner during their disease and seeking suitable expert ophthalmic care [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThese findings underscore the importance of educating the public on eye health, how to prevent eye diseases and when to consult an ophthalmologist. Its been shown that when advised to see an ophthalmologist, individuals are more likely to take the recommendation seriously if it comes from other healthcare professionals, family members, friends, and colleagues, with a particular emphasis on their general practitioner [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e], which is supported by our findings. Education is important as a lack of knowledge about eye care and ocular diseases could present barriers to seeking treatment that could prevent vision loss [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]. This knowledge is vital because early interventions improve outcomes in numerous eye conditions, including glaucoma, AMD or diabetic retinopathy [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThis study has some limitations. A sampling bias may exist, and the results may not represent the entire population\\u0026rsquo;s opinions. This is a voluntary questionnaire and there can be a possible bias related to motivation to participate in the study. Another bias can be associated with the population sample, as there is a high proportion of teachers and students who may have some medical knowledge, including vision health. As a result, care must be used when extrapolating poll respondents\\u0026rsquo; opinions to represent the Portuguese population. However, with its high sample size, this study attempts to mitigate bias. Moreover, some questions may have been prejudiced due to wording or impacted by questions before them. To reduce bias, participants were first asked general health questions, before being asked specific questions about their eyesight.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eAccording to the study, most respondents believe that losing their eyesight would have a greater impact on their daily lives than losing their memory, hearing, speech or a limb. Many people lack knowledge about significant eye conditions such as AMD and the behavioural and genetic risk factors that lead to them. These results highlight the importance of raising awareness and improving education amongst the general population about eye health and diseases. This new data can also be used to help guide public health strategies to preserve vision.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eQ: question; AMD: age-related macular degeneration; UK: United Kingdom\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInformed consent was obtained from all participants involved in this study. The study was analyzed, reviewed and approved by the Ethics Committee of the Centro Hospitalar Universit\\u0026aacute;rio de S\\u0026atilde;o Jo\\u0026atilde;o (CHUSJ) and the Faculty of Medicine of the University of Porto.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll data gathered for this review is presented in the manuscript or as supplementary files.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis research was supported by National Funds through FCT\\u0026mdash;Funda\\u0026ccedil;\\u0026atilde;o para a Ci\\u0026ecirc;ncia e a Tecnologia, I.P., within CINTESIS, R\\u0026amp;D Unit (reference UIDB/4255/2020) and within the scope of the project RISE, Associated Laboratory (reference LA/P/0053/2020).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026rsquo; contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAC, HA, MC, \\u0026Acirc;C and JPA\\u0026nbsp;made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgments\\u003c/strong\\u003e\\u003cbr\\u003eThe authors would like to thank all participants who contributed to this study, as well all colleagues and institutions for their support throughout the research process.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eVoleti VB, Hubschman J-P (2013) Age-related eye disease. Maturitas 75: 29-33 DOI https://doi.org/10.1016/j.maturitas.2013.01.018\\u003c/li\\u003e\\n\\u003cli\\u003eK\\u0026ouml;berlein J, Beifus K, Schaffert C, Finger RP (2013) The economic burden of visual impairment and blindness: a systematic review. BMJ Open 3: e003471 DOI 10.1136/bmjopen-2013-003471\\u003c/li\\u003e\\n\\u003cli\\u003eBrown RL, Barrett AE (2011) Visual impairment and quality of life among older adults: an examination of explanations for the relationship. J Gerontol B Psychol Sci Soc Sci 66: 364-373 DOI 10.1093/geronb/gbr015\\u003c/li\\u003e\\n\\u003cli\\u003eEckert K, Carter M, Lansingh V, Wilson D, Furtado J, Frick K, Resnikoff S (2015) A Simple Method for Estimating the Economic Cost of Productivity Loss Due to Blindness and Moderate to Severe Visual Impairment. Ophthalmic Epidemiology 22: 349-355 DOI 10.3109/09286586.2015.1066394\\u003c/li\\u003e\\n\\u003cli\\u003eKuyk T, Liu L, Elliott JL, Grubbs HE, Owsley C, McGwin G, Jr., Griffin RL, Fuhr PS (2008) Health-related quality of life following blind rehabilitation. Qual Life Res 17: 497-507 DOI 10.1007/s11136-008-9336-3\\u003c/li\\u003e\\n\\u003cli\\u003eHaymes SA, Johnston AW, Heyes AD (2002) Relationship between vision impairment and ability to perform activities of daily living. Ophthalmic and Physiological Optics 22: 79-91 DOI 10.1046/j.1475-1313.2002.00016.x\\u003c/li\\u003e\\n\\u003cli\\u003eCarabellese C, Appollonio I, Rozzini R, Bianchetti A, Frisoni GB, Frattola L, Trabucchi M (1993) Sensory impairment and quality of life in a community elderly population. J Am Geriatr Soc 41: 401-407 DOI 10.1111/j.1532-5415.1993.tb06948.x\\u003c/li\\u003e\\n\\u003cli\\u003eFinger RP, Fimmers R, Holz FG, Scholl HP (2011) Incidence of blindness and severe visual impairment in Germany: projections for 2030. Invest Ophthalmol Vis Sci 52: 4381-4389 DOI 10.1167/iovs.10-6987\\u003c/li\\u003e\\n\\u003cli\\u003eScott AW, Bressler NM, Ffolkes S, Wittenborn JS, Jorkasky J (2016) Public Attitudes About Eye and Vision Health. JAMA Ophthalmol 134: 1111-1118 DOI 10.1001/jamaophthalmol.2016.2627\\u003c/li\\u003e\\n\\u003cli\\u003eBrown GC, Brown MM, Sharma S (2018) The Five Senses: A Patient Preference-Based Comparative Analysis.\\u003c/li\\u003e\\n\\u003cli\\u003eHeath Jeffery RC, Mukhtar SA, Lopez D, Preen DB, McAllister IL, Mackey DA, Morlet N, Morgan WH, Chen FK (2021) Incidence of Newly Registered Blindness From Age-Related Macular Degeneration in Australia Over a 21-Year Period: 1996\\u0026ndash;2016. The Asia-Pacific Journal of Ophthalmology 10\\u003c/li\\u003e\\n\\u003cli\\u003eWHO World Health Organization; Geneva: 2019. World Report on Vision https://wwwwhoint/publications/i/item/9789241516570 \\u003c/li\\u003e\\n\\u003cli\\u003ePezzullo L, Streatfeild J, Simkiss P, Shickle D (2018) The economic impact of sight loss and blindness in the UK adult population. BMC Health Serv Res 18: 63 DOI 10.1186/s12913-018-2836-0\\u003c/li\\u003e\\n\\u003cli\\u003eRein DB, Wittenborn JS, Zhang P, Sublett F, Lamuda PA, Lundeen EA, Saaddine J (2022) The Economic Burden of Vision Loss and Blindness in the United States. Ophthalmology 129: 369-378 DOI 10.1016/j.ophtha.2021.09.010\\u003c/li\\u003e\\n\\u003cli\\u003eOwsley C, McGwin G, Scilley K, Girkin CA, Phillips JM, Searcey K (2006) Perceived barriers to care and attitudes about vision and eye care: focus groups with older African Americans and eye care providers. Invest Ophthalmol Vis Sci 47: 2797-2802 DOI 10.1167/iovs.06-0107\\u003c/li\\u003e\\n\\u003cli\\u003eEnoch J, Jones L, McDonald L (2020) Thinking about sight as a sense. Optometry in Practice 21(3): 2-9\\u003c/li\\u003e\\n\\u003cli\\u003eEnoch J, McDonald L, Jones L, Jones PR, Crabb DP (2019) Evaluating Whether Sight Is the Most Valued Sense. JAMA Ophthalmology 137: 1317-1320 DOI 10.1001/jamaophthalmol.2019.3537\\u003c/li\\u003e\\n\\u003cli\\u003eGutierrez P, Wilson MR, Johnson C, Gordon M, Cioffi GA, Ritch R, Sherwood M, Meng K, Mangione CM (1997) Influence of glaucomatous visual field loss on health-related quality of life. Arch Ophthalmol 115: 777-784 DOI 10.1001/archopht.1997.01100150779014\\u003c/li\\u003e\\n\\u003cli\\u003eFlores R, Carneiro \\u0026Acirc;, Vieira M, Tenreiro S, Seabra MC (2021) Age-Related Macular Degeneration: Pathophysiology, Management, and Future Perspectives. Ophthalmologica 244: 495-511 DOI 10.1159/000517520\\u003c/li\\u003e\\n\\u003cli\\u003eFlaxman SR, Bourne RRA, Resnikoff S, Ackland P, Braithwaite T, Cicinelli MV, Das A, Jonas JB, Keeffe J, Kempen JH, Leasher J, Limburg H, Naidoo K, Pesudovs K, Silvester A, Stevens GA, Tahhan N, Wong TY, Taylor HR (2017) Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis. Lancet Glob Health 5: e1221-e1234 DOI 10.1016/s2214-109x(17)30393-5\\u003c/li\\u003e\\n\\u003cli\\u003eThomas CJ, Mirza RG, Gill MK (2021) Age-Related Macular Degeneration. Med Clin North Am 105: 473-491 DOI 10.1016/j.mcna.2021.01.003\\u003c/li\\u003e\\n\\u003cli\\u003eChakravarthy U, Wong TY, Fletcher A, Piault E, Evans C, Zlateva G, Buggage R, Pleil A, Mitchell P (2010) Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis. BMC Ophthalmol 10: 31 DOI 10.1186/1471-2415-10-31\\u003c/li\\u003e\\n\\u003cli\\u003eMay A, Su F, Dinh B, Ehlen R, Tran C, Adivikolanu H, Shaw PX (2021) Ongoing controversies and recent insights of the ARMS2-HTRA1 locus in age-related macular degeneration. Experimental Eye Research 210: 108605 DOI https://doi.org/10.1016/j.exer.2021.108605\\u003c/li\\u003e\\n\\u003cli\\u003eFletcher AE, Bentham GC, Agnew M, Young IS, Augood C, Chakravarthy U, de Jong PTVM, Rahu M, Seland J, Soubrane G, Tomazzoli L, Topouzis F, Vingerling JR, Vioque J (2008) Sunlight Exposure, Antioxidants, and Age-Related Macular Degeneration. Archives of Ophthalmology 126: 1396-1403 DOI 10.1001/archopht.126.10.1396\\u003c/li\\u003e\\n\\u003cli\\u003eHigginbotham EJ, Coleman AL, Teutsch S (2017) Eye Health Needs to Be a Population Health Priority. Am J Ophthalmol 173: vii-viii DOI 10.1016/j.ajo.2016.10.003\\u003c/li\\u003e\\n\\u003cli\\u003eIrving EL, Sivak AM, Spafford MM (2018) \\u0026quot;I can see fine\\u0026quot;: patient knowledge of eye care. Ophthalmic Physiol Opt 38: 422-431 DOI 10.1111/opo.12566\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003eTables 1 to 4 are available in the Supplementary Files section.\\u003c/p\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Eye Disease, Quality of Life, Survey, Age-related macular degeneration, Diabetic retinopathy\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6106931/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6106931/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003ePrevious studies have demonstrated that visual impairment impacts individuals' overall quality of life. Given the lack of research on this topic in Portugal, the primary objective of the present study is to collect the public\\u0026rsquo;s opinion on the importance of vision.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eA questionnaire of 36 questions was made, categorized into the following groups: Personal data (Q1-Q3), General Health (Q4-Q17), Knowledge (Q18-Q25) and Lifestyle (Q26-Q36). Quantitative statistical methods were used to analyze the responses.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eThere were 575 respondents with ages 18 or older. Most respondents answered that losing their vision would significantly impact their quality of life, more so than losing their hearing, memory, speech, or limb. As for the worst loss of sense, most participants said blindness, with respondents over 40 years old considering this more than their younger counterparts (92.9\\u0026ndash;93.0% vs. 82.8\\u0026ndash;87.6%, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.035), followed by loss of speech (4.9%), hearing loss (4.2%) and loss of smell or taste (0.2%).\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eIt is considered that the loss of vision would lead to losing independence, decreased productivity and a lower quality of life. The results also show that the population is often uninformed, or even ill-informed, about the prevalence of and risk factors for ocular diseases, including those leading to irreversible blindness. It is important to raise awareness and improve education amongst the general population about eye health and diseases.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Evaluation of the Importance of Quality of Life in Terms of Vision\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-03-11 09:17:36\",\"doi\":\"10.21203/rs.3.rs-6106931/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"fa475064-3aac-4375-9d03-f22b91714995\",\"owner\":[],\"postedDate\":\"March 11th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-03-11T09:17:38+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-03-11 09:17:36\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6106931\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6106931\",\"identity\":\"rs-6106931\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}