Table 2. Findings on the Outcomes of Ophthalmic Interventions and Quality of Life by Systematic Review^a.

Source	Year	Country of lead author	Quality of life outcome or measure	Assessment tools	Assessment	Participants, No.b	Studies, No.	Study Type	Countries of primary studiesc	Findings	Quality of evidence
Age-related cataract
Chou, et al13	2016	UK	VRQOL after cataract surgery	NR	Treatment of early impairment in visual acuity due to cataract error	1627	5	Cohort studies	NR	Three studies found moderate improvement in VRQOL and function after cataract surgery. Two studies found similar VRQOL in the groups with vs without cataract surgery (measures of association not provided).	Fair
Hodge, et al14	2007	Canada	Patient QOL and satisfaction	NR	Expedited (<6 wk waiting time) first-eye or second-eye cataract surgery vs control group awaiting surgery	NR	2	RCTs	The UK	Better QOL in the group that received cataract surgery in <6 wk vs a group awaiting surgery (routine waiting time, >6 mo) at 6 mo after randomization (measures of association not provided).	NR
Conner-Spady, et al15	2007	Canada	VRQOL	VF-14	Expedited (<6 wk waiting time) first-eye or second-eye cataract surgery vs control group awaiting surgery	514	2	RCTs	The UK	Significant VRQOL benefits in the groups that received cataract surgery vs control groups still awaiting cataract surgery 6 mo after randomization. Deterioration in VRQOL in the control group while waiting (measures of association not provided).	NR
Casparis, et al16	2017	Switzerland	VRQOL	Impact of Vision Impairment questionnaire	Immediate vs no or delayed cataract surgery (>6 mo) among patients with AMD	56	1	RCT	Australia	Better VRQOL in the immediate-cataract surgery group vs the control group awaiting surgery (waiting time >6 mo) after 6 mo of follow-up (MD, 1.60 [95% CI, 0.61-2.59]; I2 = NA).	Low
Ishikawa, et al17	2013	Canada	Self-reported visual functioning	VF-14, Tailored questionnaire, or ADVS	Second-eye cataract surgery vs cataract surgery in 1 eye only	1554	7	3 RCTs, 4 cohort studies	NR	Better VRQOL after second-eye cataract surgery vs cataract surgery in 1 eye only was reported in all studies. Four studies found that the magnitude of improvement was smaller after second-eye surgery than after first-eye surgery (measures of association not provided).	Moderate
Frampton, et al18	2014	UK	VRQOL	VF-14	Second-eye cataract surgery vs cataract surgery in 1 eye only	535	2	RCT	The UK and Spain	Better VRQOL existed in those post–expedited second-eye surgery vs those awaiting second-eye cataract surgery, but the difference was not clinically meaningful (VF-14: study 1: MD, 7.5 [95% CI, 5.1-9.9]; P < .001; study 2: MD, 8.24 [95% CI, 4.35-12.36]; P < .001).	NR
Ishikawa, et al17	2013	Canada	HRQOL	SIP, HRQOL, SF-12, SF-36, EQ-5D, or SRS	Second-eye cataract surgery vs cataract surgery in 1 eye only	1261	6	3 RCTs, 3 cohort studies	NR	Inconsistent and mixed results. One study found improvement in HRQOL after second-eye cataract surgery, 3 found no improvement in HRQOL, and 2 found mixed results (measures of association not provided).	NR
Frampton, et al18	2014	UK	HRQOL	SF-12, SF-36, or EQ-5D	Second-eye cataract surgery vs cataract surgery in 1 eye only	743	3	RCT	The UK and Spain	Mixed results; 2 studies found no significant improvement in HRQOL after second-eye cataract surgery. One study found clinically relevant improvement in the mental health component of HRQOL after expedited vs no second-eye surgery (point difference, 1.90 [95% CI, 0.03-3.79]; P < .05).	NR
Riaz, et al19	2009	UK	VRQOL	NR	Extracapsular cataract extraction with posterior chamber IOL vs intracapsular cataract extraction with aphakic glasses	3400	1	RCT	India	Improved VRQOL in both groups, with the advantage of extracapsular cataract extraction with posterior chamber IOL vs aphakic glasses across all categories (measures of association not provided).	NR
Refractive error
Chou, et al13	2016	UK	VRQOL	NEI-VFQ	Treatment of early impairment in visual acuity due to uncorrected refractive error	282	2	RCT	NR	Beneficial effects of corrective lenses on VRQOL or vision-related function in the group with immediate correction of refractive error with eyeglasses compared with delayed treatment (scores on the NEI-VFQ were improved by a mean of approximately 10 of 100 points in the immediate-treatment groups).	Fair
Age-related macular degeneration
Chou, et al13	2016	UK	VRQOL	NR	Anti-VEGF injections vs control for neovascular AMD	NR	3	Trials??	NR	Mild to moderate improvements in VRQOL in the groups who took anti-VEGF vs sham injections, but the differences were not always significant (measures of association not provided).	Fair
Solomon, et al20	2019	UK	VRQOL	NEI-VFQ	Anti-VEGF injections vs control for neovascular AMD	1134	2	RCT	The US, France, Germany, Hungary, Czech Republic, and Australia	Greater improvement in VRQOL in the ranibizumab than control groups (no anti-VEGF) after 1 y of follow-up (MD, 6.7 [95% CI, 3.4-10.0]; I2 = 68.3%).	Moderate
Sarwar, et al21	2016	US	VRQOL	NEI-VFQ-25	Aflibercept or ranibizumab therapy vs baseline for AMD	2412	2	RCT	The US, Canada, Argentina, Australia, Austria, Brazil, Belgium, Colombia, Czech Republic, France, Germany, Hungary, India, Israel, Italy, Japan, Latvia, Mexico, the Netherlands, Poland, Portugal, South Korea, Singapore, Slovakia, Spain, Sweden, Switzerland, and the UK	Improvement in VRQOL from baseline to 1 y in both aflibercept and ranibizumab groups to a similar extent (MD, −0.39 [95% CI, −1.71 to 0.93]; I2 = 54.71%).	High
Giansanti, et al22	2009	Italy	VRQOL	NEI-VFQ-25	Macular/submacular surgery vs observation for subfoveal neovascular AMD	689	2	RCT	The US	Better VRQOL in the surgery vs observation group at 1 y (RR, 1.35 [95% CI, 1.09-1.68]; I2 = 0.0%).	Low
Evans, et al23	2010	UK	VRQOL	Daily Living Tasks Dependent on Vision questionnaire	Radiotherapy vs observation for neovascular AMD	203	1	RCT	The UK	No differences in VRQOL between treatment and observation groups 12 or 24 mo after treatment (measures of association not provided).	NR
Evans, et al23	2017	UK	VRQOL	NEI-VFQ-25	Multivitamin supplements vs placebo or no treatment for AMD	110	1	RCT	Italy	Better VRQOL in the multivitamin supplements group vs placebo at 24 mo (MD, 12.3 [95% CI, 4.24-20.36]).	Low
Evans, et al23	2017	UK	QOL	NEI VFQ-25	Lutein and/or zeaxanthin vs placebo for AMD	108	1	RCT	China	Similar VRQOL changes in the intervention and placebo groups at 12 mo (MD, 1.48 [95% CI, −5.53 to 8.49]).	Low
Liu, et al24	2014	China	VRQOL	VFQ	Lutein and/or zeaxanthin vs placebo for AMD	253	2	RCT	NR	No significant difference in VRQOL improvement between groups (weighted MD, 6.51 [95% CI, −6.16 to 19.17]).	NR
Retina (other)
Virgili, et al25	2018	Italy	VRQOL	NEI-VFQ-25	Anti-VEGF therapy vs laser photocoagulation for diabetic macular edema	412	3	RCT	Canada, Europe, Australia, Canada, and Turkey	Improvement in VRQOL from baseline to 6 or 12 mo in both groups; greater improvement in the ranibizumab group vs laser photocoagulation group (mean change in composite score, 5.14 [95% CI, 2.96-7.32]).	Moderate
Braithwaite, et al26	2014	UK	VRQOL	NEI-VFQ-25	Anti-VEGF injection vs sham injection for macular edema secondary to central retinal vein occlusion	743	3	RCT	Argentina, Asia/Pacific, Canada, Colombia, Europe, India, Israel, and the US	Significant improvement in VRQOL in the anti-VEGF vs sham groups at 6 mo (MD not provided; range, 6.2 to 7.5, based on 1 study).	Moderate
Zhou, et al27	2014	China	VRQOL	NEI-VFQ-25	Anti-VEGF injection vs sham injection for macular edema secondary to central retinal vein occlusion	743	3	RCT	Argentina, Asia/Pacific, Canada, Colombia, Europe, India, Israel, and the US	Significant improvement in VRQOL in the anti-VEGF vs sham groups at 6 mo (MD, 4.58 [95% CI, 2.93-6.23]; P < .001; I2 = 0%).	High
Ford, et al28	2014	UK	VRQOL	NEI-VFQ-25	Anti-VEGF injection vs sham injection for macular edema secondary to central retinal vein occlusion	782	3	RCT	NR	Significantly better changes in VRQOL in both the aflibercept and ranibizumab groups vs sham groups at 6 mo (MDs, 6.4, 4.0, nad 3.4, respectively; confidence intervals not provided).	NR
Mitry, et al29	2013	UK	VRQOL	NEI-VFQ-25	Anti-VEGF injection vs sham injection for macular edema secondary to branch retinal vein occlusion	397	1	RCT	The US	Greater VRQOL improvement in the ranibizumab groups vs sham group at 6 mo of treatment (change in NEI-VFQ-25 composite score, 9.3 [95% CI, 7.2-11.4] in the 0.3-mg ranibizumab group; 10.4 [95% CI, 8.3-12.4] in the 0.5-mg ranibizumab group; and 5.4 [95% CI, 3.6-7.3] in the sham group; P < .005 for each group vs the sham group).	NR
Zhu, et al30	2016	China	VRQOL	NEI-VFQ-25	Anti-VEGF injection vs sham injection for choroidal neovascularization secondary to pathological myopia	121	1	RCT	Hong Kong, Japan, Korea, Singapore, and Taiwan	Better VRQOL outcomes in the anti-VEGF vs sham groups (mean change in NEI-VFQ-25 score, 5.72 [95% CI, 1.60-9.84].	Moderate
Lescrauwaet, et al31	2019	Belgium	VRQOL	NEI-VFQ-25	Ocriplasmin injection vs sham or placebo injection for symptomatic vitreomacular traction	870	2	RCT	NR	A higher proportion of people in the ocriplasmin group had a clinically meaningful improvement in VRQOL vs those in the control group (difference in proportions, 11.8% [95% CI, 3.8%-19.7%]; P = .004).	NR
Neffendorf, et al32	2017	UK	VRQOL	VFQ	Ocriplasmin injection vs sham or placebo injection for symptomatic vitreomacular adhesion	656	2	RCT	The US, Belgium, Czech Republic, Germany, Poland, Spain, and the UK	Greater improvement in VRQOL in the ocriplasmin group vs sham/placebo group at 6 mo (MD in improvement, 2.7 [95% CI, 0.8-4.6] points).	Moderate
Brito-García, et al33	2017	Spain	VRQOL	VAQ and VF-14	Nutritional supplementation treatments for hereditary retinal dystrophies (retinitis pigmentosa, Best disease)	52	2	RCT	The US and Canada	No significant differences in VRQOL were noted between the groups of participants with retinitis pigmentosa and Best disease who received nutritional supplementation vs those who did not.	NR
Glaucoma
Rolim de Moura, et al34	2007	Brazil	VRQOL	NEI VFQ-25	Laser trabeculoplasty and topical β-blocker vs placebo for early open-angle glaucoma	255	1	RCT	NR	No significant difference in VRQOL between the treatment and placebo groups at 3 y.	NR
Chi, et al35	2020	Taiwan	QOL	GQL-15	Selective laser trabeculoplasty and medication or medication only for open-angle glaucoma	41	1	RCT	Unspecified countries in Asia	No significant change in QOL from baseline to follow-up at 6 mo in the selective laser trabeculoplasty and medication and medication-only groups.	NR
Low vision
van Nispen, et al36	2020	the Netherlands	VRQOL	NEI-VFQ- 25, VA-LV-VFQ48, Activity Inventory, IVI	Vision rehabilitation using methods of enhancing vision (eg, low-vision outpatient service, customized prism glasses) vs passive control for adults with vision impairment	262	5	RCT	The US, Germany, and Canada	Small benefit in VRQOL favoring low vision rehabilitation, but the effects were moderately heterogenous and imprecisely estimated, including no benefit (standardized MD, −0.19 [95% CI, −0.54 to 0.15]; I2 = 34%).	Very low
van Nispen, et al36	2020	The Netherlands	HRQOL	EQ-5D, SF-36	Multidisciplinary vision rehabilitation (eg, low-vision rehabilitation plus home visit) vs passive control for adults with vision impairment	183	2	RCT	The UK and the US	Rehabilitation resulted in more favorable HRQOL, but estimates were very imprecise and included no effect (standardized MD, −0.08 [95% CI, −0.37 to 0.21]; I2 = 0%).	Very low
van Nispen, et al36	2020	The Netherlands	VRQOL	NEI- VFQ-25, VFQ-48 questionnaire	Multidisciplinary vision rehabilitation (eg, low-vision rehabilitation plus home visit) vs passive control for adults with vision impairment	193	2	RCT	The UK and the US	Both studies found better VRQOL with rehabilitation, but the effect was large in a large trial delivering intensive rehabilitation (standardized MD, 1.64 [95% CI, −2.05 to −1.24]) and small in the other study (standardized MD, −0.42 [95% CI, −0.90 to 0.07]).	Very low
Vision screening
Evans, et al37	2018	UK	VRQOL	NEI- RQL-42	School vision screening and ready-made spectacles vs vision screening and custom-made spectacles	188	1	RCT	China	Improvement in VRQOL to a similar extent in both groups after wearing spectacles for 2 mo (change in NEI-RQL-42 score in the ready-made spectacles group, 4.65 [95% CI, 2.45-6.86]; similar change in the custom-made spectacles group).	Moderate
Rhinoconjunctivitis
Erekosima, et al38	2014	UK	QOL	RQOL questionnaire	Subcutaneous immunotherapy vs placebo for rhinoconjunctivitis	539	4	RCT	NR	Greater improvement in disease-specific QOL among adults in the subcutaneous immunotherapy group vs placebo group (measures of association not provided).	High
Kim, et al39	2013	US	QOL	RQOL questionnaire	Subcutaneous immunotherapy vs placebo for rhinoconjunctivitis	350	2	RCT	NR	Significant improvement in disease-specific QOL in the subcutaneous immunotherapy arm vs the control group (measures of association not provided).	Low
Kim, et al39	2013	US	QOL	Pediatric and Adolescent RQOL questionnaires	Sublingual immunotherapy vs placebo for rhinoconjunctivitis among children only	461	2	RCT	NR	No improvement in disease-specific QOL in the sublingual immunotherapy group vs placebo among children.	NR
Lin, et al40	2013	US	Disease-specific quality of life for rhinoconjunctivitis and asthma	RQOL questionnaire	Sublingual immunotherapy vs placebo for rhinoconjunctivitis among children and adults	819	8	RCT	NR	Improvement in disease-specific QOL in the sublingual immunotherapy group in 7 of 8 studies. Results were statistically significant in 4 of the studies, and a strong magnitude of association (>40% difference in effect) was reported in 2 studies.	Moderate
Rodrigo, et al41	2010	Uruguay	QOL	RQOL Questionnaire	Intranasal fluticasone furoate vs placebo for seasonal allergic rhinitis	2219	5	RCT	NR	Significant improvement in disease-specific QOL in the intranasal fluticasone furoate group vs placebo (weighted MD, −0.68 [95% CI, −0.80 to −0.56]; I2 = 0%).	NR
Rodrigo, et al41	2010	Uruguay	QOL	RQOL Questionnaire	Intranasal fluticasone furoate vs placebo for perennial allergic rhinitis	919	3	RCT	NR	Significant improvement in disease-specific QOL in the intranasal fluticasone furoate group vs placebo (weighted MD, −0.51 [95% CI, −0.76 to −0.22]; I2 = 44%).	NR
Uveitis
Urruti-coechea-Arana, et al42	2019	Spain	VRQOL	NEI-VFQ-25	Adalimumab or dexamethasone vs placebo in the treatment of uveitis	443	2	RCT	NR	Significantly greater improvement in VRQOL in the adalimumab group vs placebo among participants with active uveitis (measures of association not provided). However, no differences were found in the treatment group vs placebo among those with inactive uveitis.	NR
Squires, et al43	2017	UK	VRQOL	NEI-VFQ-25	Adalimumab or dexamethasone vs placebo in the treatment of uveitis	681	3	RCT	Europe, North America, and Australia	Significantly greater improvement in VRQOL in the adalimumab vs placebo group in patients with active uveitis (MD, 4.20 [95% CI, 1.02-7.38]; P = .01), but not in those with inactive uveitis (MD, 2.12 [95% CI, −0.84 to 5.08]; P = .16). Similarly, significant VRQOL benefits noted using dexamethasone implant vs sham procedure.	NR
Squires, et al43	2017	UK	HRQOL	EQ-5D	Adalimumab or dexamethasone vs placebo in the treatment of uveitis	452	2	RCT	Europe, North America, and Australia	Significantly greater improvement in HRQOL in the adalimumab vs placebo groups among participants with active uveitis (MD, 0.04 [95% CI, 0.00-0.07]). However, no differences were found in the treatment group vs placebo among those with inactive uveitis (MD, 0.00 [95% CI, –0.03 to 0.04]).	NR
Trichiasis
Burton, et al44	2015	UK	VRQOL	??	Perioperative azithromycin vs no azithromycin	1903	2	RCT	Gambia and Ethiopia	VRQOL (vision function, eye comfort, and physical functioning) improved following surgery; however, studies did not analyze by groups allocated to azithromycin vs control (measures of association not provided).	NR
Thyroid eye disease or Graves ophthalmopathy
Viani, et al45	2012	Brazil	QOL	NR	Radiotherapy vs sham radiotherapy for thyroid eye disease	88	1	RCT	NR	No differences in QOL in the radiotherapy vs sham radiotherapy groups.	NR
Rajendram, et al46	2012	UK	QOL	Graves Ophthalmopathy QOL, Euro-QoL, Sickness Impact Profile, and Medical Outcomes Study Short-General Health Survey questionnaires	Radiotherapy vs sham radiotherapy for thyroid eye disease	88	1	RCT	NR	No significant differences in QOL between the radiotherapy vs sham radiotherapy groups.	NR

Abbreviations: anti-VEGF, anti–vascular endothelial growth factor; EQ-5D, EuroQol-5 Dimension; GQL-15, Glaucoma Quality of Life-15; HRQOL, health-related quality of life; IVI, impact of vision impairment; MD, mean difference; NEI-RQL-42, National Eye Institute Refractive Error Quality of Life Instrument–42; NEI-VFQ-25, National Eye Institute 25-Item Visual Function Questionnaire; NR, not reported; QOL, quality of life; RCT, randomized clinical trial; RR, risk ratio; RQOL, rhinoconjunctivitis quality of life; SF-12, 12-Item Short Form Survey; SF-36, 36-Item Short Form Health Survey; SIP, Sickness Impact Profile; VRQOL, vision-related quality of life.

^aList of included studies in eTable 4 in the Supplement.

^bInforming the specific outcome (a given systematic review may have included more studies for other outcomes).

^cIndicates overlap of studies. In this column, we report the name of the study or first author and year of publication (as reported by the systematic review). Only applicable for outcomes assessed by more than 1 systematic review.