Functional status and well-being in patients with glaucoma as measured by the Medical Outcomes Study Short Form-36 questionnaire

Impact of glaucoma on vision-specific quality of life in monocular glaucoma patients using the Indian vision function questionnaire

Purpose

To evaluate the determinants affecting the quality of life in monocular glaucoma patients using the Indian vision function questionnaire.

Methods: In this prospective cross-sectional study,

total of 196 patients were divided into two groups: cases and controls. Indian Vision Function Questionnaire (IND-VFQ) was administered and analyzed. One hundred twenty-nine (58.6%) patients who had lost their vision in one eye due to glaucoma were included as cases and 67 (30.4%) patients who had lost their vision due to other causes were taken as controls.

Results

Median composite score of subscales was 54.62 (29.7-74.7) in group 1 and 45.38 (23.7-76.7) in group 2. The psychosocial impact scale was the most affected scale, the median scores were 33.02 (0 to 60.0) and 19.07 (0 to 53.0) in groups 1 and 2, respectively. Among all dimensions of IND-VFQ, the highest score was for color vision 100.0 (0-100.0) and 100.0 (0-100.0), and the lowest median score was found in mental health and dependency in both the groups. Multiple linear regression analysis demonstrated that visual acuity was associated with a low score (P < 0.001). Female gender was significantly associated with the overall score in the univariate model (P = 0.006).

Conclusion

Monocular glaucoma patients have a poor general and vision-related quality of life. Depression associated with monocularity and the perception of dependency and being a burden on their family members greatly impacted the mental health of the participants.

Glaucoma Medication and Quality of Life after Phacoemulsification Combined with a Xen Gel Stent

Glaucoma has a significant impact on quality of life. Here, we aimed to evaluate the influence of a reduction in glaucoma medications on quality of life and patient satisfaction after phacoemulsification combined with the Xen gel stent. We carried out a cross-sectional survey of patients who underwent phacoemulsification with the Xen gel stent at the Medical University of Graz, Austria. Quality of life was assessed using the German version of the Glaucoma Symptoms Scale (GSS)—questionnaire. Patients were also asked whether the operation reduced glaucoma medications and to indicate their overall satisfaction from 1 (totally discontented) up to 10 (totally contented). Questionnaires of 80 patients were evaluated. A total of 36 patients (45.0%) reported a reduction in glaucoma medications. Three items of the GSS were significantly better in patients who needed fewer glaucoma medications after the operation (“hard to see in daylight”, 75.0 ± 31.1 vs. 57.7 ± 39.1, p = 0.035; “hard to see in dark places”, 81.1 ± 28.7 vs. 54.9 ± 41.2, p = 0.002; and “halos around lights”, 88.3 ± 25.9 vs. 68.8 ± 38.6, p = 0.002). Patient satisfaction was significantly higher when the procedure led to a reduction in glaucoma medication (8.3 ± 2.0 vs. 6.8 ± 3.1; p = 0.034). The reported quality of life and patient satisfaction were significantly better when phacoemulsification with the Xen gel stent reduced the number of glaucoma medications needed.

The Effect of Glaucoma on the Quality of Patient’s Life

Glaucoma is a chronic, progressive opticopathy with morphological optic disc changes and visual field disturbances. Visual field disturbances change the patient’s life habits. Medical as well as surgical treatments also disturb patients` activities of daily living. According to this, glaucoma is the disease which affects quality of patient’s life (QQL). Visual field (VF) evaluation is very important in glaucoma disease diagnostic process. Location of the VF defects also have an impact on the QOL. Patient`s daily activities, such as walking, low light condition adaptation, peripheral seeing of the objects, can be affected by glaucoma progression and with VF defects. All social, religious, cultural and traveling events are more difficult for the severe glaucomatous patients (MD<-12dB) in comparison with mild glaucomatous, defined as patients with MD > −6 dB. Every day usage of the local antuglaucomatous therapy disturbs patients’ QOL. The side effects of the eye drops can produce burning sensation, bronchospasm, bradycardia, increased iris pigmentation, increased eyelash length. Also, locally applied therapy provokes ocular surface disease. Benzalkonium chloride provokes destruction of the epithelial cells junction with development of the epitheliopathy and ocular surface disease. Surgically treated glaucoma patients can have disturbed QOL due to ocular surface disease symptoms (foreign body sensation, eye pain, redness, and increased tearing). These symptoms are caused by trabeculectomy and they are correlated with filtering bleb existence.To achieve QOL of the glaucomatous patients, different founded instruments are used. They are classified in: general health, vision specific, and glaucoma specific.

Utility Index and Patient-Reported Outcome Measures in Glaucomatous Patients Comparing with Normal Participants

Purpose

Utility index is a significant outcome in terms of health economics assessment while patient-reported outcome measure (PROMs) evaluates quality of life (QOL) from patient’s perspective. Our objective was to evaluate both utility indices and PROMs using generic and eye specific QOL in glaucomatous patients compared with normal population.

Methods

This is a case-control study. We interviewed normal and glaucomatous participants with the European Quality of Life questionnaire (EQ-5D-5L), the European visual analogue scale (EQ-VAS) and the visual function questionnaire 28 (Thai version) (VFQ-28). The visual function questionnaire utility index (VFQ-UI) and generic utility index from EQ-5D-5L were calculated.

Results

There were 47 normal and 127 glaucomatous participants in this study. Amongst glaucoma group, 35 participants were in the early stage of the disease, 43 were in the moderate stage, 30 normal vision participants were in the severe stage, 14 participants had blindness one eye, and 5 had blindness both eyes. The mean age of the participants in both groups was statistically similar (63.78±6.84 vs 66.30±8.93 years old, respectively, p=0.062). Underlying diseases between groups were also comparable. The EQ-5D-5L utility index score and the EQ-VAS score were not statistically different between normal and glaucomatous groups, respectively (EQ-5D-5L: 0.874±0.122 vs 0.837±0.191, p=0.215; EQ VAS: 76.06±15.07 vs 74.02 ±15.10, p=0.43). By contrast, VFQ-UI of the glaucomatous group was significantly lower than that of the normal group, (VFQ-UI: 0.833±0.147 vs 0.895±0.070, accordingly, p<0.05).

Conclusions

Utility index from the VFQ-UI was a relevant PROMs for evaluating the QOL of glaucomatous patients in terms of visual function specificity and acceptable validity.

HEALTH-RELATED QUALITY OF LIFE IN PRIMARY OPEN-ANGLE GLAUCOMA PATIENTS

The purpose of this research was to evaluate the relationship between general health-related quality of life (GHRQL) and sociodemographic factors in primary open-angle glaucoma (POAG) patients. A prospective cross-sectional study included 207 glaucoma patients. GHRQL was determined via two self-administered questionnaires: the 36-Item Short Form Survey (SF-36) and the EuroQol-5D (EQ-5D) questionnaire. Male and 50- to 69-year-old glaucoma patients, followed by patients who regularly used antiglaucoma therapy and those without progression of glaucoma reported a significantly higher quality of life as measured by the EQ-5D index and the EQ-5D visual analog scale (VAS) (p<0.05 all). Similarly, the Physical Component Summary (PCS) and Mental Component Summary (MCS) of SF-36 had significantly higher values for these patients (p<0.05 all). Furthermore, glaucoma patients with higher education and economic status, glaucoma patients who lived in rural areas, and those who were married achieved higher scores on EQ-5D and SF-36. In conclusion, progression of the disease, female sex, older age, lower education and economic status, urban area and unmarried status negatively affect quality of life in glaucoma patients.

Comparison of central visual sensitivity between monocular and binocular testing in advanced glaucoma patients using imo perimetry

BACKGROUND/AIM

This study aimed to compare central visual sensitivity under monocular and binocular conditions in patients with glaucoma using the new imo static perimetry.

METHODS

Fifty-one consecutive eyes of 51 patients with open-angle glaucoma who were affected with at least one significant point in the central 10° were examined in this cross-sectional study. Monocular and binocular random single-eye tests were performed using the imo perimeter and the Humphrey field analyser (HFA) 24-2 and 10-2 tests. The eyes were assigned to 'better' and 'worse' categories based on the visual acuity and central visual thresholding. Central visual sensitivity results obtained by monocular, binocular random single-eye tests and binocular simultaneous both eye test were compared.

RESULTS

The average mean deviation with the HFA 24-2 was -5.5 (-1.5, -14.6) dB (median, (IQR)) in the better eyes and -18.0 (-12.9, -23.8) dB in the worse eyes. The mean sensitivity in the central 4 points of the visual field (VF) of the worse eyes was lower when measured under the binocular eye condition than under the monocular condition. Conversely, this value of the better eyes was greater when measured under the binocular eye condition than under the monocular condition.

CONCLUSIONS

The central sensitivity of the better eyes was better and that of the worse eyes poorer with binocular testing than with monocular testing in patients with glaucoma. Although monocular VF testing is still the most straightforward means to monocularly monitor glaucoma at clinical settings, binocular testing, such as provided with imo perimetry, may be a useful clinical tool to predict the effect of VF impairments on a patient's quality of visual life.

Patient-reported Outcomes, Functional Assessment, and Utility Values in Glaucoma

In clinical glaucoma research, the measurement of patient reported outcomes, functional assessment of disability, and health economic impact is critical. However, valid, time-efficient and comprehensive tools are not available and several current instruments lack in the appropriate precision for measuring the various dimensions of glaucoma-related quality of life (QoL), including functioning and mobility. Furthermore, statistical methods are inconsistently and sometimes incorrectly used in otherwise sound clinical studies. Standardizing and improving methods of patient-centered data collection and analysis in glaucoma studies are imperative. This paper outlines recommendations and provides a discussion of some of the pertinent issues relating to the optimization of patient-reported outcomes research in glaucoma.

Measuring Disability in Glaucoma

BACKGROUND

Glaucomatous visual field loss can have far-reaching and debilitating consequences on an individual, affecting one's ability to perform many important tasks. Although assessment of glaucoma-related disability constitutes an important part of clinical care, there remains a lack of organized, detailed information on the most suitable methods to capture disability in glaucoma.

PURPOSE

This review details the available methods to measure glaucoma-related disability and highlights important findings from studies utilizing these various methods.

METHODS

The literature was reviewed to identify papers evaluating disability in glaucoma and findings were summarized by research methodology used and area of impairment.

RESULTS

Identified methods for capturing glaucoma-related disability included qualitative descriptions, glaucoma-specific quality of life questionnaires, vision-specific questionnaires, general health questionnaires, functional domain-specific questionnaires, evaluation of task performance, event assessment (ie, falls and motor vehicle accidents), and real-world behavior (ie, daily physical activity). Findings using these methods show a strong relationship between glaucoma and/or glaucoma severity and difficulties with reading, driving, mobility, and other tasks such as prehension and facial recognition. In addition, glaucoma has financial and psychological implications on the patient, and can affect caregivers in some cases as well.

CONCLUSIONS

A wide variety of research tools have been used to characterize the disability resulting from glaucoma. Together, these tools show that glaucoma affects many abilities which are important for independent living. Strengths and limitations of the various research techniques are discussed so that future studies may use the method(s) most suitable for answering the research question posed.

Lessons learned from the development and implementation of a patient-reported outcome and experience measure (POEM) in an Australian glaucoma practice

Background

A patient’s perception of how their glaucoma is managed will influence both adherence to their medication and outcome measures such as quality of life.

Methods

Prospective consecutive study using a Glaucoma Patient-reported Outcome and Experience Measure (POEM) modified for an Australian ophthalmic private clinical practice setting. The Australian Glaucoma POEM consists of eight items related to the patient’s understanding of the diagnosis and management, acceptability of the treatment, whether they feel their glaucoma is getting worse, interfering with their daily life and concerns regarding loss of vision as well as addressing whether they feel safe under the care of their glaucoma team and how well their care is organised.

Results

Two hundred and two patients (M:F 91:111) participated in the study. Mean ± standard deviation for subject age was 69 ± 13 years. Patient’s overall perception of their treatment and outcome was favourable. Younger patients felt their glaucoma interfered more with their daily lives and were more worried about losing vision from glaucoma. The greater the number of medications in use, the more they felt their glaucoma was getting worse and that glaucoma interfered with their daily lives. With all other variables accounted for by the multivariate linear model, female patients more strongly agreed that they understood their glaucoma diagnosis and glaucoma management. The patients with a severe visual defect in their worse eye, reported a greater perceived understanding of their glaucoma diagnosis and management and that they felt that glaucoma had a greater interference on their daily life. They were also more concerned about losing vision from glaucoma than their fellow glaucoma patients with less severe or no visual field deficit in the worse eye.

Conclusions

The modified POEM demonstrates potential to capture the concerns of a practice’s glaucoma cohort with a view to enhancing the quality of glaucoma care delivered.

A Path Analysis of Effects of Patients' Underlying Conditions, Treatment Satisfaction, and Adherence on Quality of Life Among Korea Glaucoma Patients

PRéCIS:: This observed patient-specific features and treatment-driven conditions that were significantly associated with the impairment of health-related quality of life (HRQOL) among glaucoma patients. The results suggest that more systematic strategies should be implemented to improve an HRQOL.

PURPOSE

To determine factors contributing to an HRQOL and assess total, direct and indirect, effects that may exist between the determinants using path analysis.

MATERIALS AND METHODS

Data were derived from previous Korea glaucoma outcomes research. A total of 847 glaucoma outpatients with ≤2 years of eye-drop use were included in the present study. Including factors and their hypothetical pathways to an HRQOL were based on the literature review and consultation with specialists. Age, sex, comorbidities, and education levels were included as underlying conditions and treatment patterns were defined by the number of daily instillations of prescribed eye-drops. Treatment satisfaction and adherence were estimated using a Treatment Satisfaction Questionnaire for Medication, which assessed side-effects, effectiveness, convenience, global satisfaction, and pill count. An HRQOL was assessed by EQ-5D and EQ-visual analogue scale (EQ-VAS).

RESULTS

In EQ-5D analysis, male individuals showed total effects (β=0.102, P=0.0026), including both direct (β=0.076, P=0.0095) and indirect effects (β=0.0253, P=0.0020), which were mediated by treatment satisfaction in the side effects and global satisfaction categories. Higher education (β=0.197, P=0.0020) and satisfaction in the side effect (β=0.095, P=0.0076) and global satisfaction (β=0.075, P=0.0414) categories were found to have direct effects on EQ-5D. For EQ-VAS, higher education levels had significant total effects (β=0.153, P=0.0020) accounting for direct effects (β=0.131, P=0.0030) and indirect effects (β=0.0223, P=0.0531) through global satisfaction. In addition, male individuals had indirect effects (β=0.274, P=0.0165), which was indirectly mediated by satisfaction in the global satisfaction category. Comorbidity (β=-0.096, P=0.0090) and satisfaction in the effectiveness (β=0.094, P=0.0302), convenience (β=0.076, P=0.0390), and global satisfaction (β =0.144, P=0.0020) categories showed indirect effect on EQ-VAS.

CONCLUSION

Higher education and better treatment satisfaction had positive effects on HRQOL both in direct and indirect ways whereas comorbidities indirectly showed negative associations with HRQOL.

Patients’ Perceptions of the Need for Low Vision Devices

This pilot study of the perceptions of 149 men and women, aged 50 and older, of their need for low vision devices found that the most frequently reported uses of low vision devices were for close, intermediate, and distance reading tasks; television viewing; recognizing people; and finding items.

Quality of life among patients with age-related severe macular degeneration assessed using the NEI-VFQ, HADS-A, HADS-D and SF-36 tests. A cross-sectional study

BACKGROUND

Exudative age-related macular degeneration (e-AMD) may cause severe central vision loss. Patients with e-AMD can experience difficulties in daily basic activities and suffer from psychological problems. Our aim was to assess quality of life (QoL) and anxiety and depression status among patients with e-AMD.

DESIGN AND SETTING

Cross-sectional study in a state university.

METHODS

We included 200 e-AMD patients and 120 age and gender-matched controls. We assessed QoL using the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25) and the Short Form (SF)-36 test; and anxiety and depression status using the Hospital Anxiety Depression Scales A and D (HADS-A and HADS-D).

RESULTS

The mean ages in the e-AMD and control groups were 68.40 ± 9.8 and 66.31 ± 8.98, respectively. Visual acuity among e-AMD patients was 0.37 ± 0.31 and 0.39 ± 0.32 in the right and left eyes, respectively. The e-AMD patients performed significantly worse than the controls in NEI-VFQ-25 (P < 0.05 for all items). The proportions of e-AMD patients scoring higher than the cutoffs in HADS-A and HADS-D were significantly higher than among the controls (41.5% versus 12.5% and 63.5% versus 27.5%; P < 0.001). The e-AMD patients had significantly lower mean scores than the controls for each of the SF-36 QoL items (P < 0.001). The NEI-VFQ-25 scores were significantly lower among patients with bilateral e-AMD than among those with unilateral disease (P < 0.05 for all). The HADS scores were positively correlated with duration of e-AMD and patient age, but negatively with vision levels (P < 0.05 for all items).

CONCLUSION

The e-AMD patients had higher depression and anxiety scores and lower QoL scores.

[Impact of glaucoma medications and ocular surface disease on the quality of life of glaucoma patients in the district of Sousse (Tunisia)]

PURPOSE

To assess the impact of glaucoma treatment and ocular surface disease (OSD) on the vision-specific quality-of-life (VS-QoL) of glaucoma patients attending Farhat Hached university hospital Sousse-Tunisia.

METHODS

This was a cross-sectional study enrolling one-hundred-twenty patients followed for primary open angle glaucoma. All patients successfully responded to the Arabic version of the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ 25). QoL was quantified in terms of scores (0-100) and correlated with the characteristics of glaucoma treatment and status of the ocular surface.

RESULTS

One hundred and twenty patients were studied. The mean number of medications and instilled drops was 1.95 (1-4) and 2.69 (1-7) respectively. A total of 66.7% patients reported side effects of treatment. On examination, moderate or severe dry eye syndrome was identified in 90% of cases. A total of 16.7% of patients had superficial punctate keratopathy. The number of instilled drops per day, the use of brimonidine or oral carbonic anhydrase inhibitors, and the presence of OSD had a negative impact on the NEI-VFQ 25 scores.

CONCLUSIONS

Glaucoma treatment and OSD are 2 factors potentially reducing the QoL of glaucoma patients, on which the ophthalmologist can act by optimizing treatment and regularly examining the ocular surface of glaucoma patients.

Quality of life and participation of young adults with a visual impairment aged 18-25 years: comparison with population norms

Purpose

To compare health‐related quality of life and participation of visually impaired young adults with normative groups, and to explore severity of vision loss and its association with participation and quality of life.

Methods

Young adults aged 18–25 years (n = 172) registered at two Dutch low vision rehabilitation organizations completed the Short Form Health Survey (SF‐36), EuroQol‐5 Dimensions (EQ‐5D), Impact on Participation and Autonomy (IPA) and Low Vision Quality of Life questionnaire (LVQOL). EQ‐5D and SF‐36 scores were compared to age‐specific norms. IPA scores were compared to norms of a population having three chronic diseases simultaneously. Linear regression was used to assess the association between severity of vision loss (mild VI, moderate VI and severe VI/blindness), and quality of life and participation.

Results

Participants scored significantly worse on almost all (sub)scales compared with relevant norms. Effect sizes for the EQ‐5D and SF‐36 (sub)scales were mostly small; moderate and large effect sizes were found for the IPA. Compared to young adults with mild VI, corrected models showed a significant association between having moderate VI and the physical component score of the SF‐36, and between severe VI/blindness and the LVQOL.

Conclusion

VI has a moderate impact on some aspects of quality of life and a large impact on participation of young adults when compared with relevant normative populations. Severity of vision loss is associated with worse physical functioning and vision‐related quality of life. The results contribute to a better understanding of the impact of VI and might lead to improved low vision services.

Annexins in Glaucoma

Glaucoma is one of the leading causes of irreversible visual loss, which has been estimated to affect 3.5% of those over 40 years old and projected to affect a total of 112 million people by 2040. Such a dramatic increase in affected patients demonstrates the need for continual improvement in the way we diagnose and treat this condition. Annexin A5 is a 36 kDa protein that is ubiquitously expressed in humans and is studied as an indicator of apoptosis in several fields. This molecule has a high calcium-dependent affinity for phosphatidylserine, a cell membrane phospholipid externalized to the outer cell membrane in early apoptosis. The DARC (Detection of Apoptosing Retinal Cells) project uses fluorescently-labelled annexin A5 to assess glaucomatous degeneration, the inherent process of which is the apoptosis of retinal ganglion cells. Furthermore, this project has conducted investigation of the retinal apoptosis in the neurodegenerative conditions of the eye and brain. In this present study, we summarized the use of annexin A5 as a marker of apoptosis in the eye. We also relayed the progress of the DARC project, developing real-time imaging of retinal ganglion cell apoptosis in vivo from the experimental models of disease and identifying mechanisms underlying neurodegeneration and its treatments, which has been applied to the first human clinical trials. DARC has potential as a biomarker in neurodegeneration, especially in the research of novel treatments, and could be a useful tool for the diagnosis and monitoring of glaucoma.

Knowledge Base and Preferred Methods of Obtaining Knowledge of Glaucoma Patients

PURPOSE

To gather information regarding patient's understanding of glaucoma and the manner in which patients wish to learn about the disease with the intent of improving patient education.

METHODS

Forty-four of sixty randomly selected ophthalmologists (73%) asked four of their patients consecutively to complete a questionnaire about glaucoma. The selection of questions was based on focus group interviews and suggestions from several experts. Topics included knowledge about glaucoma and its treatment, the need for information, and preferred providers and methods of patient education.

RESULTS

Fifty percent of the patients had 49% or less correct answers to questions about glaucoma or its treatment. Per item the correct answers ranged from 5% to 90%. Lack of knowledge was associated with low level of education, short duration of glaucoma, high age, and no preference for the Internet as method of supplying information. These variables, however, did not identify groups with a considerable lack of knowledge sufficiently accurately to target patient education. A high need for information was observed and included information about the patient's own glaucoma. Almost all patients preferred the ophthalmologist and many also a nurse or a representative of the Glaucoma Patient Society as providers of information. Written material was the preferred method.

CONCLUSIONS

Patient education should address all patients. A patient education program should cover a wide range of topics with a focus on general information through written material and information tailored to the individual glaucoma patient's needs. The ophthalmologist is a key- person, but others could play an important role in patient education.

Visual field loss and vision-related quality of life in the Italian Primary Open Angle Glaucoma Study

The aim of this study was to examine the relationship between visual field (VF) loss, vision-related quality of life (QoL) and glaucoma-related symptoms in a large cohort of primary open angle glaucoma (POAG) patients. POAG patients with or without VF defects or “glaucoma suspect” patients were considered eligible. QoL was assessed using the validated versions of the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and glaucoma-related symptoms were assessed using the Glaucoma Symptom Scale (GSS). Patients were classified as having VF damage in one eye (VFD-1), both eyes (VFD-2), or neither eye (VFD-0). 3227 patients were enrolled and 2940 were eligible for the analysis. 13.4% of patients were classified in the VFD-0, 23.7% in the VFD-1, and 62.9% in the VFD-2 group. GSS visual symptoms domain (Func-4) and GSS non-visual symptoms domain (Symp-6) scores were similar for the VFD-0 and VFD-1 groups (p = 0.133 and p = 0.834 for Func-4 and Symp-6, respectively). VFD-0 group had higher scores than VFD-2 both in Func-4 (p < 0.001) and Symp-6 domains (p = 0.035). Regarding the NEI-VFQ-25, our data demonstrated that bilateral VF defects are associated with vision-related QoL deterioration, irrespective of visual acuity.

Establishing a Regional Glaucoma Physician Collaborative to Improve Quality of Care

PURPOSE

Improving adherence to practice guidelines can improve patient safety and quality of care. We sought to establish a regional glaucoma physician collaborative to evaluate and improve adherence to the American Academy of Ophthalmology's Primary Open-angle Glaucoma (POAG) Preferred Practice Pattern (PPP) guidelines.

DESIGN

Prospective interventional study.

METHODS

The collaborative consisted of 13 glaucoma specialists from 3 practices in Michigan. All consecutive POAG new patient visits were reviewed from each study site to determine physician adherence to the 13 major examination elements of the PPP. In phase 1 of the study, physician adherence rates for each of the recommended examination elements were combined and averaged for all groups. Averages for the collaborative were reported to each site, and each physician received his or her individual adherence rates. Physicians discussed strategies to improve overall adherence to the PPP. Adherence rates were collected in phase 2 to determine if feedback and sharing of strategies resulted in improved adherence.

RESULTS

A total of 274 new POAG patient visits from phase 1 and 280 visits from phase 2 were reviewed. After accounting for multiple comparisons, overall improvement approached statistical significance for the evaluation of visual function (91.2% to 96.1%, P < .02) and target intraocular pressure determination (73.7% to 83.2%, P < .01). Improvement for other measures that had a high rate of adherence at baseline (eg, ocular history, pupil examination, and central corneal thickness measurement) was not statistically significant.

CONCLUSIONS

It is feasible to establish a regional glaucoma physician collaborative to improve standardization of care for patients with newly diagnosed POAG.

Developing an Item Bank to Measure Quality of Life in Individuals With Glaucoma, and the Results of the Interview With Patients: The Effect of Visual Function, Visual Field Progression Rate, Medical, and Surgical Treatments on Quality of Life

PURPOSE

To construct a new item bank to measure quality of life (QOL) in glaucoma patients and to evaluate glaucoma patients' QOL using the item bank.

METHODS

An item bank of questions was generated through a literature review of QOL instruments useful for glaucoma patients. Using this item bank, a cognitive survey was performed on 203 patients with glaucoma (112 males and 91 females, 61.9±11.9 y old; mean±SD). The results were then analyzed using the Rasch analysis, and the Rasch-derived disability scores were predicted using linear modelling and the following clinical parameters: age, mean total deviation (mTD) in superior and inferior visual field (mTDsup/mTDinf), mTD progression rate, better visual acuity, worse visual acuity, number of eye drops administered per day, number of trabeculectomy procedures experienced in both eyes.

RESULTS

A total of 23 questionnaires of QOL in glaucoma patients were identified resulting in an item bank of 187 questions related to the following tasks: reading/writing, walking, going out, eating and driving (direct disability) as well as questions concerned with worry/anxiety, social participation, and physical symptoms (indirect disability). In the optimal model for direct disability, age and mTDinf were identified as significant predictors, whereas number of eye drops administered per day and number of trabeculectomy experienced were included in the optimal model for indirect disability.

CONCLUSIONS

A new item bank to measure QOL in glaucoma patients was developed and evaluated. Age and mTDinf were found to be related to direct disability while medical and surgical treatments were related to indirect disability.

Patient-Reported Vision-Related Quality-of-Life Differences between Primary Angle-Closure Glaucoma and Primary Open-Angle Glaucoma

Purpose

To investigate the different impacts on patient-reported vision-related quality of life (pVRQOL) outcomes in patients with primary angle-closure glaucoma(PACG) and primary open-angle glaucoma(POAG).

Methods

Prospective cross-sectional study. PACG and POAG patients who had a best-corrected visual acuity(BCVA) in the better eye equal to or better than 20/60, intraocular pressure controlled at or below 25 mmHg and reliable visual field test were invited to participate. The control group included patients with BCVA in the better eye equal to or better than 20/60 and who did not have major eye disease. A validated Taiwanese version of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25(T)) was performed to assess pVRQOL. The association between each domain of NEI VFQ-25(T) among 3 groups was determined using multivariable linear regression analysis.

Results

A total of 106 PACG, 186 POAG, and 95 controls were enrolled. In multivariable regression analysis of all three groups(PACG/POAG/controls), compared to POAG, PACG showed a weakly positive association with social functioning (R² = 0.13, β = 0.22, P = 0.04). PACG showed no significantly negative impact on pVRQOL compared to controls. Taking only glaucoma patients into consideration, PACG patients had a higher score on social functioning compared to POAG (R² = 0.16, β = 0.27, P = 0.01). The results of other domains of NEI VFQ-25(T) between the two groups did not differ significantly(p>0.05).

Conclusions

In patients with controlled disease, the impact of PACG and POAG on most domains of NEI VFQ-25(T) were similar, except for better social functioning in PACG compared to POAG.

Quality of Life in Glaucoma: A Review of the Literature

The ultimate goal of glaucoma management is the preservation of patients’ visual function and quality of life (QoL). The disease itself as well as the medical or surgical treatment can have an enormous impact on a patient’s QoL. Even the mere diagnosis of a chronic, irreversible, potentially blinding disorder can adversely affect the patient’s sense of well-being and QoL by eliciting significant anxiety. Patients with primary open-angle glaucoma rarely present with visual symptoms, at least early in the course of the disease. A better understanding of patient-reported QoL can improve patient–physician interaction and enhance treatment adherence by customizing treatment options based on individual patient profile, thus optimizing long-term prognosis. These aspects are summarized and critically appraised in this article.

The Association of Health-Related Quality of Life with Severity of Visual Impairment among People Aged 40-64 Years: Findings from the 2006-2010 Behavioral Risk Factor Surveillance System

PURPOSE

To examine the association of health-related quality of life (HRQoL) with severity of visual impairment among people aged 40-64 years.

METHODS

We used cross-sectional data from the 2006-2010 Behavioral Risk Factor Surveillance System to examine six measures of HRQoL: self-reported health, physically unhealthy days, mentally unhealthy days, activity limitation days, life satisfaction, and disability. Visual impairment was categorized as no, a little, or moderate/severe. We examined the association between visual impairment and HRQoL using logistic regression accounting for the survey's complex design.

RESULTS

Overall, 23.0% of the participants reported a little difficult seeing, while 16.8% reported moderate/severe difficulty seeing. People aged 40-64 years with moderate/severe visual impairment had more frequent (≥14) physically unhealthy days, mentally unhealthy days, and activity limitation days in the last 30 days, as well as greater life dissatisfaction, greater disability, and poorer health compared to people reporting no or a little visual impairment. After controlling for covariates (age, sex, marital status, race/ethnicity, education, income, state, year, health insurance, heart disease, stroke, heart attack, body mass index, leisure-time activity, smoking, and medical care costs), and compared to people with no visual impairment, those with moderate/severe visual impairment were more likely to have fair/poor health (odds ratio, OR, 2.01, 95% confidence interval, CI, 1.82-2.23), life dissatisfaction (OR 2.06, 95% CI 1.80-2.35), disability (OR 1.95, 95% CI 1.80-2.13), and frequent physically unhealthy days (OR 1.69, 95% CI 1.52-1.88), mentally unhealthy days (OR 1.84, 95% CI 1.66-2.05), and activity limitation days (OR 1.94, 95% CI 1.71-2.20; all p < 0.0001).

CONCLUSION

Poor HRQoL was strongly associated with moderate/severe visual impairment among people aged 40-64 years.

Impact of Glaucoma on Quality of Life and Activities of Daily Living

Objective/Background

This study was performed to assess the associations of glaucoma with health-related quality of life (HRQOL) and activities of daily living (ADL).

Methods

Using data from the Korean National Health and Nutrition Examination Survey III in 2005, we analysed 9,047 participants (≥ 50 years old) and 3,518 participants (> 65 years old) to assess the associations of glaucoma with HRQOL and ADL, respectively. The diagnosis of glaucoma was based on questionnaires. HRQOL was evaluated by the EuroQol five-dimension descriptive system (EQ-5D) and the EuroQol visual analogue scale. The ADL was evaluated by the Korean-optimised ADL questionnaire. Logistic-regression analyses were used to assess the associations of glaucoma with HRQOL and ADL.

Results

The glaucoma patients showed lower HRQOL and ADL scores compared to the healthy participants. The glaucoma patients showed significantly higher prevalence of impaired health status in all dimensions of EQ-5D, as well as in the “bathing” dimension of ADL as compared with the healthy participants. Impaired HRQOL and ADL were significantly associated with the risk of glaucomatous status (odds ratio [95% confidence interval] of EQ-5D: 1.65 [1.33, 2.05], EuroQol visual analogue scale: 1.75 [1.43, 2.15], and ADL: 2.04 [1.12, 3.74]).

Conclusion

In line with previous studies conducted in other countries, Koreans with glaucoma had impaired HRQOL and ADL as compared with healthy Koreans.

Eye Care Quality and Accessibility Improvement in the Community (EQUALITY) for adults at risk for glaucoma: study rationale and design

Background

Primary open angle glaucoma is a chronic, progressive eye disease that is the leading cause of blindness among African Americans. Glaucoma progresses more rapidly and appears about 10 years earlier in African Americans as compared to whites. African Americans are also less likely to receive comprehensive eye care when glaucoma could be detected before irreversible blindness. Screening and follow-up protocols for managing glaucoma recommended by eye-care professional organizations are often not followed by primary eye-care providers, both ophthalmologists and optometrists. There is a pressing need to improve both the accessibility and quality of glaucoma care for African Americans. Telemedicine may be an effective solution for improving management and diagnosis of glaucoma because it depends on ocular imaging and tests that can be electronically transmitted to remote reading centers where tertiary care specialists can examine the results. We describe the Eye Care Quality and Accessibility Improvement in the Community project (EQUALITY), set to evaluate a teleglaucoma program deployed in retail-based primary eye care practices serving communities with a large percentage of African Americans.

Methods/Design

We conducted an observational, 1-year prospective study based in two Walmart Vision Centers in Alabama staffed by primary care optometrists. EQUALITY focuses on new or existing adult patients who are at-risk for glaucoma or already diagnosed with glaucoma. Patients receive dilated comprehensive examinations and diagnostic testing for glaucoma, followed by the optometrist’s diagnosis and a preliminary management plan. Results are transmitted to a glaucoma reading center where ophthalmologists who completed fellowship training in glaucoma review results and provide feedback to the optometrist, who manages the care of the patient. Patients also receive eye health education about glaucoma and comprehensive eye care. Research questions include diagnostic and management agreement between providers, the impact of eye health education on patients’ knowledge and adherence to follow-up and medication, patient satisfaction, program cost-effectiveness, and EQUALITY’s impact on Walmart pharmacy prescription rates.

Discussion

As eye-care delivery systems in the US strive to improve quality while reducing costs, telemedicine programs including teleglaucoma initiatives such as EQUALITY could contribute toward reaching this goal, particularly among underserved populations at-risk for chronic blinding diseases.

The relationship between quality of life and adherence to medication in glaucoma patients in Singapore

PURPOSE

(i) To evaluate the medication adherence rate of glaucoma patients in Singapore. (ii) To evaluate patients' quality of life status. (iii) To explore the factors related to patients' nonadherence to medication.

PATIENTS AND METHODS

A cross-sectional, prospective study, using interviewer-administered survey questionnaires. A total of 314 patients were interviewed altogether, of which 175 (55.7%) were male and 139 (44.3%) were female. (i) Patients' medication adherence was assessed using the Reported Adherence to Medication scale. (ii) Patients' beliefs about glaucoma and treatment were evaluated using the Brief Illness Perception Questionnaire and the Beliefs about Medicine-Specific Questionnaire. (iii) Patients' quality of life was evaluated using Glaucoma Symptom Scale and The Glaucoma Quality of Life-15 questionnaire.

RESULTS

Sixty-two (19.7%) patients reported themselves to be adherent to their medication. Male patients (P=0.044) and smokers (P=0.002) were more likely to be nonadherent to their medication regimen. Nonadherent patients were more likely to have (i) more concerns about their glaucoma medications (P=0.000); (ii) less belief in the effects of their medications (P=0.026); (iii) a lower quality of life (higher score of GQOL-15, P=0.014); (iv) less symptoms from their glaucoma (lower score of Glaucoma Symptom Scale, P=0.026); and (v) more effect on their lives from glaucoma (P=0.01).

CONCLUSIONS

The full-adherence rate is low among glaucoma patients. Having less belief in the need for and more concerns about their medication are the 2 factors associated with nonadherence. In the future, effective strategies should be explored to improve patients' beliefs. Nonadherence has an association with decreased quality of life. Strategies to improve adherence will need to deal with these areas.

Binocular visual field impairment in glaucoma and at-fault motor vehicle collisions

PURPOSE

To evaluate the association between the binocular visual field defects in drivers with glaucoma and the risk of motor vehicle collision (MVC) involvement.

METHODS

A retrospective cohort study was conducted on 438 drivers with glaucoma aged 55 years or older using data from 1994 through 2000. Demographic, clinical, and driving characteristics were obtained from chart abstractions and patient survey. Binocular field measures were generated by combining data from the monocular (central 24-degree radius) fields whereby the binocular field measure was defined as the more sensitive point at each monocular field location. Measures included threshold (TH), total deviation (TD), and pattern deviation (PD); severe impairment in these measures was defined as falling into the worst quartile. MVC data were obtained from police records. Rate ratios (RR) and 95% confidence intervals (CI) were calculated.

RESULTS

Drivers with severely impaired PD measures were twice as likely to have an at-fault MVC compared with those not severely impaired (RR, 2.13; 95% CI, 1.21-3.75); those with severely impaired TH (RR, 1.49; 95% CI, 0.81-2.74) and TD (RR, 1.50; 95% CI, 0.82-2.74) also had an increased rate of at-fault MVCs, although these were not significant. When the binocular central visual field was stratified into 9 regions, drivers with impaired TH, TD, or PD had similarly elevated MVC rates in all regions compared with those not severely impaired, though not all reached statistical significance.

CONCLUSIONS

On the basis of clinical measures of visual field routinely used in the management of glaucoma, drivers with glaucoma with severe PD field defects in the binocular field have a higher rate of at-fault MVC compared with those with less impaired or unimpaired binocular visual fields.

Health-related quality of life among people aged ≥65 years with self-reported visual impairment: findings from the 2006-2010 behavioral risk factor surveillance system

PURPOSE

To examine the association between health-related quality of life (HRQoL) and visual impairment among people aged ≥65 years.

METHODS

We used cross-sectional data from the 2006-2010 Behavioral Risk Factor Surveillance System to examine six HRQoL measures: self-reported health, physically unhealthy days, mentally unhealthy days, activity limitation days, life satisfaction, and disability. Visual impairment was categorized as no, a little, and moderate/severe. We examined the association between self-reported visual impairment and HRQoL using logistic regression accounting for the survey's complex design.

RESULTS

People with self-reported moderate/severe visual impairment had more frequent (≥14) physically unhealthy days, mentally unhealthy days, and activity limitation days in the last 30 days compared to those reporting a little or no visual impairment. After controlling for all covariates (age, sex, marital status, race/ethnicity, education, income, diabetes, heart disease, stroke, heart attack, body mass index, leisure time activity, smoking, and medical care cost concerns) and comparing to those with no self-reported visual impairment, people reporting a little visual impairment were more likely to have fair/poor health (odds ratio, OR, 1.2, 95% confidence interval, CI, 1.1-1.3), life dissatisfaction (OR 1.6, 95% CI 1.3-2.0), and disability (OR 1.5, 95% CI 1.3-1.6), and those with self-reported moderate/severe visual impairment had more fair/poor health (OR 1.8, 95% CI 1.6-2.0), life dissatisfaction (OR 2.3, 95% CI 1.8-2.9), and disability (OR 2.0, 95% CI 1.8-2.2). They also had more frequent physically unhealthy days (OR 1.9, 95% CI 1.7-2.1), mentally unhealthy days (OR 1.8, 95% CI 1.5-2.1), and activity limitations days (OR 1.9, 95% CI 1.6-2.2).

CONCLUSION

Poor HRQoL is strongly associated with the severity of self-reported visual impairment among people aged ≥65 years.

Is glaucoma comprehension associated with psychological disturbance and vision-related quality of life for patients with glaucoma? A cross-sectional study

OBJECTIVE

To investigate whether understanding of glaucoma is associated with psychological disturbance and vision-related quality of life (QoL) in patients with glaucoma.

DESIGN

A prospective, hospital-based, cross-sectional study.

SETTING

Shanghai, China.

PARTICIPANTS

Five hundred patients with glaucoma were included in the study. Participants were asked to complete the glaucoma comprehension questionnaire, the Hospital Anxiety and Depression Scale (HADS) questionnaire, and the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25).

OUTCOME MEASURES

Sociodemographic data and clinical data were collected. Multivariate adjusted linear regression analyses were performed to examine factors related to psychological disorder and QoL. The relationship between understanding of glaucoma and psychological status or QoL was analysed.

RESULTS

The mean age of patients was 56.5±17.2 years, and the mean duration of glaucoma was 4.6±6.3 years. About half (54.2%) of the patients had primary open angle glaucoma, 37.2% had primary angle closure glaucoma, and 8.6% had secondary glaucoma. The total score and the subscores of knowledge of glaucoma, compliance and habits were all negatively correlated with the HADS-Depression and HADS scores. For NEI VFQ-25, the total comprehension score was positively related to general vision, near activity, distance activity, social function, colour vision and the composite score. Habits had a significant influence on both HADS-Depression and the composite score of NEI VFQ-25.

CONCLUSIONS

The level of understanding about glaucoma is an independent factor negatively associated with psychological disturbance and positively associated with QoL in patients with glaucoma. However, it is a subjective factor which can be regulated, so imparting knowledge about glaucoma and establishing appropriate habits might help patients alleviate psychological disturbance and enhance their QoL.

Impact of better and worse eye damage on quality of life in advanced glaucoma

The purpose of the study was to investigate the influence of VF and the VA on vision related quality of life (VRQoL) in advanced glaucoma. Subjects consist of 50 glaucoma patients with mean deviation (MD) less than −20 dB in at least one eye. Patients' VRQoL was assessed using the ‘Sumi questionnaire’. The impact of seven visual measures on VRQoL were compared using principal component regression: MDs of better and worse eyes with 10-2 and 24-2 Humphrey VFs, LogMAR VAs of better and worse eyes and the Esterman score. The root mean of the squared prediction error (RMSE) was calculated using leave-one-out cross validation. Better eye summary measurements were much more influential on VRQoL than corresponding worse eye measurements and Esterman score in every VRQoL task. In conclusion, in advanced glaucoma, VF parameters of the better eye are important for the VRQoL of the patient.

Resident compliance with the american academy of ophthalmology preferred practice pattern guidelines for primary open-angle glaucoma

PURPOSE

To examine resident adherence to preferred practice pattern (PPP) guidelines set up by the American Academy of Ophthalmology for follow-up care of primary open-angle glaucoma (POAG) patients.

DESIGN

Retrospective chart review.

PARTICIPANTS

One hundred three charts were selected for analysis from all patients with an International Classification of Diseases, Ninth Revision, code of open-angle glaucoma or its related entities who underwent a follow-up evaluation between July 2, 2003, and December 15, 2004, at the resident ophthalmology clinic in the Durham Veteran Affairs Medical Center.

METHODS

Follow-up visits of POAG patients were evaluated for documentation of 19 elements in accordance to PPP guidelines.

MAIN OUTCOME MEASURES

Compliance rates for the 19 elements of PPP guidelines first were averaged in all charts, and then were averaged per resident and were compared among 8 residents between their first and second years of residency.

RESULTS

The overall mean compliance rate for all 19 elements was 82.6% for all charts (n = 103), 78.8% for first-year residents, and 81.7% for second-year residents. The increase from first to second year of residency was not significant (P>0.05). Documentation rates were high (>90%) for 14 elements, including all components of the physical examination and follow-up as well as most components of the examination history and management plan. Residents documented adjusting target intraocular pressure downward, local or systemic problems with medications, and impact of visual function on daily living approximately 50% to 80% of the time. Documentation rates for components of patient education were the lowest, between 5% and 16% in all charts.

CONCLUSIONS

Residents' compliance with PPP guidelines for a POAG follow-up visit was very high for most elements, but documentation rates for components of patient education were poor. Adherence rates to PPP guidelines can be used as a tool to evaluate and improve resident performance during training. However, further studies are needed to establish the advantages of using PPP guidelines for resident education and to determine if such assessments can lead to improved patient care.

Comparison of resource utilization in the treatment of open-angle glaucoma between two cities in Finland: is more better?

INTRODUCTION

Glaucoma is a progressive optic neuropathy associated with neural rim loss of the optic disc and the retinal nerve fibre layer typically causing visual field (VF) deterioration. Generally, glaucomatous lesions in the eye and in the visual field progress slowly over the years. In population-based cross-sectional studies, the percentage of unilateral or bilateral visual impairment varied between 3-12%. In screening studies, 0.03-2.4% of patients have been found to suffer visual impairment. Glaucoma has previously been associated with substantial healthcare costs and resource consumption attributable to the treatment of the disease. The disease also causes reduction in health-related quality of life (HRQoL) in patients with glaucoma.

OBJECTIVE AND METHODS

This study compares patients with diagnosed open-angle glaucoma from two geographically different regions in Finland. A total of 168 patients were examined, 85 subjects from an area with higher per patient treatment costs (Oulu) and 83 patients from a region with lower per patient treatment costs (Turku). All patients had a history of continuous glaucoma medication use for a period of 11 years. For each patient, the total direct costs from glaucoma treatment were calculated and the total amount of resource consumption was determined from registries and patient records. Each patient underwent a clinical examination with visual field assessment and fundus photography. These data were used to determine the current stage of disease for each patient. Health-related quality of life questionnaire (15D) was used in determining each patient's subjective HRQoL score.

RESULTS

When applying the current diagnostic criteria for open-angle glaucoma, a total of 40% of patients did not to display any structural or functional damage suggesting glaucoma after 11 years of continuous medical treatment and follow-up. Patients with higher glaucoma stage (worse disease) were found to have statistically higher treatment costs compared with those at lower disease stages. Resource consumption was also greater in the patients in higher glaucoma stage. Patients in the Oulu district consumed more resources, and glaucoma treatment was more expensive than in the Turku area. The total treatment cost in Oulu and Turku was 6010 € and 4452 €, respectively, for the whole 11-year period. There was no statistically significant difference in quality-of-life scores between the two areas. No difference was noted between the higher-spending and lower-spending areas in this respect. However, when the population was analysed as a whole, patients with higher glaucoma stage were found to have lower vision-based 15D scores compared with those at lower disease stages. This observation was made also at both districts independently.

CONCLUSIONS

Major cost source in open-angle glaucoma treatment is medication, up to 74% of annual costs. In addition, it seems that higher resource consumption and higher treatment costs do not increase the patients' HRQoL as assessed by the 15D instrument.

Identifying areas of the visual field important for quality of life in patients with glaucoma

PURPOSE

The purpose of this study was to create a vision-related quality of life (VRQoL) prediction system to identify visual field (VF) test points associated with decreased VRQoL in patients with glaucoma.

METHOD

VRQoL score was surveyed in 164 patients with glaucoma using the 'Sumi questionnaire'. A binocular VF was created from monocular VFs by using the integrated VF (IVF) method. VRQoL score was predicted using the 'Random Forest' method, based on visual acuity (VA) of better and worse eyes (better-eye and worse-eye VA) and total deviation (TD) values from the IVF. For comparison, VRQoL scores were regressed (linear regression) against: (i) mean of TD (IVF MD); (ii) better-eye VA; (iii) worse-eye VA; and (iv) IVF MD and better- and worse-eye VAs. The rank of importance of IVF test points was identified using the Random Forest method.

RESULTS

The root mean of squared prediction error associated with the Random Forest method (0.30 to 1.97) was significantly smaller than those with linear regression models (0.34 to 3.38, p<0.05, ten-fold cross validation test). Worse-eye VA was the most important variable in all VRQoL tasks. In general, important VF test points were concentrated along the horizontal meridian. Particular areas of the IVF were important for different tasks: peripheral superior and inferior areas in the left hemifield for the 'letters and sentences' task, peripheral, mid-peripheral and para-central inferior regions for the 'walking' task, the peripheral superior region for the 'going out' task, and a broad scattered area across the IVF for the 'dining' task.

CONCLUSION

The VRQoL prediction model with the Random Forest method enables clinicians to better understand patients' VRQoL based on standard clinical measurements of VA and VF.

Five-year forecasts of the Visual Field Index (VFI) with binocular and monocular visual fields

BACKGROUND

In clinical care, visual field (VF) damage is assessed using monocular VF testing, yet patients perceive the world binocularly. This study was conducted to compare 5-year forecasts for the Visual Field Index (VFI) generated from series of binocular and monocular VFs.

METHODS

Series of ten consecutive VFs (Humphrey 24-2 Full-threshold) spanning on average 3.7 (SD: ±0.8) years from 60 eyes of 30 glaucomatous patients were retrospectively examined. The VFs of both eyes were merged to produce the integrated VF and its VFI score (Binocular VFI) was estimated. Forecasts of binocular and monocular VFIs were calculated for each patient by projecting the fitted linear regression 5 years ahead from the last VF following the method on the Humphrey Guided Progression Analysis (GPA) print-out. The precisions of the forecasts were calculated as the width of the 95% prediction limit (PL).

RESULTS

The mean 5 year forecast for binocular VFIs was 92% (SD: 11%), which was significantly higher than forecasts from right and left eyes (79% [SD: 19%] and 82% [SD: 16%] respectively; P < 0.05). The width of the 95% PL for 5-year predictions with monocular VFIs (mean right eye: 29% [SD: 19%] and mean left eye: 27% [SD: 16%]) were significantly larger than that of the binocular VFI (mean: 12% [SD: 7%]; P < 0.05).

CONCLUSIONS

Five year forecasted VFI values using binocular measures return significantly better values, and can be made with greater confidence than those based on monocular measures. In turn, forecasts of a patient's binocular VFI might be more relevant to estimating the patient's future functional VF.

A comparison of the sensitivity of EQ-5D, SF-6D and TTO utility values to changes in vision and perceived visual function in patients with primary open-angle glaucoma

Background

Economic viability of treatments for primary open-angle glaucoma (POAG) should be assessed objectively to prioritise health care interventions. This study aims to identify the methods for eliciting utility values (UVs) most sensitive to differences in visual field and visual functioning in patients with POAG. As a secondary objective, the dimensions of generic health-related and vision-related quality of life most affected by progressive vision loss will be identified.

Methods

A total of 132 POAG patients were recruited. Three sets of utility values (EuroQoL EQ-5D, Short Form SF-6D, Time Trade Off) and a measure of perceived visual functioning from the National Eye Institute Visual Function Questionnaire (VFQ-25) were elicited during face-to-face interviews. The sensitivity of UVs to differences in the binocular visual field, visual acuity and visual functioning measures was analysed using non-parametric statistical methods.

Results

Median utilities were similar across Integrated Visual Field score quartiles for EQ-5D (P = 0.08) whereas SF-6D and Time-Trade-Off UVs significantly decreased (p = 0.01 and p = 0.001, respectively). The VFQ-25 score varied across Integrated Visual Field and binocular visual acuity groups and was associated with all three UVs (P ≤ 0.001); most of its vision-specific sub-scales were associated with the vision markers. The most affected dimension was driving. A relationship with vision markers was found for the physical component of SF-36 and not for any dimension of EQ-5D.

Conclusions

The Time-Trade-Off was more sensitive than EQ-5D and SF-6D to changes in vision and visual functioning associated with glaucoma progression but could not measure quality of life changes in the mildest disease stages.

Estimating quality-adjusted life years from patient-reported visual functioning

PURPOSE

Glaucoma is an important disease, the impacts of which on vision have been shown to have implications for patients' health-related quality of life (HRQoL). The primary aim of this study is to estimate a mapping algorithm to predict EQ-5D and SF-6D utility values based on the vision-specific measure, the 25-item Visual Functioning Questionnaire (VFQ-25), as well as the clinical measures of visual function, that is, integrated visual field, visual acuity, and contrast sensitivity.

METHODS

Ordinary least squares (OLS), Tobit, and censored least absolute deviations were compared using data taken from the Moorfields Eye Hospital in London, to assess mapping functions to predict the EQ-5D and SF-6D from the VFQ-25, and tests of visual function. These models were compared using root mean square error (RMSE), R(2), and mean absolute error (MAE).

RESULTS

OLS was the best-performing model of the three compared, as this produced the lowest RMSE and MAE, and the highest R(2).

CONCLUSIONS

The models provided initial algorithms to convert the VFQ-25 to the EQ-5D and SF-6D. Further analysis would be needed to validate the models or algorithms.

Balancing efficacy and tolerability of prostaglandin analogues and prostaglandin-timolol fixed combinations in primary open-angle glaucoma

BACKGROUND

Lowering intraocular pressure (IOP) is currently the only therapeutic approach that preserves visual function in primary open-angle glaucoma. In making treatment decisions for first- and second-line therapy, the clinician needs to provide an appropriate balance of efficacy and tolerability. Prostaglandin analogues (PGAs) are frequently used as first-line monotherapy, because of their efficacy and low risk of systemic side effects. Similarly, PGA-based fixed combinations are frequently used in patients who progress or fail to achieve the target IOP.

SCOPE

We have reviewed the literature on the management of primary open-angle glaucoma with PGAs, both as monotherapies and in fixed combinations.

FINDINGS

In the clinical trial and meta-analysis data identified, bimatoprost 0.03% seems to be associated with a greater overall ability to lower IOP compared with latanoprost, travoprost or tafluprost, at the cost of a slightly higher incidence of conjunctival hyperaemia. Studies indicate that patients' adherence to treatment is generally better with PGAs than with many other monotherapies. In patients requiring more than one IOP-lowering agent, fixed combination treatments may provide improved adherence and tolerability benefits compared with concomitant use of individual treatments. Bimatoprost/timolol fixed combination appears to be slightly more efficacious than latanoprost/timolol or travoprost/timolol, and tolerability differences between the fixed combinations appear to be slight, probably because the addition of timolol to the PGA component lessens the associated hyperaemia. Surveys on EU physician attitudes appear largely in line with these clinical data.

CONCLUSION

An appropriate balance between efficacy and tolerability ensures optimum IOP lowering and reduces the risk of non-adherence. PGAs largely fulfil this need as monotherapies and as components of combinations.

Anxiety, depression, and quality of life in Turkish patients with glaucoma

The purpose was to investigate the relationship between anxiety, depression, and quality of life in patients with glaucoma. This case-control study was carried out with 121 participants with glaucoma (M age=64.2, SD=13.2; 68 women, 76.0% married) and 64 controls. The data were collected by using a data collection form involving questions on patients' specific characteristics, the Hospital Anxiety and Depression Scale, and the National Eye Institute Visual Function Questionnaire. Rate of clinical anxiety was 14.0% and depression 57.0% among the participants with glaucoma. The anxiety risk in women with glaucoma was found to be 7.5 times higher than in men. Risk of depression was 2.94 times higher in unmarried compared to married participants. Anxiety scores were higher in unmarried participants and women. The mean Depression score was statistically significantly higher for unmarried participants. The incidence of depression and anxiety increased with decreasing quality of life scores. Quality of life was associated negatively with anxiety and depression in patients with glaucoma. Evaluating quality of life, anxiety, and depression in older individuals who have glaucoma and examining the risk factors are important to provide earlier health care service and preventive psychological treatment.

Correlation of visual function with health-related quality of life in glaucoma patients

OBJECTIVES

The purpose of this study was to assess visual impairment and quality of life (QOL), the relationship between visual function and health-related and vision-related QOL, and to identify factors significantly impacting QOL for glaucoma patients.

METHODS

One-on-one interviews of 280 glaucoma patients at a regional hospital in Taiwan from 1 April 2005 to 30 September 2005. Data collected included demographics, clinical examinations and treatment status. QOL data collected utilized the Chinese (Taiwanese) version of the Medical Outcomes Study Short-Form 36 Health Survey (SF-36) and the National Eye Institute Visual Function-25 (NEIVFQ-25).

RESULTS

The majority of study participants had open-angle glaucoma (54.3%) and were classified as moderate stage (33.6%). The higher the health-related QOL scores for both questionnaires, the fewer difficulties experienced by the patients. Moderate correlation was found between the SF-36 and NEIVFQ-25 subscales and visual function. Significant predicting factors for the SF-36 were gender, age, employment status, presence of systemic disease, better-eye visual acuity and better-eye mean defect. For the NEIVFQ-25, these were general vision, near and distance activities, colour vision and peripheral vision scores.

CONCLUSIONS

A combination of demographic data, clinical examination and QOL questionnaires may help clinicians better ascertain the impact of disease severity on glaucoma patients' QOL. This information may help in patient education, treatment compliance and selection of treatment options.

Quality of life in glaucoma and three other chronic diseases: a systematic literature review

Chronic diseases have a long-term negative impact on quality of life (QOL). Decreased QOL is associated with increased financial burden on healthcare systems and society. However, few publications have investigated the impact of glaucoma on patients' QOL in comparison with other chronic diseases observed in patients with similar demographic characteristics. To this end, a systematic literature search to assess QOL in glaucoma and three other chronic diseases (osteoporosis, type 2 diabetes mellitus and dementia) was performed. A total of 146 publications were identified that reported QOL using six commonly used generic QOL instruments: 36-, 12- and 20-item Short-Form Health Surveys (SF-36, -12 and -20), EuroQoL (EQ-5D), Sickness Impact Profile (SIP) and the Health Utilities Index-Mark III (HUI-III). The publication breakdown was as follows: glaucoma (10%), osteoporosis (26%), diabetes (52%) and dementia (12%); one publication assessed QOL in glaucoma, diabetes and dementia. QOL was affected to a similar or slightly lesser degree by glaucoma than by osteoporosis, diabetes or dementia. Among the publications reporting SF-36, -12 and -20 evaluations, physical component scores were generally lower than mental component scores across all diseases. QOL was affected more in patients with glaucoma than in demographically matched non-glaucomatous controls according to SF-20 assessment. EQ-5D and SIP results showed that QOL decreased as the severity of glaucoma increased. Patients with glaucoma had the lowest scores on the SIP instrument, indicating better QOL than patients with osteoporosis or diabetes (no data were available on dementia). The HUI-III instrument identified poorer QOL in patients with dementia than other diseases, probably due to cognitive deficits. However, for some of the instruments, data were scarce, and interpretation of the results should be conservative. Although there are limited published QOL studies in glaucoma, its impact on QOL appears to be broadly similar to that of other serious chronic diseases. Development of a QOL instrument that measures vision-specific and general health aspects would better document the impact of glaucoma on QOL and would facilitate comparisons with other chronic disease states.

Associations of eye diseases and symptoms with self-reported physical and mental health

PURPOSE

To study the associations of eye diseases and visual symptoms with the most widely used health-related quality-of-life (HRQOL) generic profile measure.

DESIGN

HRQOL was assessed using the short form-36 (SF-36) version 1 survey administered to a sample of patients receiving care provided by a physician group practice association.

METHODS

Eye diseases, ocular symptoms, and general health were assessed in a sample of patients from 48 physician groups. A total of 18,480 surveys were mailed out and 7,093 returned; 5,021 of these had complete data. Multiple linear regression models were used to examine the decrements in self-reported physical and mental health associated with eye diseases and symptoms, including trouble seeing and blurred vision.

RESULTS

Nine percent of the respondents had cataracts, 2% had age-related macular degeneration, 2% glaucoma, 8% blurred vision, and 13% trouble seeing. Trouble seeing and blurred vision both had statistically unique associations with worse scores on the SF-36 mental health summary score. Only trouble seeing had a significant association with the SF-36 physical health summary score. While these ocular symptoms were significantly associated with SF-36 scores, having an eye disease (cataracts, glaucoma, and macular degeneration) was not, after adjusting for other variables in the model.

CONCLUSIONS

Our results suggest an important link between visual symptoms and general HRQOL. The study extends the findings of prior research to show that both trouble seeing and blurred vision have independent, measurable associations with HRQOL, while the presence of specific eye diseases may not.

Glaucoma and disability: which tasks are affected, and at what stage of disease?

PURPOSE OF REVIEW

To summarize recent work from clinical and epidemiological studies that describe how, and at what stage, glaucoma affects the performance of important vision-related activities.

RECENT FINDINGS

Difficulties with the extremes of lighting are the most frequent complaint in glaucoma. Individuals with bilateral glaucoma also self-report difficulty with a broad array of tasks, including reading, walking, and driving. Bilateral glaucoma is associated with driving cessation and limitation, bumping into objects, slower walking, and falls. Some, but not all, studies also demonstrate higher accident rates in glaucoma. Measurable effects on reading speed have only been observed with field damage severe enough to affect binocular central acuity.

SUMMARY

Glaucoma with bilateral visual field loss is associated with increased symptoms and a measurable decline in mobility and driving. Further work is necessary to establish whether unilateral glaucoma has a significant impact on patients, to determine whether reading difficulty is common in patients with bilateral glaucoma, and to establish the effects of lighting conditions on task performance in glaucoma.

Impact of visual field loss on health-related quality of life in glaucoma: the Los Angeles Latino Eye Study

PURPOSE

To examine the association between health-related quality of life (HRQOL) and visual field (VF) loss in participants with open-angle glaucoma (OAG) in the Los Angeles Latino Eye Study (LALES).

DESIGN

Population-based cross-sectional study.

PARTICIPANTS

Two hundred thirteen participants with OAG and 2821 participants without glaucoma or VF loss.

METHODS

Participants in the LALES-a population-based prevalence study of eye disease in Latinos 40 years and older, residing in Los Angeles, California-underwent a detailed eye examination including an assessment of their VF using the Humphrey Automated Field Analyzer (Swedish interactive thresholding algorithm Standard 24-2). Open-angle glaucoma was determined by clinical examination. Mean deviation scores were used to assess severity of VF loss. Health-related QOL was assessed by the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) and 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Linear regression and analysis of covariance were used to assess the relationship between HRQOL scores and VF loss after adjusting for sociodemographic variables and visual acuity.

MAIN OUTCOME MEASURES

The 25-item NEI-VFQ and SF-12 scores.

RESULTS

A trend of worse NEI-VFQ-25 scores for most subscales was observed with worse VF loss (using both monocular and calculated binocular data). Open-angle glaucoma participants with VF loss had lower scores than participants with no VF loss. This association was also present in participants who were previously undiagnosed and untreated for OAG (N = 160). Participants with any central VF loss had lower NEI-VFQ-25 scores than those with unilateral or bilateral peripheral VF loss. There was no significant impact of severity or location of VF loss on SF-12 scores.

CONCLUSION

Greater severity of VF loss in persons with OAG impacts vision-related QOL. This impact was present in persons who were previously unaware that they had glaucoma. Prevention of VF loss in persons with glaucoma is likely to reduce loss of vision-related QOL.

Developing a Preference-Based Glaucoma Utility Index Using a Discrete Choice Experiment

PURPOSE

To estimate a utility-based glaucoma health outcome measure, known as the Glaucoma Utility Index.

METHODS

Based on focus group studies, involving people with glaucoma, existing profile measures relevant to glaucoma were modified and a six-dimensional profile instrument was developed. Dimensions were: central and near vision; lighting and glare; mobility; activities of daily living; eye discomfort and other effects. Each dimension was assigned four levels (no difficulty; some difficulty; quite a lot of difficulty; and severe difficulty). The discrete choice experiment (DCE) approach was employed to move from this profile instrument to a preference-based utility measure. Experimental design techniques were used to derive a sample of health states for which preferences were elicited using the DCE. Four hundred and seventy-three people with glaucoma received the choice questionnaire.

RESULTS

The regression analysis was based on 286 consistent responses to the DCE. The regression coefficients for three of the dimensions ("central and near vision," "mobility," and "activities of daily living") moved as expected. Moving from "no difficulty" to "severe difficulty" for central and near vision resulted in the most loss of utility, followed by activities of daily living and mobility. Systemic ("other effects") and local side effects were considered the least important. Utility weights were related to self-reported glaucoma state. Utility estimates moved in line with generic measures of health outcome.

CONCLUSIONS

This study developed a preference-based utility measure (Glaucoma Utility Index) using the DCE approach. The index, estimated on the basis of 286 respondents, demonstrated both theoretical and convergent validity with other generic health outcome measures and measures of glaucoma severity. Further research investigating preferences by clinically defined glaucoma health status is indicated. Methodological research should focus on alternative methods of scaling for use within a generic Quality Adjusted Life Year framework.