Impact of initial topical medical therapy on short-term quality of life in newly diagnosed patients with primary glaucoma

A comparative study of vision-related quality of life (VRQoL) among glaucoma and nonglaucoma patients at a tertiary care center of North India

Purpose

Glaucoma influences vision-related quality of life (VRQoL) of an individual in various ways. There are very limited studies on the Indian population and the northern part of India. Therefore, we conducted the present study to evaluate VRQoL in glaucoma patients as well as the association between the severity of glaucoma and VRQoL.

Methods

An institution-based, cross-sectional, analytical study was conducted from August 2022 to October 2022 involving 190 participants (95 glaucoma patients and 95 controls). The glaucoma quality of life-15 (GQL-15) questionnaire was explained in their vernacular language by the interviewer. The scoring was given according to the validated scoring algorithm for the questionnaire.

Results

Mean GQL score in the control group was 19.66 ± 5.5 and in glaucoma cases was 32.8 ± 10.2, whereas the mean score of mild glaucoma cases was 22.3 ± 4.83, moderate glaucoma cases was 36.3 ± 4.09, and severe glaucoma cases was 47.24 ± 3.03. Therefore, as the severity of glaucoma increases, the GQL score also increases, indicating poorer quality of life. Visual field loss was strongly positively correlated (correlation coefficient = 0.759, P < 0.01) with the GQL-15 score, while a weaker positive correlation was found with best corrected visual acuity (BCVA), cup disc ratio, and duration of treatment.

Conclusion

Besides controlling or reducing intraocular pressure (IOP) to the target level, the goal of glaucoma treatment should be to provide an individual with good functional vision to maintain an acceptable quality of life. It would also help in providing patients with the best possible treatment, not only in terms of good vision but also in maintaining or improving their overall quality of life.

In search of disambiguation: development of eye drop bottle sleeves to aid in identification and survey among possible users. A cross-sectional study

BACKGROUND

Considerable numbers of individuals present low vision, blindness, illiteracy and other conditions that could possibly impair their identification of medications, such as eye drops. Through helping these individuals to identify their eye drops, they can achieve greater autonomy. Misidentification can be avoided through use of multisensory sleeves that can be adapted to most eye drop bottles. Correct use of eye drops is important for preventing progression of diseases like glaucoma that could potentially lead to blindness.

OBJECTIVE

To develop bottle sleeves to aid in identification of eye drops and then interview a group of possible users to evaluate the acceptance of the solution.

DESIGN AND SETTING

Cross-sectional survey performed at an ophthalmological clinic in São Paulo (SP), Brazil.

METHODS

We describe the development of multisensory sleeves to assist in identification of eye drops. To assess the acceptance of this solution, we interviewed 18 patients who were currently using three or more types of eye drops.

RESULTS

We developed four prototypes for eye drop bottle sleeves and conducted an acceptance test on them. Most of the patients who answered the survey about the sleeves were elderly. Most (95%) reported believing that the sleeves would help reduce the risk of mixing up eye drops with other medications that also dispense drops. They also believed that these would increase their autonomy in using eye drops.

CONCLUSION

The solution presented was well accepted and may help increase safety in using eye drops through preventing misidentification.

Low-energy Selective Laser Trabeculoplasty Repeated Annually: Rationale for the COAST Trial

The recent Laser in Glaucoma and Ocular Hypertension Trial provided the evidentiary basis for a paradigm shift away from the historical medication-first approach to glaucoma--which has numerous limitations, the most important of which is poor adherence to therapy --and toward a laser-first approach. Now 20 years after its commercialization, selective laser trabeculoplasty (SLT) is routinely performed consistently with its initial description, with energy titrated to the appearance of fine, champagne-like cavitation bubbles. A recent data set suggested that lower energy SLT, applied as primary therapy and repeated annually irrespective of intraocular pressure--rather than pro re nata when its effect wanes and irrespective of intraocular pressure rises --yields longer medication-free survival than standard energy SLT repeated pro re nata. A new study--Clarifying the Optimal Application of SLT Therapy --has been initiated to explore this preliminary finding in a pair of consecutive randomized trials. Herein, we provide an evidence-based rationale for the use of low-energy SLT repeated annually as primary therapy for mild to moderate primary open-angle glaucoma or high-risk ocular hypertension.

Psychometric Assessment of the Chinese Version of the Indian Vision Functioning Questionnaire Based on the Method of Successive Dichotomizations

Purpose

The purpose of this study was to assess whether a Chinese translated version of the 33-item Indian Vision Function Questionnaire (IND-VFQ-33) forms a valid measurement scale and to evaluate its psychometric properties based on the method of successive dichotomizations (MSD).

Methods

The English version of the IND-VFQ-33 was translated, back translated, and cross-culturally adapted for use in China. It was interviewer administered to patients with cataracts. MSD, a polytomous Rasch model that estimates ordered thresholds, was used to assess and optimize psychometric properties of the overall scale and three subscales separately.

Results

One hundred and seventy-nine patients provided complete responses. After the removal of 2 misfitting items, a revised 31-item overall scale demonstrated adequate precision (person reliability [PR] = 0.92) and no misfitting items. The general functioning subscale fit the MSD model well after removing two misfitting items. The psychosocial impact subscale and the visual symptoms subscale were not considered further due to poor measurement precision. After addressing psychometric deficiencies, a 31-item overall scale (IND-VFQ-31-CN) and a 19-item general functioning subscale (IND-VFQ-GF-19-CN) were developed.

Conclusions

The original IND-VFQ-33 required re-engineering to form valid measures for use in China. The revised overall scale and general functioning subscale demonstrated adequate MSD based psychometric properties.

Translational Relevance

The revised IND-VFQ-33 is a valid patient-reported outcome assessment for Chinese patients with cataract based on MSD analysis.

Evaluation of Vision-related Quality of Life in Patients with Glaucoma: A Hospital-based Study

Introduction

Quality of life (QoL) is a broad concept that is affected in a complex way by many factors. Healthcare interventions are targeted now days to improve quality of life of affected individuals. Glaucoma is a major cause of irreversible blindness throughout the world and affects patient's quality of life in several ways. In present study, we aim to evaluate and quantify vision related quality of life in glaucoma patients in a tertiary care hospital setting.

Materials and methods

Vision related quality of life was evaluated in glaucoma patients using GQL-15 questionnaire, which compares the subjective performance of various vision related tasks in these patients. Fifty diagnosed cases of glaucoma and fifty healthy volunteers were included in the study. In both these groups, standard tests for visual function were done and both were assigned to complete the questionnaire. GQL-15 questionnaire includes 15 items divided between 4 factors pertaining to visual disability: central and near vision, peripheral vision, dark adaptation and glare, and outdoor mobility. Higher scores indicate greater difficulty in performing vision-related activities and poorer QoL.

Results

A total of 100 cases were enrolled out of which 50 were diagnosed glaucoma cases and 50 were controls. Almost three fourth of glaucoma patients, i.e., 72% were diagnosed as chronic open angle glaucoma where 24% were angle closure patients and rest 4% were normal tension glaucoma patients. The mean GQL score of glaucoma cases was 26.00 ± 10.84 and for controls it was 15.02 ± 0.14 (p value < 0.05). All subscale scores also showed a uniform rise in their value as we move from mild to severe cases thereby concluding that all visual parameters worsen with increase in severity pattern of disease.

Conclusions

As glaucoma patients have reduced vision related quality of life, so every effort should be made to preserve visual functions in these patients. Many activities that define independence and productivity in society require good vision and hence one of most devastating consequences of advancing visual impairment in glaucoma is progressive loss of independence thereby affecting patients quality of life.

How to cite this article

Dhawan M, Hans T, et al. Evaluation of Vision-related Quality of Life in Patients with Glaucoma: A Hospital-based Study. J Curr Glaucoma Pract 2019;13(1):9–15.