青光眼与生存质量

青光眼是当今世界范围内的主要致盲性眼病,严重影响患者的生存质量。随着医学模式的转变,单纯观察视功能的变化已不能够全面反映疾病对患者的影响,生存质量作为一种较全面的体现新的健康观和医学模式的评价体系已经引入眼科领域,是传统视功能评价方法的有益补充。本文就国内外与视觉相关的生存质量的研究进展及青光眼患者的生存质量状况和如何提高他们的生存质量作一综述。     

Vision-related quality of life and visual function after retinal detachment surgery

PURPOSE: To compare the vision-related quality of life (VR QOL) after rhegmatogenous retinal detachment (RD) surgery with that of normal controls and to investigate the relationship between the VR QOL and visual function after surgery for RD. DESIGN: Prospective, consecutive, comparative case series. METHODS: The 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25) was self-administered by 51 RD patients at six months after surgery. Among the patients with RD, 33 underwent pars plana vitrectomy and 18 received scleral buckling. We examined the logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), contrast sensitivity with the CSV-1000E (Vector Vision Co, Greenville, Ohio, USA), and low-contrast visual acuity (VA) with the CSV-1000LanC10% (Vector Vision Co). From the data obtained by CSV-1000E, the area under the log contrast sensitivity function (AULCSF) was calculated. The VFQ-25 also was administered to the 46 age-matched normal controls. RESULTS: The VFQ-25 composite score and the subscales associated with near activities, mental health, dependency, and peripheral vision were significantly lower in the RD group than in the normal controls (P < .05). The VFQ-25 composite score significantly correlated with AULCSF (r = 0.354; P < .05) and low-contrast VA (r = -0.475; P < 0.001), whereas there was no correlation between the VFQ-25 composite score and logMAR BCVA (r = 0.172; P = .229). CONCLUSIONS: The VR QOL is significantly impaired in patients after surgery for RD. The disturbance in VR QOL was significantly associated with deterioration of postoperative contrast sensitivity.     

Gains from cataract surgery: visual function and quality of life.

AIMS: To describe the impact of cataract surgery in terms of visual function (functioning in everyday life with respect to vision dependent activities) and health related quality of life. METHODS: An observational, longitudinal study of patients undergoing cataract surgery was carried out at three district general hospitals in outer London districts of North Thames Region with follow up at 4 and 12 months postoperatively for a clinical assessment and a standardised administered interview. Patients were admitted for surgery to the first eye for age-related cataract between 1 May 1993 and 31 August 1994. Visual functioning was assessed by the VF-14, health related quality of life was assessed by the sickness impact profile (SIP), and vision related quality of life was assessed by VR-SIP (a modification of the generic SIP). RESULTS: Significant gains in all the outcome measures were demonstrated at 4 months postoperatively. No significant change (gain or loss) was observed between 4 and 12 months after surgery to the first eye. Postoperatively, the mean visual function (VF-14) scores, and health related (SIP) and vision related (VR-SIP) quality of life scores, indicated less reported trouble with vision dependent activities and better perceived quality of life, respectively. The average gains in visual function and quality of life (health and vision related) were apparent in groups with good visual outcome and poor visual outcome. Significant additional gains were seen at 1 year in patients who had second eye surgery in the interval between the postoperative assessments. CONCLUSIONS: Gains in visual functioning and quality of life (health and vision related) have been demonstrated following cataract surgery. These gains were sustained at 1 year after surgery to the first eye, with additional gains being conferred if second eye surgery had been performed. Assessment of the outcomes of cataract surgery by clinical indicators alone may underestimate the overall benefits of surgery, particularly in patients with poor visual outcome.     

中老年人群视功能和生存质量的研究

目的 评价中老年人群中视功能损害的主观视功能和生存质量。方法 对广东省斗门县随机整群抽样法抽取的所有５０岁以上的中老年人进行问卷调查,由５名问卷调查员,使用视功能和生存质量（ｖｉｓｕａｌ ｆｕｎｃｔｉｏｎ ａｎｄ ｑｕａｌｉｔｙ ｏｆ ｌｉｆｅ,ＶＦ ａｎｄ ＱＯＬ）问卷,对所有至少１只眼日常生活视力低于０．１的受检者（视功能损害组）和部分双眼视力均高于０．３（正常对照组）的受检者进行问卷调查。结     

Assessment of visual function after corneal transplantation: the quality of life and psychometric assessment after corneal transplantation (Q-PACT) study

PURPOSE: Many patients with successful corneal grafts have poor vision postoperatively. This study evaluates changes in vision-related quality of life after penetrating keratoplasty (PK). DESIGN: Multicenter prospective cohort study. METHOD: Penetrating keratoplasty candidates from the university-affiliated ophthalmology clinics of four participating centers were enrolled and followed up prospectively. We used the PK-VFQ, a modified version of the Visual Function Index-14, combined with clinical examinations before and at 6 and 12 months after PK. We used multivariate linear regression models to examine predictors of change in PK-VFQ scores. RESULTS: We studied 74 grafts in 71 eyes of 67 patients aged 23 to 91 (mean, 61) years who were followed up for at least 6 months. Indications for surgery included bullous keratopathy (27%), scarring (16%), keratoconus (16%), dystrophies (16%), and regrafts (15%). Median preoperative visual acuity was 20/200 in the graft candidate and 20/30 in the best eye. Median best-corrected postoperative visual acuity in the operated eyes was 20/60 at 6 months. PK-VFQ scores improved at 6 months in 79% by an average of 13.0 points (range, -16.7 to 67.5). Improvement in PK-VFQ scores was associated with younger age (P =.04), poorer preoperative visual acuity in the best eye (P =.001), and postoperative contact lens use (P =.04) but not with postoperative acuity in the grafted eye (P =.49). Postoperatively, 80% of patients were moderately to very satisfied with their vision, and 97% of patients stated they would have the surgery again. CONCLUSIONS: Improvement in visual function is inversely associated with visual acuity in the better-seeing eye but does not correlate with the postoperative acuity in the grafted eye. Although most keratoplasties are done unilaterally in the setting of good visual acuity in the contralateral eye, for the majority of patients visual function improves after PK.     

白内障患者超声乳化术后视功能和生存质量的调查研究

目的评价白内障超声乳化术后患者的视力、视功能(visual function,VF)和生存质量(quality of life,QOL)。方法随访检查172例(205眼)白内障超声乳化术后6~36个月患者的日常生活视力。用尼泊尔眼病调查视力分级标准进行日常生活视力检查分级,同时由调查员采用美国眼科研究所开发的VF和QOL调查表进行现场问卷调查。结果本组病例平均VF得分为79.00±15.46,与视力等级的相关系数为-0.4,与远视力等级回归系数为-7.769,经t检验(t=-7.12,P=0.000)有统计学意义;与术前眼疾手术史的回归系数为-6.5059,经t检验(t=-2.92,P=0.004)有统计学意义。平均QOL得分为89.35±13.97,与视力等级的相关系数为-0.59。QOL与远视力等级的回归系数为-8.2867,经t检验(t=-9.27,P=0.000)有统计学意义。经方差分析术后不同时间组平均VF得分(F=1.09,P=0.3398)和QOL得分(F=0.62,P=0.5407)差别无统计学意义。结论白内障超声乳化术后6~36个月患者的VF和QOL状况稳定。     

年龄相关性黄斑变性患者治疗后视功能及生活质量评价

目的：评估由雷珠单抗转为康柏西普治疗的年龄相关性黄斑变性(ARMD)患者治疗后视功能及生活质量情况。

方法：选取2016-01/2017-08我院收治的因雷珠单抗治疗疗效不佳转为康柏西普治疗的新生血管性ARMD患者20例29眼,比较行玻璃体腔注射康柏西普治疗前和治疗第4mo患者最佳矫正视力(BCVA)、对比敏感度(CS)、中央视网膜厚度(CRT)及生活质量评分情况。

结果：治疗第4mo,患者BCVA较治疗前改善,差异有统计学意义(P<0.05); OCT检测CRT较治疗前降低,差异有统计学意义(P<0.05); 各空间频率CS均较治疗前改善,差异均有统计学意义(P<0.05); NEI VFQ-25评分总分及各项目评分均较治疗前提高,差异均有统计学意义(P<0.05)

结论：玻璃体腔注射康柏西普治疗ARMD可明显改善患者的视功能和生活质量。     

The importance of the phase transfer function to visual function and visual quality metrics

PURPOSE: To propose a vision quality metric that directly incorporates the phase transfer function. METHODS: The process of retinal image formation from the pupil to the retina is presented to identify possible domains for calculating vision quality metrics. These domains are pupil plane metrics using ocular aberrations, and retinal plane metrics using the point spread function or optical transfer function. The importance of the phase transfer function to visual performance is demonstrated and a method is proposed for directly including phase in a vision quality metric based on ocular wavefront error. RESULTS: A family of vision quality metrics is proposed, which directly incorporates the Stiles-Crawford effect, contrast sensitivity function, and the phase transfer function. CONCLUSION: The phase transfer function is an important aspect of the quality of an image, and it may be directly included in metrics intended to quantify vision quality.     

Cataract surgical outcomes, visual function and quality of life in four rural districts in Vietnam

Background: To evaluate cataract surgical outcomes in four rural districts of Ha Tinh Province, Vietnam. Design: Cross‐sectional study. Participants: Post‐cataract surgery patients sampled randomly from facilities in four rural districts of Ha Tinh Province >3 months after surgery. Main Outcome Measures: Postoperative visual acuity (VA), visual function and quality of life. Results: Among 412 patients, the mean age was 74.5 ± 9.4 years, 67% (276) were female, and 377 (91.5%) received intraocular lenses (IOL). Nearly two‐thirds of patients had no postoperative visits after discharge. Postoperatively, more than 40% of eyes had presenting VA <6/18, while 20% remained <6/60. The mean self‐reported visual function and quality of life for all patients were 68.7 ± 23.8 and 73.8 ± 21.6, respectively. Most patients (89.5%) were satisfied with surgery and the majority (94.4%) would recommend surgery to others. One‐third of patients paid ≥$US50 for surgery. In multiple regression modelling, older age (P < 0.01), intraoperative complications (P < 0.01) and failure to receive an IOL (P < 0.01) were associated with postoperative VA <6/60. Conclusion: Satisfaction with surgery was high, and many patients were willing to pay for their operations. Poor visual outcomes were common; however, and better surgical training is needed to reduce complications and their impact on visual outcomes. More intensive postoperative follow‐up may also be beneficial.     

开角型青光眼药物对患者身心健康的影响

目的:评价原发性开角型青光眼(primary open angle glaucoma,POAG)患者的心理和生活质量状况并分析其影响因素。方法:采用前瞻性临床对照的方法,对60例POAG患者分别采用青光眼生活质量-15中文版(Glaucoma Quality of Life-15,GQL-15)和综合医院焦虑抑郁量表(Hospital Anxiety and Depression Scale,HADS)中文版评定患者最近1mo的生活质量和焦虑、抑郁状况,给予降压药物干预后1mo再次进行评定。60例健康自愿者作为对照,分析其心理和生活质量变化情况。结果:POAG患者焦虑、抑郁及共患患者发生率分别为33.3%,26.7%,13.4%。患者抑郁焦虑评分及GQL评分与病程、眼压、年龄、药物种类和价格成正相关(P<0.05),与平均月收入、视力成负相关(P<0.05)。通过降压药物干预,患者焦虑、抑郁评分及生活质量评分明显好转(F焦虑评分=9.54,F抑郁评分=6.88,FGQL评分=8.82;P<0.05)。结论:POAG患者焦虑、抑郁状况加重,生活质量明显降低。患者抑郁焦虑评分及生活质量评分与病程、年龄、平均月收入、药物种类、药物价格、视力、眼压、视野等方面紧密相关。降压药物干预有助于青光眼患者生活质量和心理逐步康复。     

Contribution of multiple glaucoma medications to visual function and quality of life in patients with glaucoma.

BACKGROUND: Previous studies examining the correlation between medical treatment and overall quality of life in patients with glaucoma assessed differences between a glaucoma population and a matched group (without glaucoma) and were not aimed specifically at detecting a relation between visual acuity, visual field status and medication use, and visual function and quality of life. We performed a study to determine this relation in patients with chronic open-angle glaucoma (COAG). METHODS: The study was cross-sectional. Of 235 English-speaking patients with a diagnosis of COAG, normal-pressure glaucoma or suspected glaucoma (receiving therapy) seen in a university-based glaucoma practice between Feb. 1 and Apr. 30, 1998, 224 (95.3%) agreed to participate. All subjects completed two questionnaires: the Visual Function Assessment and the EQ-5D, assessing health status (quality of life). Visual acuity, diagnosis, age, sex, country of birth, type and number of medications for topical and for oral use, dosage, and history of laser treatment and surgery were extracted from the medical record. Pearson rank correlation and multivariate analyses were performed. RESULTS: On univariate analysis visual function was correlated with age, visual acuity, number of glaucoma medications, number of applications of eyedrops, mean deviation in better eye, mean deviation in worse eye, and lower hemifield involvement in both eyes. On multivariate analysis only visual acuity and visual field status were independently associated with visual function. Univariate analysis showed that health status was correlated with age, visual function and number of medications for oral use; however, age failed to retain statistical significance in the regression analysis. INTERPRETATION: Our results suggest that the number of glaucoma medications is not predictive of quality of life.     

Glaucoma visual fields and filtering operations

Visual field defects already existing in 81 eyes prior to goniotrepanation (Elliot-Fronimopoulos) were followed up for up to 84 months postoperatively. In 11 eyes there were slight peripheral limitations due to cataract formation. In all of the other cases the visual fields were unchanged.     

视觉质量评价方法的研究进展

人眼视觉质量的评价一直是眼科学和视觉光学领域关注的重要问题,主要分为主观评价法和客观评价法,评价指标包括视力、对比敏感度、波前像差以及视网膜散射光分析等.另外,根据不同的原理和标准,成像质量评价方法还可以分为视觉屈光系统和视网膜-神经系统评价、几何光学和物理光学评价、静态和动态的视功能评价,选择视觉质量的评价方法应从多个角度进行综合考虑.近年来,视觉质量评价方法不断发展,连续性功能性视力的评价受到更多关注.本文就视觉质量评价方法的研究进展进行综述.     

Severity of visual field loss and health-related quality of life

PURPOSE: To examine the association between severity of visual field loss (VFL) and self-reported health-related quality of life (HRQOL) in a population-based sample. DESIGN: Population-based cross-sectional study. METHODS: Participants in the Los Angeles Latino Eye Study (LALES) underwent a comprehensive ophthalmic examination including visual field testing by the Humphrey Automated Field Analyzer II (Swedish Interactive Thresholding Algorithm [SITA] Standard 24-2) [Carl Zeiss Meditec, Dublin, California, USA]. Mean deviation (MD) scores were used to determine severity of VFL both as a continuous variable and stratified by severity: no VFL (MD >or= -2 decibels [dB]), mild VFL (-6 dB < MD < -2 dB), and moderate to severe VFL (MD < -6 dB). HRQOL was assessed by the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) and the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Linear regression analyses and analysis of covariance were used to assess the relationship between HRQOL scores and VFL. RESULTS: Of the 5,213 participants included in this study, 18% had unilateral mild, 1.5% unilateral moderate to severe, 19% bilateral mild, and 6.5% bilateral moderate to severe VFL. Worse NEI-VFQ-25 and SF-12 HRQOL scores were associated with VFL in a linear manner. Four- to 5-dB differences in VFL were associated with a five-point difference in the NEI-VFQ-25 composite and most subscale scores. Persons with VFL had the greatest difficulty with driving activities, dependency, mental health, distance vision, and peripheral vision. CONCLUSIONS: HRQOL is diminished even in persons with relatively mild VFL on the basis of MD scores. Prevention and management of persons with VFL may be important in preventing or reducing poor HRQOL related to difficulties in driving, distance and peripheral vision activities, and a sense of dependency.