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。     

青光眼患者生存质量的研究进展

青光眼是当今世界范围内不可逆盲的主要病因,同时也是导致视力丧失的主要原因之一。青光眼的症状、视功能的损害以及各种对症的治疗方式、不良反应使患者的日常生活、社会活动受到不同程度的限制,使患者的心理、社会和经济等方面受到影响,极大地影响患者的健康。就青光眼患者生存质量（QOL）测评的意义及工具、影响青光眼患者QOL的因素以及如何提高他们的QOL进行综述。     

青光眼与生存质量的关系

目的:了解青光眼患者视功能损害与生存质量的关系,探讨影响青光眼患者生存质量的主要因素。方法:应用视功能损害眼病生存质量量表测量60例有不同程度视功能损害的慢性闭角型青光眼及开角型青光眼患者的生存质量情况。结果:青光眼患者的视功能改变与生存质量之间存在相关关系(r=0.66,P=0.000),影响青光眼患者生存质量的主要因素是视功能损害,性别及职业。结论:青光眼患者视功能损害降低病人的生存质量,生存质量测量为青光眼筛检及治疗方案选择提供新的指标。眼科学报 1996;12:183～187。     

心理干预对青光眼患者生存质量影响的临床研究

目的 探讨心理干预对青光眼患者生存质量的影响,为青光眼的护理干预提供科学依据和对策.方法 采用视功能损害眼病患者生存质量量表、健康促进生活方式量表和自行设计的焦虑相关因素调查问卷对患者分别在人院前、手术前后、出院前进行评估.结果 实验组和对照组比较,心理干预后实验组与对照组焦虑评分、生存质量总评分、精神与心理方面评分、症状与视功能方面评分以及医患顺应性有显著差异(P<0.01).身体机能、社会活动方面评分无显著差异(P>0.05).健康行为与婚姻家庭状况、文化教育程度、心理干预、经济状况、社会支持、青光眼症状发作显著相关(P<0.01).结论 心理干预可以明显缓解青光眼患者住院期间情绪波动所造成的发作性症状,改善焦虑情绪及心理状态,提高住院期间视功能及相关生存质量.     

青光眼患者小梁切除术后生存质量的评价

目的:评价青光眼患者小梁切除术后的生存质量及其影响因素。方法:采用视功能损害患者生存质量量表对123例青光眼患者小梁切除术后的生存质量进行评价。结果:青光眼患者小梁切除术后的生活质量得分较低,视力损害严重影响着患者的生存质量得分,多因素逐步直线回归显示:影响总分的主要因素是视力损伤程度(β=-10.139,P=0.000)、健康教育(β=2.576,P=0.000)、手术次数(β=-3.598,P=0.002)及性别(β=3.807,P=0.013)。结论:青光眼患者小梁切除术后的生存质量得分较低,因此不仅要重视患者的临床治疗,在保护青光眼患者视功能的同时,根据患者的职业、经济状况等进行综合治疗,给予必要的健康教育和心理治疗,解除患者的心理问题,对提高患者的生存质量有重要的意义。     

生存质量测定在抗青光眼手术患者中的应用

目前传统视功能评价方法已不能充分反映青光眼对患者的影响,生存质量(quality of life,QOL)作为一种能较全面体现新的健康观和医学模式的评价方法已经开始用于青光眼的评价。我们就QOL的基本概念、在眼科的应用,特别是在接受抗青光眼手术患者中的研究进展和前景等方面进行综述。     

眼外伤患者的生存质量及其影响因素调查分析

目的　分析眼外伤患者的生存质量状况及其影响因素。方法　对 15 4例眼外伤患者的生存状况进行调查分析 ,采用多元逐步回归分析方法筛选影响生存质量的因素。结果　 15 4例眼外伤的住院病例的生存质量总评分的均值为 69 76分 ,其生存质量在症状及视功能 ( 3 2 45± 2 3 5 8)、身体机能 ( 16 75± 6 5 3 )、社会活动 ( 10 47± 8 80 )以及精神心理 ( 10 0 8± 7 65 )四个方面的评分均偏低。多元逐步回归模型显示 ,影响眼外伤患者生存质量的主要因素有 :工人职业 (Bs =-0 3 44)、热灼伤(Bs =-0 2 69)、拳击伤 (Bs =-0 2 40 )、手术次数 (Bs =-0 2 18)。结论　眼外伤严重地影响患者的生存质量 ,应加强眼外伤的预防 ,防患于未然。     

影响糖尿病视网膜病变患者生存质量主要因素的研究

目的 探讨我国糖尿病视网膜病变患者生存质量的主要影响因素,为提高患者的卫生保健水平和生存质量提供依据。 方法 应用健康状况调查问卷(SF-36)和世界卫生组织生存质量测量简表(WHOQOL-BREF)测量179例不同分期的糖尿病视网膜病变患者及30例健康对照组的生存质量情况,然后对资料进行相应的统计分析,筛选出有关的影响因素。 结果 筛出影响糖尿病视网膜病变患者相关性生存质量的主要因素有：性格、医疗照顾、经济状况、眼底病变程度、年龄及双眼综合视力等。 结论 实现生物医学模式向生物—心理—社会医学模式的转变对改善糖尿病视网膜病变患者的生存质量有重要的意义。 (中华眼底病杂志,2000,16:141-143)     

白内障术后生存质量分析及其影响因素的研究进展

随着医学模式的发展,白内障患者术后生存质量的评价比单纯术后视力测量更能全面体现手术对患者造成的生理及心理的改变.近年来学者们对不同的白内障手术方式、不同的人工晶状体(IOL)类型及术前术后等因素对白内障患者生存质量的影响进行了研究.此外,眼底病、术后残余屈光不正、眼表疾病及性别、年龄、社会心理学等因素也对患者术后生存质量产生一定的影响.眼科工作者不仅要关心白内障手术质量,还要了解患者对手术的期望值及具体要求,最大程度地提高白内障患者的生存质量.     

青光眼患者生活质量的研究进展

青光眼以其不可逆转的视神经损害、视野缺损及视力丧失为特征.其疾病本身和各种治疗都会明显限制青光眼患者的日常生活和社会活动,从而严重影响患者的生活质量.为此,有必要就目前有关青光眼患者的生活质量及其影响因素的研究资料予以综述,以供同道参考.(中华眼科杂志,2009,45:88-92)     

Quality of life in glaucoma patients after selective laser trabeculoplasty

AIM: To compare quality of life and treatment satisfaction between patients who had selective laser trabeculoplasty (SLT) and those on medication. METHODS: A prospective clinical trial on 143 glaucoma patients that received SLT and a control group that continued using anti glaucoma medication was conducted. Tear break-up time (BUT), punctuate keratitis, need for help, use of artificial tears and the treatment satisfaction survey of intraocular pressure (IOP) were measured at baseline, 6 and 12mo. RESULTS: SLT was able to reduce the mean number of medications needed from 1.56±0.81 to 0.42±0.66 at six months and to 0.33±0.69 at one year. Punctuate keratitis was observed significantly less often (12.24%) after SLT than before (35.94%; P=0.03). Use of artificial tears and BUT did not change significantly after SLT (P>0.05). At baseline, patients in the SLT group were significantly less convinced of medication effectiveness (P=0.006) and complained more about side effects (P=0.003). After SLT, these patients had significantly more confidence in their therapy (P<0.001), showed less side effects (P=0.006), complained less about changes in appearance of the eyes (P=0.003) and were less inconvenienced by the use of eye drops (P<0.001). CONCLUSION: SLT is able to improve treatment-related quality of life in glaucoma patients.     

Quality of life in glaucoma patients: Comparison of medical therapy,trabeculectomy, and glaucoma drainage device surgery

Purpose:To compare the quality of life (QoL) in patients with glaucoma on medical therapy and after trabeculectomy and glaucoma drainage device (GDD) using vision, glaucoma, and surgery-specific questionnaires.Methods:This cross-sectional study enrolled 30 patients of moderate to severe glaucoma, each in medical, trabeculectomy, and GDD groups. National Eye Institute Visual Function Questionnaire 25 (NEIVFQ-25), Glaucoma Quality of Life (GQL-15), and Surgery Specific Questionnaire (SSQ) were administered, and cumulative scores were compared.Results:The mean age of the participants was 58.95 ± 13.6 years with a male preponderance (73.3%, n = 66). The mean scores (SD) in the medical, trabeculectomy, and GDD groups using NEIVFQ-25 were 68.97 (6.98), 72.83 (7.81), and 75.20 (8.77), respectively, those using GQL-15 were 20.63 (6.00), 26.23 (9.12), and 28.43 (7.74), respectively, and for the SSQ, they were 74.33 (8.75) and 72.10 (5.92) in trabeculectomy and GDD groups, respectively. NEIVFQ-25 showed a better QoL in the GDD group compared to the medical group, whereas GQL-15 showed a better QoL in the medical group and comparable QoL in trabeculectomy and GDD. Both these QoL scores correlated to the LogMAR visual acuity. SSQ scores did not show a significant difference in the QoL across both surgical groups.Conclusion:NEIVFQ-25 questionnaire scores provided a holistic measure of QoL. GQL-15 assessed the activity limitation and visual disability of the patients but did not take into account the general health and psychological factors influencing the QoL. We did not find a significant difference between trabeculectomy and GDD using the SSQ. For QoL assessment in medically or surgically treated glaucoma, vision-specific and disease-specific questionnaires should always be used in conjunction.     

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

Purpose:

To evaluate the impact of initial topical medical therapy on newly diagnosed glaucoma patients using the Indian Vision Function Questionnaire (IND-VFQ33).

Patients and Methods:

The IND-VFQ33 was used to evaluate the quality of life (QoL) in 62 newly diagnosed patients with moderate to severe primary glaucoma and 60 healthy controls. IND-VFQ33 is a 33 item QoL assessment tool with three domains: General functioning, psychosocial impact and visual symptoms. The glaucoma patients were started on medical therapy and the QoL assessment was repeated after 3 months.

Results:

Glaucoma patients (mean age: 55.6 ± 9.6 years, range 40–77 years) and controls (mean age: 54.9 ± 6.7 years, 42–73 years) were matched with respect to age (P = 0.72), gender (P = 0.91) and literacy (P = 0.18). Glaucoma patients had significantly worse QoL as compared to controls at baseline across all the three domains (P < 0.001). 3 months after initiation of treatment, the overall QoL life significantly worsened from baseline with a decrease in general functioning (P < 0.001) and psychosocial impact (P = 0.041). Visual acuity in better eye significantly co-related to poor QoL at baseline (P < 0.001) and at 3 months (P = 0.04). In addition, the use of >2 topical medications significantly co-related to poor QoL at 3 months (P = 0.01).

Conclusions:

Evaluation using the IND-VFQ33 revealed that newly diagnosed glaucoma patients have a significant worsening of QoL after initiation of topical ocular hypotensive therapy. This should be an important consideration when educating patients about the disease and its therapy.     

209例眼外伤患者术后生存质量及其影响因子分析

目的调查眼外伤患者术后生存质量状况,并分析其影响因子。方法采用视功能损害眼病患者生存质量量表对209例手术眼外伤患者进行术后2周及术后3个月的调查。t检验比较术后凋及3个月的生活质量变化,针对术后3个月的生活质量进行逐步回归法分析其影响因子。结果209例眼外伤的生活质量总分及视功能、社会活动、精神心理、身体机能四方面的得分,术后2周和术后3个月相比,有明显的提高,差异具有统计学意义。多元回归分析筛选出5个主要影响因子：术后3月视力（Bs=0．355）、手术次数（Bs=-0．302）、爆炸伤（Bs=-0．275）、有医疗保险（Bs=0．240）、脑力劳动（Bs=-0．210）结论随着术后时间的推移,眼外伤患者的生存质量得到逐步的提高。根据术后生存质量的影响因子,不仅要重视患者的临床治疗,同时还要了解患者的职业、经济状况等,注重进行心理疏导,对提高眼外伤患者的生存质量有重要的意义。     

弱视患儿生活质量现状及其影响因素的研究

目的:调查弱视患儿生活质量现状及其影响因素。方法:本研究为横断面研究,采用随机抽样法,选取2021-03/05就诊于天津市眼科医院的178例弱视患儿作为研究对象,采用中文版儿童生存质量普适性核心量表对研究对象进行调查,分析弱视对儿童生活质量的影响。结果:纳入研究的弱视患儿生活质量总分平均分为77.23±15.52分,多元线性回归结果显示,父母学历、左眼BCVA、右眼BCVA、遮盖、早产、出生时缺氧、分娩方式是弱视患儿生活质量的主要影响因素,可解释弱视患儿生活质量38.6%的变异量(F=15.242,P<0.001)。结论:弱视患儿生活质量现状处于中等偏下水平,弱视可对儿童日常生活、学习、心理及社会交往产生较大的负面影响,需要对弱视患儿及其父母实施健康教育指导,提高遮盖治疗依从性,改善视力,加强对育龄年轻人优生优育的健康指导,为进一步提高弱视患儿的生活质量提供参考依据。