Comparison on the vision‐related quality of life between outpatients and general population with dry eye syndrome

Purpose: To compare the impact of dry eye syndrome (DES) on vision‐related quality of life (VR‐QoL) between outpatients and general populations. Methods: This cross‐sectional comparative study enrolled 154 participants, 77 outpatients and 77 general participants, all of whom met the diagnostic criteria of DES. Apart from the collection of sociodemographic and clinical data, the Chinese version of 25‐item National Eye Institute Visual Functioning Questionnaire (NEI VFQ‐25) and Ocular Surface Disease Index Questionnaire (OSDI) were administered. Main outcome measures include the comparison on the OSDI score and VFQ‐25 score between two groups, and their correlation with sociodemographic and clinical data. Results: The two groups were comparable concerning sociodemographic parameters except that the outpatients were better educated (χ² = 18.609, p < 0.001). The ophthalmic data related with DES did not have statistically significant differences between two groups except that the proportion of subjects with positive corneal fluorescein staining (CFS) was higher in outpatients (χ² = 21.296, p < 0.001). The outpatients reported significantly higher OSDI scores and lower VFQ‐25 scores. The VFQ‐25 composite score had negative correlation with the OSDI score of all participants or that of outpatients solely (ρ = ?0.247 and ?0.397, p = 0.030 and 0.000, respectively). Among outpatients, the value of Schirmer test (ST), tear film breakup time (TBUT) and CFS in the eyes with worse DES had significant correlations with the OSDI overall scores, while TBUT and CFS of both eyes correlated with the VFQ‐25 composite score. Conclusions: DES exerts more adverse impact on VR‐QoL in outpatients than general patients. The impairment of VR‐QoL has a significant correlation with the severity of DES.     

Dry‐eye syndrome after allogeneic stem‐cell transplantation in children

Purpose: To report the prevalence of dry‐eye syndrome (DES) in children and young adults treated with allogeneic stem‐cell transplantation (SCT) during childhood; to relate DES to conditioning regimes, including total body irradiation (TBI) and chemotherapy, and to immunosuppressive drugs and graft‐versus‐host disease (GVHD). Methods: This cross‐sectional study included 60 children/young adults transplanted because of leukaemia, various haematological disorders and inborn errors of metabolism between 1986 and 2004, with a follow‐up time of 7.0 years (median, range 2–18). Clinical assessments, performed at a median age of 15.6 years (range 5.5–23.5), included an inquiry form on dry‐eye symptoms, corneal status including fluorescein staining, ‘break‐up time’ (BUT) and Schirmer test. Results: A total of 37 of 60 patients had DES defined as presence of corneal epithelial lesions with a pathological BUT and/or Schirmer test. Twenty‐nine had had staining <1–10% of the corneal surface while eight patients had staining ≥10–25% of the corneal surface. All 37 patients with objective signs of DES, graded and not graded, had significant associations to subjective symptoms of dry eyes including dry eyes, red eyes, ocular irritation, secretion and sensitivity to light. Frequent occasions (above median; n = 7) of high cyclosporine A trough levels above 250 ng/ml were associated significantly with DES (P = 0.002). However, there was no association between DES and conditioning with single‐dose (s‐TBI) or fractionated TBI (f‐TBI), busulfan or other chemotherapy. There were no associations between prolonged corticosteroid treatment or chronic GVHD and DES in the present study. DES was more common in patients with malignant diseases (P = 0.02). Malignant disease increased the risk of DES in girls but not in boys. Increased age at SCT increased the risk for DES in boys but not in girls (P = 0.02). Although severe keratitis occurred in three patients, nobody suffered corneal perforation. Conclusion: DES with epithelial punctata keratopathy was common in children/young adults treated with SCT and more common if the patients were exposed to repeated high trough levels of cyclosporine A; however, DES was not associated with irradiation, corticosteroids or GVHD in the present study. Patients with objective DES also had subjective symptoms of dry eyes, which facilitate diagnosis. Girls with malignant diseases and boys who underwent SCT at later ages seem to demand higher attention and more frequent check‐ups regarding DES. Patients with diagnosed severe DES needed frequent and continuous ophthalmological care to maintain treatment motivation.     

造血干细胞移植术后的眼部观察

目的 观察造血干细胞术后移植物抗宿主病(GVHD)及预处理措施对眼部的影响。方法 对35例行造血干细胞移植患者的眼科检查进行回顾性分析。结果 35例中慢性GVHD14例，占异基因造血干细胞移植的70％。其中8例合并有干眼，占GVHD患者的57．14％；6例睑板腺功能障碍并伴有干眼。眼部其他并发症有结膜瘢痕、睑球粘连、角膜溃疡、白内障、急性结膜炎、眼底出血或结膜出血。自体造血干细胞移植不出现移植物抗宿主病及干眼。结论 干眼是异基因造血干细胞移植术后的主要眼部并发症，仅见于发生GVHD的患者。异基因造血干细胞移植的眼部并发症明显高于自体干细胞移植。     

Vision‐related function after low‐dose transpupillary thermotherapy versus photodynamic therapy for neovascular age‐related macular degeneration

Purpose: To compare the effects of low‐dose transpupillary thermotherapy (TTT) and verteporfin photodynamic therapy (PDT) on patient‐reported visual function using the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ‐25) in patients with occult neovascular age‐related macular degeneration (AMD). Methods: Patients were randomized to receive either low‐dose TTT (and sham PDT) (n = 52) or PDT (and sham TTT) (n = 46). Patients were followed for 12 months with retreatment according to clinical assessment. The clinical outcome of this study has been recently reported. The NEI VFQ‐25 questionnaire was administered at baseline and at 12 months. Results: Forty‐two patients (80.1%) in the TTT group and 37 patients (80.0%) in the PDT group completed the questionnaire at the 12‐month follow‐up. The mean change in the NEI VFQ‐25 composite score was +1.2 for the TTT group (p > 0.05) and +0.7 for PDT group (p > 0.05). None of the subscale categories showed significant changes between treatment groups at 12 months. Subgroup analysis showed that NEI VFQ‐25 scores were lower in patients treated in their better‐seeing eye. Conclusion: In this randomized study on patients with occult neovascular AMD, low‐dose TTT and PDT appeared to be equally potent at stabilizing patient‐reported visual function. However, the study was underpowered for this conclusion to be made firmly. Also, given the impressive results obtained with ranibizumab for all types of neovascular AMD, neither PDT nor low‐dose TTT should be considered as first‐line treatments.     

Acupuncture for treating dry eye: a randomized placebo‐controlled trial

Acta Ophthalmol. 2010: 88: e328–e333

Abstract.

Purpose: To evaluate the efficacy and safety of acupuncture for ocular symptoms, tear film stability and tear secretion in dry eye patients. Methods: This is a randomized, patient‐assessor blinded, sham acupuncture controlled trial. Forty‐two participants with defined moderate to severe dry eye underwent acupuncture treatment three times a week for 3 weeks. Seventeen standard points (GV23; bilateral BL2, GB14, TE23, Ex1, ST1 and GB20; and unilateral SP3, LU9, LU10 and HT8 on the left for men and right for women) with ‘de qi’ manipulation for the verum acupuncture group and seventeen sham points of shallow penetration without other manipulation for the sham group were applied during the acupuncture treatment. Differences were measured using the ocular surface disease index (OSDI), the visual analogue scale (VAS) of ocular discomfort, the tear film break‐up time (BUT) and the Schimer I test with anaesthesia. In addition, adverse events were recorded. Results: There were no statistically significant differences between results on the OSDI, VAS, BUT or Schimer I tests from baseline between the verum and sham acupuncture groups. However, results from the within‐group analysis showed that the OSDI and VAS in both groups and the BUT in the verum acupuncture group were significantly improved after 3 weeks of treatment. No adverse events were reported during this trial. Conclusion: Both types of acupuncture improved signs and symptoms in dry‐eye patients after a 4‐week treatment. However, verum acupuncture did not result in better outcomes than sham acupuncture.     

Impression cytology and ocular surface characteristics in patients with seborrhoeic dermatitis

Purpose: To evaluate the clinical findings, tear film functions and ocular surface changes in patients with seborrhoeic dermatitis. Methods: This prospective study involved 63 patients with seborrhoeic dermatitis (Group 1) and 65 control subjects (Group 2). Best‐corrected visual acuity measurement, slit‐lamp examination, Schirmer I test, tear film break‐up time (BUT), Rose Bengal staining and conjunctival impression cytology were performed in all patients. Subjective ocular complaints were scored using an Ocular Surface Disease Index (OSDI) questionnaire. Results between the two groups were compared. Results: In group 1, meibomitis, blepharitis and conjunctival hyperemia were seen significantly more frequently than in group 2 (p < 0.001). Impression cytology revealed grade 0 changes in 25 (39.6%) eyes, grade 1 changes in 22 (34.9%) eyes, grade 2 changes in 13 (20.6%) eyes and grade 3 changes in 3 (4.7%) eyes in group 1, whereas grade 0 changes in 48 (73.8%) eyes, grade 1 changes in 11 (16.9%) eyes and grade 2 changes in 6 (9.2%) eyes were seen in group 2 (p = 0.032). Mean goblet cell density was 795 ± 55 cells/mm² in group 1 and 1820 ± 100 cells/mm² in group 2 (p < 0.001). Mean Schirmer I and mean BUT results were statistically lower in group 1 than in group 2 (p = 0.043 and p < 0.001, respectively). Mean Rose Bengal scores and mean OSDI scores were statistically higher in group 1 than in group 2 (p = 0.002 and p < 0.001, respectively). Conclusions: Our data show that patient with seborrhoeic dermatitis has decreased tear production, tear film instability and significant degeneration of the ocular surface epithelium, compared with normal subjects.     

Ocular manifestations and quality of life in patients after hematopoietic stem cell transplantation

AIM: To explore the relationship between ocular and systemic conditions and the impact of ocular complications on the quality of life (QOL) in patients after allogeneic hematopoietic stem cell transplantation (ALLO-HSCT). METHODS: Forty-four patients with severe hematopoietic disease were enrolled after ALLO-HSCT at our center from July 2018 to October 2020. They completed two questionnaires: the Ocular Surface Disease Index (OSDI) and the quality-of-life scale for Chinese patients with visual impairment (SQOL-DV1). Ocular conditions and systemic conditions were also assessed. RESULTS: Eye damage was correlated with total bilirubin (P=0.005), and gamma-glutamyl transferase (GGT) (P=0.021). There was no significant correlation between the overall QOL score and OSDI (P=0.8226) or SQOL-DV1 (P=0.9526) scores. The OSDI and the overall QOL score were not correlated with ocular conditions, including best-corrected visual acuity (BCVA), intraocular pressure, Schirmer tear test II, sodium fluorescein staining, tear film breakup time, and tear meniscus height. SQOL-DV1 was correlated with BCVA (P=0.0007), sodium fluorescein staining (P=0.007), and tear film breakup time (P=0.0146). CONCLUSION: In some patients, early ocular symptoms are not evident after ALLO-HSCT, while ocular surface complications can be observed after a comprehensive ophthalmological examination. Especially for those with elevated total bilirubin or GGT, regular ophthalmic follow-up visits are essential to diagnose and treat ocular graft versus host disease (oGVHD), especially for patients with elevated total bilirubin or GGT.     

Corneal fluorescein staining and ocular symptoms but not Schirmer test are useful as indicators of response to treatment in chronic ocular GVHD

Purpose

To evaluate long-term ocular surface clinical signs and symptoms response to therapy in patients with chronic ocular GVHD.

Effects of Glaucoma Medication on Dry Eye Syndrome and Quality of Life in Patients with Glaucoma

PurposeTo investigate ocular surface diseases and changes in the quality of life of patients using glaucoma medications.MethodsParticipants were divided into the normal (31 individuals, 62 eyes) and glaucoma medication (30 patients, 60 eyes) groups. Changes in tear break-up time, lipid layer thickness (LLT), corneal and conjunctival staining scores, ocular surface disease index (OSDI), and Visual Function Questionnaire 25 (VFQ-25) score were assessed for 1 year.ResultsThe change in mean LLT was lower in glaucomatous eyes than in control eyes (p = 0.019) after 1 year. The results of OSDI deteriorated (p’ = 0.008), but conjunctival staining and Schirmer test results showed improvement in glaucomatous eyes compared to those in control eyes (p’ =0.035 and 0.009, respectively). The average LLT decreased at 6 and 12 months, but there was no change at 24 months. In pairwise analysis, the decrease in LLT over the first 6 months was statistically significant (p < 0.001) and remained unchanged until 24 months. Among the VFQ items, scores for near activity and social function deteriorated over 1 year in the medication group (p’ = 0.033 and 0.015, respectively). However, there was no difference in the total VFQ score.ConclusionsSignificant reduction in LLT and deterioration of OSDI were observed in the medication group compared to the control group. However, this deterioration was observed only in the first 6 months. There was no significant difference in the VFQ total score. Nonetheless, there were significant differences in near activity and social function between the control and medication groups. Therefore, the results of this study showed that although glaucoma medication worsened eye dryness, the change was limited and did not worsen the quality of life. Glaucoma medication should be used with the consideration that they can limit near activity and social functioning.     

Quality of Life Assessment in Ocular Toxoplasmosis in a Colombian Population

Objective: To assess the quality of life in patients with ocular toxoplasmosis.

Methods: The participants were 29 otherwise healthy patients with retinochoroidal lesions consistent with Toxoplasma infection. The controls were 29 gender and age-matched people with normal visual function who came from the same socioeconomic and educational background as the participants. The authors used the version of the National Eye Institute 25-item visual function questionnaire (NEI VFQ25).

Results: Patients with ocular toxoplasmosis had statistically significant lower scores than controls for all the subscales, except for color vision. Patients with bilateral lesions were more affected in the mental health, difficulties role, and specific vision subscales. The median of the compound score for the participants was 79 (range 35–99) and for the controls was 95 (range 72–98).

Conclusions: People with ocular toxoplasmosis have worse vision-related quality of life than people without the condition, especially if they have bilateral lesions and more recurrences.     

Multicenter prospective validation study for international chronic ocular graft-versus-host disease consensus diagnostic criteria

PurposeTo validate the international chronic ocular graft-versus-host disease (GVHD) diagnostic criteria (ICCGVHD) compared to the National Institute of Health diagnostic criteria 2014 (NIH2014) for chronic ocular GVHD.MethodsBetween 2013 and 2019, the study enrolled 233 patients with or without chronic ocular GVHD combined with the presence or absence of systemic chronic GVHD in an internationally prospective multicenter and observational cohort from 9 institutions. All patients were evaluated for four clinical parameters of ICCGVHD.ResultsThe relation between the ICCGVHD score (0-11) and NIH2014 eye score (0–4) was relatively high (r = 0.708, 95% CI: 0.637–0.767, p < 0.001). The sensitivity and specificity of ICCGVHD for NIH 2014 for 233 patients were 94.3% (95% CI: 89.6%–98.1%) and 71.7% (95% CI: 63.0–79.5%), respectively (cutoff value of the ICCGVHD score = 6). The positive predictive value was 77.1% (95% CI: 71.1%–82.1%), and the negative predictive value was 87.0% (95% CI:81.6–92.5%). For the patients with systemic GVHD (n = 171), the sensitivity and specificity were 94.2% and 67.2%, respectively (ICCGVHD-score cutoff value = 6). By receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) was 0.903 (95% CI: 0.859–0.948). For patients without systemic GVHD (n = 62), the sensitivity and specificity were 100% and 76.7%, respectively (ICCGVHD-score cutoff value = 6). The AUC was 0.891 (95% CI 0.673–1.000).ConclusionsGood sensitivity, specificity, predictive value and correlation were found between ICCGVHD and NIH2014. ICCGVHD scores ≥6 can be useful to diagnose ocular GVHD with or without systemic GVHD for clinical research.     

【In Press】The association between demodex infestation and ocular surface manifestations in meibomian gland dysfunction

AIM: To investigate the association between ocular demodex folliculorum infestation and ocular surface manifestations in meibomian gland dysfunction (MGD). METHODS: Eight-six subjects with MGD were enrolled. All enrolled subjects were tested in the following sequence: ocular surface disease index (OSDI), slit lamp biomicroscope examination, corneal surface regularity index (SRI) and asymmetry index (SAI), tear fluid collection, fluorescein tear film break-up time (F-BUT), corneal fluorescein staining (CFS), modified Schirmer I test with anesthetic (SIT) and finally demodex folliculorum counting. Tear matrix metalloprotein (MMP)-9 activity was assessed with a MMP-9 activity assay kit. RESULTS: Ocular demodex mite was found in 40 of 86 patients with MGD. The ocular demodex-positive group showed significantly increased scores of OSDI (25.96±13.74 vs 18.07±11.55, p=0.01), lid margin abnormality (2.38±0.87 vs 1.98±0.91, p=0.04) and CFS (1.28±2.00 vs 0.94±1.36, p=0.01) compared to the ocular demodex-free group. The tear MMP-9 activity was higher in the ocular demodex-positive group (102.9±32.4 ng/ml) than the ocular demodex-free group (46.2±19.2 ng/ml, p=0.03). There was no significant difference in meibum quality and expressibility, SRI, SAI, F-BUT and SIT between the two groups (p>0.05 for each). No significant correlation was noted between the number of demodex and ocular surface parameters in demodex-positive MGD (p>0.05 for each). CONCLUSION: Ocular demodex folliculorum infestation may be associated with ocular discomfort and ocular surface damage in MGD.     

Nutritional,lifestyle and environmental factors in ocular hypertension and primary open‐angle glaucoma: an exploratory case–control study

Purpose: To evaluate known and potential risk factors, including nutritional, lifestyle and environmental factors, differentiating patients with high‐tension primary open‐angle glaucoma (POAG) from control subjects with ocular hypertension (OHT). Methods: In 2006–2007, 111 French ophthalmologists prospectively enrolled 339 cases of POAG and 339 age‐matched controls with OHT. After a clinical examination with assessment of ocular risk factors, the ophthalmologist filled, during face‐to‐face interview, a detailed questionnaire developed by nutritionists and epidemiologist on lifestyle and environmental risk factors, including socio‐demographic variables, dietary habits related to omega‐3 fatty acids intake, smoking and alcohol drinking and professional exposure to pesticides and other chemicals. Associations of POAG with risk factors were estimated using conditional logistic regression, with adjustment for age, gender and duration of disease. Results: In the final multivariate model, by comparison with OHT, POAG was significantly associated with more frequent use of pesticides during the professional life [OR = 2.65, 95% confidence interval (CI): 1.04–6.78, p = 0.04] and with low consumption of fatty fish (OR = 2.14, 95% CI: 1.10–4.17, p = 0.02) and walnuts (OR = 2.02, 95% CI: 1.18–3.47, p = 0.01). POAG was also associated with higher frequency of heavy smoking (40 pack‐years or more, OR = 3.93, 95% CI: 1.12–13.80, p = 0.03) but not with moderate (20–40 pack‐years) and light smoking (<20 pack‐years). Conclusions: These exploratory observations suggest a protective effect of omega‐3 fatty acids and a deleterious effect of heavy smoking and professional exposure to pesticides in POAG. This will need to be confirmed in future studies.     

Conjunctival impression cytology and tear‐film changes in patients with familial Mediterranean fever

Purpose: To evaluate the ocular surface changes and tear‐film functions in patients with familial Mediterranean fever (FMF). Methods: This prospective case–control clinical study examined 35 patients with FMF (group 1) and 35 controls (group 2). All patients underwent a full ophthalmological examination. Ocular surface changes were evaluated by determining cell content of surface conjunctival epithelium using conjunctival impression cytology and tear‐film functions using Schirmer‐I, break‐up time (BUT), corneal fluorescein and Rose Bengal tests. Subjective ocular complaints were scored with a four‐point scale. Between‐group results were compared. Results: In group 1, impression cytology revealed grade 0 changes in 15 eyes, grade 1 changes in 11 eyes and grade 2 changes in nine eyes in group 1; in group 2, it revealed grade 0 changes in 27 eyes, grade 1 changes in five eyes and grade 2 changes in three eyes (p = 0.013). Mean goblet cell density was 765 ± 45 cells/mm² in group 1 and 1730 ± 100 cells/mm² in group 2 (P < 0.001). Mean results on the Schirmer‐I test results were 17.36 ± 3.18 mm in group 1 and 19.60 ± 4.17 mm in group 2 (p = 0.364). Mean BUT was 8.20 ± 1.60 seconds in group 1 and 9.93 ± 2.33 seconds in group 2 (p = 0.001). Mean corneal fluorescein and Rose Bengal staining scores were 3.26 ± 1.67 and 0.96 ± 0.71 in group 1 and 1.37 ± 0.34 and 0.40 ± 0.49 in group 2 (p = 0.037, p = 0.005). The presence of subjective ocular complaints was more frequent in group 1 than in group 2. Conclusion: Despite normal tear production, the ocular surface and tear‐film functions of FMF patients differ from those of healthy individuals. These changes may be related to the chronic inflammatory nature of FMF.     

Treatment patterns,visual acuity and quality‐of‐life outcomes of the WAVE study – A noninterventional study of ranibizumab treatment for neovascular age‐related macular degeneration in Germany

Purpose: To evaluate effectiveness, tolerability and safety of repeated intravitreal injections of 0.5 mg ranibizumab for the treatment of neovascular age‐related macular degeneration in routine medical practice in Germany. Methods: A noninterventional study with 3470 patients treated in 274 medical centres according to German guidelines, with monthly intravitreal injections of 0.5 mg ranibizumab during upload (3 months) followed by a maintenance phase (9 months) with reinjections if medically indicated. Results: Mean injection rate was 4.34 (SE = 0.05; median = 3.0). Best‐corrected visual acuity (BCVA) remained stable (mean change 0.02 LogMAR, SE = 0.01, p = 0.0169) and central retinal thickness (CRT) decreased (by ?78.9 μm, SE = 2.95 μm, p < 0.0001). The NEI‐VFQ 25 summary score showed a positive stabilization with a mean change of 0.73 (SE = 0.37, p = 0.0501) compared with baseline. Adverse events were documented for 6.5% of the patients with 3.9% of these events being classified as serious. Conclusions: The number of administered intravitreal injections of ranibizumab over the first year of treatment was very low but still achieved a stabilization of BCVA, a reduction in CRT and maintained vision‐related quality of life. The management of patients with neovascular AMD in Germany needs to be improved to achieve better treatment results.     

Ocular surface disease index for the diagnosis of dry eye syndrome

PURPOSE: Evaluation of ocular surface disease index (OSDI) questionnaire for the diagnosis of dry eye syndrome. METHODS: Sixty-eight patients admitted to the Ophthalmology Polyclinic of the Dumlupinar University between December 2005 and April 2006 were randomly studied. The OSDI questionnaire was performed before, and the Schirmer and tear film breakup time (TBUT) tests were performed after the routine ophthalmologic examination. RESULTS: There was a significant inverse correlation between the OSDI and TBUT test scores, but no correlation between the Schirmer test scores and OSDI (r = -.296, p = .014, r = -.182, p = .138, respectively). Although there was a significant difference between the low and high OSDI having cases according to the TBUT test scores (p = .043), there was not according to the Schirmer test scores. CONCLUSIONS: The OSDI is a standardized instrument to evaluate symptoms, and can easily be performed and used to support the diagnosis of dry eye syndrome.     

Evaluation of ocular surface and tear film function following modified Hughes tarsoconjunctival flap procedure

Purpose: To evaluate ocular surface characteristics and tear film function following modified Hughes flap for eyelid reconstruction. Methods: This is an institutional study including 18 patients (6 male, 12 female) who underwent a tarsoconjunctival flap for reconstructing the lower eyelid’s posterior lamella in one eye between 2005 and 2010. The median age of the patients was 72 (49–93) years at the time of surgery and 77 (51–97) years at the time of evaluation. The median follow‐up time was 34 (9–69) months. All patients had large malignant or semi‐malignant lid tumours. Data for subjective symptoms (OSDI questionnaire), lid margin morphology, tear break‐up time (BUT), vital staining, Schirmer test, impression cytology, tear film osmolarity, lipid layer interference patterns, meibography and the size of the tumour and flap were recorded and compared with the contralateral side. Results: Statistical analysis of the data revealed a significant difference between the surgically treated lid and the untreated side in meibomian gland loss, more lid margin abnormalities in the upper and lower eyelid (p < 0.001) and increased fluorescein staining of the cornea (p = 0.031). For the operated side, the median OSDI score was higher (17.2 versus 14.7), and the median BUT value was shorter (4.2 versus 5.6 seconds) compared with the median values of the contralateral side. Conclusion: Despite the favourable cosmetic and functional results of the Hughes tarsoconjunctival flap, our results indicate that this procedure does affect the ocular surface health in the treated eyes.     

Correlation between vision‐ and health‐related quality of life scores

Purpose: To examine the correlation between health‐related quality of life (HRQOL) scores [assessed using the generic Short Form Health Survey (SF‐36) questionnaire] and vision‐related quality of life (VRQOL) scores [assessed using the National Eye Institute Visual Function Questionnaire (NEI‐VFQ25)]. Methods: Cross‐sectional analytic study. All surviving participants of the Blue Mountains Eye Study (n = 1952, aged 60 years and older) were invited to attend comprehensive eye examinations 10 years after baseline examinations and were asked to complete both questionnaires. Results: Complete data were available for 1436 participants. After controlling for age, sex and the presence of either unilateral or bilateral visual impairment, the number of hospital admissions, chronic medical conditions and disabilities, we found that the composite NEI‐VFQ score was significantly associated with the two main domains of the SF‐36 survey: the summary physical component score (P < 0.001) and the mental component score (P < 0.001). There was relatively low correlation (r < 0.3) between the NEI‐VFQ25 subscales and SF‐36 subscales including the physical and mental composite scores. Conclusion: VRQOL is influenced by both general health and HRQOL. However, there is a relatively low correlation between the individual subscales of these two quality of life questionnaires.     

干眼患者症状与泪膜脂质层厚度的相关性

目的 研究干眼患者症状与泪膜脂质层厚度（LLT）的相关关系。设计 回顾性病例系列。研究对象 随机选取2015年7- 10月就诊于北京同仁医院眼科门诊的干眼患者139例,其中男性58例,女性81例,年龄18~77岁,平均（37.75±12.86）岁。方法 所有入组患者均进行眼表疾病指数（OSDI）问卷（共包括12项症状）调查以及用LipiView?誖眼表面光干涉仪测量LLT。根据干眼症状（OSDI问卷评分）分为三组：轻度症状组35例（0~20分）,中度症状组61例（21~45分）,重度症状组43例（46~100分）。分析干眼症状与LLT的相关性以及不同程度干眼症状与LLT的关系。主要指标  OSDI问卷评分、泪膜脂质层厚度。结果 139例干眼患者OSDI评分与LLT呈显著相关且为负相关（r=-0.256, P=0.002）,随着OSDI得分增加（症状的加重）脂质层厚度变薄。OSDI问卷中异物感、眼酸痛、看电视、看电脑眼部不适与LLT有明显相关性（r=-0.206、-0.232、-0.190、-0.179,P均<0.05）,其他8项症状与LLT无相关性。严重程度不同的三个组别之间LLT存在差异,尤其是轻度症状组（64.89±16.40 nm）与重度症状组（54.65±14.48 nm)之间差异更明显（F=10.092, P=0.027）;轻度症状组中LLT≤60 nm者14例（40%）,而重度组中LLT≤60 nm者30例（70%）（χ2=6.953, P=0.008）。结论 干眼症状与泪膜脂质层厚度呈明显负相关。干眼症状中的异物感、眼酸痛、看电视或电脑眼部不适等症状与泪膜脂质层厚度相关性较显著。泪膜脂质层厚度低于60 nm者干眼症状严重。（眼科, 2017, 26： 90-94）     

Measurement of health‐related quality of life with glaucoma: validation of the Glau‐QoL© 36‐item questionnaire

Purpose: To validate a glaucoma‐specific health‐related quality of life (HRQoL) questionnaire: the Glau‐QoL^©. Methods: Patients with ocular hypertension (OHT) or glaucoma took part in a cross‐sectional psychometric validation study (n = 573) and a separate reproducibility study (n = 244). Patients answered the 36‐item Glau‐QoL^©, designed from in‐depth patient interviews. Results: The clinical validity of the Glau‐QoL^© was excellent and clearly demonstrated that as disease severity and visual field impairment increased, HRQoL scores for the Psychological Wellbeing, Self‐image, Daily Life, Driving, Anxiety and Burden of Treatment domains were negatively affected. Increased age and lower visual acuity were also associated with lower HRQoL scores, although to a lesser extent than the previously mentioned criteria. Worsening of HRQoL domains correlated with the clinical stage of glaucoma: Anxiety and Burden of Treatment scores dropped noticeably when patients were first diagnosed and started treatment, followed by a decrease in scores for Driving, Daily Life, Psychological Wellbeing, and Self‐image as clinical conditions worsened. Psychometric validation showed acceptable convergent and discriminant validity of the Glau‐QoL^©, and good reproducibility, with intraclass correlation coefficients (ICC) and concordance correlation coefficients (CCC) ≥ 0.69. Internal consistency reliability was high (Cronbach's α coefficients > 0.70) for the Daily Life, Psychological Wellbeing, Burden of Treatment and Driving domains; acceptable (coefficients of 0.65 and 0.68, respectively) for the Self‐image and Anxiety domains; and weak (coefficient = 0.58) for the Confidence in Health Care domain. Conclusions: The Glau‐QoL^© questionnaire is a valid and specific HRQoL instrument that demonstrates excellent correlations with disease progression in patients with glaucoma and/or OHT.