The impact of glaucoma on the quality of life of patients in Norway. I. Results from a self-administered questionnaire

PURPOSE: To evaluate the feelings and experiences of patients living with glaucoma. METHODS: A questionnaire was delivered to patients willing to take part, at a regular visit to their ophthalmologist, for filling in anonymously at home. A total of 589 questionnaires were returned. RESULTS: More than 80% reported negative emotions on learning that they had glaucoma, one-third were afraid of going blind. Half the patients had no visual problem at all, 14% complained of poor or very poor vision. This proportion increased with age. One-fourth of the patients on topical medication experienced adverse effects of moderate or high degree. About half the patients being treated with laser or surgery felt their situation had improved afterwards. Nine-tenths of the individuals were satisfied with the information and care given, although their knowledge about glaucoma was rather incomplete. One-fifth missed information, mainly on causes, treatment and prognosis of the disease. The younger patients were more anxious and inquiring, reported more side effects and were less satisfied than the older patients. The women were in general more dissatisfied than the men. CONCLUSION: Giving a patient a diagnosis of glaucoma influences his quality of life negatively. Only half of our patients experienced any visual difficulties, whereas one-fourth reported adverse reactions due to the therapy. Most of the patients were very satisfied with the information and care given. Ophthalmologists in private practice are quite central in the management and care of the glaucoma patients in a medical setting like ours.     

Utility values among glaucoma patients: an impact on the quality of life

AIM: To ascertain utility values and associated quality of life with different severity and duration of glaucoma among Indian patients. METHODS: Utility values of 105 consecutive patients with primary glaucoma of at least 12 months' duration were evaluated in a cross sectional study. Utility values were ascertained in five groups using both the time-trade off and standard gamble methods: group 1 (best corrected visual acuity in the better eye of 6/9 or better), group 2 (best corrected visual acuity in the better eye of 6/18 to 6/12), group 3 (best corrected visual acuity in the better eye of 6/36 to6/24), group 4 (best corrected visual acuity in the better eye of 3/60 to 6/60), and group 5 (best corrected visual acuity in the better eye of 3/60 or worse). RESULTS: The mean utility value for the glaucoma group as a whole was 0.64 (SD 0.69; 95% confidence interval (CI), 0.58 to 0.70) with the time-trade off method and 0.86 (SD 1.00; 95% CI, 0.81 to 0.90) with the standard gamble method for a gamble of death and 0.97 (SD 1.00; 95% CI, 0.94 to 0.99) for a gamble of blindness. The mean utility results by the time-trade off method were as follows: group 1 = 0.66, group 2 = 0.66, group 3 = 0.62, group 4 = 0.55, and group 5 = 0.61. The utility value was much lower (0.46) in those with no formal education or only primary education compared to those with postgraduate education (0.75) (p = 0.038). Those patients with glaucoma of less than 5 years' duration had a utility score of 0.62 while those with glaucoma for more than 10 years had a score of 0.74 (p = 0.40). CONCLUSIONS: Visual acuity loss occurring secondary to glaucoma is associated with a substantial decrease in patient utility value (and quality of life) in a developing country like India. The utility value is directly dependent on the degree of visual acuity loss associated with the disease and educational status and not on the duration of disease, the number of medications, or the visual field indices.     

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。     

PACG患者视觉生活质量和心理状况的临床研究

目的:评估原发性闭角型青光眼（primary angle-closure glaucoma,PACG）患者的心理和视觉健康相关生存质量状况,分析青光眼小梁切除手术对其影响。 方法:采用前瞻性随机临床对照的方法, 对42例PACG患者分别采用国家眼科研究视功能问卷（25-item national eye institute visual functioning questionnaire, NEI-VFQ-25）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的视觉生活质量和焦虑、抑郁评分,术后1mo再次患者评定焦虑、抑郁情况及视觉生活质量,42例健康自愿者作为对照,分析其心理和视觉健康相关生存质量变化情况。 结果:PACG患者焦虑、抑郁及共患患者发生率分别为23.8%,23.8%和 16.7%。NEI-VFQ-25评分显示患者在视觉健康相关生存质量部分亚功能（10/12）如一般健康、总体视觉、社会功能、心理问题、周边视野和依赖性等均有不同程度的损害(P<0.05)。通过小梁切除手术干预,患者焦虑、抑郁评分明显好转(P<0.05),视觉健康相关生存质量的样本中位数差值\[41.6(一般健康)、34.5 (眼痛)、32.6 (社会功能)、21.2(心理问题)、24.8(社会活动)、21.8（依赖性）\],均较手术前明显改善\[10.4(一般健康)、6.4 (眼痛)、10.6(社会功能)、8.3(心理问题)、7.3(社会活动)、6.9（依赖性）;均为P<0.05\]。 结论: PACG患者焦虑、抑郁状况加重,视觉健康相关生存质量明显降低。小梁切除术有助于患者视觉生活质量和心理康复。     

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.     

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。     

Study of the quality of life in patients with glaucoma

The purpose of the study was the assessment of the perception of the disease (glaucoma) and life quality (LQ) by a patient and interrelations between the objective parameters of visual functions and the self-assessment of the condition in patients with glaucoma. A total of 74 glaucoma patients were prospectively examined. The SF-36 russified version and adapted, by the authors, NEI-VFQ-25, 2000, method were made use of. Threshold testing 24-2 and Esterman's binocular screening test were used to detect any disorders in the peripheral vision. The study results are indicative of that the LQ parameters go down in patients with glaucoma according to both the results of the self-assessment of the health condition as a whole (SF = 36), and in relation with glaucoma (NEI-VFQ-25). The LQ parameters of NEI-VFQ-25 of glaucomatous patients are reliably lower as compared to the control group. A moderate statistically significant correlation was used to determine the LQ dependence on the peripheral vision changes virtually in all NEI-VFQ-25 scales. The LQ dependence on a degree of visual functions' disorders was found to be reliable; however, the LQ indices were notably reduced in glaucomatous patients without visual field defects, which was due to a changed psychological status.     

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)     

Assessment of psychosocial impact of primary glaucoma and its effect on quality of life of patients in Western India

Purpose:To assess the impact of primary glaucoma of varying severity and duration on psychosocial functioning and quality of life of patients.Methods:A cross-sectional observational study was carried on 200 patients attending the glaucoma clinic of a tertiary care hospital in western India. After obtaining approval from the institutional ethics committee, written informed consent was taken. All patients underwent a thorough ophthalmic examination. Those with primary glaucoma were classified as per Hodapp–Parrish–Anderson criteria and asked to respond to the National Eye Institute Visual Function Questionnaire (NEIVFQ)-25 questionnaire. Responses were analyzed statistically.Results:Overall mean NEIVFQ 25 composite score was 74.4 ± 18.6. Mean scores were 87.0 (SD 7.2) for mild, 75.9 (SD 8.1) for moderate, and 47.0 (SD 13.7) for severe glaucoma groups. Lower scores were associated with males. Driving (62.2, SD 34.6) and ocular pain (63.5, SD 18.7) were maximally affected while color vision (90.1, SD 18.7) and social health (86.7, SD 20.1) were least affected. The duration of treatment had no effect on mean composite scores with impaired scores seen even in newly diagnosed cases. Age of the patient negatively correlated with NEIVFQ 25 composite score.Conclusion:With disease progression, the psychosocial functioning of the patients is negatively affected. This effect is irrespective of treatment duration and newly diagnosed cases can have impaired Quality of life scores. Quantification of psychosocial status along with education and counseling for all patients may play a definitive role in customizing treatment and providing patients with a better quality of Life.     

Health-related quality of life in patients with cataract and glaucoma

The patient's perspective of his or her own health status as it relates to functioning and well-being is referred to as health-related quality of life. Various generic and ophthalmology-specific survey instruments have been used to gain an understanding of patient-oriented health status in patients with cataract or with glaucoma. Improvement in vision-targeted quality of life has been shown following cataract surgery; however, an improvement in self-perceived overall health status following cataract surgery has not been established. Increasing severity of glaucoma has been shown to be negatively related to vision-targeted quality of life; the relationship between increasing severity of glaucoma and overall self-perceived health status is inconclusive. Integration of the concepts of health-related quality of life into clinical practice will require the development of better measurement instruments that can demonstrate notable outcome advantages for patients.     

Visual function and quality of life in Korean patients with glaucoma

The relationship between visual acuity, the level of visual field impairment, visual functioning, and the quality of life was evaluated in Korean patients with glaucoma. Forty-three consecutive glaucoma patients from the glaucoma service at Severance Eye and Ear Hospital were included in this study. Each subject underwent a vision-specific functional status questionnaire (VF-14), a modified VF-14 (VF'-14) and general quality-of-life questionnaires of the Medical Outcomes Study 36-Items Short Form Health Survey (SF-36). The visual acuity and visual field measurements with a Humphrey automated perimeter were taken within one month of the initial visit. The mean age of the subjects was 57.9 +/- 17.8. Among these patients, there were 23 males and 20 females. The mean deviation (MD) and the corrected pattern standard deviation (CPSD) by the automated perimeter in the eye with the better visual acuity were -5.87 +/- 5.16 dB and 3.92 +/- 2.74 dB respectively. The VF-14 and SF-36 scores were 41.28 +/- 14.56 and 52.39 +/- 6.61 respectively. There were significant correlations between the VF-14, VF'-14, and the MD of the better eye (p < 0.05). In Korean patients with glaucoma, the VF-14 and VF'-14 have significant relationship with the MD of the better eye in the visual field.     

Evaluation of quality of life and priorities of patients with glaucoma

PURPOSE: To investigate the quality of life and priorities of patients with glaucoma. METHODS: Patients diagnosed with glaucoma and no other ocular comorbidity were consecutively recruited. Clinical information was collected. Participants were asked to complete three questionnaires: EuroQuol (EQ-5D), time tradeoff (TTO), and choice-based conjoint analysis. The latter used five-attribute outcomes: (1) reading and seeing detail, (2) peripheral vision, (3) darkness and glare, (4) household chores, and (5) outdoor mobility. Visual field loss was estimated by using binocular integrated visual fields (IVFs). RESULTS: Of 84 patients invited to participate, 72 were enrolled in the study. The conjoint utilities showed that the two main priorities were "reading and seeing detail" and "outdoor mobility." This rank order was stable across all segmentations of the data by demographic or visual state. However, the relative emphasis of these priorities changed with increasing visual field loss, with concerns for central vision increasing, whereas those for outdoor mobility decreased. Two subgroups of patients with differing priorities on the two main attributes were identified. Only 17% of patients (those with poorer visual acuity) were prepared to consider TTO. A principal component analysis revealed relatively independent components (i.e., low correlations) between the three different methodologies for assessing quality of life. CONCLUSIONS: Assessments of quality of life using different methodologies have been shown to produce different outcomes with low intercorrelations between them. Only a minority of patients were prepared to trade time for a return to normal vision. Conjoint analysis showed two subgroups with different priorities. Severity of glaucoma influenced the relative importance of priorities.     

关注斜视对患者生存质量的影响

斜视患者的生存质量状况越来越受到重视,研究发现儿童和成年斜视患者均伴有不同程度的社会心理障碍、视功能异常等显著影响生存质量状况的因素。目前临床上已有经过评估的专用于斜视患者的生存质量评估量表,通过量表评估发现手术后患者生存质量显著改善,量表得分与手术效果显著相关,有研究建议生存质量评估可作为手术后效果的评价手段之一。临床上应更重视患者的生存质量评估,来指导斜视治疗,提高患者满意度。