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。     

青光眼滤过性手术的护理

青光眼滤过性手术的护理四川省德阳市罗江县人民医院（６１８００９）佘华滤过性手术是治疗青光眼的主要方法之一。青光眼手术的成败因素取决于患者的信任与合作。所以了解和掌握患者的心理特点，做好心理护理以及日常护理工作，排除患者的恐惧，使其充满复明的信心是很重...     

青光眼治疗对眼表组织结构的影响

青光眼是一组以视神经凹陷性萎缩和视野缺损为共同特征的疾病,病理性眼压增高是其主要危险因素.目前青光眼的治疗方法主要包括抗青光眼药物治疗、激光治疗、手术治疗以及视神经保护治疗等.研究证明,青光眼各种临床治疗对患者的眼表组织结构(泪膜、结膜、角膜上皮)均会产生明显影响,引起泪膜功能破坏、球结膜亚临床炎症、球结膜和角膜上皮细胞的损伤,导致患者眼部不适、长期用药依从性降低、干眼的发生甚至降低手术成功率等.本文主要针对抗青光眼治疗对眼表组织结构的影响作一简要综述.     

采用效用分析方法测量中国人青光眼患者的视觉相关生活质量

背景近年来关于青光眼对患者生活质量的影响日益受到临床工作者的关注,但调查结果表明各种视功能量表均存在一定的不足,准确、全面地评价影响青光眼患者生活质量的主观和客观因素值得深入研究。目的利用效用分析的方法测量青光眼患者视觉相关生活质量并初步分析其相关因素。方法收集北京同仁医院门诊确诊的青光眼患者,采用效用分析中的线性等级尺度（RS）法和时间交易（TTO）法进行问卷调查以获得反映青光眼患者疾病相关生活质量的效用值,比较RS法和TTO法所得效用值的差异和相关性,分析不同性别、年龄、受教育程度、工作状态、青光眼家族史、青光眼手术史、不同视功能损害程度以及不同青光眼类型对患者效用值的影响。结果研究共纳入青光眼患者86例,其中男62例,女24例;平均年龄44．67岁。RS法和TTO法测得青光眼患者的效用值分别为0．62±0．19和0．77±0．12,两种方法获得的效用值之间无显著相关关系（r=0．074,P=0．499）。RS法计算所得的效用值受日常生活视力、视野缺损程度以及青光眼手术史的影响,而TTO法测得的效用值主要与患者的年龄、工作状态以及受教育程度有关,与患者视力和视野损害的严重程度无相关性。校正了年龄、工作状态和受教育程度以后,较差眼视力≥0．3的青光眼患者其TTO效用值显著高于较差眼视力〈O．3者（P=0．029）。结论效用分析的方法简单、灵敏,可较好地被患者所接受。RS法所得效用值受日常生活视力、视野缺损程度以及青光眼手术史的影响,反映了患者对自身视觉状态的主观评价。TTO法测得的效用值主要与患者的年龄、工作状态以及受教育程度有关,反映了不同患病个体对自身视觉相关生活质量的主观评价。视功能的损害程度在青光眼患者的总体生活质量中不起决定性作用。     

甲状腺相关眼病合并高眼压患者视觉相关生存质量及相关因素

目的:调查甲状腺相关眼病(thyroid associated ophthalmopathy,TAO)合并高眼压患者视觉生存质量及相关因素。方法:采用VF/QOL(vision function,VF,视功能;quality of life,QOL,生存质量)问卷调查量表对90例甲状腺相关眼病合并高眼压患者和90例非TAO的患者作为对照组的视觉生存质量进行评价研究。计算两组患者VF/QOL总得分以及各个维度得分。VF和QOL问卷测量的指标分别包括主观视觉、周边视野、视觉适应、立体视觉以及自理能力、活动能力、社交能力、心理状态。结果:TAO合并高眼压的VF(89.93±8.9)和QOL(92.89±5.91)得分均值显著低于对照组(98.18±4.06,99.21±1.87),两组间比较差异具有统计学意义(P<0.01)。VF得分中除周边视野外(Z=-0.65,P=0.52),其他与对照组差异显著(P<0.01);QOL中各个维度得分均显著低于对照组(P<0.05)。多元线性回归分析发现,病程分级和心理因素均是影响患者VF得分的独立因素,和眼压、年龄、病程等无关,学历是影响QOL得分的因素。结论:合并高眼压的TAO患者视觉相关生存质量下降和眼压无关,疾病严重程度的分级只会影响到患者的VF得分,和QOL无关。     

普通眼科门诊青光眼认知度的调查

目的提高公众对青光眼的认知度及青光眼患者的检出率。方法采用问卷随机抽样调查646例普通眼科门诊就诊者。所有数据用χ^2检验和多因素logistic回归分析处理数据。结果66.6%的受访者表示对青光眼不了解,其中51.61%为已确诊的青光眼患者。青光眼的认知与性别、服用糖皮质激素史、高血压、糖尿病以及近视均无相关性（P〉0.05）,与年龄、教育程度、具有卫生部门工作经历、定期眼科检查、曾经接受散瞳检查、具有青光眼家族史等显著相关。心血管患者及服用降血压药物的受访者对青光眼的认知度高于其他人群。结论青光眼认知度问卷调查为青光眼患者的宣教和知识普及提供了目标人群,使早期防治有所提示。近视患者、糖皮质激素服用者、高龄人群、低教育程度者、糖尿病及高血压患者、无定期眼科保健者以及部分对青光眼缺乏认识的青光眼患者,是今后加强宣教的目标人群。     

青光眼知晓度研究进展

青光眼是全球主要的致盲眼病之一,由于其发病相对隐匿,若不急性发作,不易被发现,故其致盲率相当高.90％以上的青光眼患者并不了解此病,提高人们对青光眼的知晓度,有利于青光眼患者更早地发现疾病,避免不可挽回的视觉损失.提高人们对青光眼的知晓度是早期发现、早期诊断、及时治疗、挽救青光眼患者残存视功能的有效途径.国内外许多学者对青光眼知晓度做了一定的研究.本文从青光眼知晓度的现状、获得青光眼知识的途径、影响青光眼知晓度的相关因素、青光眼知晓度对心理障碍及生存质量的影响、主动学习和健康教育方式对知晓度的影响几个方面,就近年来关于青光眼知晓度的相关研究进行综述.     

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。     

青光眼视野损害的身心交互特征

进行性视野缩小是青光眼的主要视功能损害特征。偏执人格及焦虑/抑郁特征则贯穿了发病过程及病程进展。而焦虑/抑郁为主要特征的青光眼患者情绪/心理障碍，对残留视野的范围和视敏度均产生负性影响。身心交互作用的结果使青光眼视功能损害的速度和程度都发生特征性变化。“心因性误差”或称“功能性误差”，导致视功能病理损害的误判。关注青光眼患者情绪障碍与视野损害的交互作用，促进了对青光眼病程身心联合干预策略的发展。     

原发性青光眼患者确诊途径调查

目的了解何种原因使得原发性青光眼患者到医院就诊,最终青光眼得以诊断。设计以医院为基础的问卷调查。研究对象 287例已确诊为原发性青光眼的连续患者。方法设计一组问题,对本组青光眼患者进行以医院为基础的问卷调查,问卷内容主要包括患者首次被诊断青光眼的医院;患者到眼科寻医的原因;患者求治的主要症状;以及其青光眼被诊断的主要依据。主要指标统计分析患者寻医的主要原因和症状,以及患者所了解的主要诊断依据。结果视力下降(87．7％),眼痛 (80．8％)和眼红是急性闭角型青光眼患者求医的原因。在慢性闭角型青光眼和开角型青光眼,分别有39．7％和46．2％的病例主诉有视力问题,部分患者主诉有眼部症状,但这些症状多与青光眼无关,约25％的患者没有任何症状。71％(205／287)的患者认为眼压升高对青光眼诊断最为关键。在慢性闭角型青光眼和开角型青光眼中,75％的病例在确诊时,至少有1眼已属于青光眼中晚期。结论急性闭角型青光眼因症状明显,常引导患者主动就诊。慢性闭角型青光眼和开角型青光眼早期多无症状,他们得以诊断的原因是因为其他非青光眼症状,或有青光眼家族史而到医院检查,或常规体检发现了青光眼。     

Practical approach to medical management of glaucoma

Primary open angle glaucoma (POAG) is usually a chronic, slowly progressive disease. At present, all resources are directed towards reduction of intraocular pressure (IOP), the only known causal and treatable risk factor for glaucoma, and medical management is frequently the first choice in most cases. With the introduction of innovative tools for early diagnosis and newer medications for treatment, decision-making in diagnosis and treatment of glaucoma has become more complex. The philosophy of glaucoma management is to preserve the visual function and quality of life (QOL) of the individual with minimum effects on QOL in terms of cost, side effects, treatment regime, follow-up schedules as well as socioeconomic burden. Our aim should be not to treat just the IOP, optic disc or visual field, but to treat the patient as a whole so as to provide maximum benefit with minimal side effects. In this article, we describe the scientific approach to medical management, mainly of POAG.     

The Collaborative Initial Glaucoma Treatment Study: interim quality of life findings after initial medical or surgical treatment of glaucoma.

OBJECTIVE: To present interim quality of life (QOL) findings in the Collaborative Initial Glaucoma Treatment Study (CIGTS) using all available follow-up through 5 years from treatment initiation. DESIGN: Randomized controlled clinical trial. PARTICIPANTS: Six hundred seven newly diagnosed patients with open-angle glaucoma from 14 clinical centers. INTERVENTION: Patients were randomly assigned to either initial medical therapy or initial trabeculectomy. After treatment initiation and early follow-up, patients received clinical and QOL evaluations at 6-month intervals. QOL assessments were administered by telephone at a centralized interviewing center. MAIN OUTCOME MEASURES: The CIGTS collected comprehensive QOL information that included both generic and vision-specific QOL measures. This article focuses on initial treatment group differences related to symptom reporting, as measured by a Symptom and Health Problem Checklist, and changes in daily visual functioning, as measured by the Visual Activities Questionnaire (VAQ). RESULTS: Across both treatment groups, there was an overall decline in the percent of participants reporting symptoms over time. Of 43 possible symptoms, 12 symptoms were reported with greater frequency by the surgically treated group and 7 symptoms more frequently by the medically-treated group. The surgical patients reported more total Symptom Impact Glaucoma (P = 0.005) and, in particular, more bother related to local eye symptoms. Very few treatment group differences were noted in visual functioning, although surgical patients reported more problems with activities related to their visual acuity (P = 0.024). The percentage of patients across treatment groups reporting worry about blindness was 50% at baseline but declined to approximately 25% over time. CONCLUSIONS: Overall, the QOL impact reported by the two treatment groups as measured by instruments used in this study is remarkably similar, with relatively few significant study group differences observed after up to 5 years of follow-up in the CIGTS. When significant differences in visual function have been detected using the VAQ, they are consistent with the clinical outcomes. To date, the most persistent QOL finding is the increased impact of local eye symptoms reported by the surgical group compared with the medical group. Although no changes are recommended in the treatment of newly diagnosed glaucoma patients at the time of this interim report, further follow-up will allow for more definitive answers to the QOL impact of these two treatment approaches.     

Quality of life evaluation of age-related macular degeneration

PURPOSE: To evaluate quality of life (QOL) characteristics and ophthalmic factors influencing QOL in age-related macular degeneration (AMD) patients. SUBJECTS AND METHODS: The subjects were 80 patients with AMD. An eye-disease specific QOL questionnaire, The 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25), was administered. Results were compared with those of glaucoma or cataract patients and those of individuals without eye diseases. The VFQ-25 score was assessed according to visual acuity, absolute scotoma size, and disease type. Multiple regression analysis was used to evaluate ophthalmic factors influencing the QOL score. RESULTS: VFQ-25 scores were significantly lower in AMD patients than in all other groups. Scores of patients with visual acuity less than 0.1, with large absolute central scotoma, and bilateral exudative AMD were lower, for several items, than those of patients with visual acuity of 0.4 or more, those of patients without absolute scotoma, and those of bilateral atrophic AMD patients, respectively. Visual acuity and absolute central scotoma size influenced social functioning and mental health. The exudative form influenced mental health and critical print size influenced dependency. CONCLUSION: The VFQ-25-assessed QOL of AMD patients was lower than that of glaucoma or cataract patients. Visual acuity, absolute central scotoma and the existence of exudative AMD influenced the QOL in AMD patients.     

Relevance of quality of life and treatment compliance measurement in patients with chronic open-angle glaucoma

Chronic glaucoma is a severe disease that can induce blindness.Early diagnosis and symptomatic treatment reduce the risk of blindness. Treatment that will be started before the onset of clinical signs and will remain lifelong thereafter is troublesome, and therapeutic compliance is usually poor. Thus, quality of life (QOL) measurement in patients with chronic glaucoma has a particular purpose: to measure patients' perception of the disease and treatment in order to maintain good treatment compliance to ensure therapeutic management efficacy and to preserve visual function. No glaucoma-specific instrument is available in the medical and QOL literature. Various generic(SF-36, SF-20 and SIP) and specific(VAQ, VF-14, NEI-VFQ) QOL questionnaires,one glaucoma-specific symptomatic scale (GSS),and one treatment preference scale (COMTol) have been used to measure QOL in glaucoma patients. These instruments do not sufficiently measure the psychosocial dimension of the disease and the QOL impact of treatment. An instrument able to measure all dimensions needs to be developed in order to help ophthalmologists in the therapeutic management of their patients and to measure QOLin patients in the successive stages of the disease.     

Quality of life in newly diagnosed glaucoma patients : The Collaborative Initial Glaucoma Treatment Study

OBJECTIVE: The Collaborative Initial Glaucoma Treatment Study (CIGTS) was designed to determine whether patients with newly diagnosed open-angle glaucoma are better treated initially by medicine or immediate filtering surgery. This paper describes the quality-of-life (QOL) measurement approach, instruments included, and the CIGTS participants' QOL findings at the time of diagnosis. DESIGN: Baseline results from a randomized, controlled clinical trial. PARTICIPANTS: Six hundred seven patients from 14 clinical centers were enrolled. INTERVENTION: Patients randomized to initial medication received a stepped medical regimen (n = 307). Those randomized to initial surgery underwent a trabeculectomy (n = 300). The baseline interview was conducted before treatment initiation. All baseline and posttreatment QOL assessments were conducted by telephone from a centralized interviewing center. MAIN OUTCOME MEASURES: The primary outcome measure described in this paper was QOL. The QOL instrument is multidimensional and incorporates both disease-specific and generic measures, including the Visual Activities Questionnaire, Sickness Impact Profile, and a Symptom and Health Problem CHECKLIST: RESULTS: The correlations between QOL measures and clinical outcomes were in the expected direction, but relatively weak. At initial diagnosis, difficulty with bright lights and with light and dark adaptation were the most frequently reported symptoms related to visual function, whereas visual distortion was the most bothersome. Approximately half of the patients reported at least some worry or concern about the possibility of blindness. Within the Visual Activities Questionnaire, higher scores on the Peripheral Vision subscale were associated with more field loss (P < 0.01). In regression analyses controlling for sociodemographics and nonocular comorbidities, increased visual field loss was significantly associated with higher dysfunction among five disease-specific QOL measures (P < 0.05). CONCLUSIONS: Newly diagnosed glaucoma patients reported experiencing some visual function symptoms at the time of diagnosis that would not be intuitively expected based on clinical testing. Some discussion about the association between clinical presentation and worry about blindness may reduce unnecessary concern. These results provide the basis for long-term comparisons of the QOL effects of initial medical and surgical treatment for open-angle glaucoma.     

Impact of impaired vision and eye disease on quality of life in Andhra Pradesh

PURPOSE: To determine the impact of visual impairment and eye diseases on quality of life (QOL) in an older population of Andhra Pradesh in southern India. METHODS: The World Health Organization (WHO) QOL (WHOQOL) instrument was adapted as a health-related quality of life (HRQOL) instrument for administration to adults participating in the Andhra Pradesh Eye Disease Study. Participants aged 40 years and older (n = 3702), 99.4% of the 3723 eligible, who underwent interview and detailed dilated ocular eye evaluation by trained professionals were included in this study. Psychometric properties of the HRQOL instrument were evaluated among visually impaired people. Relationships among overall QOL scores and presenting visual acuity in the better eye, specific eye diseases, and demographic variables were examined. RESULTS: Internal consistency was high for the entire questionnaire (alpha = 0.94). Each item of the QOL scale had an adequate item-total correlation (range, 0.25-0.77) greater than 0.2. After adjusting for demographic variables and ocular disease, Subjects with blindness had significantly lower QOL scores. Subjects with glaucoma or corneal disease independent of visual acuity had lower scores than subjects without those eye diseases. Subjects with cataract or retinal disease had significantly lower scores than those without cataract or retinal disease in the model without visual acuity but not when visual acuity was added to the model. CONCLUSIONS: Decreased QOL was associated with the presence of glaucoma or corneal disease independent of visual acuity and with cataract or retinal disease as a function of visual acuity. Visual impairment from uncorrected refractive errors was not associated with decreased QOL.     

Evaluation of the relationship between quality of vision and the visual function index in Japanese glaucoma patients

Background  

We compared two types of visual field index including mean deviation (MD) and the visual field index (VFI) for assessing the relationship between quality of life (QOL) and the loss of visual field in open-angle glaucoma patients.     

Impact of glaucoma, lens opacities, and cataract surgery on visual functioning and related quality of life: the Barbados Eye Studies

PURPOSE: To determine the relationship of open-angle glaucoma (OAG) and lens opacities to visual functioning and related quality of life (QOL), by using the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) in a population of African origin. METHODS: The study included 962 black participants of the Barbados Eye Studies with known glaucoma, prior cataract surgery, visual acuity (VA) 相似文献