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。     

视盘的有效评估:与杯盘比的对比

青光眼是一种以进行性视盘变化和视野损失为特征的眼压相关性疾病。杯盘比在过去40a来都是评价视盘青光眼性改变的标准方法。然而我们却发现是一些小视盘的患者有典型青光眼性视野损失,而一些大视盘的患者却没有视野损失。杯盘比的检查效力和可重复性都低于一些新的检查方法。视盘损伤可能度分级(DDLS)是一种衡量视盘盘沿面积、并且校正了视盘大小等影响因素的新型视盘评价方法。DDLS也许是评价青光眼视盘的更为优化的方法。     

白内障患者防盲手术前视力状况和生存质量的调查

目的评价白内障防盲手术前患者视力、主观视功能(visual function,VF)和视觉相关生存质量(quality of life,QOL)状况.方法检查江苏省姜堰市拟接受白内障防盲术的251名患者的术前日常生活视力,由5名调查员进行VF和QOL现场问卷调查.结果单眼盲患者占54.6%,严重盲患者占33.9%,视力损伤占6.4%,中度盲占5.2%;VF和QOL平均得分分别为48.58±31.18、65.97±26.77,与视力等级的相关系数分别为-0.61、-0.56;多因素分析表明VF和QOL得分与视力等级和年龄相关,与其他因素无关.结论接受防盲手术的白内障患者主要为单眼盲和严重盲患者,VF和QOL得分基本随视力状况下降而下降,需重视白内障患者的心理健康问题.(中国眼耳鼻喉科杂志,2005,5:379～381)     

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。     

青光眼患者术前心理焦虑状况调查研究

目的研究青光眼患者术前的焦虑状况。方法对50例青光眼依据焦虑自评表按分组分别进行焦虑状况的评价。结果总平均分都超过临界标准分，尤其是术前2h明显。不同病例中，闭角型青光眼患者的焦虑程度要高于开角型青光眼和继发性青光眼患者；不同年龄组中，60岁以上组患者的焦虑程度要高于30～60岁组患者；不同性别组中，女性患者要高于男性患者；不同学历组中，焦虑程度差异无统计学意义。结论青光眼手术患者的焦虑自评表评分明显高于国内常模，证明青光眼患者与一般人群相比，存在心理差异。     

青光眼患者的生存质量及其影响因素研究

目的：评价青光眼患者的生存质量并探讨影响其生存质量的因素。 方法：采用国家眼科研究所视功能问卷-25,对126例青光眼患者的生活质量进行评价。 结果：青光眼患者的生存质量普遍下降,不同程度的视力损害明显影响着患者的生存质量得分（P＜0.01）。多因素逐步直线回归显示：生存质量的得分与年龄、经济收入、遵医行为有密切关系（P＜0.05）。 结论：在保护青光眼患者视功能的同时,要重视其社会、心理等因素,给予其必要的健康教育和心理辅导,以期提高其生存质量。     

白内障手术后生存质量改善的评价

目的 评价白内障手术后的视力提高及生存质量改善状况。方法 对我院2002年1月到2003年6月行白内障手术的患者采用生存质量(quality of life，QOL)问卷在白内障手术前、后进行问卷调查。结果 白内障术后患者视力提高，患者的自理能力、活动能力、社交活动、心理健康状态等QOL指标均明显优于术前，QOL得分提高与视力提高显著相关。结论 白内障手术后视力提高，生存质量各项指标得分均相应提高，视觉相关的生存质量明显改善。     

继发性青光眼治疗及预后的临床分析

目的:探讨各类继发性青光眼的治疗方法及预后。方法:回顾性分析109例112眼继发性青光眼患者的临床资料,根据原发病分为晶状体相关性青光眼、眼外伤相关性青光眼、血管性疾病相关性青光眼、炎症相关性青光眼、眼部手术相关性青光眼及其他6组。对各组病例的治疗方法及效果予以评价。结果:各组治疗后1wk,眼压较入院眼压显著降低(P<0.05)。视力较入院最佳矫正视力提高。结论:继发性青光眼原发病具有多样性,其治疗须同时结合原发病和眼压,对视功能损害严重的继发性青光眼改善或解除症状亦为其治疗的主要目的。     

青光眼患者局部用药依从性及其影响因素

目的调查青光眼患者局部用药依从性及其影响因素，以期为青光眼患者设计更好的治疗方案。方法调查研究。应用局部药物的青光眼门诊患者120例，采用调查问卷的形式，依照Morisky推荐的评价依从性的标准评定患者的依从性，用单因素logistic回归和两分类变量的关联性检验分析青光眼患者局部用药依从性的影响因素。结果获得有效问卷108份，青光眼患者局部用药依从率为63．9％，不依从率为36．1％；年龄、月收入情况、用药次数、用药方法和医生是否告知对青光眼患者局部用药依从性有影响（X^2=18．752、17．783、13．530、9．022、14．831，P〈0．05）。结论所调查的青光眼患者局部用药的依从性较好：60岁以上、月收入600元以上、每天用药3次、用药方法正确、医生告知的患者，局部用药依从性好：简单、合理的治疗方案以及加强对青光眼患者的宣传教育，可以提高青光眼患者局部用药的依从性。     

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.     

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.     

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.     

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.     

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.     

原发性先天性青光眼患者术后生活质量的评价

目的 应用儿童和青少年眼病生活质量量表评价原发性先天性青光眼患者的生活质量.方法 横断面研究.首先对5～20岁共51例原发性先天性青光眼术后患者和50例相匹配的正常对照者进行生活质量量表调查,并对量表的信度、效度及反应度进行评价;然后应用该量表对上述原发性先天性青光眼患者术后7年(中位数)末次随访时的生活质量状况进行量表调查.应用SPSS13.0统计学软件对数据进行处理.采用单因素相关分析和多因素逐步回归分析方法评价生活质量得分情况及其与疾病类型、病情严重程度、手术疗效、术后视力、年龄、性别、性格等关系.结果 量表共由23个条目组成,经评定具有较好的信度、效度及反应度;23个条目完全符合原发性先天性青光眼患者生活质量的评价要求.原发性先天性青光眼患者的生活质量量表总分60.02±10.02,比正常对照者的总分(71.41±10.11)明显偏低(t=5.682,P=0.000).单因素相关分析结果表明,病情严重程度(F=24.026,P=0.000)、手术疗效(t=2.638,P=0.009)及术后视力分级(F=11.248,P=0.000)均与生活质量总分相关,病情严重程度(F=12.677,P=0.000)和术后视力分级(F=10.369,P=0.000)与视功能领域得分相关,病情严重程度(F=11.064,P=0.000)和手术疗效(t=2.297,P=0.042)与自理能力领域得分相关;病情严重程度(F=6.869,P=0.020;F=5.721,P=0.019)和性格特征(t=4.352,P=0.009;t=2.297,P=0.042)均与活动交往和精神心理领域得分相关.多因素逐步回归分析结果表明,量表总分和患者病情严重程度(β=-6.985,P=0.001)、术后视力分级(β=-4.978,P=0.003)及性格(β=-5.201,P=0.020)之间均存在明显负相关.结论 该量表符合生活质量量表效度、信度、反应度及易于分析的技术要求,可以适用于5～20岁原发性先天性青光眼患者生活质量的临床研究.影响先天性青光眼患者生活质量的主要因素有病情严重程度、术后视力分级及性格特征.控制病情、提高视力、加强健康教育及心理指导是改善先天性青光眼患者术后生活质量的关键.     

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.     

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