The association between clinical parameters and glaucoma-specific quality of life in Chinese primary open-angle glaucoma patients

Correlation between visual field index and quality of life in glaucoma patients: a new tool to screen quality of life perception?

Purpose

To evaluate the correlation between the visual field index (VFI) and vision-related quality of life (QoL) considering several confounding variables that may have a positive or negative effect.

Methods

We conducted a cross-sectional, mono-centric study on glaucoma patients. Quality of life was examined with the NEI-VFQ 25 and the Glaucoma Symptom Scale (GSS). The visual field was examined with the Humphrey Field Analyzer. The variables considered were age, gender, comorbidities, years (at diagnosis and duration of the illness), treatment and related active principles, intraocular pressure, and visual acuity. The analysis was performed on both the better and the worse eye. The linear regression univariate analysis and the multivariate analyses were performed.

Results

In total, 193 patients enrolled in the study. The mean age was 70.8 ± 10.4 years. The mean follow-up period since diagnosis 11.4 ± 9.2 years. Approximately 50% of the patients suffered from primary open angle glaucoma (POAG) and 45% were on monotherapy. The mean VFI was 81.3 ± 26. Regarding QoL, the NEI-VFQ total mean was 80.4 ± 17.8 and the GSS total score was 77.2 ± 21. Regarding NEI-VFQ 25, the single linear regression analysis found the following relations: age at time of visit (r = -0.30, p = 0.016), years of illness (r = -0.32, p = 0.020), the minimum and maximal visual acuity (r = 2.04 and r = 3.96, p < 0.001), the IOP min (r = 1.13, p = 0.002) and max (r = -0.52, p = 0.017), and the number of previous surgeries (r = -3.94, p < 0.001). The multivariate analysis found the following relations: gender (r = 5.13, p = 0.019), visual acuity max (r = 3.16, p < 0.001), and previous surgeries (r = -1.80, p = 0.032). Regarding GSS, the single linear regression analysis found relations with visual acuity (r = 2.37, p < 0.001), VFI (r = 0.41, p < 0.001), previous surgeries in the eye considered (r = -7.27, p < 0.001), and number of instillations (r = -3.67, p = 0.031). Data confirmed that a higher VFI has a positive impact on the score of both the NEI-VFQ 25 (r = 0.22, p = < 0.001) and the GSS questionnaire (r = 0.36, p < 0.001).

Conclusions

The study demonstrated a correlation between the VFI and QoL of patients and their visual and non-visual ocular symptoms and function both in the worst and in the better eye, even when accounting for several clinical and demographic confounding variables. Our data support that the visual field index is an important metric instrument in the follow up of patients with glaucoma.

Vision-Related Quality of Life and Associated Factors Among an Adult Population with Glaucoma Attending a Comprehensive Specialized Hospital, Northwest Ethiopia

Background

Glaucoma is a group of ocular conditions that leads to irreversible blindness. It can affect the vision-related quality of life in many ways. In Ethiopia, limited information is available on how and to what extent the vision-related quality of life of the glaucoma population has been affected.

Objective

This study attempted to assess the vision-related quality of life and associated factors among an adult population with glaucoma attending Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia.

Methods

The cross-sectional study was conducted on the adult population with glaucoma attending Felege Hiwot Comprehensive Specialized Hospital. Systematic random sampling was employed to select 319 study participants. Descriptive and summary statistics were calculated. Simple and multiple linear regressions were performed to determine factors associated with vision-related quality of life. A p-value of <0.05 in multivariable regression was considered statistically significant at a 95% confidence level.

Results

The mean glaucoma quality of life-15 score in this study was 47.85 ± 15.41. Below primary education, primary education, visual acuity of the better eye, visual acuity of the worse eye, and severe glaucoma were significantly associated with the glaucoma quality of life-15 score.

Conclusion and Recommendation

The study observed poorer vision-related quality of life in the glaucoma population than previously reported in Ethiopia and around the globe. The vision-related quality of life was significantly associated with educational status, visual acuity of the better and worse eye, and stage of glaucoma in the better eye. Educating the glaucoma population on the nature of the disease, advice on early presentation, and better-coping strategies for the condition are warranted.

How do different lighting conditions affect the vision and quality of life of people with glaucoma? A systematic review

This article is a systematic review of evidence regarding the impact of different lighting conditions on the vision and quality of life (QoL) of people with primary open-angle glaucoma (POAG). A systematic literature search was carried out using CINAHL, MEDLINE, PsycARTICLES, PsycINFO, Embase, and Ovid Nursing Database for studies: published up to April 2019; including people diagnosed with POAG; and assessing visual function or QoL in response to changing lighting/luminance levels or glare. Two researchers independently screened studies for eligibility. Data were extracted from eligible studies regarding study design, participant characteristics, outcomes, and results. Quality of included studies was critically appraised. Of 8437 studies, 56 eligible studies were included. Studies investigated the effects of lighting on the following domains among people with POAG: QoL (18/56), psychophysical measures (16/56), functional vision (10/56), activities of daily living (10/56), and qualitative findings (2/56). POAG negatively affects low-luminance contrast sensitivity, glare symptoms, and dark adaptation time and extent. In vision-related QoL questionnaires, people with POAG report problems with lighting, glare, and dark adaptation more frequently than any other domain. These problems worsen with progressing visual field loss. Early-stage POAG patients experience significantly more difficulties in low-luminance or changing lighting conditions than age-matched controls (AMCs), challenging perceptions of early-stage POAG as asymptomatic. However, performance-based studies seldom show significant differences between POAG participants and AMCs on tasks simulating daily activities under non-optimal lighting conditions. Further research with larger samples is required to optimise ambient and task-oriented lighting that can support patients' adaptation to POAG.

The impact of glaucoma on quality of life in Ethiopia: a case-control study

Background

Glaucoma is a chronic disease characterized by irreversible optic nerve damage and visual field loss that leads to visual impairment and blindness; ultimately limiting personal independence and compromising overall quality of life of affected individuals. There is paucity of information on how glaucoma affects the quality of life of patients in low and middle-income countries where resources for both diagnosis and treatment of such conditions are limited. In this study we investigate the impact of glaucoma on quality of life in Ethiopian patients.

Methods

The quality of life of 307 glaucoma patients and 76 normal controls that were frequency matched to the age and sex profiles of the cases was assessed using Amharic version of Glaucoma Quality of Life −15 questionnaire. Linear regression models and the t-test were employed to compare significant differences in GQL-15 scores and to generate mean and mean differences between cases and controls respectively.

Results

The mean GQL-15 score in the glaucoma cases was substantially higher (indicating poorer quality of life) than the controls [cases 46.3 (95% CI, 28.8–63.8) and controls 18.6 (95% CI, 15.2–22.0), p < 0.0001]. Cases with normal visual acuity and mild glaucoma had significantly higher scores than the controls. Poorer quality of life was associated with age ≥ 71 years old 51.1 (95%CI, 26.2–75.9), rural residence 55.7 (95%CI, 49.9–61.5), monthly income of <400 Birr (53.1; 95%CI, 50.5–55.6), diagnosis time 1–5 years (49.6; 95%CI, 41.2–57.9), severe visual impairment (70.5; 95%CI, 58.1–82.8), and advanced glaucoma (50.9; 95%CI, 43.6–58.3).

Conclusion

These glaucoma patients, including those with normal visual acuity and early disease, had poorer quality of life compared to normal controls. Older age, rural residence, low income and more advanced disease were significantly associated with poorer quality of life. There is a need to increase awareness of the impact of glaucoma among clinicians, patients and their families, for a better understanding of the impact this disease has on a person’s life.

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.

Mental Health Status and Quality of Life in Undiagnosed Glaucoma Patients: A Nationwide Population-Based Study

Glaucoma is a leading cause of irreversible vision loss. Mental health and quality of life (QoL) are important issues for patients with glaucoma because visual impairment can be related to those. Analysis of mental health status or QoL in undiagnosed glaucoma patients can be free of the bias caused by awareness of the disease itself. In this study, the association between mental health status or QoL and undiagnosed glaucoma, along with the effects of visual acuity or visual field damage was investigated. Among individuals in the Korea National Health and Nutrition Examination Survey (KNHANES) V (2010-2012), subjects 40 years or older were included. KNHANES is a cross-sectional study using a stratified, multistage, probability sampling survey. The KNHANES includes questionnaires to assess psychological health, including depression, sleep duration, psychological stress, and suicidal ideations. To evaluate QoL, the KNHANES includes the EuroQoL, which is composed of a health-status descriptive system (EuroQol 5-dimension, EQ-5D) and the EQ visual analog scale (EQ-VAS). The proportion of people reporting symptoms of "some or severe problems" in all 5 dimensions of the EuroQoL-5 instrument, including anxiety/depression, was higher in the glaucoma group than in the nonglaucoma group. The subjective health status reported by the EQ-VAS was lower in the subjects with glaucoma than in those without glaucoma. Suicidal ideation was greater in subjects with glaucoma than in those without glaucoma (P = 0.005). After adjustment for demographic factors, glaucoma subjects were more likely than those without glaucoma to have some or severe problems with anxiety/depression (odds ratio 1.77; 95% confidence interval, 1.26-2.49). Worse best corrected visual acuity was associated with more problems with a lower EQ-5D score in glaucoma subjects. Individuals who had undiagnosed glaucoma were more depressed than those without glaucoma. QoL can be affected by glaucoma, especially in patients with worse visual acuity.

Vision Health-Related Quality of Life in Chinese Glaucoma Patients

This cross-sectional study evaluated VRQOL in Chinese glaucoma patients and the potential factors influencing VRQOL. The VRQOL was assessed using the Chinese-version low vision quality of life questionnaire. Visual field loss was classified by the Hodapp-Parrish-Anderson method. The correlations of VRQOL to the best corrected visual acuity and the VF loss were investigated. The potential impact factors to VRQOL of glaucoma patients were screened by single factor analysis and were further analyzed by multiple regression analysis. There were significant differences in VRQOL scores between mild VF loss group and moderate VF loss group, moderate VF loss group and severe VF loss group, and mild VF loss group and severe VF loss group according to the better eye. In multiple linear regression, the binocular weighted average BCVA significantly affected the VRQOL scores. Binocular MD was the second influencing factor. In logistic regression, binocular severe VF loss and stroke were significantly associated with abnormal VRQOL. Education was the next influencing factor. This study showed that visual acuity correlated linearly with VRQOL, and VF loss might reach a certain level, correlating with abnormal VRQOL scores. Stroke was significantly associated with abnormal VRQOL.

Association of n3 and n6 polyunsaturated fatty acids in red blood cell membrane and plasma with severity of normal tension glaucoma

AIM

To determine whether red blood cell (RBC) membrane and plasma lipids, particularly long-chain polyunsaturated fatty acids such as eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid (AA) are significantly correlated with severity of normal tension glaucoma (NTG).

METHODS

This study included 35 patients with NTG and 12 healthy normal control subjects, matched for age and sex with the study group. The stage of glaucoma was determined according to the Hodapp-Parrish-Anderson classification. Lipids were extracted from RBC membranes and plasma, and fatty acid methyl esters prepared and analyzed by gas chromatography-mass spectrometry (GC-MS).

RESULTS

When RBC lipids were analyzed, the levels of EPA, the levels of DHA and the ratio of n3 to n6 were positively associated with the Humphrey Perimetry mean deviation (MD) score (r=0.617, P<0.001; r=0.727, P<0.001 and r=0.720, P<0.001, respectively), while the level of AA was negatively associated with the MD score (r=-0.427, P=0.001). When plasma lipids were analyzed, there was a significant positive relationship between the levels of EPA and the MD score (r=0.648, P<0.001), and the levels of AA were inversely correlated with the MD score (r=-0.638, P<0.001).

CONCLUSION

The levels of n3 and n6 polyunsaturated fatty acids in RBC membrane and plasma lipids were associated with severity of NTG.