Quality of life in glaucoma and three other chronic diseases: a systematic literature review

Lifestyle Measures for Glaucoma Patients: An Objective Social Media Content Analysis

Aim

In this study, we analyze the content quality and characteristics of the most viewed search results on various internet platforms related to lifestyle measures for patients with glaucoma.

Materials and methods

In this internet-based cross-sectional study, we used search keywords "glaucoma," "lifestyle," "glaucoma," and "exercise" on the most popular internet platforms-Google, Facebook, YouTube, and Reddit. The top 30 Google searches about each of the keyword combinations were identified. We also assessed the first 30 videos on YouTube and Facebook Watch, the first 30 Reddit posts and the first 30 Google images about each of the keyword combinations. The quality of content from the platforms was evaluated by three independent reviewers using the well-established Sandvik score, Health on Net (HON) code, and risk score for different uploaders. The quality of content regarding lifestyle measures in glaucoma uploaded by healthcare professionals (HCPs) was further evaluated.

Results

The established criteria resulted in 48 websites from the Google search engine, 22 videos from YouTube, 37 posts from Reddit, and 28 videos from Facebook Watch, which were included in the final analysis. The mean Sandvik scores were 11.14 ± 1.8 (Google webpages), 10.4 ± 2.19 (YouTube videos), 10.54 ± 2.21 (Facebook Watch), and 4.24 ± 1.18 (Reddit). The mean risk scores were 0.22 ± 0.68 (YouTube videos), 0.18 ± 0.47 (Facebook Watch), and 0.11 ± 0.31 (Reddit). The mean HON code scores were 5.45 ± 1.62 (YouTube), 6.55 ± 1.44 (Google webpages), 5.29 ± 1.04 (Facebook Watch), and 8.27 ± 3.05 (Reddit). The content uploaded by HCPs was primarily from ophthalmologists and had significantly (p < 0.05) higher content quality scores. The majority of the content recommended aerobic exercise as a lifestyle measure in patients with glaucoma as an adjuvant to medical and surgical management.

Conclusion

The majority of the content regarding lifestyle measures in glaucoma was uploaded by HCPs and had medically accurate and well-referenced information, especially on Google and YouTube.

Clinical significance

Primary care physicians and ophthalmologists can reliably use social media content to guide recently diagnosed patients about the requisite lifestyle measures.

How to cite this article

Chahal R, Jindal A, Parmar UPS, et al. Lifestyle Measures for Glaucoma Patients: An Objective Social Media Content Analysis. J Curr Glaucoma Pract 2023;17(3):141-148.

Individualized Treatment for Glaucoma Patients with Diabetes mellitus

Glaucoma and diabetes mellitus are two common chronic diseases in Europe and worldwide which require intensive therapy. Various pathophysiological mechanisms have been discussed which favour the development of glaucoma, especially in the presence of diabetes mellitus. Medicinal and surgical adjustment of intraocular pressure is associated with some limitations in patients with diabetes mellitus, for example, filtering interventions show lower success rates than in non-diabetic glaucoma patients. Besides pure ophthalmological endocrinological therapy, the psychological burden of two chronic diseases should also be considered and included in the individual therapy plan.

Anxiety and depression in Chinese patients with glaucoma and its correlations with vision-related quality of life and visual function indices: a cross-sectional study

OBJECTIVE

To investigate anxiety and depression in patients with glaucoma and its correlations with vision-related quality of life (VR-QoL) and visual function indices.

DESIGN

A hospital-based, cross-sectional study.

SETTING

Shanghai, China PARTICIPANTS: The Hospital Anxiety and Depression Scale and the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) were administered to 446 Chinese patients with glaucoma to assess their psychological disorders, namely anxiety and depression, and VR-QoL, respectively.

OUTCOME MEASURES

Sociodemographic and clinical data were collected at the same time. Multivariate linear regression analysis was carried out to investigate the associations between VR-QoL, visual function indices and psychological disorders. Standardised partial regression analysis was used to identify the variable mostly indicative in evaluating psychological burdens.

RESULTS

The prevalence of anxiety and depression in Chinese patients with glaucoma was 12.11% and 25.78%, respectively. Most of the subscales and the composite score of NEI VFQ-25 were negatively associated with each parameter of anxiety and depression after adjusting for sociodemographic and clinical variables. For visual function indices, only the best-corrected visual acuity of both eyes was correlated with anxiety after adjustment. Standardised partial regression analysis further showed VR-QoL, but not the objective visual function indices, was mostly relevant to psychological disturbances.

CONCLUSIONS

Anxiety and depression were common in Chinese patients with glaucoma. Self-reported VR-QoL was beneficial in assessing psychological status of patients with glaucoma, while objective visual function indices provide little hint on it.

Quality of Life and Anxiety in Age Macular Degeneration Patients: A Cross-Sectional Study

(1) Background: Chronic diseases affect patients' quality of life. Age Macular Degeneration (AMD) is one of the most prevalent chronic ocular diseases. The study aims to measure the anxiety and quality of life related to vision in patients with AMD, as well as the relationship with other visual and demographic parameters. (2) Methods: Prospective cross-sectional study in AMD patients. Visual acuity (VA), contrast sensitivity (CS), line difference in the Colenbrander test, and the degree of pathology were measured. Other variables such as gender, age, and time from the diagnosis were also collected. Anxiety was measured with the Spielberger State-Trait Anxiety Inventory (STAI) and quality of life with the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was followed. (3) Results: Patients with higher punctuation in Trait STAI showed lower punctuation in NEI VFQ-25 questionnaire (Spearman coefficient -0.415; p = 0.001). The variables VA, CS, and age were correlated to the quality of life. The relationship between trait anxiety and subscales of NEI VFQ-25 was significant for all subscales (p < 0.05), except for social functioning, peripheral vision, general vision, ocular pain, and driving. (4) Conclusions: AMD patients with higher levels of anxiety show a decrease in their quality of life. The quality of life of AMD patients depends on their VA and CS.

The prevalence of anxiety symptoms and disorders among ophthalmic disease patients

Background:

Progressive and irreversible vision loss has been shown to place a patient at risk of mental health problems such as anxiety. However, the reported prevalence of anxiety symptoms and disorders among eye disease patients vary across studies. Thus, this study aims to clarify the estimated prevalence of anxiety symptoms and disorders among ophthalmic disease patients.

Methods:

Relevant studies on the prevalence of anxiety symptoms and disorders among eye disease patients were collected through international databases, PubMed, Scopus, and Web of Science. A random-effects model was used to determine the pooled prevalence of anxiety symptoms and disorders among ophthalmic disease patients.

Results:

The 95 included studies yielded a pooled prevalence of 31.2% patients with anxiety symptoms and 19.0% with anxiety disorders among subjects with ophthalmic disease. Pediatric patients were more anxious (58.6%) than adults (29%). Anxiety symptoms were most prevalent in uveitis (53.5%), followed by dry eye disease (DED, 37.2%), retinitis pigmentosa (RP, 36.5%), diabetic retinopathy (DR, 31.3%), glaucoma (30.7%), myopia (24.7%), age-related macular degeneration (AMD, 21.6%), and cataract (21.2%) patients. Anxiety disorders were most prevalent in thyroid eye disease (TED, 28.9%), followed by glaucoma (22.2%) and DED (11.4%). When compared with healthy controls, there was a twofold increase on the prevalence of anxiety symptoms (OR = 1.912, 95% CI 1.463–2.5, p < 0.001) and anxiety disorders (OR = 2.281, 95% CI 1.168–4.454, p = 0.016).

Conclusion:

Anxiety symptoms and disorders are common problems associated with ophthalmic disease patients. Thus, comprehensive and appropriate treatments are necessary for treating anxiety symptoms and disorders among ophthalmic disease patients.

Quality of life of older adults with primary open angle glaucoma using Bahasa Malaysia version of Glaucoma Quality of life 36 questionnaire

BACKGROUND

Primary open-angle glaucoma (POAG) is an age-related chronic optic neuropathy causing progressive constriction of visual field, which compromised quality of life (QoL) of older adults.

OBJECTIVE

The study aims to determine the QoL according to the severity of visual field using Bahasa Malaysia version of the Glaucoma Quality of Life- 36 (Glau-QoL 36) in older adults with POAG in Malaysia.

METHODS

A cross-sectional study was conducted in two tertiary hospitals in Malaysia: Hospital Universiti Sains Malaysia, Kelantan, and Hospital Selayang, Selangor. POAG patients who were ≥ 60 years old at the time of recruitment had minimal cataract, underwent cataract or trabeculectomy surgery at least 3 months prior and were on medical and surgical treatment. The severity of POAG was based on the modified Advanced Glaucoma Intervention Study (AGIS) score on two reliable reproducible Humphrey visual field SITA program 24-2 analysis. Face to face, one-on-one interview was conducted using validated Bahasa Malaysia version of GlauQol 36.

RESULTS

A total of 360 older adults with POAG were recruited. Majority were between ages 60-67 (38.3%) with 64 (17.8%) mild, 93 (25.8%) moderate, 115 (31.9%) severe POAG and 88 (24.4%) end-stage severity of POAG. The majority of the recruited patients were not working (88.9%) and live with their families (68.1%). There was a significant association between GlauQoL 36 score of all domains: daily living, driving, physiological well-being, self-image, anxiety, burden of treatment and confidence in healthcare with the severity of POAG (p<0.001). Increased severity of POAG was associated with decreased QoL in all GlauQoL 36 domains except confidence in healthcare. There was also a significant increase in dependency, with a majority of the end-stage were living with their families (p<0.001).

CONCLUSIONS

QoL and independency of older adults with POAG decrease with worsening of visual field defect. Addressing the problem of visual-related activities in older adults with POAG may reduce their dependency and QoL. Happy living is important to lead to healthy living among older adults with POAG.

Development and Validation of a Preference-Based Glaucoma Utility Instrument Using Discrete Choice Experiment

Importance

A glaucoma-specific instrument for estimating utilities across the spectrum of glaucoma severity is currently lacking, hindering the assessment of the cost-effectiveness of glaucoma treatments.

Objective

To develop and validate the preference-based Glaucoma Utility Instrument (Glau-U) and to ascertain the association between Glau-U utilities and severity of glaucoma and vision impairment.

Design, Setting, and Participants

This cross-sectional study was conducted in 2 stages at the Singapore National Eye Centre glaucoma clinics. Stage 1 focused on the identification and pretesting of the Glau-U attributes and was carried out between June 2009 and May 2016. Stage 2 involved the development and administration of the discrete choice experiment (DCE) survey and tasks and was conducted between May 7, 2018, and December 11, 2019. Stage 2 participants were English- or Mandarin-speaking Singaporean citizens or permanent residents of Chinese, Malay, or Indian ethnicity who were 40 years or older and had a clinical diagnosis of glaucoma in at least 1 eye.

Exposures

Glau-U comprised 6 quality-of-life attributes: activities of daily living, lighting and glare, movement, eye discomfort, other effects of glaucoma, and social and emotional effects. The descriptions or response options for these attributes were no difficulty or never, some difficulty or sometimes, or severe difficulty or often.

Main Outcomes and Measures

Utility weights for Glau-U were developed using a DCE questionnaire, which was interviewer administered to participants. Mixed logit regression determined utility weights for each health state. Glau-U utility weights across better- or worse-eye glaucoma and vision impairment severity were calculated using 1-way analysis of variance. Correlations between Glau-U utilities and better- or worse-eye visual fields and EuroQol 5-Dimension utilities were ascertained to assess convergent and divergent validity.

Results

Of the 304 participants (mean [SD] age, 68.3 [8.7] years; 182 men [59.9%]), 281 (92.4%) had no vision impairment in the better eye, 13 (4.3%) had mild impairment, and 10 (3.3%) had moderate to severe vision impairment. Mean (SD) Glau-U utilities decreased as better-eye glaucoma severity increased (none: 0.73 [0.21]; mild: 0.66 [0.21]; moderate: 0.66 [0.20]; severe: 0.60 [0.28]; and advanced or end-stage: 0.22 [0.38]; P < .001), representing reductions of 20.7% to 76.1% in quality-adjusted life-years compared with a health state that included preperimetric glaucoma. Mean (SD) Glau-U utilities also decreased as better-eye vision impairment worsened from 0.67 (0.23) for none to 0.58 (0.32) for mild to 0.46 (0.29) for moderate to severe vision impairment. Glau-U utilities demonstrated moderate correlations with better-eye (r = 0.34; P < .001) and worse-eye (r = 0.33; P < .001) mean deviation scores and low correlations with EuroQol 5-Dimension utilities (r = 0.22; P < .001), supporting convergent and divergent validity.

Conclusions and Relevance

Use of Glau-U revealed large decrements in utility that were associated with late-stage glaucoma, suggesting that this new instrument may be useful for cost-effectiveness analyses of interventions and informing resource allocation policies for glaucoma and vision loss.

Utility Index and Patient-Reported Outcome Measures in Glaucomatous Patients Comparing with Normal Participants

Purpose

Utility index is a significant outcome in terms of health economics assessment while patient-reported outcome measure (PROMs) evaluates quality of life (QOL) from patient’s perspective. Our objective was to evaluate both utility indices and PROMs using generic and eye specific QOL in glaucomatous patients compared with normal population.

Methods

This is a case-control study. We interviewed normal and glaucomatous participants with the European Quality of Life questionnaire (EQ-5D-5L), the European visual analogue scale (EQ-VAS) and the visual function questionnaire 28 (Thai version) (VFQ-28). The visual function questionnaire utility index (VFQ-UI) and generic utility index from EQ-5D-5L were calculated.

Results

There were 47 normal and 127 glaucomatous participants in this study. Amongst glaucoma group, 35 participants were in the early stage of the disease, 43 were in the moderate stage, 30 normal vision participants were in the severe stage, 14 participants had blindness one eye, and 5 had blindness both eyes. The mean age of the participants in both groups was statistically similar (63.78±6.84 vs 66.30±8.93 years old, respectively, p=0.062). Underlying diseases between groups were also comparable. The EQ-5D-5L utility index score and the EQ-VAS score were not statistically different between normal and glaucomatous groups, respectively (EQ-5D-5L: 0.874±0.122 vs 0.837±0.191, p=0.215; EQ VAS: 76.06±15.07 vs 74.02 ±15.10, p=0.43). By contrast, VFQ-UI of the glaucomatous group was significantly lower than that of the normal group, (VFQ-UI: 0.833±0.147 vs 0.895±0.070, accordingly, p<0.05).

Conclusions

Utility index from the VFQ-UI was a relevant PROMs for evaluating the QOL of glaucomatous patients in terms of visual function specificity and acceptable validity.

Patient-reported Outcomes, Functional Assessment, and Utility Values in Glaucoma

In clinical glaucoma research, the measurement of patient reported outcomes, functional assessment of disability, and health economic impact is critical. However, valid, time-efficient and comprehensive tools are not available and several current instruments lack in the appropriate precision for measuring the various dimensions of glaucoma-related quality of life (QoL), including functioning and mobility. Furthermore, statistical methods are inconsistently and sometimes incorrectly used in otherwise sound clinical studies. Standardizing and improving methods of patient-centered data collection and analysis in glaucoma studies are imperative. This paper outlines recommendations and provides a discussion of some of the pertinent issues relating to the optimization of patient-reported outcomes research in glaucoma.

The association between visual impairment and fatigue: a systematic review and meta-analysis of observational studies

PURPOSE

The aim was to compare fatigue levels between patients with visual impairment and controls with normal sight and to examine the association between fatigue and vision loss severity.

METHODS

A systematic literature search was performed using databases of PubMed, Embase, PsycINFO and Cochrane to identify observational studies with outcomes related to fatigue (e.g. vitality subscale of the Short-Form 36, Fatigue Assessment Scale). A meta-analysis was performed using standardised mean differences (SMDs) and odds ratios (OR) to quantitatively summarise the association between visual impairment and fatigue. Sources of heterogeneity were explored by subgroup and sensitivity analyses. Study quality was assessed with the Newcastle-Ottawa scale.

RESULTS

After reviewing 4477 studies, 22 studies with a total of 40 004 participants were included, of which 18 contributed to meta-analysis. Among these, eight were assessed as moderate quality studies and 10 as high quality studies. Pooled analysis involving 2500 patients and 8395 controls showed higher fatigue severity levels (S.M.D. = -0.36, 95% CI -0.50 to -0.22, 14 studies) among visually impaired patients compared to normally sighted controls. This effect size was small and persisted in sensitivity analyses that involved study quality, fatigue assessment tools and visual acuity data. Furthermore, pooled analysis of four studies including 2615 patients and 5438 controls showed a significant association between visual impairment and fatigue (OR = 2.61, 95% CI 1.69 to 4.04). Secondary meta-analysis of four studies showed no significant difference in fatigue severity (S.M.D. = 0.01, 95% CI -0.37 to 0.39) between patients with moderate visual impairment and patients with severe visual impairment or blindness.

CONCLUSIONS

Current moderate to high quality evidence suggest that patients with visual impairment experience more severe fatigue symptoms than persons with normal sight. However, a limited number of available studies indicates that fatigue is not associated with severity of vision loss. Future studies are required to determine which factors and underlying mechanisms may explain the association between visual impairment and fatigue. Discussing fatigue at an early stage and developing intervention options for vision-related fatigue should be considered within the field of low vision rehabilitation.

Smartphones, tele-ophthalmology, and VISION 2020

Telemedicine is an emerging field in recent medical achievements with rapid development. The "smartphone" availability has increased in both developed and developing countries even among people in rural and remotes areas. Tele-based services can be used for screening ophthalmic diseases and also monitoring patients with known diseases. Electronic ophthalmologic records of the patients including captured images by smartphones from anterior and posterior segments of the eye will be evaluated by ophthalmologists, and if patients require further evaluations, they will be referred to experts in the relevant field. Eye diseases such as cataract, glaucoma, age-related macular degeneration, diabetic retinopathy, and retinopathy of prematurity are the most common causes of blindness in many countries and beneficial use of teleophthalmology with smartphones will be a good way to achieve the aim of VISION 2020 all over the world. Numerous studies have shown that teleophthalmology is similar to the conventional eye care system in clinical outcomes and even provides more patient satisfaction as it saves time and cost. This review explains how teleophthalmology helps to improve patient outcomes through smartphones.

Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: an economic evaluation based on data from the EAGLE trial

OBJECTIVE

To investigate the cost-effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (PACG) compared to standard care.

DESIGN

Cost-effectiveness analysis alongside a multicentre pragmatic two-arm randomised controlled trial. Patients were followed-up for 36 months, and data on health service usage and health state utility were collected and analysed within the trial time horizon. A Markov model was developed to extrapolate the results over a 5-year and 10-year time horizon.

SETTING

22 hospital eye services in the UK.

POPULATION

Males and females aged 50 years or over with newly diagnosed PACG or primary angle closure (PAC).

INTERVENTIONS

Lens extraction compared to standard care (ie, laser iridotomy followed by medical therapy and glaucoma surgery).

OUTCOME MEASURES

Costs of primary and secondary healthcare usage (UK NHS perspective), quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for lens extraction versus standard care.

RESULTS

The mean age of participants was 67.5 (8.42), 57.5% were women, 44.6% had both eyes eligible, 1.4% were of Asian ethnicity and 35.4% had PAC. The mean health service costs were higher in patients randomised to lens extraction: £2467 vs £1486. The mean adjusted QALYs were also higher with early lens extraction: 2.602 vs 2.533. The ICER for lens extraction versus standard care was £14 284 per QALY gained at three years. Modelling suggests that the ICER may drop to £7090 per QALY gained by 5 years and that lens extraction may be cost saving by 10 years. Our results are generally robust to changes in the key input parameters and assumptions.

CONCLUSIONS

We find that lens extraction has a 67-89% chance of being cost-effective at 3 years and that it may be cost saving by 10 years.

TRIAL REGISTRATION NUMBER

ISRCTN44464607; Results.

Health-related quality of life in patients with primary open-angle glaucoma. An Italian multicentre observational study

PURPOSE

As a progressive condition, glaucoma may impair health-related quality of life (HRQoL), due to vision loss and other factors. This study evaluated HRQoL in a cohort of patients treated for primary open-angle glaucoma (POAG) and assessed its association with clinical features.

METHODS

This was an Italian, multicentre, cross-sectional, observational study with the subgroup of newly diagnosed patients with POAG prospectively followed up for one year. Patients with previous or new diagnosis (or strong clinical suspicion) of POAG aged >18 years were considered eligible. Information was collected on demographic characteristics, medical history, clinical presentation and POAG treatments. HRQoL was measured using the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and Glaucoma Symptom Scale (GSS). Subscale and total scores were obtained and a Pearson correlation coefficient between instruments' scores calculated.

RESULTS

A total of 3227 patients were enrolled from 2012 to 2013 and 3169 were analysed. Mean age was 66.9 years. A total of 93.8% had a previous diagnosis (median duration: 8.0 years). Median values for mean deviation and pattern standard deviation were 3.9 and 3.6 dB, respectively. Mean scores on most subscales of the NEI-VFQ-25 exceeded 75.0 and mean GSS subscale scores ranged between 70.8 and 79.7 (with a total mean score of 74.8). HRQoL scores on both scales were significantly inversely associated with POAG severity.

CONCLUSION

In this large sample of Italians treated for POAG, disease severity was limited and HRQoL scores were high. QoL decreased with advancing disease severity. These findings confirm the role of vision loss in impairing QoL in POAG, underlying the importance of timely detection and appropriate treatment.

Quality of Life in Glaucoma: A Review of the Literature

The ultimate goal of glaucoma management is the preservation of patients’ visual function and quality of life (QoL). The disease itself as well as the medical or surgical treatment can have an enormous impact on a patient’s QoL. Even the mere diagnosis of a chronic, irreversible, potentially blinding disorder can adversely affect the patient’s sense of well-being and QoL by eliciting significant anxiety. Patients with primary open-angle glaucoma rarely present with visual symptoms, at least early in the course of the disease. A better understanding of patient-reported QoL can improve patient–physician interaction and enhance treatment adherence by customizing treatment options based on individual patient profile, thus optimizing long-term prognosis. These aspects are summarized and critically appraised in this article.

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.

Social media use by patients with glaucoma: what can we learn?

PURPOSE

Much health-related information is available on the internet but its quality is known to be variable. This research aimed to analyse the ophthalmic content of social media platforms which has yet to be formally assessed.

METHODS

Five online social media platforms were selected, the International Glaucoma Association (IGA) forum, Facebook, Twitter, YouTube and Patient Opinion.org.uk. A total of 3785 items were scraped from the sites, collated and analysed using simple thematic analysis by two coders.

RESULTS

Fourteen themes were identified. The most commonly discussed topics included treatments, care experiences, promotions and support. Un-moderated sites contain more misleading information. Complementary therapies and treatments with a poor evidence base are presented more positively than established, evidence-based treatments.

CONCLUSION

Online forums give patients a space to air questions, grievances, suggestions and to provide mutual support. The information they contain may be of use to physicians by flagging adverse drug reactions, areas for service improvement or topics about which patients require more information. There is a risk of exposure to misleading content which is heightened in un-moderated sites. Social media platforms may be an adjunct to current care models by providing a supportive and educational online community if these risks are understood.

Resident compliance with the american academy of ophthalmology preferred practice pattern guidelines for primary open-angle glaucoma

PURPOSE

To examine resident adherence to preferred practice pattern (PPP) guidelines set up by the American Academy of Ophthalmology for follow-up care of primary open-angle glaucoma (POAG) patients.

DESIGN

Retrospective chart review.

PARTICIPANTS

One hundred three charts were selected for analysis from all patients with an International Classification of Diseases, Ninth Revision, code of open-angle glaucoma or its related entities who underwent a follow-up evaluation between July 2, 2003, and December 15, 2004, at the resident ophthalmology clinic in the Durham Veteran Affairs Medical Center.

METHODS

Follow-up visits of POAG patients were evaluated for documentation of 19 elements in accordance to PPP guidelines.

MAIN OUTCOME MEASURES

Compliance rates for the 19 elements of PPP guidelines first were averaged in all charts, and then were averaged per resident and were compared among 8 residents between their first and second years of residency.

RESULTS

The overall mean compliance rate for all 19 elements was 82.6% for all charts (n = 103), 78.8% for first-year residents, and 81.7% for second-year residents. The increase from first to second year of residency was not significant (P>0.05). Documentation rates were high (>90%) for 14 elements, including all components of the physical examination and follow-up as well as most components of the examination history and management plan. Residents documented adjusting target intraocular pressure downward, local or systemic problems with medications, and impact of visual function on daily living approximately 50% to 80% of the time. Documentation rates for components of patient education were the lowest, between 5% and 16% in all charts.

CONCLUSIONS

Residents' compliance with PPP guidelines for a POAG follow-up visit was very high for most elements, but documentation rates for components of patient education were poor. Adherence rates to PPP guidelines can be used as a tool to evaluate and improve resident performance during training. However, further studies are needed to establish the advantages of using PPP guidelines for resident education and to determine if such assessments can lead to improved patient care.

Comparison of resource utilization in the treatment of open-angle glaucoma between two cities in Finland: is more better?

INTRODUCTION

Glaucoma is a progressive optic neuropathy associated with neural rim loss of the optic disc and the retinal nerve fibre layer typically causing visual field (VF) deterioration. Generally, glaucomatous lesions in the eye and in the visual field progress slowly over the years. In population-based cross-sectional studies, the percentage of unilateral or bilateral visual impairment varied between 3-12%. In screening studies, 0.03-2.4% of patients have been found to suffer visual impairment. Glaucoma has previously been associated with substantial healthcare costs and resource consumption attributable to the treatment of the disease. The disease also causes reduction in health-related quality of life (HRQoL) in patients with glaucoma.

OBJECTIVE AND METHODS

This study compares patients with diagnosed open-angle glaucoma from two geographically different regions in Finland. A total of 168 patients were examined, 85 subjects from an area with higher per patient treatment costs (Oulu) and 83 patients from a region with lower per patient treatment costs (Turku). All patients had a history of continuous glaucoma medication use for a period of 11 years. For each patient, the total direct costs from glaucoma treatment were calculated and the total amount of resource consumption was determined from registries and patient records. Each patient underwent a clinical examination with visual field assessment and fundus photography. These data were used to determine the current stage of disease for each patient. Health-related quality of life questionnaire (15D) was used in determining each patient's subjective HRQoL score.

RESULTS

When applying the current diagnostic criteria for open-angle glaucoma, a total of 40% of patients did not to display any structural or functional damage suggesting glaucoma after 11 years of continuous medical treatment and follow-up. Patients with higher glaucoma stage (worse disease) were found to have statistically higher treatment costs compared with those at lower disease stages. Resource consumption was also greater in the patients in higher glaucoma stage. Patients in the Oulu district consumed more resources, and glaucoma treatment was more expensive than in the Turku area. The total treatment cost in Oulu and Turku was 6010 € and 4452 €, respectively, for the whole 11-year period. There was no statistically significant difference in quality-of-life scores between the two areas. No difference was noted between the higher-spending and lower-spending areas in this respect. However, when the population was analysed as a whole, patients with higher glaucoma stage were found to have lower vision-based 15D scores compared with those at lower disease stages. This observation was made also at both districts independently.

CONCLUSIONS

Major cost source in open-angle glaucoma treatment is medication, up to 74% of annual costs. In addition, it seems that higher resource consumption and higher treatment costs do not increase the patients' HRQoL as assessed by the 15D instrument.

A meta-analysis of health state valuations for people with diabetes: explaining the variation across methods and implications for economic evaluation

PURPOSE

To review published studies on the effect of diabetes and its complications on utility scores to establish whether there is systematic variation across studies and to examine the implications for the estimation of quality-adjusted life years (QALYs).

METHODS

A systematic review was performed using studies reporting QALY measures elicited from people with diabetes including those with a history of complications. Meta-analysis was used to obtain the average utility, and meta-regression was employed to examine the impact of study characteristics and elicitation methods on these values. The effect of different utility scores on QALYs was examined using diabetes simulation models.

RESULTS

In the meta-analysis based on 45 studies reporting 66 values, the average utility score was 0.76 (95% CI 0.75-0.77). A meta-regression showed significant variation due to age, method of elicitation and the proportion of males. The average utility score for individual complications ranged from 0.48 (95% CI 0.25, 0.71) for chronic renal disease to 0.75 (95% CI 0.73, 0.78) for myocardial infarction, and these differences produced meaningful changes in simulated QALYs. There was significant heterogeneity between studies.

CONCLUSIONS

We provide summary utility scores for diabetes and its major complications that could help inform economic evaluation and policy analysis.

Focusing on glaucoma progression and the clinical importance of progression rate measurement: a review

PURPOSE

This review aims to provide guidance in managing glaucoma patients more effectively. It focuses on the importance of detecting progression and measuring its rate within the management of primary open-angle glaucoma today. Recent findings strongly indicate that continued monitoring of visual fields (VFs) and reassessment of target intraocular pressures (IOPs) depending on VF progression rates are mandatory in the management of glaucoma.

METHODS

Data on glaucoma progression from older as well as most recent literature findings are summarized in this article. In addition, the article elaborates on the scientific content from a series of lectures given by experts in the field during several international symposia on 'rate of progression' in 2008.

RESULTS

This review summarizes key findings on the natural history of glaucoma and known factors for disease progression. It highlights the visual function changes observed as glaucoma progresses and discusses disease impact on patients' quality of life. Findings support the need to obtain information on rate of progression and its importance for clinical management. Practical ways to measure rate of progression are given by new software options to help measure major parameters. Finally, on the basis of a patient's individual rate of progression therapeutic options are assessed, such as maximum medical therapy with fixed combinations.

CONCLUSIONS

Estimating a patient's individual rate of VF progression by using newly developed analyses will be helpful to forecast the potential future development of the glaucoma. An individualized treatment approach then requires that in patients in whom the risk of becoming visually impaired or blind during their lifetime is higher, a more intensive medical IOP-lowering therapy such as fixed combinations can be considered as treatment option.