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Glaucoma Quality of Life in Glaucoma Patients Simon Skalicky, MBBS, MMed (Ophthal Sci), MPhil 1,2 and Ivan Goldberg, AM, FRANZCO, FRACS 1,2 1. Professorial Senior Ophthalmology Registrar, Glaucoma Unit, Sydney Eye Hospital, and Clinical Senior Lecturer, Discipline of Ophthalmology, University of Sydney; 2. Head, Glaucoma Unit, Sydney Eye Hospital, and Clinical Associate Professor, Discipline of Ophthalmology, Faculty of Medicine, University of Sydney Abstract Glaucoma affects the quality of life (QoL) of millions of people. Patients with glaucoma have a reduced QoL in early stage disease, which worsens as the disease progresses. Reduced visual function is the main determinant of poor QoL in glaucoma, however ocular surface discomfort, psychological factors, and social constraints contribute to the burden of disease. The assessment of QoL in glaucoma is important in clinical practice to assessing a patient’s wellbeing, visual function and level of satisfaction with their care. It can be used to make important therapeutic decisions and allow clinician and patient to share common, realistic goals leading to better treatment outcomes. Quality of life assessment is increasingly important in clinical research. Various tools have been used to assess QoL in glaucoma, including general health-related questionnaires, vision-specific questionnaires, glaucoma-specific questionnaires, utility value assessments and objective visual function assessment. These tools are summarized and critically appraised in this article. Keywords Glaucoma, Quality of Life (QoL), quality of life assessment, visual loss, ocular surface discomfort Disclosure: The authors have no conflicts of interest to declare. Received: November 5, 2012 Accepted: December 20, 2012 Citation: US Ophthalmic Review, 2013;6(1):6–9 Correspondence: Simon Skalicky, Sydney Eye Hospital, Macquarie Street, Sydney, NSW 2000, Australia. E: seskalicky@gmail.com Despite advances in therapy the global burden of glaucoma remains high and will continue to rise. In 2010 an estimated 60.5 million people suffered from glaucoma; by 2020 this will reach 79.6 million, of whom 11.2 million will be bilaterally blind. 1 Glaucoma will impact the quality of life (QoL) of all patients with the disease. QoL is a reflection of a person’s overall wellbeing: their ability to pursue a happy and fulfilled life. It includes dimensions of physical ability, mental health, general health perceptions, social functioning, and independence. 2,3 Although the components of a good QoL differ among individuals and societies, vision has consistently been demonstrated as one of its key determinants. 4,5 Quality of Life for Glaucoma Patients— The Clinical Perspective Reduced health-related QoL occurs with even early stage glaucoma. 6 Using both the National eye institute visual function questionnaire (NEI-VFQ) and the 12-item Short Form general health survey, glaucoma subjects in the Los Angeles latino eye study (LALES) with early visual loss reported poorer QoL scores compared with healthy controls. As severity of field loss increased, the impact on health-related QoL rose in a linear fashion.Those with severe glaucoma had the lowest QoL scores. The negative QoL effects of visual field loss may be influenced by knowledge of the condition, but not entirely: reduced QoL related to visual field loss was present in individuals who were previously unaware that they had glaucoma. 7 Subgroup analysis between those who knew of their condition (one quarter) and those who were unaware (three quarters) did not reveal any significant difference in scores in those with severe field loss. The detrimental impact of loss of visual function in one eye 6 increases considerably when vision loss is bilateral. 8 Several QoL studies show that patients with glaucoma in both eyes had the poorest visual functioning. 7–9 Loss of visual function is the main determinant of health-related QoL for glaucoma patients. This can impact driving, walking, venturing from home, reading, seeing at night, adjusting to different levels of illumination, judging distances, and seeing objects coming from the side. 10–12 Serious consequences of reduced vision include injuries from falling (typically among elderly patients) and automobile accidents. 13,14 Treatment-related issues such as ocular surface discomfort, regular clinical reviews with possibly time-consuming and costly treatment contribute to the overall burden of disease. 15 As vision decreases the psychological burden increases, together with a growing fear of blindness, social withdrawal from impaired vision, and depression. 16–18 Other debilitating medical conditions, psychological and social constraints may influence patients’ visual morbidity. All of these factors interact in a complex manner and can be reflected in holistic QoL assessment. A thorough medical history allows QoL assessment for glaucoma patients in clinical practice. QoL is addressed when assessing a patient’s wellbeing, visual function, and level of satisfaction with their care. Quality of life concerns are frequently considered in making clinical decisions, such as determining a patient’s suitability for glaucoma surgery, or whether a regular regime of topical medications is feasible. 19 The aim of the therapeutic relationship between clinician and patient is to maximize the patient’s QoL. Preserving vision by preventing glaucomatous visual loss, treating other causes of visual morbidity and minimizing the © Tou c h ME di cal ME dia 2013