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Quality-of-life parameters rarely include visual field loss
Few patients go blind, so other concerns need to be addressed.
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LONDON - Few glaucoma patients in the Western world have extensive field defects that cause significant visual disability, so other parameters are more important to assessing quality of life, said Tor Odberg, MD, of Central Hospital in Hedmark, Hamar, Norway.
Researchers wanted to study ordinary glaucoma patients, most of them being treated by ophthalmologists in private practice, and evaluate their feelings and experiences of living with their disease. They gave 589 questionnaires to chronic open-angle glaucoma patients who had been treated at least 1 year. Patients completed the surveys anonymously at home.
Only 15 patients did not respond. In the study, 9% were younger than 60 years, and 47% were between the ages of 70 and 80.
Everyday activities
---Survey of 589 patients
Researchers wanted to evaluate the feelings and experiences of patients living with glaucoma. Dr. Odberg said that more than 80% reported negative emotions after learning that they had glaucoma, while one-third were afraid of going blind.
"Giving a patient a diagnosis of glaucoma influences his or her quality of life negatively," Dr. Odberg said.
Anxiety, depression and fear of blindness were significantly more frequent among patients younger than 60 years. One-third of patients had been treated for more than 10 years.
However, half the patients had no visual problem at all, and only 14% complained of poor or very poor vision. This proportion increased with age. In the study, 83% of patients told that their vision was good or excellent, and 4% said that they were blind in one eye. Only 6% reported on reduced quality of life because of impaired vision.
The most frequently affected everyday activities influenced by decreased vision were reading, walking on stairs and recognizing another person while outdoors.
Effects of care
--- Survey of 589 patients
Of all the patients, 13% were on a multidrug regimen of three or more bottles, while 11% depended on someone else to help them with treatments.
One-fourth of the patients on topical medication experienced adverse effects of moderate or high degree. The most frequent was itching or pain (24%), followed by foggy vision (18%) and tearing (15%). Most adverse events were reported as mild.
About half the patients being treated with laser or surgery felt their situation had improved afterwards, while 38% reported it was unchanged. Only 1% felt their situation worsened, and the rest did not respond to the question.
Ninety percent of the individuals were satisfied with the information and care given, although their knowledge about glaucoma was incomplete, Dr. Odberg said. About 19% of patients older than 70 years reported that they missed information, mainly on causes, treatment and prognosis of the disease.
The younger patients were more anxious and inquiring, and reported missing information twice as often, Dr. Odberg said. They reported more side effects and were less satisfied than their elders. Women in general were more dissatisfied than men.
Satisfied patients
Researchers wanted to find the relationship between the visual difficulties reported by patients treated for glaucoma and their objective functional damage, as well as evaluate the reliability of the patient responses.
Few patients had visual field damage judged to be of functional significance, Dr. Odberg said.
A high proportion of the patients had normal binocular visual field and a stable disease, raising the suspicion that some of them were treated for ocular hypertension. The agreement between the responses from the patients and the ophthalmologists concerning the topical treatment was good. There was moderate agreement about treatment duration and other diseases.
"The association between subjective visual disability and presence of visual field defects was weak to moderate in our patients, and this association was further weakened by adjusting for visual acuity," Dr. Odberg said. "Some patients might be treated unnecessarily, and a favorable prognosis might be given to most of them," he said.
"A diagnosis of glaucoma should not be given before it is for certain, and initiation of treatment that is not really necessary should be avoided," Dr. Odberg said.
For Your Information:
- Tor Odberg, MD, can be reached at the Eye Department, Central Hospital in Hedmark, N-2326 Hamar, Norway; (47) 62-53-78-90; fax: (47) 62-53-79-65. Dr. Odberg has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.