BLOG: ODs must consider impact of glaucoma care choices on patient quality of life
Click Here to Manage Email Alerts
Quality of life with glaucoma can be affected not only by vision loss, but also by less tangible factors such as the burden of daily drops or an increase in fear and anxiety.
For many of my early-stage patients, glaucoma feels rather abstract, because they aren’t experiencing any symptoms. However, for a patient who has witnessed a parent, grandparent or other family member going blind, a glaucoma diagnosis can provoke great anxiety. I calmly explain exam findings and stage of disease to patients and encourage them to match their level of concern to mine. In the early stages, or when glaucoma is well controlled, I strive to be reassuring. If a rapidly progressing patient isn’t taking the disease seriously, however, I do want them to be more concerned.
In general, I don’t find fear to be an effective motivator. Fear of losing vision can cause people to shut down or avoid going to the doctor. It may make them give up on treatment and become less compliant. To avoid this, I conduct my glaucoma consultations in exactly the same way with every patient, so they always know what to expect. I go through each of the tests that we do, explaining the results and showing them images of their retinal nerve fiber layer, optic nerve and visual fields, along with comparisons to the normal or ideal state. I explain that the goal of treating glaucoma is to slow down progression as much as possible, so they don't experience symptoms or end up in late-stage glaucoma.
Late-stage glaucoma, with significant visual field loss, has many detrimental effects on quality of life. Patients may have to stop driving, which makes them feel like a burden on others and can increase social isolation. That can contribute to depression, anxiety and feelings of poor self-worth.
At the earlier stages, chronic topical medications can contribute to ocular surface disease, so that needs to be proactively managed. Many patients willingly accept daily glaucoma drops just as they do other medications, while others find drops extremely burdensome. One patient of mine told me that being on two glaucoma drops daily was “ruining her life” and that she felt like a prisoner to her drops. She felt that she had to schedule appointments around her drops and sometimes avoided social functions, because not having her drops with her caused anxiety.
Studies suggest that minimally invasive glaucoma surgery (MIGS) can have a positive impact on patient quality of life, in large part because MIGS can reduce or eliminate dependence on drops. It may also delay or prevent the need for more invasive surgical procedures. In one study, more than one-third of patients who underwent cataract surgery with various forms of MIGS [including Kahook Dual Blade goniotomy, New World Medical; iStent or iStent inject, Glaukos; and the Gonioscopy Assisted Transluminal Trabeculotomy (GATT) procedure], noted improvements in their social life after combined surgery (Al-Habash, et al.). Additionally, 79% said their overall quality of life improved after the procedure.
In the randomized, controlled pivotal trial for the latest-generation trabecular micro-bypass stents (iStent inject), patient-reported outcomes (PROs) were measured using the Vision Function Questionnaire (VFQ-25) and the Ocular Surface Disease Index (Samuelson, et al.). Both questionnaires were administered at baseline and months 1, 6, 12 and 24 after cataract surgery with or without implantation of the iStent inject. The group that underwent cataract surgery with MIGS had a greater percentage of PRO responders across all follow-up visits over 24 months than the cataract surgery-only group. The biggest differences between the two groups on the VFQ-25 were noted in the subscales of driving, ocular pain and general vision.
In treating glaucoma patients, we need to take into consideration not just the data — IOP, cup-to-disc ratio and visual field loss — but also the cost of care and the impact of our care choices on patients’ quality of life.
References:
- Al Habash A, et al. Clin Ophthalmol. 2020;doi:10.2147/OPTH.S276124.
- Samuelson TW, et al. Am J Ophthalmol. 2021;doi:10.1016/j.ajo.2021.03.007.
For more information:
Nicole Albright, OD, is clinic director at Moses Eyecare Center in Merrillville, Ind., where she also serves as externship coordinator for optometry students from Indiana University and Chicago College of Optometry. She practices full-scope optometry, with a focus on specialty lenses, perioperative care and ocular disease management.
Collapse