Patients with POAG have poorer social functioning, dependency
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Social functioning and dependency were significantly worse in patients with primary open-angle glaucoma compared with patients with normal tension glaucoma, according to a study published in the Journal of Glaucoma.
“There are no reports in the literature on whether there is a difference in [quality of life] between patients with [normal tension glaucoma] and those with [primary open-angle glaucoma],” Yeoun Sook Chun MD, PhD, of the department of ophthalmology at Chung-Ang University College of Medicine in Seoul, and colleagues wrote. “If there is a difference, it could be important for planning, counseling and visual rehabilitation in each disease group.”
Seeking to compare vision-related quality of life (QOL) between the two groups, Chun and colleagues used survey results from the LIGHT study, which measured QOL using the Korean version of the self-reported National Eye Institute Visual Function Questionnaire.
Researchers analyzed clinical, demographic and socioeconomic data from 506 patients with normal tension glaucoma (NTG) and 287 with primary open-angle glaucoma (POAG) and used propensity score matching to account for various confounding factors. They also measured integrated binocular visual field (IVF) for each participant.
After 2:1 matching, researchers compared 387 patients with NTG and 238 with POAG and reported no statistically significant differences in ocular pain, near and far distance activities, mental health, role difficulties, ability to drive and overall composite score between groups.
However, patients with POAG did have significantly worse social functioning (P = .016) and dependency (P = .026) compared with patients with NTG.
Although researchers reported no difference in the IVF mean deviation value between the two groups, they did note that the superior center was worse in NTG patients compared with those in the POAG group, while inferior IVF values were worse in the POAG group.
Because social functioning involves eye contact when interacting with others, Chun and colleagues speculated that an inferior field deficit, as seen in POAG patients, likely affects an individual’s ability to participate in social activities. Likewise, worse inferior IVF values in POAG patients also were linked to dependency, or a person’s need to stay home or rely on others for assistance because of their eyesight.
“Confirmation of our present findings in a large scale study will help improve treatment planning, counseling and visual rehabilitation of patients with glaucoma,” Chun and colleagues wrote.
Perspective
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We all know of glaucoma’s invisibility when it comes to patient signs or symptoms, but perhaps equally as hidden are the mental health and quality of life aspects of the disease. As modern eye care providers we must take a holistic approach to glaucoma management. A key element of this is an awareness of different risks for various populations and types of glaucoma.
This Korean study’s particular strength was the uniformity of culture and ethnicity to account for QOL differences between high tension glaucoma (HTG) and NTG. They found that HTG patients have a lower QOL score than NTG patients with respect to social functioning.
Visual field deficits in NTG and HTG differ. Chun and colleagues propose that inferior visual field loss in POAG may result in difficulty reading facial expressions and participating in social activities, leading to more dependency and fear of leaving the home.
We must be conscious of the far-reaching implications of glaucoma damage and encourage a multidisciplinary approach to its management. Glaucoma can create a sedentary lifestyle and social isolation, which can have devastating consequences if left untreated.
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Chun YS, et al. J Glaucoma. 2022;doi:10.1097/IJG.0000000000002007.
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