A prospective, longitudinal, observational cohort study examining how glaucoma affects quality of life and visually-related function over 4 years: design and methodology

Abstract

BackgroundThe aim of this study is to summarize the design and methodology of a prospective, longitudinal, observational cohort study to investigate how glaucoma affects patients’ quality of life and visually-related function over a 4-year period.Methods/DesignOne hundred sixty-one (161) subjects were enrolled in this ongoing study. Patients between the ages of 21–85 years with a minimum 2-year diagnosis of primary open-angle glaucoma, chronic primary angle-closure glaucoma or pseudoexfoliation glaucoma were included. Each patient visited Wills Eye Hospital for a baseline visit. Follow-up is planned for a minimum of 4 years, with annual visits. Each visit includes (1) Clinical evaluation: a slit lamp examination, fundoscopy, intraocular pressure measurement, visual field examination, spectral domain optical coherence tomography, Pelli-Robson Contrast Sensitivity test and the Spaeth-Richman Contrast Sensitivity test; (2) a performance based measure: the Compressed Assessment of Ability Related to Vision; and (3) Subjective measures of vision-related quality of life (the National Eye Institute Visual Functioning Questionnaire 25 and the Modified Glaucoma Symptom Scale).DiscussionThe results of this ongoing, prospective, longitudinal study are expected to shed light on the relationships between clinical measures, performance-based measures and subjective measures of well-being, in order to assess changes in the quality of life and the ability to function of patients with glaucoma over time.

Contrast Sensitivity and Glaucoma

“…However, not only do measurements of CS detect and characterize visual loss that acuity charts and perimeters miss, the results of CS testing are more sensitive, more specific, and correlate better with quality of life and ability to perform the activities of daily living than any other method of assessing visual function. [8,9] If the primary objective of medical care is to help patients, such as those with glaucoma, it seems reasonable to use diagnostic tests that are least inexpensive, most accessible, and that best assess what correlates most closely with how patients feel and how they function. The Pelli-Robson chart accomplishes this for central vision.…”

The Importance of the Assessment of Quality of Life in Glaucoma Patients

“…Glaucoma is a chronic neurodegenerative disorder that could lead to irreversible changes of retinal ganglion cells and loss of optic nerve cells (7). If not treated properly and timely, it could cause severe vision impairment and blindness.…”

“…There are wide possibilities available to assess the QoL in glaucoma patients (7,19) but it seems that these possibilities are mostly reserved for the researches' purposes and not for the clinical practice. On the other hand, the perception of patients suggests the necessity of including the assessment of QoL in daily work of ophthalmologists.…”

“…It is assumed that only half of glaucoma patients in developed countries are aware of their disease (3), in comparison to 90% of unaware glaucoma patients in the developing countries. Glaucoma is important public health issue of 21 st century (4,5,6,7). The projection of glaucoma prevalence in the world suggests that in 2020, 79,6 million of people will have glaucoma and 11,2 million of them will be bilaterally blind (6,8).…”

Lebensqualität bei Glaukompatienten

“…B. Bestimmung der zentralen Sehschärfe, des Kontrastsehens oder des Gesichtsfelds, (ii) die Messung der selbst berichteten Beeinträchtigung, also der Lebensqualität und (iii) Messung der individuellen Beeinträchtigung, um Dinge des Alltags zu erledigen (sog. "performance-based measures") [7]. Auf die klinischen Messungen wird in dieser Übersichtsarbeit nicht eingegangen, es soll aber erwähnt sein, dass die Prüfung des Kontrastsehens bei Glaukom einen höheren Stellenwert einnehmen muss als bislang in der Praxis Einzug gehalten hat.…”