Impact of age‐related macular degeneration in patients with glaucoma: understanding the patients' perspective

Skalicky, Simon E.; Fenwick, Eva; Martin, Keith R; Crowston, Jonathan G; Goldberg, Ivan; McCluskey, Peter

doi:10.1111/ceo.12672

Cited by 10 publications

(5 citation statements)

References 69 publications

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“…We had insufficient ethnic and racial diversity to consider those factors. We did not evaluate personality type, depressive symptoms, economic status, topical eyedrop therapy, coexistent cataract, or coexistent age-related macular degeneration, which others have reported to influence HRQOL scores . We did not collect longitudinal data on change in HRQOL, but we focused on a single point, including points as short as 1 month since surgery.…”

Section: Discussionmentioning

confidence: 99%

“…We did not evaluate personality type, depressive symptoms, economic status, topical eyedrop therapy, coexistent cataract, or coexistent age-related macular degeneration, which others have reported to influence HRQOL scores. [27][28][29][30][31] We did not collect longitudinal data on change in HRQOL, but we focused on a single point, including points as short as 1 month since surgery. We do not know whether the patients who underwent GDD surgery had poor HRQOL prior to that specific surgery and we acknowledge that, in our particular practice, GDDs tend to be used later in the surgical treatment algorithm.…”

Section: Limitationsmentioning

confidence: 99%

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Factors Associated With Health-Related Quality of Life in Medically and Surgically Treated Patients With Glaucoma

Khanna

Holmes

2018

JAMA Ophthalmol

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IMPORTANCE Health-related quality of life (HRQOL) is often reduced with glaucoma, but associated factors are poorly understood. OBJECTIVE To determine factors associated with reduced HRQOL in medically and surgically treated patients with glaucoma. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study at a tertiary referral glaucoma practice, with 160 consecutive, prospectively enrolled medically or surgically treated adult patients with glaucoma. MAIN OUTCOME AND MEASURES All patients completed 2 HRQOL questionnaires (the 25-item National Eye Institute Visual Function Questionnaire and the Adult Strabismus-20 questionnaire [AS-20]). Thirty-six patients had undergone glaucoma drainage device surgery, 51 underwent trabeculectomy, and 73 were medically treated. Factors considered for association with HRQOL in multiple regression analyses were age, sex, best-eye and worst-eye mean deviation on Humphrey visual fields, treatment modality, best-eye and worst-eye visual acuity, and diplopia. RESULTS The mean (SD) age of participants was 69 (13) years, 63% were female, 97% were white, 93% were not Hispanic, and the mean deviation (SD) was −13 (10) dB. Reduced HRQOL was associated with worse diplopia (Diplopia Questionnaire score) on 6 subscales (range of partial r 2 [r p 2 ], 0.207-0.069). Reduced HRQOL was associated with lower best-eye mean deviation on 5 of 6 subscales (r p 2 range, 0.379-0.027), lower worst-eye mean deviation on 4 of 6 (r p 2 range, 0.242-0.046), treatment group on 3 of 6 (r p 2 range, 0.190-0.025), lower worst-eye visual acuity on 5 of 6 (r p 2 range, 0.063-0.025), lower best-eye visual acuity on 2 of 6 (r p 2 range, 0.032-0.017), and younger age on 2 of 6 (r p 2 range, 0.021-0.014). In adjusted analyses, glaucoma drainage device was associated with worse HRQOL in 3 AS-20 subscales compared with trabeculectomy and 2 AS-20 subscales compared with medical. Differences ranged from −14.7 to −7.4, with half the absolute magnitude of the full range of the 95% CI ranging from 9.2 to 5.7. CONCLUSIONS AND RELEVANCE Our findings support the assertion that reduced HRQOL is common in surgically and medically treated patients with glaucoma. Overall, poor HRQOL in patients with glaucoma is moderately associated with worse diplopia, lower mean deviation on visual field testing in either eye, poorer visual acuity in either eye, treatment type, and younger age. Previous glaucoma drainage device surgery was specifically associated with poorer HRQOL compared with trabeculectomy or medical treatment. Psychosocial effects of glaucoma drainage device should be considered when counseling patients with glaucoma.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Factors Associated With Health-Related Quality of Life in Medically and Surgically Treated Patients With Glaucoma

Khanna

Holmes

2018

JAMA Ophthalmol

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“…Similarly, clinicians should have a high index of suspicion while reviewing patients with RPD, paying attention to optic disc morphology for features of NTG, being aware of potential difficulties in diagnosing NTG in patients with AMD. Moreover, there is evidence suggesting patients with AMD and glaucoma pose extra hazards such as increased difficulties walking safely when compared to patients with glaucoma alone [59]. This is not surprising when glaucoma predominantly affects tasks requiring contrast discrimination and peripheral vision/light-dark adaptation [60], while AMD influences tasks involving central vision such as reading and recognising faces [61].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of optic disc haemorrhages in an elderly UK Caucasian population and possible association with reticular pseudodrusen—the Bridlington Eye Assessment Project (BEAP): a cross-sectional study (2002–2006)

Wilde

Poostchi

Narendran

et al. 2018

Eye

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Aims To determine disc haemorrhage (DH) prevalence in an elderly UK population-the Bridlington Eye Assessment Project (BEAP). Methods Thirty-degree fundus photographs (3549 participants ≥65 years) were graded for DH/macula changes. Glaucoma evaluation included Goldmann tonometry, 26-point suprathreshold visual-fields and mydriatic slit-lamp assessment for glaucomatous optic neuropathy. Results In all, 3548 participants with photographs in at least one eye. DHs were present in 53 subjects (1.49%), increasing from 1.17% (65-to 69-year age group) to 2.19% (80-to 84-year age group), p = 0.06. DH was found in 9/96 (9.38%) right eyes (RE) with open-angle glaucoma (OAG). Two of twelve RE (16.67%) with normal-tension glaucoma (NTG) had DH. Prevalence in eyes without glaucoma was lower (32/3452, [0.93%]). Reticular pseudodrusen (RPD) occurred in 170/3212 (5.29%) subjects without DH, and 8/131 subjects (6.11%) with OAG. Twenty eyes had NTG, two of whom had RPD (10%) (p = 0.264). Within a logistic regression model, DH was associated with glaucoma (OR 10.2, 95% CI 5.32-19.72) and increasing age (OR 1.05, 95% CI 1.00-1.10, p = 0.03). DH was associated with RPD (p = 0.05) with univariate analysis but this was not statistically significant in the final adjusted model. There was no significant association with gender, diabetes mellitus (DM), hypertension treatment or Age-related Macular Degeneration (AMD) grade. Conclusion DH prevalence is 1.5% in those over 65 years old and significantly associated with glaucoma and increasing age. There appears to be increased RPD prevalence in eyes with DH and NTG with age acting as a confounding factor. Larger studies are required to fully assess the relationship and investigate a possible shared aetiology of choroidal ischaemia.

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“…One study by Skalicky and colleagues (2016) included 200 participants with glaucoma, 73 of whom also had some degree of age-related macular degeneration (AMD). 15 The authors found that adjusting to dim lights was one of the GAL-9 items which was significantly more difficult for glaucoma patients without AMD than those with AMD (P = 0.04). All other GAL-9 items with reference to light ("Walking after dark"; "Seeing at night"; and "Going from light to dark room or vice versa") were all more difficult for study participants with glaucoma alone, compared to those with both glaucoma and AMD, although these differences were not statistically significant (P = 0.20, 0.42 and 0.11 respectively).…”

Section: Glaucoma Activity Limitation (Gal-9)mentioning

confidence: 95%

How do different lighting conditions affect the vision and quality of life of people with glaucoma? A systematic review

Enoch

Jones

Taylor

et al. 2019

Eye

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from eligible studies regarding study design, participant characteristics, outcomes and results. Quality of included studies was critically appraised. Of 8437 studies, 56 eligible studies were included. Studies investigated the effects of lighting on the following themes among people with POAG: QoL (18/56), psychophysical measures (16/56), functional vision (10/56), activities of daily living (10/56) and qualitative findings (2/56). POAG negatively affects low-luminance contrast sensitivity, glare symptoms, and dark adaptation time and extent. In vision-related QoL questionnaires, people with POAG report problems with lighting, glare and dark adaptation more frequently than any other domain. These problems worsen with progressing visual field loss. Early-stage POAG patients experience significantly more difficulties in low-luminance or changing lighting conditions than age-matched controls (AMCs), challenging perceptions of early-stage POAG as asymptomatic. However, performance-based studies seldom show significant differences between POAG participants and AMCs on tasks simulating daily activities under non-optimal lighting conditions. Further research with larger samples is required to optimise ambient and task-oriented lighting that can support patients' adaptation to POAG.

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Impact of age‐related macular degeneration in patients with glaucoma: understanding the patients' perspective

Abstract: Background: The aim of the study is to measure the impact of age-related macular degeneration on vision-related activity limitation and preferencebased status for glaucoma patients.

Cited by 10 publications

References 69 publications

Factors Associated With Health-Related Quality of Life in Medically and Surgically Treated Patients With Glaucoma

Factors Associated With Health-Related Quality of Life in Medically and Surgically Treated Patients With Glaucoma

Prevalence of optic disc haemorrhages in an elderly UK Caucasian population and possible association with reticular pseudodrusen—the Bridlington Eye Assessment Project (BEAP): a cross-sectional study (2002–2006)

How do different lighting conditions affect the vision and quality of life of people with glaucoma? A systematic review

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