The impact of glaucoma on the quality of life of patients in Norway

Abstract

ABSTRACT.Purpose: To evaluate the feelings and experiences of patients living with glaucoma. Methods: A questionnaire was delivered to patients willing to take part, at a regular visit to their ophthalmologist, for filling in anonymously at home. A total of 589 questionnaires were returned. Results: More than 80% reported negative emotions on learning that they had glaucoma, one-third were afraid of going blind. Half the patients had no visual problem at all, 14% complained of poor or very poor vision. This proportion increased with age. One-fourth of the patients on topical medication experienced adverse effects of moderate or high degree. About half the patients being treated with laser or surgery felt their situation had improved afterwards. Nine-tenths of the individuals were satisfied with the information and care given, although their knowledge about glaucoma was rather incomplete. One-fifth missed information, mainly on causes, treatment and prognosis of the disease. The younger patients were more anxious and inquiring, reported more side effects and were less satisfied than the older patients. The women were in general more dissatisfied than the men. Conclusion: Giving a patient a diagnosis of glaucoma influences his quality of life negatively. Only half of our patients experienced any visual difficulties, whereas one-fourth reported adverse reactions due to the therapy. Most of the patients were very satisfied with the information and care given. Ophthalmologists in private practice are quite central in the management and care of the glaucoma patients in a medical setting like ours.

Identifying Content for the Glaucoma-specific Item Bank to Measure Quality-of-life Parameters

“…7 Over the years, several glaucoma-specific patient-reported outcome (PRO) instruments have been developed. [3][4][5][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] While these instruments measure various QOL domains such as activity limitation, symptoms, convenience of eye-drop use, treatment of side effects and satisfaction; each instrument typically measures only one domain. 7,24 For instance, the Glaucoma Quality of Life (GQL-15) measures only activity limitation, 3,25 the Treatment Satisfaction Survey of Intra-ocular Pressure (TSS-IOP) was developed to assess treatment satisfaction and side effects of glaucoma medication, 13 and the Comparison of Ophthalmic Medication for Tolerability (COMTOL) measures tolerability and compliance of glaucoma eyedrops.…”

“…2 As a result, glaucoma can have a significant impact on issues such as, emotional well-being, social relationships, and financial constraints. [3][4][5][6] Therefore, traditional clinical measures of glaucoma (intraocular pressure, optic nerve head evaluation and visual field examination) fail to elicit the actual impact of glaucoma on a patient's quality of life (QOL). 7 Over the years, several glaucoma-specific patient-reported outcome (PRO) instruments have been developed.…”

Drops, Drops, and More Drops

“…(Curtis et al, 2008) A Norwegian study found that despite patient satisfaction with instructions and education, patients' knowledge about glaucoma was weak, and 20% missed information. (Odberg et al, 2001) Hahn has identified 3 patient-centered strategies for helping physicians detect and address patient adherence to glaucoma medication, recognizing that patients naturally want their physicians to see them as good patients. (Hahn, 2009) The first strategy is a 4-step adherence assessment interview that redefines the good patient as someone who works collaboratively with their physician to overcome the normal barriers to adherence, rather than as someone who adheres to treatment.…”

“…(Blondeau et al, 2007) Knowledge about side effects and the importance of adherence is lacking in many patients, regardless of health literacy. (Odberg et al, 2001) Hyperemia is one of the side effects of prostaglandins that can significantly reduce adherence and persistence. A multicenter, randomized patient education program on hyperemia associated with bimatoprost therapy was provided to 106 patients in an effort to encourage patients to continue using their medication in order to lower IOP.…”

“…Between 14% and 25% of patients reported troubling side effects. (Schwartz and Quigley, 2008;Sleath et al, 2006;Odberg et al, 2001) Patients who need multiple medications have more difficulty with adherence than those on monotherapy. (Schwartz and Quigley, 2008) The necessity for dosing a single medication several times daily, or for using multiple medications with complex dosing schedules adds another layer of complexity that discourages adherence.…”