Vision-related Performance and Quality of Life of Patients With Rapid Glaucoma Progression

Abstract

Purpose: The purpose of this study was to determine how clinical measures, performance-based measures and subjective assessments of vision-related quality of life (VRQoL) are affected in patients with rapid glaucoma progression. Methods: Prospective longitudinal study that included 153 patients diagnosed with moderate glaucoma. A subset of patients that presented with rapid glaucoma progression (n=22), defined as visual field (VF) mean deviation (MD) loss >2.0 dB/y, were compared with patients with nonrapid progression (n=131). Groups were compared using t tests, χ2, or Fisher exact test. Main outcome measures were visual acuity (VA), VF MD, retinal nerve fiber layer thickness (RNFL), contrast sensitivity (CS), Compressed Assessment of Ability Related to Vision (CAARV), and Rasch calibrated National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) scores. Results: At baseline, patients who progressed rapidly had lower measurements of VA (P=0.041), VF MD (P<0.001), Pelli-Robson score (P=0.004), Spaeth/Richman Contrast Sensitivity (SPARCS) score (P=0.001), RNFL thickness (P=0.009), CAARV total score (P<0.001), and NEI-VFQ-25 composite score (P=0.03). A multivariable logistic regression was performed and showed VF MD to be the only baseline independent predictor of rapid progression. After 1 year, patients who progressed rapidly also had a significant decrease in SPARCS score (P=0.04). Conclusions: Factors associated with rapid glaucoma progression included worse VF MD decreased scores of performance-based measures and subjectively worse VRQoL. After 1 year, rapid progressors had a significant reduction in contrast sensitivity as measured by SPARCS.

A Comparative Study between Swedish Interactive Thresholding Algorithm Faster and Swedish Interactive Thresholding Algorithm Standard in Glaucoma Patients

“… 22 Establishing the rate of progression in a timely manner is vital to detect which patients are at risk of developing visual impairment early enough to maintain patients’ quality of life. 23 24 …”

Vision-related quality-of-life in Jamaican glaucoma patients at Kingston Public Hospital

“…Vision-related quality of life (VRQoL) may be defined as a person's satisfaction with their visual function and its effect on daily life, and this may be negatively impacted by glaucoma-related visual impairment [5] . Studies have found associations between healthrelated or VRQoL scores and multiple factors in glaucoma patients including visual acuity [6][7][8][9][10][11] , visual field status [6][7][8]10,[12][13][14][15][16] , optical coherence tomography [17] , visual symptoms [18] , rate of glaucoma progression [19] , and socio-economic factors such as age, marital status, literacy, and place of residence [20] . The number of QoL studies in glaucoma has increased since the early 1990's however, there are still fewer QoL studies in glaucoma than in other disabling chronic diseases [4] .…”

Performance na condução de automóvel por pacientes portadores de glaucoma primário de ângulo aberto: atenção dividida e discriminação de objetos

“…Ainda que a farmacoterapia ofereça a forma menos invasiva do tratamento, os pacientes podem experimentar eventos adversos que reduzem a VRQoL ou comprometer os resultados em saúde (15,32,33) . Devido ao curso crônico e progressivo da doença, geralmente, os pacientes mantêm o tratamento farmacoterápico diário, com a intensidade do tratamento aumentando de acordo com a progressão da doença (15) .…”

“…Dessa forma, as medidas baseadas no desempenho ou performance, que são menos comuns em ensaios clínicos, podem fornecer uma avaliação objetiva de como o glaucoma afeta a VRQoL dos pacientes. Entretanto, são poucos os estudos que investigaram o impacto do glaucoma em medidas baseadas no desempenho (33) . Ramulu et al (2009) (58) apontaram diminuição na velocidade da leitura e seu comprometimento com a perda bilateral do CV.…”

“…Sun et al (2016) (55) em estudo transversal apontaram que, a sensibilidade do CV central e inferior estaria significativamente correlacionada com medidas baseadas no desempenho. No entanto, são escassos os estudos prospectivos e longitudinais que mostram como a progressão do glaucoma afeta o desempenho relacionado à perda da qualidade da visão (33) . Dessa forma, um estudo mais aprofundado, em condução simulada, com o objetivo de avaliar a performance de condução nessa doença, torna-se pertinente, levando-se em conta que a capacidade de dirigir pode de fato estar afetada por uma perda de campo periférico glaucomatoso, e por aspectos cognitivos como de atenção seletiva, agravados por déficits no processamento da informação visual (61) .…”