Editorial Glaucoma Quality of Lifedownloads.hindawi.com/journals/joph/2017/4257151.pdf · Editorial Glaucoma Quality of Life Antonio Maria Fea,1 Fritz Hengerer,2 Carlo Lavia,1 and

EditorialGlaucoma Quality of Life

Antonio Maria Fea,1 Fritz Hengerer,2 Carlo Lavia,1 and Leon Au3

1Dipartimento di Scienze Chirurgiche-Clinica Oculistica, Università di Torino, Turin, Italy2Goethe University of Frankfurt, Frankfurt am Main, Germany3Manchester Royal Eye Hospital, Central Manchester Foundation Trust, Manchester, UK

Correspondence should be addressed to Antonio Maria Fea; [email protected]

Received 13 June 2017; Accepted 14 June 2017; Published 18 July 2017

Copyright © 2017 Antonio Maria Fea et al. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work isproperly cited.

Growing attention has been given to the quality of life inseveral fields of medicine. The concept of quality of lifeis not unknown to the glaucoma culture if we recall that theEuropean Glaucoma Society Guidelines state “the goal ofglaucoma treatment is to maintain the patient’s visual func-tion and related quality of life (QoL), at a sustainable cost.”

Nevertheless in the past, more attention has been given toquantitative matters as IOP, visual field, and optic nervebecause those were the ones that can be directly modifiedand physicians were less interested in qualitative and subjec-tive measures as the QoL. Measurements of QoL, on theother hand, tend to be time consuming and can be stronglyinfluenced by other factors (general physical health, psycho-logical state, personality, relationships, wealth, etc.), whichare not necessarily related to the disease itself.

However, there is no doubt that when the physician paysattention to the claims of the patients, he will realize thatmost of their questions are related to everyday issues suchas “will I be able to drive my car? Will I be able to be indepen-dent in my daily tasks within my home? And will I be able togo the supermarket two blocks from my house? Will I haveproblems reading?”

The same questions are relevant for insurances and gov-ernments because the disability caused by any disease willhelp determine the level at which the benefits of screeningoutweigh costs and decide which patient should be treatedand how aggressive treatment should be. Furthermore,knowing the degree of disability can potentially help toincrease patient safety with appropriate guidelines, to

recognize patients who can benefit from rehabilitation andevaluate the efficacy of those measures.

Since the first studies on quality of life in glaucoma,several areas of interest have been identified and explored:(1) determining the symptoms that are more bothersomefor the patients and correlating them with the stage ofdisease; (2) testing and building better methods to investigatethe impact of glaucoma on the QoL; (3) assessing the impactof glaucoma on mental status; and (4) analyzing the impactof different therapies on the QoL of glaucoma patients.

(1) Thanks to recent investigations, we are now awarethat vision defects in glaucoma patients are not assimple as the traditional view of peripheral visionloss, but they affect several aspects related to a gener-ally decreased image quality including glare, lettersappearing faded when reading, and needing morelight. Glaucoma patients gave the higher importanceto tasks involving central and near vision (reading)and to mobility outside the home, whereas the mostfrequent complaints were difficulties related to light-ing and in particular adapting to different levels oflight. Common complaints also included difficultyin walking, stair climbing, face recognition, and driv-ing. The relative importance of these problems iscorrelated to the degree of visual function and tothe age of the patient. The correlation coefficientsfor the lower paracentral and lower peripheral VFof the better eye were the highest for several sub-

HindawiJournal of OphthalmologyVolume 2017, Article ID 4257151, 2 pageshttps://doi.org/10.1155/2017/4257151

https://doi.org/10.1155/2017/4257151

scales, such as general vision, near vision, distancevision, social function, mental health, role limitation,and driving. Although the best correlations weregenerally found in the visual field of the better eye,the best metric to relate disease severity to disabilityis still a matter of debate and further work is neededin the field.

(2) QoL assessment traditionally used patient-reported-outcome (PRO) questionnaires. More than 30vision-specific PRO measures have been developedin the context of glaucoma and can be classified inthree categories: PROs addressing functional statusrelated to vision, PROs addressing overall QoL, andPROs assessing other factors related to disease andtreatment (i.e., symptoms, side effects, adherence,satisfaction, and self-efficacy). Several studies failedto demonstrate a correlation between QoL andglaucoma severity especially when PROs were notspecifically designed. Research on the most appropri-ate type of PRO has been very active. The informa-tion gathered with questionnaires are subjective andinfluenced by many factors other than the disease,including emotions, concentration, personality, anddesire to please or to mislead. Furthermore, datafrom the SEE project showed that 10% of the subjectshave differences between their perception on theirability to perform activities and their actual perfor-mance. Nevertheless, responses to questions aboutvisual ability seem to correlate with clinical objectivemeasures, which suggests that in the future, it may bepossible to use them to define subgroups in the over-all population. An active area of research in the lastfew years was the development and testing of stan-dardized, performance-based measures of functionperformed in a clinical setting. Potential implica-tions of the disagreement between subjective andobjective testing will be to investigate why somepatients have discrepancies between self-reportedand performance-based tests. The knowledge ofwhat an individual with a specific vision problemcan actually do opens the way to develop tools toimprove his performance, lessen his problems,and actively improve his quality of life. Anotherpotential and poorly explored area is to follow pro-spectively the patients to understand how attitudesand QoL modify as the disease progresses, as thepatient ages, or as other subjective or objective factors(wealth, social relationships, activities, etc.) change.

(3) Glaucoma doctors always had the clinical impressionthat some psychological traits are typical of the glau-coma patients, but several papers demonstrated thatglaucoma is a significant predictor of depression afteradjustment for demographic factors and multiplecomorbidities with a prevalence estimated around10%. The finding that objective measures are not cor-related to depression should alert clinicians that ahigh prevalence of depression may be present even

among patients without clinically significant visualdisabilities. Counseling regarding the generally slowprogression rate of the disease may result in adecreased burden from depression.

(4) The impact of new therapies, minimally invasive sur-gical procedures, and slow drug-releasing implantson the patient’s QoL will certainly be a rapid growingfield of investigation. The research in this field maypotentially guide the researchers to select new thera-pies that have minimal effect on the quality of lifeand the agencies to evaluate the general and eco-nomic impacts of these new therapies on the glau-coma patients.

We decided to dedicate this special issue to QoL withthe aim to shed light on the quality of life of glaucomapatients and attract attention of the scientific communityto pursue further investigations leading to a rapid develop-ment of this field.

A better understanding of patient-reported QoL canimprove the relationship between the patient and the physi-cian and enhance adherence in choosing the treatmentoptions on the basis of the patient profile.

Acknowledgments

We would like to express our appreciation to all the authorsfor their informative contributions and the reviewers fortheir support and constructive critiques in making thisspecial issue possible.

Antonio Maria FeaFritz Hengerer

Carlo LaviaLeon Au

2 Journal of Ophthalmology

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Editorial Glaucoma Quality of Lifedownloads.hindawi.com/journals/joph/2017/4257151.pdf · Editorial Glaucoma Quality of Life Antonio Maria Fea,1 Fritz Hengerer,2 Carlo Lavia,1 and