Download QUALITY OF LIFE IN THE GLAUCOMA CONTINUUM

THE GLAUCOMA CONTINUUM
 The path followed by healthy individuals who subsequently develop ocular hypertension and glaucoma.
 Progresses from undetectable disease to asymptomatic disease to functional impairment.
o
Weinreb RN, et. al. Risk Assessment in the Management of Patients with Ocular Hypertension. AJO 2004; 138: 458-467.
OPTOMETRY’S ROLE IN THE CONTINUUM
 Consider Everyone a Glaucoma Suspect
o Know the Risk Factors
 Gather Baseline Data
o IOP, Pachymetry, Goni
 Evaluate the Optic Nerve
o ISNT Rule, Big Disc
o Advanced ONH Imaging
 Evaluate the Nerve Fiber Layer
o Clinical NFL Evaluation / Advanced NFL Imaging
 Evaluate the Visual Field
o Minimum Diagnostic Criteria
o SWAP, FDT
o Classify Amount of VF Loss
 Normal, Early, Moderate, Severe
 Determine the Need for Intervention
o Based on all the above
 Educate the Patient
 Treat or Monitor the Patient
o What to Consider
o First Line Options
 Monitor for Progression
o How to Monitor
 Adjust Treatment as Necessary
o Second Line, ALT / SLT, Surgery
TRADITIONAL MEASURES OF SUCCESS IN REGARDS TO TREATMENT
 IOP
 Snellen VA
o May be the most important indicator of day-to-day functioning
 Perimetric Findings
 Side Effects of Treatment
WHAT ABOUT QUALITY OF LIFE?
 We cannot forget that. What does it mean?
HEALTH-RELATED QUALITY OF LIFE
 A measure of a person’s well-being that focuses on the dimensions of physical functioning, social functioning,
role functioning, mental health, and general health perceptions.
o
Wilson IB, Cleary PD. Linking clinical variables with health- related quality of life. A conceptual model of patient out-comes. JAMA 1995;273:59 – 65.
REASONS FOR LOSS OF QUALITY OF LIFE IN GLAUCOMA PATIENTS
 The stress of the diagnosis
 The insidious loss of vision
o Functional loss
 The loss of independence
 The problems with frequent treatment
o Inconvenience
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o Side effects
The regular appointments
Cost of treatment
GLAUCOMA’S IMPACT ON QUALITY OF LIFE
 Slower walking
 Worse performance ona mobility course
 Falling
 More avoidance of difficult driving
HOW IS QUALITY OF LIFE MEASURED
 The Short Form-36 (SF-36)
 Short Form-12 (SF-12)
 The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25)
 The Visual Activities Questionnaire (VAQ)
 The Activities of Daily Vision Scale
 The Visual Function Index (VF-14
 The Glaucoma Quality of Life-15 (GQL-15).
STUDY RESULTS
 COLLABORATIVE INITIAL GLAUCOMA TREATMENT STUDY (CIGTS)
 607 Newly Diagnosed Glaucoma Patients from 14 clinical centers 1993-1997
o randomized to initial medication with stepped regiment or initial surgery (trabeulectomy)
o 90% of patients with Open-Angle Glaucoma, the rest had pigmentary and pseudoexfoliative
glaucoma
o 50% worry some or a lot about blindness
o 25% reported eye irritation or burning, eye pain, red eyes (50% of patients attribute these to
glaucoma)
CASE EXAMPLES
OCULAR HYPERTENSION
Case History
Where do they fall on glaucoma continuum?
Impact on Quality of Life
GLAUCOMA SUSPECT
Case History
Where do they fall on glaucoma continuum?
Impact on Quality of Life
EARLY GLAUCOMA
Case History
Where do they fall on glaucoma continuum?
Impact on Quality of Life
MODERATE GLAUCOMA
Case History
Where do they fall on glaucoma continuum?
Impact on Quality of Life
SEVERE GLAUCOMA
Case History
Where do they fall on glaucoma continuum?
Impact on Quality of Life
LEGALLY BLIND DUE TO GLAUCOMA
Case History
Where do they fall on glaucoma continuum?
Impact on Quality of Life
WHAT HAVE WE LEARNED REGARDING QUALITY OF LIFE IN THE GLAUCOMA CONTINUUM?
 Never give a diagnosis of glaucoma until it is confirmed (Odberg, Jakobsen, Hultgren and Halseide (Acta Ophthalmologica)
 Emphasize that usually glaucoma has a good prognosis
 Follow the highest technical standards for examination and treatment
 Remember that patients with glaucoma are people and not just two eyes
o
Heijl A. Acta Ophthalmologica Scandinavica 2001