Surgical treatment impacts health-related quality of life for patients with glaucoma

Patients with glaucoma often report reduced health-related quality of life (HRQOL). Clinical factors associated with reduced HRQOL for these patients, however, are still poorly understood.

In research published in JAMA Ophthalmology in 2018, Cheryl L. Khanna, M.D., David A. Leske, M.S., and Jonathan M. Holmes, M.D., conducted a study of patients with glaucoma who were medically and surgically treated at Mayo Clinic's campus in Rochester, Minnesota, to determine the factors associated with reduced HRQOL.

Of the 160 study participants:

  • 73 were medically treated
  • 51 received trabeculectomy
  • 36 received glaucoma drainage device surgery

Patients who received both trabeculectomy and glaucoma drainage device surgery were analyzed in the glaucoma drainage device surgery group.

Diplopia and strabismus

In a previous study published in Ophthalmology in 2017, the team reported that diplopia and strabismus are common in patients with glaucoma and more frequent when treated with glaucoma drainage devices.

In the present study, factors associated with reduced HRQOL were assessed using two HRQOL instruments: the strabismus-specific Adult Strabismus-20 (AS-20) Questionnaire and the National Eye Institute Visual Function Questionnaire-25 (VFQ-25). Diplopia was formally quantified using the diplopia questionnaire.

Factors associated with reduced HRQOL

The present study reports that reduced HRQOL is common in surgically and medically treated patients with glaucoma and poor HRQOL in patients with glaucoma is associated with:

  • Worse diplopia
  • Lower mean deviation on visual field testing in either eye
  • Decreased visual acuity in either eye
  • Younger age
  • Previous glaucoma drainage device surgery
  • Treatment effects

When accounting for visual acuity, visual field loss, diplopia, age and sex in adjusted analyses, comparing glaucoma drainage device surgery with trabeculectomy, lower HRQOL was found in patients treated with glaucoma drainage device surgery on the self-perception, interactions and general function subscales of the AS-20. Trends toward lower scores were also found on both VFQ-25 subscales (socioemotional and visual functioning), although these differences did not reach significance.

When comparing glaucoma drainage device surgery with medical treatment, HRQOL was lower after glaucoma drainage device surgery for the self-perception and interactions subscales of the AS-20. Scores were lower on both VFQ-25 subscales, but this difference did not reach statistical significance.

Patients' negative self-perception with glaucoma drainage devices

Reduced AS-20 self-perception and interactions subscale scores in patients who have had glaucoma drainage device surgery highlight the specific negative impact in these patients. Patients appear to be self-conscious of the device and may feel the physical presence or have a psychological awareness of the device.

Currently, translucent patching materials such as cornea, which may mitigate a patient's poor self-perception after glaucoma drainage device placement, are frequently used at Mayo Clinic. Many patients in this study had opaque patching materials placed in the past, which may partly explain why their self-perception, interactions and socio-emotional scores were so low.

Ophthalmologists should be conscious of the potential contributors to poor HRQOL and openly discuss them with patients when considering surgical options. These findings suggest that patients with glaucoma should be assessed for diplopia before and after surgery, given diplopia's negative effect on HRQOL, and be aware of the potential psychosocial effects of glaucoma drainage device surgery.

For more information

Khanna CL, et al. Factors associated with health-related quality of life in medically and surgically treated patients with glaucoma. JAMA Ophthalmology. 2018;136:348.

Sun PY, et al. Diplopia in medically and surgically treated patients with glaucoma. Ophthalmology. 2017;124:257.