Influence of Diplopia on Health-Related Quality of Life in Medically- and Surgically-Treated Glaucoma Patients
David A. Leske; Cheryl L. Khanna; Jonathan M. Holmes
Introduction: To determine the factors associated with reduced health-related quality of life (HRQOL) in medically- and surgically-treated glaucoma patients.
Methods: 160 prospectively enrolled adult glaucoma patients treated medically (n=73) or surgically (51 had trabeculectomy, 36 had glaucoma drainage device (GDD) surgery) in a tertiary referral glaucoma practice completed 2 HRQOL questionnaires [VFQ-25 (2 subscales) and the Adult Strabismus-20 questionnaire (AS-20, 4 subscales)]. Multiple regression analysis was performed to assess association of factors with poor HRQOL (age, gender, worst-eye mean deviation (MD) on Humphrey visual field testing, best-eye mean deviation, treatment modality, best-eye visual acuity, worst-eye visual acuity, and diplopia score based on a Diplopia Questionnaire (DQ; scored 0 to 100)).
Results: Reduced HRQOL was associated with worse diplopia (DQ score) on all 6 subscales (VFQ-25 visual functioning and socioemotional, AS-20 self-perception, interactions, reading function, and general function). Reduced HRQOL was associated with lower best-eye MD on 5 of 6 subscales, lower worst-eye MD in 4 of 6 subscales, treatment group (GDD vs trabeculectomy vs medical) on 3 of 6 subscales, lower worst-eye visual acuity on 5 of 6 subscales, lower best-eye visual acuity on 2 of 6 subscales, and younger age on 2 of 6 subscales of the AS-20.
Discussion: The AS-20 Self-perception, Interactions, General Function and Reading Function subscales are sensitive in detecting reduced HRQOL in glaucoma patients.
Conclusion: Reduced HRQOL is common in glaucoma patients and is particularly associated with worse diplopia.