Association of Psychosocial Factors with Activation Among Patients with Glaucoma.

OBJECTIVE: To investigate the association of psychosocial factors with health self-management behaviors and beliefs among patients with primary open-angle glaucoma (POAG). DESIGN: Prospective cross-sectional cohort study. PARTICIPANTS: Patients (n = 202) with mild, moderate, or advanced bilateral POAG. METHODS: Patients (N = 1164) were identified from electronic medical records at a single academic medical center. Letters soliciting participation were mailed to 591 randomly selected potential participants. Psychometric measures and a social determinants of health questionnaire were administered by phone to 202 study participants. MAIN OUTCOME MEASURES: The National Eye Institute Visual Function Questionnaire-8 (NEI-VFQ), the Multidimensional Health Locus of Control (MHLC), the Perceived Medical Condition Self-Management Scale-4, the Patient Health Questionnaire-9 (PHQ), the Patient Activation Measure-13 (PAM), a health literacy question, and a social determinants of health questionnaire. RESULTS: For each increase in level of POAG severity, there was a decrease in mean NEI-VFQ score (P < 0.001). For each unit increase in NEI-VFQ item 1, self-rated vision, mean PAM score increased (R2 = 5.3%; P = 0.001; 95% confidence interval [CI], 0.077-0.276). For each unit increase in "Internal" on the MHLC, mean PAM score increased (R2 = 19.3%; 95% CI, 0.649-1.166; P < 0.001). For each unit increase in "Doctors" on the MHLC, mean PAM score increased (R2 = 11.0%; 95% CI, 1.555-3.606; P < 0.001). For each unit increase in "Chance" on the MHLC, mean PAM score decreased (R2 = 2.6%; 95% CI, -0.664 to -0.051; P = 0.023). On multivariate analysis, adjusting for age, sex and race, for each unit increase in PHQ, mean PAM score decreased (95% CI, 0.061-1.35; P = 0.032); for each unit increase in MHLC "Doctors", mean PAM score increased (95% CI, -1.448 to 3.453; P < 0.001); for each unit increase in MHLC "Internal", mean PAM score increased (95% CI, 0.639-1.137; P < 0.001); for each unit increase in MHLC "Chance", mean PAM score decreased (95% CI, -0.685 to -0.098; P = 0.009). CONCLUSIONS: We identified modifiable behavioral factors that could increase patients' self-perceived ability and confidence to manage their own eye care. Locus of control (MHLC), level of depression (PHQ), and self-rated functional vision (NEI-VFQ) were each associated with patient behaviors, attitudes, and beliefs needed for health self-management (activation, assessed by the PAM) and may be important determinants of adherence behaviors. Targeting change in patients' care beliefs and behaviors may improve activation and treatment outcomes. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Primary trabeculectomy for advanced glaucoma: pragmatic multicentre randomised controlled trial (TAGS).

OBJECTIVE: To determine whether primary trabeculectomy or primary medical treatment produces better outcomes in term of quality of life, clinical effectiveness, and safety in patients presenting with advanced glaucoma. DESIGN: Pragmatic multicentre randomised controlled trial. SETTING: 27 secondary care glaucoma departments in the UK. PARTICIPANTS: 453 adults presenting with newly diagnosed advanced open angle glaucoma in at least one eye (Hodapp classification) between 3 June 2014 and 31 May 2017. INTERVENTIONS: Mitomycin C augmented trabeculectomy (n=227) and escalating medical management with intraocular pressure reducing drops (n=226) MAIN OUTCOME MEASURES: Primary outcome: vision specific quality of life measured with Visual Function Questionnaire-25 (VFQ-25) at 24 months. SECONDARY OUTCOMES: general health status, glaucoma related quality of life, clinical effectiveness (intraocular pressure, visual field, visual acuity), and safety. RESULTS: At 24 months, the mean VFQ-25 scores in the trabeculectomy and medical arms were 85.4 (SD 13.8) and 84.5 (16.3), respectively (mean difference 1.06, 95% confidence interval -1.32 to 3.43; P=0.38). Mean intraocular pressure was 12.4 (SD 4.7) mm Hg for trabeculectomy and 15.1 (4.8) mm Hg for medical management (mean difference -2.8 (-3.8 to -1.7) mm Hg; P<0.001). Adverse events occurred in 88 (39%) patients in the trabeculectomy arm and 100 (44%) in the medical management arm (relative risk 0.88, 95% confidence interval 0.66 to 1.17; P=0.37). Serious side effects were rare. CONCLUSION: Primary trabeculectomy had similar quality of life and safety outcomes and achieved a lower intraocular pressure compared with primary medication. TRIAL REGISTRATION: Health Technology Assessment (NIHR-HTA) Programme (project number: 12/35/38). ISRCTN registry: ISRCTN56878850.

The effect of anxiety and depression on progression of glaucoma.

Glaucoma is considered a chronic disease that requires lifelong management. Chronic diseases are known to be highly associated with psychological disturbances such as depression and anxiety. There have also been many studies on association between anxiety or depression and glaucoma. The majority of these studies explained that the glaucoma diagnosis causes anxiety or depression. However, It is also necessary to evaluate whether the psychological disturbance itself affect glaucoma. Therefore, we investigated the association of anxiety and depression with glaucoma progression, and elucidate mechanisms underlying that. We included 251 eyes with open angle glaucoma who were followed up for at least 2 years in this retrospective case-control study. The Beck Anxiety Inventory (BAI) and Beck Depressive Inventory-II (BDI-II) were used to assess anxiety and depression in glaucoma patients. Patients were classified into groups (high-anxiety group; HA-G, low-anxiety group; LA-G, high-depression group; HD-G, low-depression group; LD-G) according to their score on the BAI or BDI-II (separately). In logistic regression analysis, disc hemorrhage, peak intraocular pressure (IOP) and RNFL thickness loss rate were significantly associated with high anxiety (p = 0.017, p = 0.046, p = 0.026). RNFL thinning rate and disc hemorrhage were significant factors associated with anxiety in multivariate models (p = 0.015, p = 0.019). Multivariate linear regression analysis showed a significant positive correlation between the rate of RNFL thickness loss and BAI score (B = 0.058; 95% confidential interval = 0.020-0.097; p = 0.003), and RNFL loss and IOP fluctuation (B = 0.092; 95% confidential interval = 0.030-0.154; p = 0.004). For the depression scale, visual field mean deviation and heart rate variability were significantly associated with high depression in multivariate logistic regression analysis (p = 0.003, p = 0.006). We suggest that anxiety increase the risk of glaucoma progression and they are also associated with IOP profile and disc hemorrhage.

Binocular superior visual field areas associated with driving self-regulation in patients with primary open-angle glaucoma.

BACKGROUND/AIMS: The aim of our study was to investigate the associations between driving self-regulation and glaucoma severity, and between driving self-regulation and glaucomatous visual field (VF) defect patterns. METHODS: In 247 patients with primary open-angle glaucoma included in this prospective observational study, a battery of ophthalmic examination was performed, including visual acuity (VA) and VF. Integrated binocular VF was constructed and mean of total deviation (mTD) values in four sectors was calculated (mTDsup-peri, mTDsup-centre, mTDinf-peri and mTDinf-centre). In addition, all participants answered seven questions regarding their avoidance in driving. (1) at night, (2) in rain, (3) in fog, (4) on freeways, (5) lane changing, (6) at high speed and (7) close to the car in front. The associations between these driving behaviours and 10 variables (age, gender, best VA, worst VA, the four sectorial average TD values, years holding a driver's licence and distance driven per week) were analysed using the generalised linear model with binomial distribution, followed by the model section method using the corrected Akaike information criterion. RESULTS: As a result of the model selection, it was suggested that deterioration of mTDsup-peri was associated with (1) avoiding driving at night and (2) avoiding driving in rain. On the other hand, mTDsup-centre was related to (3) avoiding driving in fog. CONCLUSION: Damage in visual function was related with driving behaviours in patients with glaucoma.

Optical Quality Assessed by Optical Quality Analysis System in Chinese Primary Open-Angle Glaucoma Patients and Its Correlations with Psychological Disturbances and Vision-Related Quality of Life.

PURPOSE: To investigate if optical quality assessed by Optical Quality Analysis System (OQAS) is a new factor for psychological disturbance and vision-related quality of life (QoL) in Chinese patients with primary open-angle glaucoma (POAG). METHODS: This is a cross-sectional study. OQAS, automated static perimetry, the Hospital Anxiety and Depression Scale (HADS) Questionnaire, and the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) were used to assess optical quality, visual field, psychological health, and QoL in 64 POAG patients. Correlation between the OQAS parameters and QoL or psychological health was analyzed by linear regression model. RESULTS: OQAS parameters, the modulation transfer function cutoff frequency (MTF cutoff) and the mean OQAS values (mean OV) were significantly related to mean deviation (MD). Statistically significant correlation was also found between MTF cutoff, the mean OV, and QoL in more than half of the NEI VFQ-25 subscale scores and the composite. The correlation coefficients between OQAS parameters and QoL were similar to those between MD and QoL in most of the subscale scores. HADS-Depression and HADS-Anxiety scores significantly correlated with MD in the worse eye, the composite and 3 subscales of NEI VFQ-25, general health, social function, and mental health, but were not correlated with optical quality parameters measured by OQAS. CONCLUSIONS: OQAS-assessed optical quality is negatively related to MD and is a valid indicator for vision-related QoL, but not for psychological health in our study group. OQAS might be an alternative or supplement to perimeter in POAG patients.

Altered coupling of cerebral blood flow and functional connectivity strength in visual and higher order cognitive cortices in primary open angle glaucoma.

Primary open-angle glaucoma (POAG) has been suggested to be a neurodegenerative disease associated with altered cerebral vascular hemodynamics and widespread disruption of neuronal activity within the visual, working memory, attention and executive networks. We hypothesized that disturbed neurovascular coupling in visual and higher order cognitive cortices exists in POAG patients and correlates with glaucoma stage and visual field defects. Through multimodal magnetic resonance imaging, we evaluated the cerebral blood flow (CBF)-functional connectivity strength (FCS) correlations of the whole gray matter and CBF/FCS ratio per voxel for all subjects. Compared with normal controls, POAG patients showed reduced global CBF-FCS coupling and altered CBF/FCS ratios, predominantly in regions in the visual cortex, salience network, default mode network, and dorsal attentional network. The CBF/FCS ratio was negatively correlated with glaucoma stage, and positively correlated with visual field defects in the lingual gyrus in POAG patients. Moreover, early brain changes were detected in early POAG. These findings indicate neurovascular coupling dysfunction might exist in the visual and higher order cognitive cortices in POAG patients and its clinical relevance. The results may contribute to the monitoring of POAG progression and provide insight into the pathophysiology of the neurodegenerative process in POAG.

Diagnosing the Dry Eye Syndrome in modern society and among patients with glaucoma: a prospective study.

The dry eye syndrome (DES) is a disease of the ocular surface, which can become a social issue in our country, given the changes in lifestyle as a consequence of the economic and technological developments of the last decade. A current problem is the prevalence of DES in patients with glaucoma. The glaucoma treatment, especially the prolonged instillation of preservative-containing medicines, is an important factor in DES morbidity, especially in people aged over 40. In this paper, we presented the findings of our study, which was aimed at assessing the prevalence of DES in the Republic of Moldova and the effect of this impairment on the quality of life. 353 patients (706 eyes) were investigated using the data provided by the visual acuity (VA) and slit-lamp examinations, Schirmer's test results, and the Ocular Surface Disease Index (OSDI) score. Our findings showed a high estimate of signs and symptoms of DES (67.4%) and their impact on the quality of life. Simultaneously, we aimed to analyze the issue of DES in patients with glaucoma. To this end, we examined 30 cases with primary open angle (POA) glaucoma. We also presented a clinical case, in which the prospect of associating the two pathologies in a patient was considered.

Evaluation of Fear of Falling in Patients with Primary Open-Angle Glaucoma and the Importance of Inferior Visual Field Damage.

Purpose: To evaluate fear of falling using the Fall Efficacy Scale-International (FES-I) in glaucoma patients and investigate its association with glaucomatous visual field loss. Methods: This study included 273 patients (160 men and 113 women, average age 64.2 years) with primary open-angle glaucoma. Participants were requested to answer the FES-I questionnaire, translated into Japanese, in a face-to-face interview. The relationship between total FES-I score and the following variables was analyzed using multivariable linear regression: age, sex, better and worse best corrected visual acuity, total deviation (TD) in four visual field areas, body mass index (BMI), minutes walked per day, history of diabetes mellitus, history of systemic hypertension, number of previous falls. Results: Univariate analysis suggested that total FES-I score increased with age and in woman, whereas other variables were not significantly associated with total FES-I score. However, age (coefficient, 0.23; standard error [SE], 0.04; P < 0.001), sex (coefficient, 1.79 for women; SE, 0.84; P = 0.034), mean TD in the inferior central area (coefficient, 0.92; SE, 0.22; P <0.001), and mean TD in the inferior peripheral area (coefficient, -0.86; SE, 0.21; P < 0.001) were included in the optimal model for total FES-I score. Conclusions: Inferior peripheral visual field damage and preserved inferior central visual field sensitivity were associated with increased fear of falling assessed with FES-I in glaucoma.

Psychosocial Predictors of Glaucoma Medication Adherence Among the Support, Educate, Empower (SEE) Personalized Glaucoma Coaching Pilot Study Participants.

PURPOSE: To evaluate the association between baseline psychosocial milieu and subsequent glaucoma medication adherence among participants in the Support, Educate, Empower (SEE) personalized glaucoma coaching program pilot study. DESIGN: Prospective cohort study. METHODS: Participants (University of Michigan glaucoma patients aged ≥40 years, taking ≥1 glaucoma medication, who self-reported poor adherence) completed a baseline survey that assessed the following: (1) demographics; (2) social network; (3) perceived stress; (4) consideration of future consequences; (5) glaucoma-related distress; and (6) social support. Medication adherence was then monitored electronically for 3 months and the percentage of prescribed doses taken was calculated. The relationship between baseline factors and medication adherence was assessed using univariate and multivariate analysis. Main outcome measure was median percent adherence over 3 months. RESULTS: Of the 95 study participants, 63% had graduated from college, 55% were white, 35% were African-American, and 97% had insurance. Median adherence over 3 months was 74% ± 21% (±standard deviation, SD). Higher income and more education were significantly associated with better adherence (P < .0001, P = .03). Glaucoma-related distress (mean score 5.6, SD = 3.0) was inversely associated with medication adherence on univariate (P < .0001) and multivariate analysis (P = .0002). Every 1-point increase in glaucoma-related distress score predicted a 2.4-percentage-point decrease in medication adherence. CONCLUSIONS: Lower income, lower educational attainment, and a higher level of glaucoma-related distress all predicted lower adherence to glaucoma medications. Additional glaucoma self-management support resources should be directed toward patients with such risk factors for poor adherence.

Illness perceptions in people newly diagnosed with glaucoma and ocular hypertension.

BACKGROUND/AIMS: To determine whether self-reported illness perceptions in newly diagnosed patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT) are more negative compared with peers who have lived with their diagnosis for more than 2 years. METHODS: A cross-sectional study of 58 newly diagnosed patients with POAG and OHT recruited at their first clinic visit. Electronic patient records were used to identify similar patients (n=58, related by age and severity of visual field loss) who had their diagnosis for >2 years. All participants completed the Brief Illness Perception Questionnaire (BIPQ), EQ5D general health measure and Type D Personality Scale (DS14). RESULTS: Average BIPQ scores were similar for people newly diagnosed with POAG and POAG diagnosed >2 years and were no different to newly diagnosed OHT and OHT diagnosed >2 years POAG (p=0.46). An analysis correcting for personality type (DS14) and general health (EQ5D) indicated newly diagnosed patients with POAG to have marginally better illness perceptions on individual BIPQ items quantifying impact on life in general, experience of symptoms and 'understanding' of their condition (all p<0.01). In contrast, patients with POAG with a diagnosis >2 years understood better their condition to be long-term (p<0.01). CONCLUSIONS: Some illness perceptions differed between newly diagnosed people and patients living with their diagnosis for >2 years. Illness perception for people with manifest glaucoma and at risk of glaucoma (OHT) were similar; the latter might benefit from an intervention at diagnosis that highlights the better prognosis for OHT compared with POAG.

Beyond Intraocular Pressure: Visual Functioning and Quality of Life in Primary Congenital Glaucoma and Secondary Childhood Glaucoma.

PURPOSE: To compare the visual functioning (VF) and vision-related QoL (VRQoL) of children 8-18 years old treated for primary congenital glaucoma (PCG) and secondary childhood glaucoma. DESIGN: Cross-sectional study. METHODS: A total of 309 children 8-18 years old treated for PCG and secondary childhood glaucoma between 2000 and 2010 by a single pediatric glaucoma specialist were prospectively enrolled at LV Prasad Eye Institute, Hyderabad, India. Children completed 2 questionnaires, the LV Prasad Functional Vision Questionnaire-II (LVP-FVQ-II), and the Impact of Vision Impairment-Children (IVI-C) questionnaire. Rasch-calibrated scores from both these questionnaires were used to compare the VF and VFQoL between the 2 groups. RESULTS: Mean ages of the children were 12.2 and 12.6 years in the PCG (53%, median age at diagnosis = 5 months) and secondary glaucoma groups (47%, median age at diagnosis = 3 years), respectively. A majority (80%) of children had bilateral glaucoma and underwent filtering surgery (83%). Mean better eye logMAR visual acuity (VA) was comparable between PCG and secondary childhood glaucoma groups (0.49 vs 0.52, respectively; P = 0.59). Children with PCG reported significantly better VF and VRQoL than secondary childhood glaucoma patients. Unadjusted and adjusted childhood glaucoma group comparisons revealed secondary childhood glaucoma to be associated with worse VF and VRQoL compared to PCG (difference for VF, -0.83; 95% confidence interval [CI], -1.34 to 0.31; P = 0.002; 0.39; 95% CI, 0.16-0.62; P = 0.001 for VRQoL). CONCLUSIONS: Results show that children with treated PCG experience significantly better VF and VRQoL than those with secondary childhood glaucoma, despite comparable VA and IOP.

Bilateral asymmetry improved accuracy when assessing glaucomatous vision-related quality of life impairment.

Bilateral asymmetry has been used in optical coherence tomography tests to find early damage to the optic nerve. However, limited studies have quantitatively evaluated bilateral asymmetry in electrophysiological disorders in patients with glaucoma. The aim of the study was to evaluate bilateral asymmetry in pattern visual evoked potentials (PVEPs) and conventional clinical markers as well as its potential use in detecting glaucomatous impairment. After investigating 60 glaucomatous patients (120 eyes) and 65 age and sex-matched normal control subjects (130 eyes) using uni- and multivariable analysis, we found that vision-related quality of life (VRQOL) impairment was significantly associated with larger bilateral asymmetry index (BAI) of clinical markers. Rasch-calibrated National Eye Institute Visual Function Questionnaire-25 scores were significantly associated with the BAI in PVEPs latency in 15 minutes check size (ß = -0.478, 95% confidence interval [CI], -0.708 to -0.248, P < .001) and the BAI in visual field mean deviation (ß = -0.249, 95% CI, -0.454 to -0.044, P = .018) according to multivariable analysis. Bilateral asymmetry in objective and subjective functional measurements was quantitatively associated with glaucomatous VRQOL impairment. This finding may help bridge the gap in understanding between patients and clinicians, and increase awareness of how glaucomatous neuropathic progression may interfere with patients' daily life.

Measuring Contrast Sensitivity in Specific Areas of Vision - A Meaningful Way to Assess Quality of Life and Ability to Perform Daily Activities in Glaucoma.

Purpose: To investigate: 1) the impact of reduced contrast sensitivity (CS) in specific areas of vision on subjective assessment of vision-related quality of life (VRQoL) and objective performance-based measures in patients with primary open-angle, primary angle-closure, and pseudoexfoliation glaucoma; and 2) correlations between measurements of contrast sensitivity (CS) in specific areas of vision and visual field (VF) tests. Methods: The Spaeth/Richman Contrast Sensitivity Test (SPARCS) measured CS in the inferior, superior, and central areas, while the Pelli-Robson test measured central CS. Visual fields were tested in participants using standard-automated perimetry. The National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) assessed VRQoL, and the Compressed Assessment of Ability Related to Vision (CAARV) assessed vision-related performance. Results: Three hundred and twenty-two eyes of 161 participants were included in our analysis. Significant correlations were found between CS and VF scores in the inferior, central, and superior areas (P < .0001 for all). Significant correlations were found between SPARCS scores in the inferior areas in both eyes and most CAARV scores (P < .05). Significant correlations were also found between SPARCS scores in the inferior and superior areas in the worse eye and most NEI-VFQ -25 scores (P < .05). Conclusion: Contrast sensitivity and VF scores significantly correlated in all tested areas. Reduced CS in the inferior areas of both eyes affected most performance-based measures. Measurement of CS areas using SPARCS is a meaningful way to assess VRQoL and ability to perform daily activities in participants with glaucoma.

Vision-related quality of life according to location of visual field loss in patients with glaucoma.

PURPOSE: To assess influence of the location of visual field (VF) loss on vision-related quality of life (VRQOL) in patients with glaucoma. METHODS: We included 826 patients with primary open-angle glaucoma (POAG) enrolled in the prospectively designed Life Quality of Glaucoma Patients Who Underwent Treatment (LIGHT) study organized by the Korean Glaucoma Society. We divided the integrated binocular visual field (IVF) into four regions and evaluated the associations between Rasch-analysed 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and location of the IVF using univariate and hierarchical multivariable linear regression. RESULTS: Mean deviation (MD) of the IVF at superior centre showed the lowest value among the four regions. Multivariable linear regression analysis revealed significant correlation of the composite score and all subscales of the NEI VFQ-25 except ocular pain and near activities at each of four IVF regions. Mean deviation at superior centre showed significant correlation with composite score (R2  = 0.181), near activities (R2  = 0.175), and social functioning (R2  = 0.166); MD at superior periphery showed highest correlation with role difficulties (R2  = 0.137); MD at inferior centre showed highest correlation with driving (R2  = 0.145); and MD at inferior periphery showed significant correlation with distance activities (R2  = 0.214) and dependency (R2  = 0.119). CONCLUSION: Four different regions of the IVF had a similarly important impact on subscales of the NEI VFQ-25 in glaucoma patients. Preservation of the superior field should be considered as much as that of the inferior field for maintaining a good VRQOL in patients with glaucoma.

Vision-related Quality of Life in Glaucoma Patients and its Correlations With Psychological Disturbances and Visual Function Indices.

PURPOSE: The purpose of this study was to assess the vision-related quality of life (VR-QoL) in glaucoma patients and its correlations with psychological disturbances and visual function components. MATERIALS AND METHODS: The 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) and Hospital Anxiety and Depression Scale (HADS) questionnaires were administered to 428 Chinese glaucoma patients to evaluate their VR-QoL and anxiety and depression disorders, respectively. Sociodemographical and clinical factors were collected at the same time. Univariate analyses were used to investigate the associations between the variables and the VR-QoL. Multivariate linear regression analyses were used to identify the independent psychological and visual functional predictors of the VR-QoL. Standardized partial regression analyses were used to reveal the variables that mostly relevant to the VR-QoL. RESULTS: The composite score (mean±SD) was 71.88±14.44 for NEI VFQ-25 and 13.17±6.56 for HADS. Visual function indices, including best-corrected visual acuity and mean deviation of both eyes in addition to psychological symptoms including anxiety and depression were both correlated with VR-QoL significantly, even after adjusting for sociodemographical and clinical factors. Standardized partial regression analyses further suggested that psychological disorders, especially anxiety rather than visual function components, were mostly relevant to VR-QoL. CONCLUSIONS: Deterioration of vision impairment and visual field defects in addition to increased recognition of psychological disturbances reduce the VR-QoL of glaucoma patients significantly. Alleviating psychological symptoms, especially anxiety, perhaps have a greater influence on the improvement of VR-QoL.

Trends in and Predictors of Depression Among Participants in the Collaborative Initial Glaucoma Treatment Study (CIGTS).

PURPOSE: To characterize longitudinal trends and factors predictive of depressive symptoms following glaucoma diagnosis in Collaborative Initial Glaucoma Treatment Study (CIGTS) participants. DESIGN: Cohort study using follow-up data from a clinical trial. METHODS: A total of 607 participants with newly diagnosed open-angle glaucoma were enrolled at 14 clinical centers in the United States from October 1993 through April 1997, randomized to treatment with medication or surgery, and followed every 6 months through 2004. The 8-item Center for Epidemiologic Studies Depression Scale (CES-D) was administered at baseline and follow-up visits. Three outcome measures were investigated: overall CES-D depression score, presence of mild or worse depression (CES-D score ≥ 7), and number of depressive symptoms endorsed. RESULTS: The average baseline CES-D score was 2.4 (SD = 3.8), 12.5% of subjects reported symptoms associated with mild or worse depression, and 55.3% reported at least 1 depressive symptom. By 1 year posttreatment, depression measures decreased (1.5, 6.7%, and 38.4%, respectively), with modest decreases thereafter. Baseline factors predictive of mild or worse depression included worse vision-related quality of life (VRQOL) (odds ratio [OR] = 2.41), female sex (OR = 1.42), younger age (OR per 10 years younger = 1.24), and less than high school education (OR = 2.93); other outcomes showed similar results. CONCLUSIONS: Depressive symptoms decreased considerably during the first year after treatment initiation, but were elevated in those with impaired VRQOL. Given the potential of depression to reduce treatment adherence and thus increase the risk of glaucoma progression, eye care providers should ask patients about depressive symptoms, provide reassurance when appropriate, and make referrals as necessary.

Meditation enhances brain oxygenation, upregulates BDNF and improves quality of life in patients with primary open angle glaucoma: A randomized controlled trial.

BACKGROUND: Glaucoma (POAG) is a kind of neurodegenerative disease known to be closely associated with stress and adverse quality of life (QOL). Stress has also been shown to be involved in etiopathogenesis of primary open angle glaucoma (POAG). Complementary treatment in form of Meditation has been reported to improve QOL, brain oxygenation and decrease markers of stress. With this premise, a randomized controlled trial was carried out to assess the effect of Meditation on intraocular pressure, subjective QOL and objective markers of stress and brain oxygenation in patients with POAG. METHODS: Sixty patients were randomized into intervention and control groups. Intervention group underwent 45 minutes of Meditation daily for 6 weeks in addition to standard medical treatment while controls received only standard medical treatment. Inclusion criteria were patients with POAG, age >45 years, best corrected visual acuity >6/60. Patients with other ocular co-morbid conditions contributing to vision loss, systemic diseases, patients already practicing meditation in any form were excluded. An assessment of IOP, brain oxygenation using functional near infrared spectroscopy (fNIRS), QOL (WHO-BREF QOL) and stress markers in serum (cortisol, ß-endorphins, interleukin-6, brain derived neurotrophic factor (BDNF), reactive oxygen species) was made at baseline and at 6 weeks. RESULTS: 21 female and 39 male patients were enrolled with a mean age of 57.28±9.37 years. All parameters were comparable between two groups at baseline. At 6 weeks mean level of IOP decreased significantly in intervention group (15.9±1.8 mmHg to 14.4±1.21 mm Hg, p-value 0.0001) as compared to control group (15.7±1.4 mmHg to 15.65±1.41, p-value 0.41). fNIRS showed significant improvement in oxygenated hemoglobin change (ΔHbO) in intervention group in the prefrontal cortex (p-value <  0.0001) as compared to control group (p-value 0.52). WHO-BREF QOL score increased significantly in intervention group (86.6±6.16 to 93.3±5.66, p-value 0.0001) as compared to control (89±7.25 to 89.07±3.24, p-value 0.74).Mean serum cortisol decreased significantly in intervention group (497±46.37 ng/ml to 447±53.78 ng/ml, p-value 0.01) as compared to control group (519.75±24.5 to 522.58±26.63 ng/ml, p-value 0.64). Mean ß-endorphin levels increased significantly (33±5.52pg/ml to 43.27pg/ml, p-value <  0.0001) as compared to control group (34.78±4.1pg/ml to 36.33pg±4.07pg/ml p-value 0.27). Interleukin-6 decreased significantly in intervention group (2.2±0.5 ng/ml to 1.35±0.32 ng/ml, p-value <  0.0001) as compared to control group (2.03±0.37 to 2.17±0.34 ng/ml p-value 0.25). BDNF increased significantly in intervention group (52.24±6.71 to 63.25±13.48 ng/ml p-value 0.004) as compared to control group (53.23±5.82 to 54.42±5.66 ng/ml p-value 0.54). ROS decreased significantly in intervention group (1596.19±179.14 to 1261±244.31 RLU/min/104 neutrophils p-value 0.0001) as compared to control group (1577.5±172.02 to 1662.5±84.75 RLU/min/104 neutrophils p-value 0.16). CONCLUSIONS: A short term course of Meditation was associated with significant improvement in brain oxygenation and QOL along with a reduction in IOP and stress markers. Meditation may be a useful as an adjunct to standard treatment in patients with POAG and potentially decrease the risk of glaucoma progression.

Macular Damage, as Determined by Structure-Function Staging, Is Associated With Worse Vision-related Quality of Life in Early Glaucoma.

PURPOSE: Macular damage is common early in glaucoma and has previously been identified as a significant factor affecting vision-related quality of life (VRQoL) across the spectrum of glaucomatous damage. This report uses structure-function correlation to identify early macular damage and assess its relationship with the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). DESIGN: Cohort study. METHODS: Setting: Institutional. STUDY POPULATION: Eighty-eight eyes of 44 participants with early open-angle glaucoma (24-2 mean deviation [MD] better than -6 dB). OBSERVATION PROCEDURE: Focal and diffuse macular defects were identified based on corresponding abnormal regions on probability maps from spectral-domain optical coherence tomography (SD-OCT) optic disc and macular cube scans, and 10-2 and 24-2 visual fields (VF). MAIN OUTCOME MEASURE: VRQoL, as measured by the NEI VFQ-25. RESULTS: Twenty-five of 44 (57%) "worse" eyes (defined by 24-2 VF MD) and 13 of 44 (31%) "better" eyes had macular damage. Mean (±standard deviation) MD of worse and better eyes were -3.03 dB (±2.3) and -1.15 dB (±1.7), respectively. Compared to those without macular damage, lower NEI VFQ-25 scores were seen in patients with macular damage in the worse eye (85.4 [± 9.0] vs 94.6 [± 3.3]; P = .0001) and the better eye (84.8 [± 11.1] vs 91.3 [± 6.3]; P = .017). Arcuate damage outside the macula did not affect VRQoL (better eye, P = .40; worse eye, P = .87). CONCLUSIONS: Early glaucomatous macular damage, as detected by abnormal topographic regions on measures of structure and function, is associated with decreased VRQoL. Arcuate damage outside the macula does not have an association with VRQoL in early glaucoma.

Influence of Sociodemographic Factors on Disease Characteristics and Vision-related Quality of Life in Primary Open-angle Glaucoma Patients: The Italian Primary Open Angle Glaucoma Study (IPOAGS).

PURPOSE: The purpose of this article was to evaluate the potential association between sociodemographic factors with clinical characteristics, vision-related quality of life (QoL), and glaucoma-related symptoms scores in a large cohort of primary open-angle glaucoma patients. MATERIALS AND METHODS: Multicenter, cross-sectional study involving academic and nonacademic centers. Previously diagnosed primary open-angle glaucoma patients aged >18 years were enrolled. At baseline, information on demographic characteristics, social, medical and ocular history, clinical presentation and treatments was collected. Vision-related QoL was evaluated by means of the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25), while glaucoma-related symptoms were evaluated using the Glaucoma Symptom Scale (GSS) questionnaire. The associations between sociodemographic factors with clinical characteristics (mean deviation, pattern standard deviation, best-corrected visual acuity), NEI-VFQ-25, and GSS scores were evaluated by means of univariate and multivariate general linear models. RESULTS: A total of 3227 patients were enrolled. Older age and male sex were significantly associated with lower mean deviation (P<0.01) and higher pattern standard deviation (P<0.01), whereas older age was associated with lower best-corrected visual acuity (P<0.01). The composite GSS score was related to age (P=0.02), sex (P<0.01), employment (P=0.01), and profession (P=0.04), while the total NEI-VFQ-25 score was associated with sex (P<0.01), marital status (P=0.02), and employment (P=0.02). CONCLUSIONS: Age and sex were significantly associated with almost all indicators of glaucoma severity at baseline. Other variables, such as employment, profession, and marital status were significantly associated with vision-related QoL scores.

The impact of primary open-angle glaucoma: Quality of life in Indian patients.

PURPOSE: Glaucoma significantly affects the quality of life (QoL) of a patient. Despite the huge number of glaucoma patients in India, not many, QoL studies have been carried out. The purpose of the present study was to evaluate the QoL in Indian patients with varying severity of glaucoma. METHODS: This was a hospital-based, cross-sectional, analytical study of 180 patients. The QoL was assessed using orally administered QoL instruments comprising of two glaucoma-specific instruments; Glaucoma Quality of Life-15 (GQL-15) and Viswanathan 10 instrument, and 1 vision-specific instrument; National Eye Institute Visual Function Questionnaire-25 (NEIVFQ25). RESULTS: Using NEIVFQ25, the difference between mean QoL scores among cases (88.34 ± 4.53) and controls (95.32 ± 5.76) was statistically significant. In GQL-15, there was a statistically significant difference between mean scores of cases (22.58 ± 5.23) and controls (16.52 ± 1.24). The difference in mean scores with Viswanathan 10 instrument in cases (7.92 ± 0.54) and controls (9.475 ± 0.505) was also statistically significant. QoL scores also showed moderate correlation with mean deviation, pattern standard deviation, and vertical cup-disc ratio. CONCLUSION: In our study, all the three instruments showed decrease in QoL in glaucoma patients compared to controls. With the increase in severity of glaucoma, corresponding decrease in QoL was observed. It is important for ophthalmologists to understand about the QoL in glaucoma patients so as to have a more holistic approach to patients and for effective delivery of treatment.