Systematic Review of Instruments for the Assessment of Patient-Reported Outcomes and Quality of Life in Patients with Childhood Glaucoma.

TOPIC: To identify patient-reported outcome measures (PROMs) that have been used in children and adolescents with glaucoma and to evaluate their methodologic quality. CLINICAL RELEVANCE: Childhood glaucoma impairs vision and quality of life (QoL) throughout all stages of life. Thus, a PROM needs to cover many different age groups and topics. Various instruments have been used to evaluate patient-reported outcomes (PROs) in patients with childhood glaucoma, however, it is unclear which PROM has the highest methodologic quality and complies best with the needs of patients with childhood glaucoma. METHODS: A systematic literature review was performed searching MEDLINE (PubMed), the Cochrane Library, Web of Science, and PsycINFO (EBSCO). We included peer-reviewed full-text articles of the past 10 years in English, German, or Spanish language that reported PROMs in children with glaucoma. The study selection and methodologic quality assessment of the identified PROMs was performed by 2 independent reviewers using a 7-point checklist. The content was mapped onto the World Health Organization International Classification of Functioning, Disability and Health. The systematic review was prospectively registered in PROSPERO (ID CRD42022353936). RESULTS: The search strategy retrieved 3295 matches. A total of 2901 studies were screened, and 11 relevant articles were identified using 10 different instruments. The instruments addressed functional visual ability, vision-related QoL, health-related QoL, and life satisfaction. Six instruments were applicable for the use in children. Seven of the questionnaires received the highest number of positive ratings (5/7). None of the instruments considered the views of patients with childhood glaucoma during their development. CONCLUSION: This systematic review provides a descriptive catalog of vision-specific and generic health PRO instruments that have been used in childhood glaucoma cohorts. An instrument specifically developed for childhood glaucoma is lacking which might result in missing important factors, such as permanent treatment with eye drops, repeated surgeries, and heritability of the disease, when investigating the QoL in children with glaucoma. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Bruch's Membrane Opening-Minimum Rim Width Assessment With Spectral-Domain Optical Coherence Tomography Performs Better Than Confocal Scanning Laser Ophthalmoscopy in Discriminating Early Glaucoma Patients From Control Subjects.

PURPOSE: To compare the diagnostic performance and evaluate diagnostic agreement for early glaucoma detection between a confocal scanning laser ophthalmoscope (CSLO) and a spectral-domain optical coherence tomography (SD-OCT). PATIENTS AND METHODS: Fifty-five eyes of 55 open-angle glaucoma patients and 42 eyes of 42 healthy control subjects were enrolled in this observational, cross-sectional study. All participants underwent comprehensive ophthalmic examination, visual field testing, and optic nerve head and retinal nerve fiber layer imaging by CSLO (HRT3) and SD-OCT (Spectralis OCT). The agreements of categorical classifications were evaluated (κ statistics). Area under receiver operating characteristic curves (AUROC) and sensitivity at 95% fixed specificity were computed. RESULTS: The agreements of HRT3 and Spectralis OCT categorical classifications were fair to moderate (κ ranged between 0.33 and 0.54), except for Moorfields regression analysis of the HRT3 and the OCT global Bruch's membrane opening-minimum rim width (BMO-MRW) (criterion 1 κ=0.63, criterion 2 κ=0.67). The AUROC of OCT global BMO-MRW (0.956) was greater than those of HRT3 cup-to-disc area ratio (0.877, P=0.0063), vertical cup-to-disc ratio (0.872, P=0.0072), and cup area (0.845, P=0.0005). At 95% specificity, Spectralis OCT global BMO-MRW attained a higher sensitivity than HRT3 cup-to-disc area ratio (P<0.001). CONCLUSIONS: The BMO-MRW assessment with SD-OCT performed well in discriminating early glaucoma patients from control subjects and had a better performance than CSLO. The diagnostic classifications of HRT3 and Spectralis OCT may reach good agreement.

Agreement among 3 optical imaging methods for the assessment of optic disc topography.

PURPOSE: To assess the agreement of disc topography measurements between the Heidelberg Retina Tomograph (HRT II), Retinal Thickness Analyzer (RTA), and Optical Coherence Tomograph (StratusOCT). DESIGN: Observational cross-sectional study. PARTICIPANTS: Forty-two randomly chosen eyes of 42 subjects. METHODS: Each subject underwent HRT II, RTA, and StratusOCT examination. Two experienced examiners drew the contour lines for the HRT II and RTA. Bland and Altman plots were used to evaluate agreement for each topographic parameter among the instruments. The Spearman coefficient of rank correlation was evaluated for each topographic parameter. MAIN OUTCOME MEASURES: Agreement in the measurement of optic disc topography among 3 imaging instruments, as evaluated by regression-based 95% limits of agreement. RESULTS: For optic disc area, the agreement between HRT II-RTA and StratusOCT-RTA revealed the existence of proportional bias, indicated by significant slopes of the regression lines (P = 0.01 and P = 0.02, respectively). The 95% limits of agreement between instruments varied with the actual optic disc size measurement. Heidelberg Retina Tomograph disc area measurements tended to be consistently lower than StratusOCT disc area measurements (fixed bias). The Spearman correlation coefficient between the instruments ranged from r = 0.35 (rim area, HRT II-StratusOCT) to r = 0.91 (cup area, HRT II-RTA). CONCLUSIONS: Moderate to high correlation was found in measurements of optic disc topography among different instruments. However, the analysis of agreement indicated important discrepancies among instruments. Therefore, these instruments should not be used interchangeably to obtain measurements of the optic disc for glaucoma diagnosis.