Relación entre la calidad de vida y la severidad del daño funcional en pacientes con glaucoma / Quality of life in glaucoma patients and normal subjects related to the severity of damage in each eye

Propósito: Evaluar la calidad de vida en pacientes con glaucoma y sujetos normales, y su relación con la gravedad del daño en cada ojo. Método: Estudio transversal con selección prospectiva de los casos. Se incluyó a un total de 664sujetos en el estudio. Se clasificaron en 4 categorías. En el grupo 1 los sujetos presentaban los 2 ojos normales: presión intraocular (PIO), disco óptico y campos visuales (CV) normales o los 2 ojos con glaucoma leve definido como PIO sin tratamiento > 21mmHg y CV anormal con defecto medio (DM) menor a -6 dB. En el grupo 2 se incluyó a pacientes con los 2ojos con glaucoma leve o moderado, esto es, PIO sin tratamiento > 21mmHg y CV anormal con DM entre -6 y -12dB. El grupo 3 lo formaron pacientes con glaucoma moderado o grave, esto es, PIO sin tratamiento >21 mmHg y CV anormal con DM menos de -12dB en ambos ojos. El grupo 4 estaba compuesto por pacientes con daño glaucomatoso asimétrico, eso es, un ojo con glaucoma severo y el otro ojo normal o con glaucoma leve. Todos los sujetos completaron 3 cuestionarios de calidad de vida diferentes. La calidad de vida global se evaluó con EuroQol (EQ-5D). La calidad de vida relacionada con la visión se evaluó con el Visual Functional Questionnaire (VFQ-25) y la relacionada con la superficie ocular se evaluó con el Ocular Surface Disease Index (OSDI). Resultados: En cuanto a la calidad de vida relacionada con la visión, el VFQ-25 mostró que el grupo 3 tiene puntuaciones significativamente inferiores al grupo 1 en salud mental (p = 0,006), dependencia (p = 0,006), visión de colores (p = 0,002) y visión periférica (p = 0,002). El EQ-5D no mostró diferencias significativas entre ningún grupo, pero sí se halló una tendencia a una mayor dificultad en el grupo 3 que en los grupos 1 y 2 en todas las dimensiones. El OSDI mostró una mayor puntuación, o lo que es lo mismo una mayor discapacidad, en los grupos 2 y 3 que en el grupo 1 (p = 0,021 y p = 0,014, respectivamente). Analizando los resultados en cada dimensión del VFQ-25, en los distintos grupos, solo se han encontrado diferencias significativas entre el grupo 1 y el grupo 4 en la visión general. En las dimensiones de la visión donde sí se han encontrado diferencias significativas entre los grupos 1 y 3 (los 2 ojos con grado moderado o avanzado), estas no existen en los grupos 1 y 4 (grupo en el que un ojo tiene solo daño de grado leve o sano). Este hallazgo confirma que el ojo con menor daño glaucomatoso es el que determina la calidad de vida del paciente. Conclusiones: Nuestros resultados demuestran que la calidad de vida está alterada en pacientes con glaucoma, y esta alteración es mayor cuanto más avanzado es el daño por glaucoma en el mejor o en ambos ojos (AU)

Objective: To assess the quality of life in glaucoma patients and normal subjects, and to assess its relationship with the severity of damage in each eye. Methods: A cross-sectional study was conducted with prospective selection of cases. The study included 464 subjects and were distributed into 4 categories. Subjects included in group 1 had both eyes normal, that is with a normal intraocular pressure (IOP), optic disk and visual fields (VF), or mild glaucoma, defined as untreated IOP > 21mmHg and abnormal VF with mean defect (MD) over -6 dB. Group 2 consisted of patients with both eyes with mild or moderate glaucoma, defined as untreated IO P> 21mmHg and abnormal VF with MD between -6 and-12 dB. Group 3 included patients with moderate to severe glaucoma, that is, untreated IOP > 21mmHg and abnormal VF with MD of less than -12dB in both eyes. Group 4 consisted of patients with asymmetric glaucoma damage, that is, they had one eye with severe glaucoma and the other eye normal or with mild glaucoma. All subjects completed 3 different questionnaires. Global quality of life was evaluated with EuroQol-5D (EQ-5D). Vision related quality of life was assessed with Visual Function Questionnaire (VFQ-25). Quality of life related to ocular surface disease was measured with Ocular Surface Disease Index (OSDI). Results: VFQ-25 showed that group 3 had significantly lower scores than group 1 in mental health (P=.006), dependence (P=.006), colour vision (P=.002), and peripheral vision (P=.002). EQ-5D showed no significant differences between any group, but a trend was found to greater difficulty in group 3 than in groups 1 and 2, and in all dimensions. OSDI showed a higher score, or which was the same as a major disability, in groups 2 and 3 than group 1 (P=.021 and P=.014, respectively). VFQ-25 only found significant differences between group 1 and group 4. Dimensions with significant differences were found between group 1 and 3 (both eyes with advanced or moderate glaucoma). These were not found between group 1 and group 4 (the group in which one eye has only mild glaucoma or no glaucoma). This finding confirms that the eye with less glaucoma damage determines the quality of life. Conclusions: Our results demonstrate that quality of life is impaired in patients with glaucoma, and this alteration is greater the more advanced is glaucoma damage in the best or both eyes (AU)

Quality of life in glaucoma patients and normal subjects related to the severity of damage in each eye. / Relación entre la calidad de vida y la severidad del daño funcional en pacientes con glaucoma.

OBJECTIVE: To assess the quality of life in glaucoma patients and normal subjects, and to assess its relationship with the severity of damage in each eye. METHODS: A cross-sectional study was conducted with prospective selection of cases. The study included 464 subjects and were distributed into 4categories. Subjects included in group 1 had both eyes normal, that is with a normal intraocular pressure (IOP), optic disk and visual fields (VF), or mild glaucoma, defined as untreated IOP>21mmHg and abnormal VF with mean defect (MD) over -6dB. Group 2 consisted of patients with both eyes with mild or moderate glaucoma, defined as untreated IOP>21mmHg and abnormal VF with MD between -6 and -12dB. Group 3 included patients with moderate to severe glaucoma, that is, untreated IOP>21mmHg and abnormal VF with MD of less than -12dB in both eyes. Group 4 consisted of patients with asymmetric glaucoma damage, that is, they had one eye with severe glaucoma and the other eye normal or with mild glaucoma. All subjects completed 3 different questionnaires. Global quality of life was evaluated with EuroQol-5D (EQ-5D). Vision related quality of life was assessed with Visual Function Questionnaire (VFQ-25). Quality of life related to ocular surface disease was measured with Ocular Surface Disease Index (OSDI). RESULTS: VFQ-25 showed that group 3 had significantly lower scores than group 1 in mental health (P=.006), dependence (P=.006), colour vision (P=.002), and peripheral vision (P=.002). EQ-5D showed no significant differences between any group, but a trend was found to greater difficulty in group 3 than in groups 1 and 2, and in all dimensions. OSDI showed a higher score, or which was the same as a major disability, in groups 2 and 3 than group 1 (P=.021 and P=.014, respectively). VFQ-25 only found significant differences between group 1 and group 4. Dimensions with significant differences were found between group 1 and 3 (both eyes with advanced or moderate glaucoma). These were not found between group 1 and group 4 (the group in which one eye has only mild glaucoma or no glaucoma). This finding confirms that the eye with less glaucoma damage determines the quality of life. CONCLUSIONS: Our results demonstrate that quality of life is impaired in patients with glaucoma, and this alteration is greater the more advanced is glaucoma damage in the best or both eyes.