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Editors Selection IGR 18-1

Quality of Life: Which surgery ?

Comment by David Friedman on:

71426 Quality of Life in the Tube Versus Trabeculectomy Study, Kotecha A; Feuer WJ; Barton K et al., American Journal of Ophthalmology, 2017; 176: 228-235

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Kotecha and colleagues have published the five-year quality of life (QoL) outcomes of the Tube Versus Trabeculectomy Study which compared tube shunt to trabeculectomy in eyes with previous ocular surgery. Two hundred twelve patients aged 18-85 years of age enrolled at 17 clinical centers were randomized to either have tube shunt or trabeculectomy surgery to lower intraocular pressure. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was administered at baseline and then annually, mostly over the phone.

Over five years, 13% of the cohort died and 18% more were lost to follow-up. Of those remaining, only 51% completed NEI VFQ at five years. Those who completed the five-year survey had better QoL scores at baseline indicating a possible bias. Furthermore, visual field data were only available for the operated eye, which could have been the better or worse eye, a limitation because most QoL surveys show that self-reported QoL is most strongly related to the better eye visual field.

The authors defined a 'Minimal important Difference' (MID) as two dB of VF loss and ten letters on ETDRS. As seen in other publications, MID change in VA had a greater impact on the NEI-VFQ score than does change in MD. Loss of VA or MD in the better eye resulted in a declined in the NEI-VFQ score. That said, overall there was almost no change overall in NEI-VFQ score over course of study. The authors did not report specifically on those who experienced complications such as hypotony or diplopia after surgery. In summary, this study supports previous research findings and also found that among those still answering the QoL questions at five years, no differences existed between those who had trabeculectomy and those who had tube shunt surgery.

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