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Editors Selection IGR 15-4
Quality of Life: Quality of Life after Glaucoma Treatment
Comment by Pradeep Ramulu on:
76554 Factors Associated With Health-Related Quality of Life in Medically and Surgically Treated Patients With Glaucoma, Khanna CL; Leske DA; Holmes JM, JAMA ophthalmology, 2018; 136: 348-355
A growing literature has explored the numerous ways that glaucoma impacts patients' quality of life, and Khanna and colleagues advance this body of work by comparing quality of life measures, including specific measures designed to evaluate various aspects of quality of life from adult strabismus, across glaucoma patients who've undergone distinct forms of IOP-lowering treatment: medical treatment, trabeculectomy, and glaucoma drainage device (GDD) implantation. When evaluating quality of life using the Adult Strabismus-20 questionnaire, patients in the GDD group reported worse self-perception and interactions scores as compared to both medically treated patients and patients having received trabeculectomy. No differences in scores were noted between for domains in the NEI-VFQ questionnaire, nor were any differences noted for any questionnaire domain when comparing patients in the trabeculectomy and medical therapy groups.
This work extends on the authors' previous work from the same cohort showing a significantly higher percentage of diplopia in patients having previously undergoing GDD implantation as compared to medically-treated and trabeculectomy patients. However, it is important to note that the observed differences in self-perception and interactions in the GDD group were found independent of patients' self-reported diplopia. Thus, the observed quality of life difficulties may not be a direct result of the diplopia produced with GDD implantation. Of note, patients who received both trabeculectomy and GDD implantation were considered in the GDD group. Thus, it is possible that patients in the GDD group were worse off simply because of the number of prior eye surgeries, and the consequences of multiple surgeries in the eye (ptosis, chronic injection, pain/discomfort, etc.) Nonetheless, the article highlights some of the difficulties encountered by patients having undergone GDD implantation, although more work is needed to determine if these troubles are directly the result of GDD implantation, or rather a reflection of having undergone multiple surgeries.
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