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Editors Selection IGR 20-4

Quality of Life: Impact of Glaucoma-related Visual Impairment in Childhood Glaucoma

Comment by Andrew Camp on:

82428 Beyond Intraocular Pressure: Visual Functioning and Quality of Life in Primary Congenital Glaucoma and Secondary Childhood Glaucoma, Gothwal VK; Sharma S; Mandal AK, American Journal of Ophthalmology, 2020; 209: 62-70

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This cross-sectional study explored the effects of childhood glaucoma on visual function (VF) and vision-related quality of life (VRQoL). VF and VRQoL are important outcome measures for glaucoma management as they reflect a patient's experience of their disease by encompassing broad functional and quality of life (QoL) measures that are affected by vision. The conventional objective measures (e.g., intraocular pressure, visual acuity [VA], visual field loss) captured as endopints in many studies may not accurately reflect a patient's subjective experience. Gothwal et al. attempt to address this shortcoming by administering subjective VF and VRQoL tests (the LV Prasad Functional Vision Questionnaire and the Impact of Vision Impairment-Children questionnaire, respectively) to 309 patients with childhood glaucoma. The subjective questionnaire results were compared to an objective measure of habitual VA of the better eye, and patients were further classified by diagnosis of primary congenital glaucoma (PCG) versus secondary childhood glaucoma (SCG).

The high prevalence of childhood glaucoma in India allowed the authors to survey a large number of patients over the course of the study. As seen in adults, impaired VA in the better eye correlated to worse VF and VRQoL scores. Bilateral glaucoma and a greater number of surgeries also correlated with worse VF. Interestingly, VF and VRQoL were significantly better in PCG compared to SCG patients, despite similar objective measures (age, VA). The authors theorize that earlier diagnosis and intervention in PCG may lead to better adaptation to the disease. Patients with PCG were diagnosed at an earlier age than SCG (2.3 years versus 4.9 years, respectively), lending credence to this theory, but future work will hopefully address this finding in greater detail. A great deal remains to be learned regarding QoL outcomes in pediatric patients, and this study demonstrates the feasibility of subjective testing in a young population.

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