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Editors Selection IGR 9-4

General aspects: Fear of blindness

Comment by Fotis Topouzis on:

19996 Fear of blindness in the Collaborative Initial Glaucoma Treatment Study patterns and correlates over time, Janz NK; Wren PA; Guire KE et al., Ophthalmology, 2007; 114: 2213-2220

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In a randomized clinical trial of 607 newly-diagnosed open-angle glaucoma patients with five years follow-up, Janz et al. (1173) report the prevalence of fear of blindness (FOB) and identify factors associated with FOB over time. Patients were randomized either to initial medical therapy or trabeculec-tomy and underwent clinical examina-tions and quality of life evaluations at baseline and six-months intervals. FOB was assessed by a single question and using a five-point response scale. At baseline, 34% of patients reported at least a moderate amount of FOB. but at five years follow-up this percentage dropped to 11%. Analyses included baseline and 12-month, 36-month and 60-month time points. Among demographic factors those associated with increased FOB were younger age, white race, lower education and lower income. Initial treatment approach was not associated with FOB. Among clinical, visual function, physical and psychological variables, the strongest associations occurred with worse eye visual acuity or visual field, the visual function subscale measures, and the physical and psychological measures. Visual acuity loss or visual field progression presented less significant associations with increases in FOB over time. However, visual function measures representing the perceived impact on a subject's ability to perform visual-related daily tasks was the most significant factor associated with FOB over time.

FOB seems to decrease over time, possibly related to improved information and/or to adaptation to diagnosis

This new Collaborative Initial Glaucoma Treatment Study report is the first study to assess FOB related to glaucoma both at the time of diagnosis and during follow-up examinations. The large sample size and the long-term follow-up with regular intervals are the advantages of this well-designed and controlled clinical trial. However, patients were informed on glaucoma diagnosis before responding to the FOB questionnaire and it is unknown to which extent health-professionals reassured them that with proper treatment the likelihood of blindness due to glaucoma is low. Also it is unknown whether information related to glaucoma diagnosis and risks was consistent among patients and among participating centers. Further, FOB is assessed through a single question. Additional questions would possibly have yielded more insights on specific reasons for FOB. Also, results were not adjusted for other possible causes of visual impairment, like cataract, which may influence both FOB and measurements of visual acuity and visual field. In addition, generalization of findings is limited by the design of the study. Patients who agreed to take part in a randomized clinical trial are highly selected especially with regards to their psychological profile and their perception of disease and related risk and therefore they are not representative of the general population with this regard. Finally, the reduction of FOB over time may be in part related to the reassurance they may perceived by their participation in a study involving treatment administration and regular clinical follow-up.

Glaucoma diagnosis has been shown to have a significant impact on a subject's psychology and fear of blindness. However, FOB seems to decrease over time, possibly related to improved information and/or to adaptation to diagnosis. Interestingly, objectively measured clinical variables were less significant, while the subjective perception of ability to perform visual related tasks was the most important factor associated with persisted FOB over time.

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