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Editors Selection IGR 10-2

Quality-of-life instrument

Comment by Rohit Varma on:

20688 Which quality of life score is best for glaucoma patients and why?, Severn P; Fraser S; Finch T et al., BMC Ophthalmology, 2008; 8: 2

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This paper by Severn et al. (6) proposes to determine which Quality-of-life instrument and score is 'best' for glaucoma patients and why? In this paper the authors conducted an online search using Medline, Embase and Google Scholar to search for relevant articles using the following keywords: Quality of Life Scores, Quality of life scales, QoL, eye disease, glaucoma. The authors identified 11 instruments which were classified into three groups:

1. Generic instruments (not disease specific): Medical Outcome Study Short Form-36 (SF-36), Sickness Impact profile (SIP)
2. Vision specific instruments: VF-14, National Eye Institute Visual Function Questionnaire-51 (NEI-VFQ-51), National Eye Insti-tute Visual Function Questionnaire-25 (NEI-VFQ-25), Activities of daily Vision Scale (ADVS)
3. Glaucoma specific instruments: Glaucoma Symptom Scale (GSS), Comparison of Ophthalmic Medication for tolerability (COMTOL), Glaucoma Quality of Life-15 (GQL-15), Symptom Impact Glaucoma Score (SIG) and the Glaucoma Health Perceptions index (GHPI).

The NEI-VFQ-25 is the most widely used Quality-of-Life instrument in ophthalmology

The authors then provide a subjective commentary on each instrument specifically providing their views on each instrument with regard to several factors - ease of use in the clinical setting, containing minimal complex mathematics, reproducibility of the measures, underlying principles pertaining to glaucoma, and having simple understandable questions with unambiguous answers. The authors conclude that the NEI-VFQ will and should remain the benchmark for QoL tools, the GQL-15 is probably the most useful and clinically relevant and the SIG is the most appropriate research tool. This paper provides a summarized and overly simplified version of each instrument. The paper lacks a rigorous assessment of the internal or external validity, reproducibility, and responsiveness of any of the instruments. Thus, it is difficult for readers of this paper to appreciate in any meaningful depth the value of various QoL instruments. Members of the glaucoma community would be well served to go to specific papers that assess the validity of various QoL instruments and determine which instrument would best serve their needs. Currently, the NEI-VFQ-25 is the most widely used QoL instrument in Ophthalmology and more recent evidence suggests that it may be a valuable tool in assessing the impact of glaucoma on QoL.

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