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Editors Selection IGR 11-4

Quality of Life: Role of visual symptoms

Comment by George Lambrou on:

24874 Associations of eye diseases and symptoms with self-reported physical and mental health, Lee PP; Cunningham WE; Nakazono TT et al., American Journal of Ophthalmology, 2009; 148: 804-808

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It seems so obvious that sight-reducing eye diseases must have a negative impact on quality of life, that one is tempted to take it for granted. Yet, as this paper by Lee et al. (1365) shows, this is not such a straightforward relation after all. The authors used the short-form (SF-36) questionnaire, a standard Health Related Quality of Life (HRQoL) measuring tool which assesses both physical and mental health, and a checklist of 25 systemic conditions, three ocular diseases (glaucoma, cataract, macular degeneration) and two visual symptoms: 'trouble seeing' and 'blurred vision'. They mailed these to a random sample of ca. 18500 patients from the Western US who had visited a physician up to one year before and, after a number of systematic follow-up actions, achieved a response rate of 59% (adjusted for undeliverable surveys), of which 5021 were complete and could be processed.

Awareness of having an ocular disease is not sufficient in itself to impact Quality of Life

Of the respondents, 9% had cataracts, 2% had AMD and 2% had glaucoma. Thirteen percent reported having 'trouble seeing', while only 8% reported 'blurred vision', with a correlation between these seemingly similar symptoms of only 0.62. The authors speculate that 'blurred vision' could be related to a specific form of visual acuity disturbance, whereas 'trouble seeing' would include difficulties other than loss of visual acuity. As one would expect, both visual symptoms were significantly associated with a decrease in health-related Quality of Life. Interestingly, 'trouble seeing' was correlated to both the physical and mental health components of the SF-36 score, whereas 'blurred vision' was significantly correlated to metal health only. However, having glaucoma, AMD or cataract was not significantly associated with QoL deterioration after adjusting for other variables, and namely for the presence or absence of visual symptoms. This is in contrast to at least two previous studies where diagnosis of glaucoma in a clinic-based population impacted QoL. The authors speculate that this may be due to co-morbidities and confounding demographic factors in the previous studies. An alternative explanation would be that in a large, home-based population, the initial negative impact of the diagnosis may have 'sunk in' and QoL may have returned in the absence of clinical symptoms or other evidence of disease progression, such as sophisticated tests likely to be performed in the clinic that may have detected asymptomatic damage. The implications of these results are two-fold. For the patient, awareness of having an ocular disease might impact Quality of Life less than the symptoms associated with the disease. For the physician, these results reinforce the importance of focusing on alleviating the patient's symptoms and complaints rather than simply 'managing the disease'.

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