067 Glaucome et qualité de vie

Abstract

The visual quality of life (QoL) is of increasing importance in ophthalmology. In patients with glaucoma quality of life measurements have also been performed. Main factors that diminish patients’ QoL with glaucoma are: the awareness to suffer from a chronic and progressive disease, the need of frequent treatment, the fear of blindness or severe visual field loss or to suffer from visual impairment in advanced disease. QoL measurements, in particular utility assessment, allow health economic evaluations. Medline was searched for relevant publications. Keywords used were: quality of life, glaucoma, value based medicine, time trade off (TTO), standard gamble (SG), VFQ-25. Furthermore, own QoL-data in a normal collective is used to illustrate the recent findings about QoL in glaucoma patients. Two major parameters can be assessed using QoL instruments in ophthalmology and glaucoma: the instrument-specific visual-QoL and the patients’ vision-related utility. Whereas the first gives a good insight in patients'subjective impairment due to glaucoma and smaller changes in different dimensions can be detected, utility values can serve well for economic evaluations. There are a number of well-documented questionnaires to quantify the subjective impairment in glaucoma. The glaucoma-specific instruments have the greatest power of discrimination between glaucoma patients and control. The two major instruments for utility assessment are SG and TTO. Compared to the visual QoL assessed by the Visual Function Questionnaire 25 (VFQ-25) in a normal collective, patients with glaucoma have a clearly diminished QoL. Visual QoL is strongly correlated with central vision, but also (less strongly) with the severity of visual field defects. The perfect QoL instrument for glaucoma has yet not been identified. The VFQ-25 appears to be the benchmark against which new glaucoma QoL instruments have to be compared. The Glaucoma Quality of Life 15 (GQL-15) is probably the most useful and clinically relevant tool. Utility instruments have the highest power for economic evaluations, whereas questionnaires have a better power to detect smaller changes in disease severity or progression. It is obvious, that current utility values in glaucoma differ markedly dependent on which method was used. Assessment of visual QoL is of increasing importance in patients with glaucoma. Individual assessment of patients’ impairment by the disease is an important factor in medical decision making for the clinician. QoL measurements allow to perform health economic analyses using utility values, which create well-founded arguments in medical and health-policy decision making.