Glaucoma Activity Limitation-9 Research Articles

Veränderungen der Lebensqualität von Glaukompatienten über einen Zeitraum von 8 Jahren

The quality of life (QoL) of glaucoma patients is affected by many factors. In particular, patient activity is compromised by the chronicity of the disease. In this study, we evaluated the change in QoL and its impact on activities over aperiod of 8 years. A total of 43 patients with glaucomatous optic nerve damage were enrolled in this retrospective longitudinal observational study. Changes in intraocular pressure (IOP), best-corrected visual acuity (BCVA) and visual field (VF) parameters, number of IOP-lowering eye drops and IOP-lowering surgery were assessed over aperiod of 8 years. Assessment of QoL was obtained by patient-reported visual functioning using the Rasch-calibrated glaucoma activity limitation9 (GAL-9) questionnaire at baseline and after 8 years. The BCVA of the better eye changed from 0.16 ± 0.22 to 0.21 ± 0.14 logMAR, whereas there was achange from 0.27 ± 0.25 to 1.39 ± 1.1 logMAR in the worse eye. The VF parameter mean deviation (MD) of the better eye changed from -2.39 ± 4.55 dB to -4.83 ± 5.09 dB, while it altered significantly from -8.86 ± 5.86 dB to -12.05 ± 8.07 dB in the worse eye. Values of GAL‑9 changed from -2.39 ± 2.14 to -1.38 ± 2.78 (in the Rasch analysis, more negative values account for abetter QoL), according to asum score change from 79.17 ± 19.63 to 69.22 ± 27.95. This change showed ahighly significant correlation with the MD at follow-up, especially with the worse eye (r = 0.43). The impact of the MD at follow-up on QoL could also be well predicted in aregression model. The QoL of glaucoma patients decreased significantly over time. Changes in the VF, particularly of the worse eye, have agreat impact on reported functioning. Careful treatment, especially of the eye with greater glaucomatous damage, is mandatory.

The Computerized Glaucoma Visual Function Test: A Pilot Study Evaluating Computer-Screen Based Tests of Visual Function in Glaucoma

PurposeWe aimed to develop and evaluate the Computerized Glaucoma Visual Function Test (CoGVFT), among a cohort of glaucoma patients, and identify potential new items to optimize the test.MethodA cross-sectional study involving 84 patients with open-angle glaucoma of varying severity and 18 controls without glaucoma were recruited. Better and worse eye visual field parameters, visual acuity, contrast sensitivity, 6-Part Cognitive Impairment Test (6CIT) and Glaucoma Activity Limitation-9 (GAL-9) questionnaire responses were recorded. The CoGVFT was administered to all participants. Rasch analysis was used to assess the psychometric properties of the CoGVFT, which was then evaluated with criterion, convergent, and divergent validity tests. Regression modeling determined factors predictive of CoGVFT performance.ResultsThe 38-item CoGVFT demonstrated convergent validity with statistically significant differences in glaucoma severity groups (P < 0.001, analysis of variance). The correlation coefficient for CoGVFT person measures (logits) with GAL-9 person measures (logits) and better eye (BE) mean deviation was 0.528 (P < 0.001) and 0.762 (P < 0.001), respectively, demonstrating convergent validity. Divergent validity was suboptimal as the 6CIT score demonstrated moderate correlation (r = 0.463, P < 0.001) with CoGVFT person measures (logits). Multivariable analysis revealed that better BE contrast sensitivity, lower age, and better BE visual acuity were associated with better CoGVFT performance (P < 0.001).ConclusionsThe CoGVFT retains most of the features of its predecessor to estimate vision-based activity limitation related to glaucoma.Translational RelevanceThe CoGVFT is an easily accessible tool that can potentially be used in the community to help detect undiagnosed glaucoma in the population.

Objective Assessment of Activity Limitation in Glaucoma with Smartphone Virtual Reality Goggles: A Pilot Study.

PurposeTo evaluate the use of smartphone-based virtual reality to objectively assess activity limitation in glaucoma.MethodsCross-sectional study of 93 patients (54 mild, 22 moderate, 17 severe glaucoma). Sociodemographics, visual parameters, Glaucoma Activity Limitation-9 and Visual Function Questionnaire – Utility Index (VFQ-UI) were collected. Mean age was 67.4 ± 13.2 years; 52.7% were male; 65.6% were driving. A smartphone placed inside virtual reality goggles was used to administer the Virtual Reality Glaucoma Visual Function Test (VR-GVFT) to participants, consisting of three parts: stationary, moving ball, driving. Rasch analysis and classical validity tests were conducted to assess performance of VR-GVFT.ResultsTwenty-four of 28 stationary test items showed acceptable fit to the Rasch model (person separation 3.02, targeting 0). Eleven of 12 moving ball test items showed acceptable fit (person separation 3.05, targeting 0). No driving test items showed acceptable fit. Stationary test person scores showed good criterion validity, differentiating between glaucoma severity groups (P = 0.014); modest convergence validity, with mild to moderate correlation with VFQ-UI, better eye (BE) mean deviation, BE pattern deviation, BE central scotoma, worse eye (WE) visual acuity, and contrast sensitivity (CS) in both eyes (R = 0.243–0.381); and suboptimal divergent validity. Multivariate analysis showed that lower WE CS (P = 0.044) and greater age (P = 0.009) were associated with worse stationary test person scores.ConclusionsSmartphone-based virtual reality may be a portable objective simulation test of activity limitation related to glaucomatous visual loss.Translational RelevanceThe use of simulated virtual environments could help better understand the activity limitations that affect patients with glaucoma.

Correlation of central field index (10-2 visual field analysis) and activity limitation with increasing severity of glaucoma using glaucoma activity limitation-9 questionnaire.

Purpose:The purpose of the study was to analyze the correlation between central field index (CFI) and activity limitation in glaucoma using glaucoma activity limitation-9 (GAL-9) questionnaire.Methods:This hospital-based, cross-sectional, noninterventional study, included 50 patients diagnosed with glaucoma, with field defect encroaching onto central 10° in Humphrey field analysis 30–2 program, in at least one eye. These patients underwent central 10–2 field analysis and CFI was calculated with the help of a calculator created by us. Patients with severe cognitive impairment were excluded and the rest completed the GAL-9 questionnaire. The data was analyzed to determine the correlation between the CFI and the GAL-9 scores.Results:There was a moderate correlation between CFI of better eye (r = −0.431, confidence interval “CI” −0.619 to −0.173, P < 0.002) and worse eye (r = −0.342, CI: −0.575 to − 0.058, P < 0.015) with GAL-9, the better eye showing a stronger correlation. Mean deviations (MD) of both better (r = −0.345, CI: −0.556 to −0.069, P < 0.014) and worse eye (r = −0.346, CI: −0.578 to −0.063 P < 0.014) showed similar moderate correlation. Vision of better eye (r = −0.398, CI: −0.577 to −0.210, P < 0.004) showed a stronger correlation with GAL-9 score than worse eye (r = −0.188, CI: −0.475 to 0.100, P < 0.192). Subscales of GAL-9 questionnaire also correlated with better eye status. “Finding dropped objects” had the strongest correlation to CFI of better eye (r = −0.676) and “adjusting to dim lights” had the weakest correlation (r = −0.052).Conclusion:The better eye status in glaucoma patients correlated better than worse eye with regard to activity limitation, signifying that the better eye has a greater influence on the quality of life and how patients perceive their disability. Furthermore, CFI showed a better correlation with GAL-9 score than MD.

Activity Limitation in Glaucoma: Objective Assessment by the Cambridge Glaucoma Visual Function Test.

We design and evaluate a computer-based objective simulation of activity limitation related to glaucoma. A cross-sectional study was performed involving 70 glaucoma patients and 14 controls. Mean age was 69.0 ± 10.2 years; 49 (58.3%) were male. The Cambridge Glaucoma Visual Function Test (CGVFT) was administered to all participants. Rasch analysis and criterion, convergent, and divergent validity tests assessed the psychometric properties of the CGVFT. Regression modeling was used to determine factors predictive of CGVFT person measures. Sociodemographic information, better and worse eye visual field parameters, visual acuity, contrast sensitivity, and the Rasch-analyzed Glaucoma Activity Limitation-9 (GAL-9) and Visual Function Questionnaire Utility Index (VFQUI) questionnaire responses were recorded. From 139 pilot CGVFT items, 59 had acceptable fit to the Rasch model, with acceptable precision (person separation index, 2.13) and targeting. Cambridge Glaucoma Visual Function Test person measure (logit) scores increased between controls (-0.20 ± 0.08) and patients with mild (-0.15 ± 0.08), moderate (-0.13 ± 0.10), and severe (-0.05 ± 0.10) glaucoma (P < 0.001, ANOVA) indicating good criterion validity. Correlation coefficients of 0.455 (P < 0.001) between CGVFT and GAL-9 person measures and 0.399 (P = 0.005) between CGVFT and VFQUI person measures demonstrated convergent validity. Divergent validity was suboptimal. On multivariable analysis, lower better eye mean deviation and greater age were associated with worsening CGVFT person measures (P ≤ 0.001). The CGVFT is a computerized visual challenge test administered to a cohort of glaucoma patients. It may benefit glaucoma patients, careers, health care providers, and policy makers, providing increased awareness of activity limitation due to glaucoma.

The Visual Function Questionnaire: Utility Index: Does It Measure Glaucoma-related Preference-based Status?

As health budgets tighten globally, evaluating the cost-effectiveness of glaucoma services is vital; however, there is a lack of validated instruments that measure utility specific to glaucoma patients. We thus evaluated the validity of the Visual Function Questionnaire-Utility Index (VFQ-UI) as a measure of vision-related function and preference-based status in glaucoma. Cross-sectional study of 141 volunteer patients over 40 years of age with moderate (n=64) or severe (n=36) glaucoma, and 41 controls. Sociodemographic information, visual acuity, and visual field test parameters were obtained. The VFQ-UI and Glaucoma Activity Limitation-9 patient-reported outcome tools were administered, and their psychometric properties explored using Rasch analysis. Criterion, convergent, and divergent validity of the VFQ-UI were also assessed. Mean age was 69.7 (±10.8) years, with a mean better eye visual acuity (LogMAR) of 0.074 (±0.356) (approximate Snellen acuity of 20/24). Overall, the VFQ-UI had satisfactory fit to the Rasch model, however targeting and precision were suboptimal with a person separation index of 1.72 and person reliability coefficient of 0.75. VFQ-UI scores significantly increased as glaucoma severity worsened between controls (-4.54, ±1.15) and patients with moderate (-3.77, ±1.57) and severe glaucoma (-1.98, ±2.98), indicating good criterion validity (P<0.001). Strong correlation between VFQ-UI and Glaucoma Activity Limitation-9 scores (r=0.764, P<0.001) demonstrated good convergent validity. There was no significant correlation between VFQ-UI scores and age and sex (r=0.150 and 0.026, respectively), demonstrating good divergent validity. The VFQ-UI shows potential to measure preference-based status in a cohort of glaucoma patients, with the means to calculate utility. Although the VFQ-UI displayed reasonable fit to the Rasch model overall and had good criterion, convergent and divergent validity, its lack of precision is a limitation. The difficulty of the VFQ-UI in discriminating among patients with varying glaucoma severity may be improved by including items specific to glaucomatous visual dysfunction.

Quality of Life in Patients with Glaucoma

The goal of glaucoma treatment is to maintain the patient's visual function and related quality of life, at a sustainable cost. In this review, methods of measuring quality of life are presented, together with their impact in clinical practice. Searches were from the inception of the database to date. Electronic databases searched included Medline (Ovid), Medline In-Process (Ovid), and Embase (Ovid). In a semistructured approach, the articles were checked for their eligibility to provide information about the measurement and application of quality of life in glaucoma patients. Well established questionnaires are available to measure quality of life in glaucoma patients, as well as instruments to measure benefits. Performance-based measures are more time-consuming. The Glaucoma Activity Limitation-9 Questionnaire (GAL-9) is a glaucoma-specific questionnaire in German, with a Rasch analysis. In eye diseases with central visual field defects, it is the better eye that determines the patient's quality of life, whereas in glaucoma patients with peripheral defects, it is the worse eye that has a stronger influence. Structural changes in glaucoma are less well correlated with quality of life than are functional impairments. There have been a few initial reports of patterns of visual field defects that correlate with subjective impairments. The data can help to improve our understanding of individual patient impairment and support our efforts to improve the medical advice and therapy that these patients receive.

Impact of age-related macular degeneration in patients with glaucoma: understanding the patients' perspective.

The aim of the study is to measure the impact of age-related macular degeneration on vision-related activity limitation and preference-based status for glaucoma patients. This was a cross-sectional study. Two-hundred glaucoma patients of whom 73 had age-related macular degeneration were included in the research. Sociodemographic information, visual field parameters and visual acuity were collected. Age-related macular degeneration was scored using the Age-Related Eye Disease Study system. The Rasch-analysed Glaucoma Activity Limitation-9 and the Visual Function Questionnaire Utility Index measured vision-related activity limitation and preference-based status, respectively. Regression models determined factors predictive of vision-related activity limitation and preference-based status. Differential item functioning compared Glaucoma Activity Limitation-9 item difficulty for those with and without age-related macular degeneration. Mean age was 73.7 (±10.1) years. Lower better eye mean deviation (β: 1.42, 95% confidence interval: 1.24-1.63, P < 0.001) and age-related macular degeneration (β: 1.26 95% confidence interval: 1.10-1.44, P = 0.001) were independently associated with worse vision-related activity limitation. Worse eye visual acuity (β: 0.978, 95% confidence interval: 0.961-0.996, P = 0.018), high risk age-related macular degeneration (β: 0.981, 95% confidence interval: 0.965-0.998, P = 0.028) and severe glaucoma (β: 0.982, 95% confidence interval: 0.966-0.998, P = 0.032) were independently associated with worse preference-based status. Glaucoma patients with age-related macular degeneration found using stairs, walking on uneven ground and judging distances of foot to step/curb significantly more difficult than those without age-related macular degeneration. Vision-related activity limitation and preference-based status are negatively impacted by severe glaucoma and age-related macular degeneration. Patients with both conditions perceive increased difficulty walking safely compared with patients with glaucoma alone.

Cataract and quality of life in patients with glaucoma.

To assess the impact of cataract on quality of life (QoL) for patients with glaucoma. Cross-sectional study. Two hundred forty-two patients with mild (n = 67), moderate (n = 80) or severe (n = 45) glaucoma and 50 controls (glaucoma suspects). Patients with cataract of any severity were included. The following data were collected: sociodemographic information, phakic/pseudophakic status, cataract grade according to the Lens Opacities Classification System (LOCS) III, visual acuity and visual field test parameters. Glaucoma severity was stratified according to binocular visual field loss. Visually significant cataract was defined as: LOCS III criteria nuclear cataract ≥3/6.9, cortical cataract ≥3/5.9 or posterior subcapsular cataract ≥2/5.9. Patients' QoL was measured using Rasch-transformed scores from the Glaucoma Activity Limitation-9 (GAL-9) questionnaire. Multiple linear regression models were used to determine the association between cataract and GAL-9 (logit) score. Fifty-six (23.1%) patients had at least one visually significant cataract. At least one visually significant cataract (standardized coefficient [β] 1.19, 95% confidence interval 1.04-1.34, P = 0.011) and poor visual field index (better eye) (β 1.47, 95% confidence interval 1.36-1.88, P < 0.001) were independently associated with worse GAL-9 score. Cataract influences glaucoma-related QoL among glaucoma patients of all severity levels and is an important cause of potentially reversible visual impairment among glaucoma patients. The Rasch-analysed GAL-9 questionnaire is a useful metric to quantify visual disability related to cataract in glaucoma patients.