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Quality of Life in Glaucoma and Its Relationship with Visual Function

Nelson, Patricia PhD*†; Aspinall, Peter PhD*†; Papasouliotis, Orestis PhD; Worton, Bruce PhD; O'Brien, Colm MD, FRCS, FRCOphth*

Original Articles

Purpose The aims of this study were (a) to explore patients self-reported visual disability resulting from glaucoma by means of a questionnaire developed for this purpose; (b) identify activities strongly associated with a measure of visual field loss, (c) to quantify different psychophysical aspects of visual function; (d) to assess the relationship between objective measures of visual function and patients' perception of their vision-related quality of life.

Patients and Methods Three groups of glaucoma patients (n = 47) with mild (n = 18), moderate (n = 19), and severe visual field loss (n = 10) and a group of normal controls (n = 19) underwent a comprehensive clinical examination, completed a questionnaire and, on a separate visit, performed a number of psychophysical tests of visual function.

Main Outcome Measures Questionnaire responses (vision-related quality of life, general health and psychosocial variables), visual acuity, visual fields, Esterman binocular disability scores, contrast sensitivity, critical flicker frequency, color vision, dark adaptation, glare disability (brightness acuity), and stereoacuity scores were measured.

Results Fifteen of the 50 questions were noted to have a strong significant relationship with a measure of visual field loss and were included in a new questionnaire scale, the Glaucoma Quality of Life – 15 (GQL-15). The scale validity showed a significant correlation with perimetric mean deviation (MD) values (r = −0.6;P < 0.0001), the reliability of the scale was high (Cronbach α = 0.95), and test-retest reliability of the questionnaire was strong (r = 0.87). An overall statistically significant decrease in performance-related quality of life was noted between normal subjects and all groups of glaucoma patients. A significant relationship was found between the scale questionnaire summary performance measure and a number of psychophysical tests: Pelli-Robson contrast sensitivity (r = −0.45, P < 0.001), glare disability (r = −0.41, P < 0.001), Esterman binocular visual field test (r = −0.39, P < 0.001), dark adaptation (r = 0.34, P = 0.007), and stereopsis (r = 0.26, P = 0.04).

Conclusion Perceived visual disability relating to certain tasks (particularly involving dark adaptation and disability glare, activities demanding functional peripheral vision such us tripping over and bumping into objects and outdoor mobility tasks) was significantly associated with the severity of binocular visual field loss. As a result, a new glaucoma-specific questionnaire scale with good performance characteristics is presented in this study. The difficulties encountered by patients in everyday life (as measured with the questionnaire) were also mirrored in their performance on a number of psychophysical tests, especially contrast sensitivity, glare disability, Esterman binocular visual field test, and dark adaptation.

*Department of Ophthalmology, Princess Alexandra Eye Pavilion, †School of the Built Environment, Heriot-Watt University, and ‡Department of Mathematics and Statistics, University of Edinburgh, Edinburgh, United Kingdom

Received June 21, 2001; accepted December 2, 2002.

This research was supported in part by a grant from the EQUAL Program of the Engineering and Sciences Research Council, Swindon, UK.

Address correspondence and reprint requests to Dr. Patricia Nelson, Department of Ophthalmology, Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, Scotland, UK. E-mail:

© 2003 Lippincott Williams & Wilkins, Inc.