Quality of life in newly diagnosed glaucoma patients : The Collaborative Initial Glaucoma Treatment Study.
OBJECTIVE
The Collaborative Initial Glaucoma Treatment Study (CIGTS) was designed to determine whether patients with newly diagnosed open-angle glaucoma are better treated initially by medicine or immediate filtering surgery. This paper describes the quality-of-life (QOL) measurement approach, instruments included, and the CIGTS participants' QOL findings at the time of diagnosis.


METHODS
Baseline results from a randomized, controlled clinical trial.


METHODS
Six hundred seven patients from 14 clinical centers were enrolled.


METHODS
Patients randomized to initial medication received a stepped medical regimen (n = 307). Those randomized to initial surgery underwent a trabeculectomy (n = 300). The baseline interview was conducted before treatment initiation. All baseline and posttreatment QOL assessments were conducted by telephone from a centralized interviewing center.


METHODS
The primary outcome measure described in this paper was QOL. The QOL instrument is multidimensional and incorporates both disease-specific and generic measures, including the Visual Activities Questionnaire, Sickness Impact Profile, and a Symptom and Health Problem CHECKLIST:


RESULTS
The correlations between QOL measures and clinical outcomes were in the expected direction, but relatively weak. At initial diagnosis, difficulty with bright lights and with light and dark adaptation were the most frequently reported symptoms related to visual function, whereas visual distortion was the most bothersome. Approximately half of the patients reported at least some worry or concern about the possibility of blindness. Within the Visual Activities Questionnaire, higher scores on the Peripheral Vision subscale were associated with more field loss (P < 0.01). In regression analyses controlling for sociodemographics and nonocular comorbidities, increased visual field loss was significantly associated with higher dysfunction among five disease-specific QOL measures (P < 0.05).


CONCLUSIONS
Newly diagnosed glaucoma patients reported experiencing some visual function symptoms at the time of diagnosis that would not be intuitively expected based on clinical testing. Some discussion about the association between clinical presentation and worry about blindness may reduce unnecessary concern. These results provide the basis for long-term comparisons of the QOL effects of initial medical and surgical treatment for open-angle glaucoma.
Janz
N K
NK
Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA. nkjanz@umich.edu
Wren
P A
PA
Lichter
P R
PR
Musch
D C
DC
Gillespie
B W
BW
Guire
K E
KE
D000328:Adult; D000368:Aged; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000627:therapeutic use; D011788:Quality of Life; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D014130:Trabeculectomy; D014786:Vision Disorders / Q000175:diagnosis; D014794:Visual Fields
D009883:Ophthalmic Solutions