title: Impact of bilateral open and closed-angle glaucoma on glaucoma-specific functioning in Asians.
abstract: OBJECTIVE
  To evaluate the impact of bilateral primary glaucoma on glaucoma-specific functioning in Asians.
  
  
  METHODS
  Patients with bilateral primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) aged 40 years or above of Chinese ethnicity in Singapore were recruited. All underwent a comprehensive clinical assessment of glaucoma. Glaucoma was diagnosed with a standard criteria including optic disc abnormality and visual field defect. The Glaucoma Quality of Life-15, a glaucoma-specific questionnaire, was used to evaluate the impact of glaucoma, and Rasch analysis was used to validate the Glaucoma Quality of Life-15.
  
  
  RESULTS
  A total of 192 patients (mean±SD age, 65.73±17.6 y and 65.1% male) were recruited, of which 56.2% (n=108) and 43.8% (n=84) had POAG and PACG, respectively. Fifty-four (28.1%), 85 (44.3%), and 53 (27.6%) had bilateral mild glaucoma, mild glaucoma in 1 eye and moderate/severe glaucoma in the other, and bilateral moderate/severe glaucoma, respectively. In multivariate analyses, compared with patients with mild glaucoma in both eyes, those with (a) mild glaucoma in 1 eye and moderate/severe in other; and (b) moderate/severe glaucoma in both eyes, reported significantly poorer functioning (β-coefficient=-8.20; confidence interval, -14.36 to -2.04; P<0.05) and (β=-21.05; confidence interval, -28.06 to -14.04; P<0.05), respectively. A similar independent association was found for POAG and PACG. These associations were also considered to be clinically significant while comparing bilateral mild glaucoma with bilateral moderate/severe glaucoma. We however, found no significant difference for functioning and severity of glaucoma between PACG and POAG patients (P<0.05).
  
  
  CONCLUSIONS
  Bilateral glaucoma is worse than the mild form in any eye and is significantly associated with poor glaucoma-specific functioning in this Singaporean Chinese sample. These data emphasize the need for strategies to identify patients early and prevent deterioration beyond the mild form of the condition.
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Bingsong
authors.initials: B
authors.lastname: Wang
authors.forename: Tin
authors.initials: T
authors.lastname: Aung
authors.forename: Manjula
authors.initials: M
authors.lastname: Marella
authors.forename: Yingfeng
authors.initials: Y
authors.lastname: Zheng
authors.forename: Tien Y
authors.initials: TY
authors.lastname: Wong
authors.forename: Shamira
authors.initials: S
authors.lastname: Perera
authors.forename: Tina T
authors.initials: TT
authors.lastname: Wong
authors.forename: Ching-Lin
authors.initials: CL
authors.lastname: Ho
authors.forename: Ecosse L
authors.initials: EL
authors.lastname: Lamoureux
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000208:ethnology*; D003430:Cross-Sectional Studies; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology*; D005902:Glaucoma, Open-Angle / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology; D009901:Optic Nerve Diseases / Q000175:diagnosis; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D018434:Sickness Impact Profile; D012846:Singapore / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014786:Vision Disorders / Q000175:diagnosis; D014794:Visual Fields