title: Glaucoma and associated visual acuity and field loss significantly affect glaucoma-specific psychosocial functioning.
abstract: OBJECTIVE
  To examine the impact of glaucoma and visual acuity (VA) and visual field (VF) losses on psychosocial functioning (PF).
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  We compared PF between 192 participants with bilateral glaucoma with VA or VF losses and 40 controls from a tertiary eye hospital clinic in Singapore.
  
  
  METHODS
  Glaucoma was defined using the Hodapp-Anderson-Parish criteria. Four psychosocial outcomes of the Glaucoma Quality of Life 36 questionnaire were psychometrically assessed using Rasch analysis. Multivariate regression was performed to determine the independent impact of glaucoma and VA and VF losses on PF. The impact of VA and VF on PF were evaluated by restricted cubic spline analysis.
  
  
  METHODS
  Anxiety, self-image, psychological well-being, and confidence in health care.
  
  
  RESULTS
  The mean age of participants was 66.2±11.0 years, and 63% were male. In the better eye, VA and mean deviation were Snellen 20/25 and -8.89±6.52 dB, respectively. In multivariate models, glaucoma patients had 63.0% greater anxiety (95% confidence interval [CI], -66.0% to -61.2%; P<0.001), 71.0% lower self-image (95% CI, -74.1% to -68.5%; P<0.001), 38.3% less psychological well-being (95% CI, -37.4% to -39.0%; P<0.001), and 32.4% reduced confidence in health care than patients without glaucoma. The worst VA and VF categories had the most reduced PF (range, 26.0% to 81.5%; P<0.001 for all associations) compared with controls. With worsening VA, there was a linear increase in anxiety (P=0.009) and decrease in self-image (P=0.005). With worsening VF from 0 to -12.1 dB (P=0.003), anxiety increased before plateauing. Self-image decreased as VF worsened from 0 to -10 dB (P<0.001), and confidence in health care decreased when VF worsened from 0 to -9.3 dB (P=0.008). However, self-image and confidence in health care actually improved at greater levels of VF loss beyond these thresholds.
  
  
  CONCLUSIONS
  Glaucoma negatively affects PF. Early stage glaucoma with mild VF loss adversely affects anxiety, self-image, and confidence in health care. As VA worsens in advanced glaucoma, anxiety further increases and self-image deteriorates. Ophthalmologists and glaucoma patients need to be aware that both VA and VF losses at different stages of glaucoma negatively impact PF.
authors.affiliation: Department of Ophthalmology, National University Health System and National University of Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
authors.forename: Errol W
authors.initials: EW
authors.lastname: Chan
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, University of Melbourne, Australia.
authors.forename: Peggy P C
authors.initials: PP
authors.lastname: Chiang
authors.affiliation: Department of Ophthalmology, National University Health System and National University of Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
authors.forename: Jiemin
authors.initials: J
authors.lastname: Liao
authors.affiliation: Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, University of Melbourne, Australia.
authors.forename: Gwyneth
authors.initials: G
authors.lastname: Rees
authors.affiliation: Department of Ophthalmology, National University Health System and National University of Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, University of Melbourne, Australia; DUKE-NUS Graduate Medical School, Singapore.
authors.forename: Tien Y
authors.initials: TY
authors.lastname: Wong
authors.affiliation: Department of Ophthalmology, National University Health System and National University of Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
authors.forename: Janice S H
authors.initials: JS
authors.lastname: Lam
authors.affiliation: Department of Ophthalmology, National University Health System and National University of Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; DUKE-NUS Graduate Medical School, Singapore.
authors.forename: Tin
authors.initials: T
authors.lastname: Aung
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, University of Melbourne, Australia; DUKE-NUS Graduate Medical School, Singapore. Electronic address: ecosse.lamoureux@duke-nus.edu.sg.
authors.forename: Ecosse
authors.initials: E
authors.lastname: Lamoureux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D005901:Glaucoma / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D012649:Self Concept; D018434:Sickness Impact Profile; D012846:Singapore; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D014786:Vision Disorders / Q000523:psychology*; D014792:Visual Acuity / Q000502:physiology*; D014794:Visual Fields / Q000502:physiology*