Factors associated with quality of life in persons with glaucoma

Istraživanje je imalo za cilj da validira upitnike Glaucoma Quality of Life 15 (GQL-15) i Glaucoma Symptome Scale (GSS) na srpskom jeziku, da proceni uticaja stadijuma glaukoma na kvalitet života (QOL) obolelih i da identifikuje prediktivne faktore QOL. Materijal i metode: Selekcija ispitanika je vršena nakon pregleda koji je uključivao i ispitivanje vidnog polja (KVP) na osnovu kojeg je glaukom obolelih razvrstan na početni, srednji i uznapredovali glaukom. QOL je procenjivan upitnicima: GQL-15, GSS, upitnikom Nacionalnog instituta za vid (NEI VFQ-25) i opštim upitnikom za merenje kvaliteta života SF-36. Upitnici GQL-15 i GSS su validirani klasičnom i Rasch analizom. Identifikacija prediktivnih faktora je vršena multiplom linearnom regresijom. Rezultati: U istraživanje je bilo uključeno ukupno 306 obolelih, prosečne starosti 63,0+12,9 godina. Kod najvećeg broja ispitanika (54,9%) bio je zabeležen početni stadijum glaukoma. Upitnici GQL-15 i GSS su pokazali dobru validnost prilikom ispitivanja psihometrijskih karakteristika. Osim u slučaju upitnika SF-36, zabeleženo je statistički značajno pogoršanje QOL sa napredovanjem stadijuma glaukoma. Izdvojeni su sledeći faktori kao prediktori pogoršanja QOL: starija životna dob, kasniji stadijum glaukoma, niža stručna sprema, više vrednosti indeksa KVP, veći broj laserskih intervencija. Faktori koji su bili povezani sa boljim QOL su bili: muški pol, mlađa životna dob, viša školska sprema, život u staračkom domu, prestanak vožnje automobila zbog očnih problema, redovna rekreacija i niži stadijum glaukoma. Zaključak: Upitnici GQL-15 i GSS na srpskom jeziku su pouzdani instrumenti za merenje QOL kod glaukoma. Ustanovljena je jaka veza između napredovanja stadijuma glaukoma i pogoršanja QOL, kao i niz prediktivnih faktora koji su povezani sa QOL.The goal was to validate Serbian versions of the Glaucoma quality of life 15 (GQL-15) and the Glaucoma Symptom Scale (GSS) questionnaires, to assess the influence of glaucoma stage on quality of life (QOL) and to indentify its predicitve factors. Materials and methods: All the participants had an ophthalmological exam, including a visual fiel (VF) exam based on which the glaucoma of patients were classified as mild, moderate and advanced glaucoma. All participants filled in the GQL-15, GSS, National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and Short Form 36 (SF-36) questionnaires. The Serbian versions of the GQL-15 and GSS were validated using the classical and Rasch analysis. Predictive factors were indentified using multiple linear regression. Results: Overall, 306 participants were recruited in the study. The average age of our patients was 63,0+12,9 years. The majority of the participants (54,9%) had glaucoma classified as mild glaucoma. The GQL-15 and GSS showed good psycometric properties. Exept for the SF-36 questionnaire, all vision-specific questionnaires showed statistically significant deterioration of the QOL according to disease progression. Statistical models indentified the following predictive factors of lower QOL: female sex, older age, more advances glaucoma stadium, lower educational status, higher VF indices, higher nuber of interventions by laser. Furthermore, factors associated with better QOL were: male sex, younger age, higher education, life in a nursing home, cessation of driving due to vision impairment, regular physical activity and less advanced stage of glaucoma. Conclusion: The Serbian versions of GQL-15 and GSS are valid instruments for measurment of QOL. A strong association was observed between the severity of glaucoma and QOL deterioration. Numerous other factors are associated with QOL in glaucoma

Contribution and significance of Heidelberg retinal tomography II in diagnostics of ocular hypertension and its conversion into primary open-angle glaucoma

Background/Aim. A term 'ocular hypertension' is used when IOP is found to be > 21 mmHg on two consecutive occasions, in the absence of detectable glaucomatous damage. The aim of this study was to determine the significance and contribution of Heidelberg Retinal Tomography II (HRT II) results that show very early, subtle changes in retinal neurofibre layers (RNFL) in the optic nerve head that are specific for glaucoma itself (the loss of neuroretinal rim area and an increase of Cup/Disc ratio), but are not possible to register by an ophthalmoscope. Also, when the results of the functional tests remain unchanged, that confirms the conversion of ocular hypertension into glaucoma. Methods. During a 5-year study period (2002-2007), 29 patients with ocular hypertension were examined. The frequency of control examinations, based on the presence of risk factors for glaucoma development, was 3-6 months. The examination also included IOP measurements with Goldmann Applanation Tonometry (GAT), central corneal thickness (CCT) determination by pachymetry, the examination of chamber angle using indirect gonioscopy, visual field tests by computerized perimetry and also papillae nervi optici (PNO) examination by using HRT II. The application of HRT II enables a great number of stereometric parameters of optic disc, the most important being the rim area and Cup/Disc (C/D) ratio, which was followed during the control examination by each segment, as well as PNO in global. Results. In the examination period, three cases of conversion of ocular hypertension into a primary open-angle glaucoma were found. In the group of patients with ocular hypertension, HRT II results after six months did not show a significant increase in C/D ratio. No significant loss of rim area or rim volume was found either. In three cases of conversion, HRT II results after 3 months showed an increase of C/D ratio and also a significant loss in rim volume at first examination (0.413) comparing to the last one. Conclusion. In diagnosing ocular hypertension and its conversion to glaucoma, HRT II is used for quantitative evaluation of retinal topography and for quantitative monitoring of topographical changes, especially regarding the increase of C/D ratio and loss of rim volume tissue, which enables to see and register subtle structural changes in optic nerve head and RNFL that are so characteristic for glaucoma, which cannot be seen by an ophthalmoscope. With these results, according to risk factors for glaucoma, one can confirm the diagnosis of ocular hypertension and its conversion to primary open-angle glaucoma. In this study HRT II revealed conversion of ocular hypertension into glaucoma in 10% of the patients

Validation of the Glaucoma Quality of Life-15 Questionnaire in Serbian language

AIM: To translate the Glaucoma Quality of Life-15 (GQL-15) to Serbian language and asses its validity and reliability in the population of Serbian patients. METHODS: The study included 177 glaucoma patients. Clinical parameters (visual acuity, mean defect and square root of loss variance of visual field) and socio-demographic data were collected. Patients were stratified according to the Nelson's glaucoma staging system as mild, moderate and advanced glaucoma. All patients filled out the GQL-15 and National Eye Institute Visual Function Questionnaire (NEI-VFQ 25). The GQL-15 was translated following the internationally-accepted methodology, and its psychometric properties were assessed by using classical test theory and Rasch analysis. RESULTS: The mean total score for the GQL-15 was 20.68 +/- 7.31. The Cronbach's alpha coefficient for the whole scale was 0.89 (central and near vision, alpha=0.24; peripheral vision, alpha=0.85; glare and dark adaptation, alpha=0.83). Factor analysis established 4 factors (70.3% of variance): two corresponding to the original factors and two new factors specific for the Serbian population. The GQL-15 score correlated positively with almost all clinical parameters and NEI-VFQ 25 proving good criterion validity. Correlation of the GQL-15 total score on test-retest confirmed appropriate scale reproducibility (rho= 0.96, P lt 0.001). The GQL-15 discriminated well advanced from mild and moderate glaucoma. In Rasch analysis we obtained adequate item (0.95) reliability index. Almost all items had infit and outfit mean squares in the accepted range. CONCLUSION: Serbian version of the GQL-15 demonstrates adequate reliability and validity. This version of the GQL-15 is a valid instrument for evaluation of quality of life among Serbian speaking patients with glaucoma and can be applied in daily clinical work

Glaucoma Symptom Scale: Psychometric properties of the Serbian version

Purpose The study aim was to translate and validate the Glaucoma Symptom Scale (GSS) in Serbian language. Methods Clinical parameters and socio-demographic data were collected for each of the 177 enrolled glaucoma patients. Each eye was classified according to the Glaucoma staging system by Mills into 6 stages. Patients filled out the GSS and National Eye Institute Visual Function Questionnaire (NEI-VFQ 25). The GSS comprises 10 complaints common for glaucoma patients on a topical treatment, grouped into two subscales: SYMP-6 (non-visual) and FUNC-4 (visual problems). The GSS was translated following the customary methodology and its psychometric properties were assessed by using both Classical Test Theory (CTT) and Rasch analysis. Results The internal consistency of the Serbian GSS for the whole scale was very good (Cronbach's alpha = 0.81). On factor analysis items were clustered into 2 factors (48.92% of variance) which corresponded to the original scale. The total and subscale GSS scores correlated significantly with measures of disease severity and also with total score and analogous NEI-VFQ 25 subscale scores. In Rasch analysis we obtained adequate item reliability index (0.90). Almost all items had infit and outfit mean squares in the accepted range. However, measurement precision was poor (low person separation reliability) and targeting revealed a ceiling effect. Conclusion When analyzed with CTT the Serbian version of the GSS seems to be a valid instrument, but Rasch analysis revealed some serious measurement flaws, therefore it should not be used in its current format. Further studies to modify and improve GSS are needed prior to its application for Serbian glaucoma patients

Influence of Diabetes Mellitus on Corneal Thickness

Ultrastrukturne promene rožnjače kod osoba obolelih od dijabetes melitusa (DM) opisane su u ranijim radovima. Cilj istraživanja je bio poređenje centralne debljine rožnjače (CDR) osoba obolelih od DM bez retinopatije u stadijumu neproliferativne i proliferativne dijabetičke retinopa-tije sa CDR zdravih osoba kontrolne grupe. Metode rada: Ukupno je ispitana 121 osoba sa DM i 125 zdravih osoba. Kontrolnu grupu su činile osobe individualno uparene prema polu i starosti sa bolesnicima iz studijske grupe. Svi ispitanici su podvrgnuti oftalmološkom pregledu, koji je obuhvatio pregled očnog dna i merenje CDR ultrazvučnim pahimetrom. Oči ispitanika sa DM su, prema kriterijumima Early Treatment Diabetic Retinopathy Study, podeljene u tri grupe: grupu bez dijabetičke retinopatije (NDR), sa neprolife-rativnom dijabetičkom retinopatijom (NPDR) i proliferativnom dijabetičkom retinopatijom (PDR). U istraživanje je uključeno samo jedno oko svakog ispitanika. Rezultati: Prosečna vrednost CDR bolesnika sa DM bila je 570,52±31,81 μm, a zdravih ispitanika 541,42±27,82 μm. Razlika u CDR između dve posmatrane grupe bila je statistički visoko značajna (p0,05). Zaključak: Veća CDR je utvrđena kod osoba sa DM u poređenju sa zdravim ispitanicima. Najveća CDR je ustanovljena u grupi očiju sa PDR; slede grupe NPDR i NDR.Introduction Ultrastructural changes in corneas of patients with diabetes mellitus have been previously described. Objective The aim of this study was to compare central corneal thickness (CDR) values in diabetic patients without retinopathy at the stage of diabetic nonproliferative and proliferative retinopathy and CDR in a control group of healthy subjects. Methods The study included 121 diabetic patients and 125 healthy subjects matched according to gender and age. Each patient underwent ophthalmological examination involving a dilated fundus examination and CDR measurement using the ultrasound pachymeter. The eyes of diabetic patients were classified according to Early Treatment Diabetic Retinopathy Study into three groups: without diabetic retinopathy (NDR), with nonproliferative diabetic retinopathy (NPDR) and a group with proliferative diabetic retinopathy (PDR). Only one eye of each subject was chosen for the study. Results The mean CDR value was significantly higher in the diabetic group (570.52 +/- 31.81 mu m) compared with the control group (541.42 +/- 27.82 mu m). The difference between the two groups was statistically significant (p lt 0.0001). The highest mean CDR value was recorded in the PDR group (585.97 +/- 28.58 mu m), followed by the NPDR group (570.84 +/- 30.27 mu m), whereas the lowest mean CDR value was recorded in the NDR group (559.80 +/- 31.55 mu m). There was a statistically significant difference in CDR between the NDR and PDR groups, as well as between the NPDR and PDR groups (p lt 0.001, p lt 0.05 respectively). No significant difference was recorded between the NDR and NPDR groups (p>0.05). Conclusion CDR of diabetic patients was higher compared to healthy subjects. The highest mean value of CDR was registered in the PDR group, followed by the NPDR and the NDR groups

GSTM1-null and GSTT1-active genotypes as risk determinants of primary open angle glaucoma among smokers

AIM: To evaluate glutathione transferase theta 1 and mu 1 (GSTT1 and GSTM1) polymorphisms as determinants of primary open angle glaucoma (POAG) risk, independently or in combination with cigarette smoking, hypertension and diabetes mellitus. METHODS: A case-control study with 102 POAG patients and 202 age and gender-matched controls was carried out. Multiplex-polymerase chain reaction method was used for the analysis of GSTM1 and GSTT1 polymorphisms. The differences between two groups were tested by the t-test or chi(2) test. Logistic regression analysis was used for assessing the risk for disease development. RESULTS: The presence of GSTM1-null genotype did not contribute independently towards the risk of POAG. However, individuals with GSTT1-active genotype were at almost two-fold increased risk to develop glaucoma (P=0.044) which increased up to 4.36 when combined with GSTM1-null carriers (P=0.024). When glutathione transferase (GST) genotypes were analyzed in association with cigarette smoking, hypertension and diabetes, only carriers of GSTT1-active genotype had significantly increased risk of POAG development in comparison with GSTT1-null genotype individuals with no history of smoking, hypertension and diabetes, respectively (OR=3.52, P=0.003; OR=10.02, P lt 0.001; OR=4.53, P=0.002). CONCLUSION: The results obtained indicate that both GSTM1-null and GSTT1-active genotypes are associated with increased POAG risk among smokers, suggesting potential gene-environment interaction in glaucoma development

Factors associated with quality of life in persons with glaucoma

Istraživanje je imalo za cilj da validira upitnike Glaucoma Quality of Life 15 (GQL-15) i Glaucoma Symptome Scale (GSS) na srpskom jeziku, da proceni uticaja stadijuma glaukoma na kvalitet života (QOL) obolelih i da identifikuje prediktivne faktore QOL. Materijal i metode: Selekcija ispitanika je vršena nakon pregleda koji je uključivao i ispitivanje vidnog polja (KVP) na osnovu kojeg je glaukom obolelih razvrstan na početni, srednji i uznapredovali glaukom. QOL je procenjivan upitnicima: GQL-15, GSS, upitnikom Nacionalnog instituta za vid (NEI VFQ-25) i opštim upitnikom za merenje kvaliteta života SF-36. Upitnici GQL-15 i GSS su validirani klasičnom i Rasch analizom. Identifikacija prediktivnih faktora je vršena multiplom linearnom regresijom. Rezultati: U istraživanje je bilo uključeno ukupno 306 obolelih, prosečne starosti 63,0+12,9 godina. Kod najvećeg broja ispitanika (54,9%) bio je zabeležen početni stadijum glaukoma. Upitnici GQL-15 i GSS su pokazali dobru validnost prilikom ispitivanja psihometrijskih karakteristika. Osim u slučaju upitnika SF-36, zabeleženo je statistički značajno pogoršanje QOL sa napredovanjem stadijuma glaukoma. Izdvojeni su sledeći faktori kao prediktori pogoršanja QOL: starija životna dob, kasniji stadijum glaukoma, niža stručna sprema, više vrednosti indeksa KVP, veći broj laserskih intervencija. Faktori koji su bili povezani sa boljim QOL su bili: muški pol, mlađa životna dob, viša školska sprema, život u staračkom domu, prestanak vožnje automobila zbog očnih problema, redovna rekreacija i niži stadijum glaukoma. Zaključak: Upitnici GQL-15 i GSS na srpskom jeziku su pouzdani instrumenti za merenje QOL kod glaukoma. Ustanovljena je jaka veza između napredovanja stadijuma glaukoma i pogoršanja QOL, kao i niz prediktivnih faktora koji su povezani sa QOL.The goal was to validate Serbian versions of the Glaucoma quality of life 15 (GQL-15) and the Glaucoma Symptom Scale (GSS) questionnaires, to assess the influence of glaucoma stage on quality of life (QOL) and to indentify its predicitve factors. Materials and methods: All the participants had an ophthalmological exam, including a visual fiel (VF) exam based on which the glaucoma of patients were classified as mild, moderate and advanced glaucoma. All participants filled in the GQL-15, GSS, National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and Short Form 36 (SF-36) questionnaires. The Serbian versions of the GQL-15 and GSS were validated using the classical and Rasch analysis. Predictive factors were indentified using multiple linear regression. Results: Overall, 306 participants were recruited in the study. The average age of our patients was 63,0+12,9 years. The majority of the participants (54,9%) had glaucoma classified as mild glaucoma. The GQL-15 and GSS showed good psycometric properties. Exept for the SF-36 questionnaire, all vision-specific questionnaires showed statistically significant deterioration of the QOL according to disease progression. Statistical models indentified the following predictive factors of lower QOL: female sex, older age, more advances glaucoma stadium, lower educational status, higher VF indices, higher nuber of interventions by laser. Furthermore, factors associated with better QOL were: male sex, younger age, higher education, life in a nursing home, cessation of driving due to vision impairment, regular physical activity and less advanced stage of glaucoma. Conclusion: The Serbian versions of GQL-15 and GSS are valid instruments for measurment of QOL. A strong association was observed between the severity of glaucoma and QOL deterioration. Numerous other factors are associated with QOL in glaucoma

Comparison of normotensive and glaucoma simplex patients according to age and sex

Introduction. According to the level of intraocular pressure (IOP), open angle glaucoma is divided into high tension glaucoma (HTG) and normal tension glaucoma (NTG). Objective. To determine if there are differences in the distribution of patients by age and sex between NTG and HTG. Methods. Our prospective study included 30 patients with NTG and 30 with HTG. A complete eye examination was performed. The examination included measuring of intraocular pressure by Goldmann applanation tonometry, examination of optic disc head by indirect ophthalmoscopy with Volk 90 D lens and visual field examination using the Octopus program. Results. The average damage of visual field in the group of patients with NTG was 8.14±4.43 dB, while in the group with HTG it was 7.40±2.84 dB (p>0.05). The average age of the group of patients with NTG was 66±11.58 years, while among those with HTG the average age was 59.7±11.63 years (p<0.01). Among the patients with NTG there were three times more women than men (χ2=9.124; p<0.01), while in the group of patients with HTG there were more men than women, but without statistically significant difference between the tested groups (χ2=1.851; p>0.05). Conclusion. Open angle glaucoma is a disease of elderly population. According to our results, risk factors for this disease can be age and sex. NTG is more frequently present than HTG among elderly population and females

Prevention of intraocular pressure elevation after argon laser trabeculoplasty in primary open angle glaucoma

Introduction. Argon laser trabeculoplasty (ALT) is an intraocular pressure lowering method that is overall safe and powerful, but often complicated by transient postoperative intraocular pressure rises. In prevention of this complication, we frequently use two potent alpha-adrenergic agonists - brimonidine and apraclonidine. Objective. The aim of this study was to compare brimonidine 0.2% and apraclonidine 0.5% efficacy and safety in prevention of intraocular pressure elevation after ALT. Methods. This was a prospective, randomized, double-masked and comparative study. This study included 27 POAG patients, 15 received 0.2% brimonidine, and 12 received 0.5% apraclonidine before laser surgery (22 eyes in both groups). Intraocular pressure readings were taken 1, 2, 3, 24 hours and 7 days after ALT. Student’s t-test was used to analyze data between two groups, and χ2 test to compare data within groups. Value p less than 0.05 was considered statistically significant. Results. We found statistically significantly lower IOP in eyes that received 0.2% brimonidine at readings taken 1 hour after ALT (p=0.001). There were no statistically significant differences in other IOP readings between two groups. Conclusion. A single preoperative drop of brimonidine 0.2% had similar efficacy and safety as apraclonidine 0.5% in preventing transient IOP elevations after ALT

The role of 24-hour ambulatory blood pressure monitoring in hypertensive patients with normal-tension glaucoma

Introduction. Extreme dippers are patients with a nocturnal fall of blood pressure (BP) of more than 20%, dippers have normal diurnal rhythm and decrease of BP of 10-15%, while patients with a nocturnal BP fall of less than 10% are considered to be non-dippers. Objective. The aim of this study was to compare 24-hour ambulatory BP monitoring results of normaltension glaucoma (NTG) patients with NTG suspects, as well as to determine whether NTG patients are more prone to daytime/nighttime systemic arterial BP and heart rate oscillations in comparison to NTG suspects. Methods. This was a prospective, cross-sectional and observational study of 57 hypertensive patients (39 female and 18 male), all examined at the Eye and the Cardiology Clinic, Clinical Center of Serbia in Belgrade, between November 2011 and March 2012. Before 24-hour ambulatory BP monitoring, complete ophthalmological examination was performed (intraocular pressure was measured with both Goldmann applanation and dynamic contour tonometer, as well as with computerized perimetry and Heidelberg retinal tomography). Results. There was no statistically significant difference between NTG patients and NTG suspects both in systolic daytime (131.86-141.81 mmHg, SD=±14.92 vs. 129.67-141.83 mmHg, SD=±13; p=0.53) and nighttime measurements (117.1-129.7 mmHg, SD=±18.96 vs. 112.11-127.59 mmHg, SD=±16.53; p=0.53) as well as diastolic daytime (74.55-80.37 mmHg, SD=±8.72 vs. 75.19-82.41 mmHg, SD=±7.72; p=0.58) and nighttime measurements (65.66-71.48 mmHg, SD=±8.73 vs. 67.12-73.78 mmHg, SD=±7.11; p=0.34). There was no statistically significant difference between NTG patients and NTG suspects in heart rate during the day (72.73-76.36 beats per minute [bpm], SD=±5.44 vs. 72.15-76.45 bpm, SD=±4.59; p=0.43) nor during the night (64.4-71.9 bpm, SD=±6.74 vs. 68.02-72.48 bpm, SD=±4.76; p=0.11). Conclusion. No statistically significant difference was found between NTG patients and NTG suspects in regard to their systolic and diastolic BP measured both during daytime and nighttime. NTG patients had lower nocturnal BP fall (both systolic and diastolic) than NTG suspects