Quality of life of primary open angle glaucoma patients in lagos, Nigeria: clinical and sociodemographic correlates

Abstract

Purpose: To evaluate the quality of life (QOL) of primary open angle glaucoma (POAG) patients attending a tertiary eye institution in Lagos, Nigeria and identify clinical and sociodemographic factors affecting it.

Methods: A hospital-based cross-sectional analytical study design was used to compare 132 patients with varying degrees of severity of glaucoma (cases) with age-matched and sex-matched controls with essentially normal eyes and no family history of glaucoma.

Results: POAG patients had reduced QOL as defined by the 2 instruments used: the National Eye Institute Visual Function Questionnaire25 (NEIVFQ25) and the 15-item Glaucoma Quality of life Questionnaire (GQL-15). The mean QOL score obtained with the NEIVFQ25 for the cases was 85.2 (±16.07) and 96.7 (±2.34) for the controls. Using the GQL-15 scale, the mean QOL score for the cases was 24.07 (±12.4), whereas for the controls the score was 15.75 (±1.85). Early or mild glaucoma was associated with reduced QOL compared with the controls. Glaucoma patients had the greatest difficulty with glare and dark adaptation subscale of the GQL-15. Increasing severity of disease defined by increasing visual field deficit (mean deviation values) correlated significantly with worsening QOL [Spearman ρ (r) values ranging from 0.32 to 0.43]. Contrast sensitivity correlated moderately with QOL (r ranges from 0.43 to 0.47; P=0.001). Cup-to-disc ratios, visual acuity, and visual field indices (mean deviation) correlated with QOL scores of both tools with r values ranging from 0.28 to 0.49 for the GQL-15 and 0.38 to 0.54 for the NEIVFQ25. Age had a negative impact on QOL (r=-0.30 for the NEIVFQ25 and 0.30 for the GQL-15) and affected all the subscales of the GQL-15 and most subscales of the NEIVFQ25 except ocular pain (P=0.40), mental health (P=0.13), color vision (P=0.05), and role difficulty (P=0.11). Women generally had better vision-related QOL scores (P=0.001 for the NEIVFQ25 and 0.005 for the GQL-15). Higher educational status was associated with better QOL scores (P<0.05). Ethnicity, religion, marital status, and living situation had no significant effect on QOL scores.

Conclusions: POAG reduces QOL even in the early stages of the disease, as there was a significant reduction in the QOL of patients with mild glaucoma compared with the controls. It showed a clear trend of worsening QOL scores with increasing severity of disease. The correlation observed between QOL scores and objective measures of visual function suggest that inclusion of QOL assessment in clinical practice could be highly informative and should be explored further.