The Research Of The Relationship Between GO VISA Clinical Score And The GO Patients Quality Of Life

Graves ophthalmopathy (GO) is an autoimmune disorder associated with Grave's disease (GD). It can occur with or without hyperthyroidism. Its typical ocular manifestations are recognized by a variety clinical features including pain, exophthalmos, eye lid retraction, chemosis and hyperemia, ocular movement restriction, diplopia,and symptoms associated with optic nerve compression. It is an debilitating disease impairing the quality of life of affected individuals. Reseach show that the quality of life of mild or moderate GO patients is similar or even worse than some kind of chronic diseases such as Diabetes,Emphysema, and Heart disease。However, among the various clinical manifestations of GO, which one most significantly affects the patients'quality of life has not been well studied. In this study, we utilized GO VISA score table and GO patients quality of life questionnaire(GO-QOL), to compare the impact of the health-related quality of life in patients with different symptoms and signs, and to compare the difference of quality of life in GO patients and GD patients without eye disease.VISA score table divides GO clinical manifestation into four parts: changes in visual acuity; ocular inflammation; eye movement restricted, diplopia; appearance change. The GO-QOL was developed as an outcome measure for evaluative studies to measure the consequences of double vision and decreased visual acuity on visual functioning and the psychosocial consequences of changed appearance.In this study ,we collected 29 patients with GO as the experimental group, whose mean age was 39.5±12.4, including 13 male and 16 female. We collected 30 GD patients without GO as the control group (GD patients), whose mean age was 40.2±10.5, including 15 male and 15 female. GO patients'GO-QOL scores for the visual function was 75.2±27.0,and the psychology scores was 62.4±25.9. The visual function and psychological scores of GD patients was 100 because their vision and eye appearance was normal. GO patients'visual function and psychology scores was significant different from GD patients(P=0,P=0). The result show that the vision and appearance related quality of life of GD patients is better than GO patients.Then we compared the quality of life of GO patient with different clinical manifestation (diplopia/exopthalmos/eyelid retraction) with GD patients and the GO overall patients. There was remarkable difference between GO diplopia, exopthalmos patient and GD patients. It showed that GO diplopia and GO exopthalmos can decrease quality of life of GO patients.While the visual function of eyelid retraction patients is at the same level with GD patients,there has no significant difference(p=0.636). It showed lid retraction patients visual function is not decreased. When comparing the quality of life in patients with diplopia or with exopthalmos or with lid retraction with GO overall patient, the quality of life in patients with diplopia was remarkable decrease, the quality of life of GO patients with exophthalmos was similar to the GO overall patient. The vision-related quality of life in GO lid retraction patients was better than GO overall patients while they were similar in psychosocial consequences.Because of the GO patients we collected did not have obvious corneal lesion and optic neuropathy, and their best corrected visual acuity of the better eyes were better than 0.8, we did not analyse the influence of decreased vision on quality of life in theses patients. While ocular inflammation in GO dose not exist alone, it can cause diplopia, exophthalmos, lid retraction, and so on, we did not analyse the influence of ocular inflammation on quality of life.At last, we compared the quality of life in GO patients with different ocular manifestations. The visual function scores of GO patients with diplopia was 48.2±24.6, patients with exophthalmos was 82.5±17.1, patients with eyelid retraction was 97.9±6.3. Psychological scores of GO patients with diplopia was 42.5±15.8, patients with exophthalmos was 67.0±32.3, patients with eyelid retraction was 77.9±16.0. Compare the impact on quality of life in GO patients with diplopia and GO patient with exophthalmos ,the result of Mann-Whitney test is ( P=0.004 for visual functioning , P=0.123 for psychological consequence). It showed that in visual function, diplopia had more severe negative impact in quality of life than exophthalmos, but in psychological aspect, they had the same impact.Comparing the impact on the quality of life of GO patient with diplopia and GO patients with lid retraction, Mann-Whitney test result was (p=0,p=0.001). It showed that there was remarkbale difference in the impact on the quality of life in GO patients with diplopia and GO patients with lid retraction. GO patients with diplopia affected quality of life more seriously.Comparing the impact on the quality of life of GO patients with exophthalomos and GO patients with lid retraction, the visual function scores and psychological scores of GO patients with exophthalomas were lower than GO patients with lid retraction, but only visual function had remarkable difference (P=0.043). It showed that vision funtion of eyelid retraction patients was better than patients with exophthalomos, but their psychological scores were at the same level. Both the GO patients with exophthalmos and patients with eyelid retraction had the best corrected visual acuity of better 0.8. Eye pain, uncomfortable and visual fatigue may be the reason of visual function decrease of GO exophthalomos patients and GO lid retraction patients.Conclusion: There is no significant negative effect in the visual function related quality of life in the GO patients without keratopathy , optic neuropathy and diplopa, but most of these patients has visual fatigue ,and this is why the quality of life is still affected. The health related quality of life is decreased in GO patient with diplopia, exophthalmos, lid retraction, and diplopia is the main affecting factor. Therefore, GO can be considered as a serious chronic diseases , and there is an urgent need to carry out more in-depth studies to find more effective treatment methods to reduce the suffering of patients. VISA scoring system is a practical method in the quality of life related research.