Quality Of Life And Psychological Disturbances In Chinese Patients With Glaucoma

In recent years, quality of life (QoL) has been increasingly recognized as an important measure in the management of glaucoma.The QoL-assessing questionnaires are generally used to quantify the patients’ QoL. The Glaucoma Quality of Life-15(GQL-15) questionnairehas been widely accepted for its simplicity, brevity, close and significant relationship with visual field loss.Further studies indicated that QoL of glaucoma patients was multifactorial and controversy remains regarding which factor plays the most important role in influencing the QoL of glaucoma patients.Glaucoma can often cause a psychological burden to patients. Anxiety and depression are two common forms of psychological disturbances that usually coexist with physical disorders.The anxiety and depression in glaucoma patients are affected by many factors. Recent studied indicated that QoL, this self-reported measure is most likely more reflective of patient psychological status.In this cross-sectional study, we intend to translate the GQL-15to form the Chinese version Glaucoma Quality of Life-15(CHI-GQL-15) questionnaire and evaluate its psychometric properties. Then we assess the QoL of Chinese glaucoma patients, and explore its sociodemographic, clinical and psychological correlates and try to determine which of them explain the largest variation.Lastly, we assess the prevalence of anxiety and depression in Chinese patients with glaucoma and identify a potential correlation with sociodemographic, clinical, and self-reported measures.The finding of our study indicated that QoL in Chineseglaucoma patients is at a moderate level when compared to the results from other regions. QoL of glaucoma patients is multifactorial, and was primarily determined by clinical indices.Prevalence of anxiety and depression among Chinese glaucoma patients is relatively high. Self-reported measures were informative in evaluating patients’ psychological disturbances, whereas objective measures of visual function were not.Part Ⅰ The Chinese Version of the Glaucoma Quality of Life-15: Translation, Reliability and Validity Purpose:To develop a Chinese version of Glaucoma Quality of Life-15item Questionnaire (CHI-GQL-15), and examine its psychometric properties.Methods:The Glaucoma Quality of Life-15item Questionnaire (GQL-15) was translated and culturally adapted into Chinese, and administered to glaucoma patients recruited from Shanghai Eye and ENT Hospital. Visual functions (habitual-corrected visual acuity (HCVA), intraocular pressure (IOP), and mean defect (MD) of visual field) were assessed through clinical examination by professionals. Sociodemographic and other clinical data were collected via interviews and chart review. According to Nelson’s glaucoma staging system, patients were stratified as mild, moderate, and severe visual field loss (VFL). The psychometric properties, including internal consistency, test-retest reliability, item-scale correlations and factor analysis were tested. The construct validity was assessed through bilateral comparisons of the CHI-GQL-15composite and subscale scores between patients of different VFL after controlling for potential confounders.Results:A total of508glaucoma patients were recruited (male:265, female:243). The mean age was55.41years. The Cronbach’s a coefficients ranged from0.747to0.913for the subscales. The test-retest reliability, as estimated by the intraclass correlation coefficients, were above0.70for all subscales. Statistically significant differences were showed in the CHI-GQL-15summary and subscale scores after controlling for sociodemographic and clinical confounders (P<0.05) among patients with different VFL.Conclusion:The CHI-GQL-15shows psychometric properties comparable to those of the original English version, and thus could be used as a reliable and valid tool for assessment of vision-related quality of life in Chinese glaucoma patients.Part Ⅱ Quality of Life of Glaucoma Patients in China: Sociodemographic, Clinical, and Psychological Correlates:a Cross-sectional StudyPurpose:To assess quality of life (QoL) in Chinese glaucoma patients and explore its sociodemographic, clinical and psychological correlates, and determine which of them explain the largest variation. Methods:This cross-sectional study included508Chinese glaucoma patients. Chinese-version Glaucoma Quality of Life-15questionnaire (CHI-GQL-15) and Hospital Anxiety and Depression Scales (HADS) were administered to all participants to evaluate their QoL and psychological distresses. Visual functions (habitual-corrected visual acuity (HCVA), intraocular pressure (IOP), and mean defect (MD) of visual field) were assessed through clinical examinations by professionals. Sociodemographic information and other treatment histories werecollected via interviews and chart review. Hierarchical multiple linear regression analyses were performed to identify sociodemographic, clinical, and psychological predictors of QoL.ResuIts:The mean composite score for CHI-GQL-15was28.79±12.74. Patients exhibited the greatest difficulty in activities involving glare and dark adaptation (28.19±22.86), followed by central and near vision (26.18±26.56), and the lowest scores werefor outdoor mobility (15.06±24.57), followed by peripheral vision (18.03±21.37). Moderate and heavy economic burden, logMARHCVA and MD of both the better and worse eye, number of glaucoma surgeries in the treatment history and the presence of depression were independent predictors for QoL of glaucoma patients. Clinical factors explained the largest variation.Conclusion:QoL in Chineseglaucoma patients is at a moderate level when compared to the results from other regions. QoL of glaucoma patients is multifactorial, and was primarily determined by clinical indices. QoL assessment could be informative when adopted as a complement to objective visual measures in clinical practice.Part III Anxiety and Depression in Chinese Patients with Glaucoma:Sociodemographic, Clinical, and Self-reported CorrelatesPurpose:To assess the prevalence of anxiety and depression in Chinese glaucoma patients, and explore their predictive factors.Methods:This cross-sectional study included506Chinese glaucoma patients. Hospital Anxiety and Depression Scales (HADS) and the Chinese-versionGlaucoma Quality of Life-15questionnaire (CHI-GQL-15) were administered to all participants to evaluate their psychological distresses and quality of life (QoL). Visual functions (habitual-corrected visual acuity (HCVA), intraocular pressure (IOP), and mean defect (MD) of visual field) were assessed through clinical examinations by professionals. Sociodemographic information and other treatment histories werecollected via interviews and chart review. Multiple linear regression analyses were performed to identify predictors of anxiety and depression.To evaluate the impact of anxiety or depression on patients QoL, the CHI-GQL-15summary and subscores of patients with and without psychological disturbances were compared using covariate-adjusted regression analyses.Results:The prevalence of anxiety and depression in Chinese glaucoma patients was22.92%and16.40%, respectively. A younger age (β=-0.058, p<0.001), female gender (β=1.219, p=0.001), moderate and heavy economic burden (β=1.186, p=0.009; β=2.705, p<0.001, respectively) and the CHI-GQL-15summary score (β=0.101, p<0.001) were independent predictors of anxiety. Significant independent predictors of depression included the duration of glaucoma ((β=0.065, p=0.019) and the CHI-GQL-15summary score (β=0.147, p<0.001). Difference in the CHI-GQL-15summary and its subscores of patients with and without psychological disturbance were statistically significant (p<0.001).Conclusions:Prevalence of anxiety and depression among Chinese glaucoma patients is relatively high. Self-reported measures were informative in evaluating patients’ psychological disturbances, whereas objective measures of visual function were not.