Impact of initial topical medical therapy on short-term quality of life in newly diagnosed patients with primary glaucoma.

PURPOSE: To evaluate the impact of initial topical medical therapy on newly diagnosed glaucoma patients using the Indian Vision Function Questionnaire (IND-VFQ33). PATIENTS AND METHODS: The IND-VFQ33 was used to evaluate the quality of life (QoL) in 62 newly diagnosed patients with moderate to severe primary glaucoma and 60 healthy controls. IND-VFQ33 is a 33 item QoL assessment tool with three domains: General functioning, psychosocial impact and visual symptoms. The glaucoma patients were started on medical therapy and the QoL assessment was repeated after 3 months. RESULTS: Glaucoma patients (mean age: 55.6 ± 9.6 years, range 40-77 years) and controls (mean age: 54.9 ± 6.7 years, 42-73 years) were matched with respect to age (P = 0.72), gender (P = 0.91) and literacy (P = 0.18). Glaucoma patients had significantly worse QoL as compared to controls at baseline across all the three domains (P < 0.001). 3 months after initiation of treatment, the overall QoL life significantly worsened from baseline with a decrease in general functioning (P < 0.001) and psychosocial impact (P = 0.041). Visual acuity in better eye significantly co-related to poor QoL at baseline (P < 0.001) and at 3 months (P = 0.04). In addition, the use of >2 topical medications significantly co-related to poor QoL at 3 months (P = 0.01). CONCLUSIONS: Evaluation using the IND-VFQ33 revealed that newly diagnosed glaucoma patients have a significant worsening of QoL after initiation of topical ocular hypotensive therapy. This should be an important consideration when educating patients about the disease and its therapy.

Anterior segment optical coherence tomography characteristics in an Asian population.

PURPOSE: To quantify the angle characteristics in an Indian population, and determine the prevalence of eyes at risk of angle closure. MATERIALS AND METHODS: This population-based cohort study was carried out to evaluate individuals, 40 to 59 years of age, clinically. The individuals underwent anterior segment optical coherence tomography of their right eyes in the horizontal meridian, using the enhanced protocol. RESULTS: The mean scleral spur angle for the population was 24.2±10.2 degrees, and a manually measured angle recess was 23.2±10.2 degrees, with a κ value of agreement of 0.78, 85.7%. An angle of <20 degrees was seen in 154 eyes, 38.7%, 20 to 30 degrees in 154 eyes, 38.7%, and >30 degrees in 90 eyes, 22.6%. An anterior chamber angle of <20 degrees was significantly associated with age, sex, and a steep iris configuration.The scleral spur angle and the manually recorded anterior chamber angle recess correlated very well with all angle ultrasound biomicroscopy parameters, but showed the highest receiver operating characteristic curve with trabecular iris space area 500, r=0.989 and angle opening distance 750, r=0.943. On multivariate analysis, there was a significant correlation with trabecular iris space area, angle opening distance, and height. CONCLUSIONS: Of individuals, 38.7%, 40 to 60 years of age, were found to have an anterior chamber angle of <20 degrees, reflecting the high prevalence of primary angle closure and primary angle closure glaucoma in India.