Bilateral asymmetry improved accuracy when assessing glaucomatous vision-related quality of life impairment.

Bilateral asymmetry has been used in optical coherence tomography tests to find early damage to the optic nerve. However, limited studies have quantitatively evaluated bilateral asymmetry in electrophysiological disorders in patients with glaucoma. The aim of the study was to evaluate bilateral asymmetry in pattern visual evoked potentials (PVEPs) and conventional clinical markers as well as its potential use in detecting glaucomatous impairment. After investigating 60 glaucomatous patients (120 eyes) and 65 age and sex-matched normal control subjects (130 eyes) using uni- and multivariable analysis, we found that vision-related quality of life (VRQOL) impairment was significantly associated with larger bilateral asymmetry index (BAI) of clinical markers. Rasch-calibrated National Eye Institute Visual Function Questionnaire-25 scores were significantly associated with the BAI in PVEPs latency in 15 minutes check size (ß = -0.478, 95% confidence interval [CI], -0.708 to -0.248, P < .001) and the BAI in visual field mean deviation (ß = -0.249, 95% CI, -0.454 to -0.044, P = .018) according to multivariable analysis. Bilateral asymmetry in objective and subjective functional measurements was quantitatively associated with glaucomatous VRQOL impairment. This finding may help bridge the gap in understanding between patients and clinicians, and increase awareness of how glaucomatous neuropathic progression may interfere with patients' daily life.

Measuring Contrast Sensitivity in Specific Areas of Vision - A Meaningful Way to Assess Quality of Life and Ability to Perform Daily Activities in Glaucoma.

Purpose: To investigate: 1) the impact of reduced contrast sensitivity (CS) in specific areas of vision on subjective assessment of vision-related quality of life (VRQoL) and objective performance-based measures in patients with primary open-angle, primary angle-closure, and pseudoexfoliation glaucoma; and 2) correlations between measurements of contrast sensitivity (CS) in specific areas of vision and visual field (VF) tests. Methods: The Spaeth/Richman Contrast Sensitivity Test (SPARCS) measured CS in the inferior, superior, and central areas, while the Pelli-Robson test measured central CS. Visual fields were tested in participants using standard-automated perimetry. The National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) assessed VRQoL, and the Compressed Assessment of Ability Related to Vision (CAARV) assessed vision-related performance. Results: Three hundred and twenty-two eyes of 161 participants were included in our analysis. Significant correlations were found between CS and VF scores in the inferior, central, and superior areas (P < .0001 for all). Significant correlations were found between SPARCS scores in the inferior areas in both eyes and most CAARV scores (P < .05). Significant correlations were also found between SPARCS scores in the inferior and superior areas in the worse eye and most NEI-VFQ -25 scores (P < .05). Conclusion: Contrast sensitivity and VF scores significantly correlated in all tested areas. Reduced CS in the inferior areas of both eyes affected most performance-based measures. Measurement of CS areas using SPARCS is a meaningful way to assess VRQoL and ability to perform daily activities in participants with glaucoma.

Vision-related Quality of Life in Glaucoma Patients and its Correlations With Psychological Disturbances and Visual Function Indices.

PURPOSE: The purpose of this study was to assess the vision-related quality of life (VR-QoL) in glaucoma patients and its correlations with psychological disturbances and visual function components. MATERIALS AND METHODS: The 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) and Hospital Anxiety and Depression Scale (HADS) questionnaires were administered to 428 Chinese glaucoma patients to evaluate their VR-QoL and anxiety and depression disorders, respectively. Sociodemographical and clinical factors were collected at the same time. Univariate analyses were used to investigate the associations between the variables and the VR-QoL. Multivariate linear regression analyses were used to identify the independent psychological and visual functional predictors of the VR-QoL. Standardized partial regression analyses were used to reveal the variables that mostly relevant to the VR-QoL. RESULTS: The composite score (mean±SD) was 71.88±14.44 for NEI VFQ-25 and 13.17±6.56 for HADS. Visual function indices, including best-corrected visual acuity and mean deviation of both eyes in addition to psychological symptoms including anxiety and depression were both correlated with VR-QoL significantly, even after adjusting for sociodemographical and clinical factors. Standardized partial regression analyses further suggested that psychological disorders, especially anxiety rather than visual function components, were mostly relevant to VR-QoL. CONCLUSIONS: Deterioration of vision impairment and visual field defects in addition to increased recognition of psychological disturbances reduce the VR-QoL of glaucoma patients significantly. Alleviating psychological symptoms, especially anxiety, perhaps have a greater influence on the improvement of VR-QoL.

[Relationships among illness perceptions, medication beliefs and medication adherence in primary angle closure glaucoma patients].

Objective: To investigate the relationships among illness perception, medication beliefs and medication adherence in primary angle closure glaucoma patients. Methods: It was a cross-sectional study. Morisky 8-item Medication Adherence Questionnaire Chinese Revised, the Brief Illness Perceptions Questionnaire, the Specific Section of the Beliefs about Medicine Questionnaire Chinese Revised were administered to 156 primary angle closure glaucoma patients from Tianjin Eye Hospital. Chi-square test was used to analyze the types of glaucoma, gender, prescription complexity, medicine schedule, other disease and course of disease between the group of adherence and non-adherence. Pearson correlation method was used to analyze the correlations among the illness perception, necessity belief, concerns belief and medication adherence. Structural equation model was used to analyze the mediational role of medication belief between illness perception and medication adherence. Results: In the 156 primary angle closure glaucoma patients being investigated, 37 male and 119 female, the average age was (61.3±8.3) years old. The medication adherence of patients was 83 (53.2%) , the medication non-adherence of patients was 73 (46.8%) . It was showed that prescription complexity and medicine schedule were significantly correlated with medicine adherence (χ(2)=13.64, 11.31; P<0.05); gender, other disease and course of disease were not correlated with medication adherence (χ(2)=1.02, 1.73, 6.08; P>0.05). The scores of illness perception were positively correlated with the necessity belief of medication scores, the scores of concerns belief (r=0.18、0.45, P<0.05), and were negatively associated with medication adherence (r=-0.22, P<0.01). The concerns belief of medication scores were negatively correlated with the medication adherence (r=-0.47, P<0.01). Concerns belief mediates the relationship between illness perception and medication adherence wholly (χ(2)/df=1.73, RMSEA=0.069, NNFI=0.98, CFI=0.98, IFI=0.98) . Conclusions: The types of medicines and the number of glaucoma medication used have a significant influence to the medication adherence in the patients with primary angle closure glaucoma. The patients with greater illness perception performed greater non-adherence can be explained by their higher concerns blief. (Chin J Ophthalmol, 2017, 53: 109-114).

Assessment of Depression, Anxiety, and Quality of Life in Singaporean Patients With Glaucoma.

PURPOSE: To determine the prevalence and risk factors for anxiety disorder and depression among glaucoma patients in Singapore, and to assess the relationship between quality of life (QOL) and depression/anxiety. METHODS: In this cross-sectional study, glaucoma patients aged 21 and above with a known diagnosis of primary open-angle glaucoma or primary angle-closure glaucoma were recruited from a tertiary care hospital. Patients with other types of glaucoma, and coexisting ocular or psychiatric disorders were excluded.Ophthalmic examination was carried out on all participants, which included best-corrected visual acuity (BCVA), intraocular pressure (IOP), gonioscopy, standard automated perimetry, and optic disc evaluation. Sociodemographic information and treatment histories were also collected.The Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and Visual Function Questionnaire (VFQ25) were administered to evaluate for depression, anxiety, and impact on QOL, respectively. RESULTS: A total of 100 patients were included in this study. The mean age was 67.1±12.0 years (range, 24 to 90 y). The frequency of depression and anxiety among our patients was 30% and 64%, respectively. The mean HAM-D score was 4.37±4.17 (range, 0 to 17), whereas the mean HAM-A score was 2.38±2.80 (range, 0 to 13). The mean VFQ25 score was 78.8±16.0 (range, 42.4 to 97.0). The poorest subscale on the VFQ25 was driving, with a mean score of 42.4±42.6 (range, 0.0 to 100.0).We did not find any significant difference between the presence of depression/anxiety between patients with primary open-angle glaucoma (P=0.263) and primary angle-closure glaucoma (P=0.830). Risk factors for depression included: female sex (P=0.020), higher logMAR BCVA in the worse eye (P=0.004), higher cup-disc ratio (P=0.016), lower MD in the better and worse eye (P=0.022 and 0.001, respectively), and lower mean VFQ25 score (P<0.001). Risk factors for anxiety included: lower MD in the worse eye (P=0.004) and lower mean VFQ25 score (P=0.004). There was also no significant association between the use of topical ß-blockers/carbonic anhydrase inhibitors with depression (P=0.793) or anxiety (P=0.282). CONCLUSIONS: There is a relatively high prevalence of depression (30%) and anxiety disorders (64%) among glaucoma patients in Singapore. Female glaucoma patients are more likely to suffer from depression. Other risk factors for depression include higher cup-disc ratio, higher logMAR BCVA, lower MD, and a lower mean VFQ25 score. Risk factors for anxiety disorder include lower MD and lower mean VFQ25 score. Ophthalmologists could consider use of the VFQ25 as an assessment for impairments in QOL in a glaucoma patient. If a glaucoma patient is at high risk of depression or anxiety disorder, a multidisciplinary management approach involving ophthalmology and psychiatry may be required.

Vision-related Quality of Life Outcomes of Cataract Surgery in Advanced Glaucoma Patients.

PURPOSE: To demonstrate longitudinal postoperative vision-related quality of life and visual acuity changes after cataract surgery in advanced glaucoma patients. MATERIALS AND METHODS: In total, 93 patients who underwent cataract surgeries were collected from June 2010 through June 2013 in Shanghai First People's Hospital, Shanghai Jiao Tong University, and were followed up for at least 3 months. Patients with advanced glaucoma, here defined as near total cupping of the optic nerve with severe visual field loss within 10 degrees of fixation, were enrolled. A standard phacoemulsification technique with the insertion of an intraocular lens was used. No complications occurred intraoperatively or postoperatively. Preoperative and 3-month postoperative vision-related quality of life were assessed in face-to-face interviews. The Chinese-version of the Low Vision Quality of Life Questionnaire (CLVQOL) was used. Wilcoxon signed-rank test was used to compare the differences in the best-corrected visual acuity (BCVA), weighted average LogMAR (WMAR), and CLVQOL scores. A binary logistic regression analysis was conducted to explore the potential factors associated with the change in CLVQOL scores. RESULTS: The overall changes in the CLVQOL composite scores ranged between 4 and 42 (median=19). Statistically significant increases occurred in the composite scores of all of the subscales, the total CLVQOL, the BCVA in the surgery eye, and the WMAR (all P<0.001). Greater increases in the CLVQOL composite scores was associated with superior preoperative WMAR (odds ratio: 9.920, P<0.05), and age below 60 years (odds ratio: 9.905, P<0.05). CONCLUSIONS: Cataract surgery should be recommended for advanced glaucoma patients with stable intraocular pressure.

A prospective, longitudinal, observational cohort study examining how glaucoma affects quality of life and visually-related function over 4 years: design and methodology.

BACKGROUND: The aim of this study is to summarize the design and methodology of a prospective, longitudinal, observational cohort study to investigate how glaucoma affects patients' quality of life and visually-related function over a 4-year period. METHODS/DESIGN: One hundred sixty-one (161) subjects were enrolled in this ongoing study. Patients between the ages of 21-85 years with a minimum 2-year diagnosis of primary open-angle glaucoma, chronic primary angle-closure glaucoma or pseudoexfoliation glaucoma were included. Each patient visited Wills Eye Hospital for a baseline visit. Follow-up is planned for a minimum of 4 years, with annual visits. Each visit includes (1) Clinical evaluation: a slit lamp examination, fundoscopy, intraocular pressure measurement, visual field examination, spectral domain optical coherence tomography, Pelli-Robson Contrast Sensitivity test and the Spaeth-Richman Contrast Sensitivity test; (2) a performance based measure: the Compressed Assessment of Ability Related to Vision; and (3) Subjective measures of vision-related quality of life (the National Eye Institute Visual Functioning Questionnaire 25 and the Modified Glaucoma Symptom Scale). DISCUSSION: The results of this ongoing, prospective, longitudinal study are expected to shed light on the relationships between clinical measures, performance-based measures and subjective measures of well-being, in order to assess changes in the quality of life and the ability to function of patients with glaucoma over time.

Utility Analysis of Vision-related Quality of Life in Patients With Glaucoma and Different Perceptions from Ophthalmologists.

PURPOSE: To evaluate patient-perceived quality of life with glaucoma and to assess whether ophthalmologists fully appreciate patients' perceptions through utility analysis. PATIENTS AND METHODS: Utility values were obtained from 87 glaucoma patients by linear rating scale (RS), standard gamble for blindness (SG), and time trade-off (TTO) methods. Identical questionnaires were delivered to ophthalmologists (n=26) at the same center, who were asked to assume they had mild (MD in better-seeing eye ≥-6 dB) or moderate to severe (MD in better-seeing eye <-6 dB) glaucoma. Responses from patients and ophthalmologists were compared. RESULTS: Patients with mild glaucoma gave a utility value of 0.70±0.14, 0.85±0.14, and 0.77±0.14 with RS, SG, and TTO method, respectively. Those with moderate to severe glaucoma generated corresponding utilities of 0.56±0.20, 0.75±0.20, and 0.78±0.11. RS and SG utilities were affected by disease severity and history of glaucoma surgery, whereas TTO utility was mainly related with education level and employment status of the patients. Ophthalmologists reported higher utility values than their patients when mild glaucoma was assumed (0.81±0.14, 0.96±0.05, and 0.95±0.05 for RS, SG, and TTO methods, respectively; P<0.05). Given the scenario of moderate to severe glaucoma, ophthalmologists gave significantly lower RS (0.35±0.21, P<0.001), but similar SG (0.74±0.27, P=0.84) and TTO (0.82±0.13, P=0.40) utility values, than the patients. CONCLUSIONS: Utility values are considerably decreased in Chinese patients with glaucoma. Ophthalmologists tend to substantially underestimate the impact of mild glaucoma on patients' quality of life. Better understanding patients' perceptions of glaucoma would be helpful for the establishment of shared decision making and patient-centered care.

Survey on vision-related quality of life and self-management among patients with glaucoma.

PURPOSE: The aim of the study was to investigate the vision-related quality of life in glaucoma patients and identify the possible predictors for outcomes. METHODS: A total sample of 167 subjects with glaucoma was recruited using a convenience sampling strategy. The National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and the Glaucoma Self-Management Questionnaire were used for assessing vision-related quality of life and self-management behavior, respectively. The demographic and disease-related data were also collected. RESULTS: Regarding the vision-related quality of life, the lowest scores were for general health (32.78±23.59), followed by general vision (46.35±19.52). The highest score was for the dimension of color vision (89.02±20.76). Multiple linear regression analysis demonstrated that self-management behavior, positive glaucoma family history, and binocular visual acuity were predictors of vision-related quality of life in this patient group. CONCLUSIONS: The current study indicates that vision-related quality of life in glaucoma patients is at a moderate level in China. Self-management behavior is an important predictor. Demographic data may not increase the explanatory effect. Future research should focus on how to integrate self-management skills into routine nursing practice for patients with glaucoma.

Impact of bilateral open and closed-angle glaucoma on glaucoma-specific functioning in Asians.

PURPOSE: To evaluate the impact of bilateral primary glaucoma on glaucoma-specific functioning in Asians. METHODS: Patients with bilateral primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) aged 40 years or above of Chinese ethnicity in Singapore were recruited. All underwent a comprehensive clinical assessment of glaucoma. Glaucoma was diagnosed with a standard criteria including optic disc abnormality and visual field defect. The Glaucoma Quality of Life-15, a glaucoma-specific questionnaire, was used to evaluate the impact of glaucoma, and Rasch analysis was used to validate the Glaucoma Quality of Life-15. RESULTS: A total of 192 patients (mean±SD age, 65.73±17.6 y and 65.1% male) were recruited, of which 56.2% (n=108) and 43.8% (n=84) had POAG and PACG, respectively. Fifty-four (28.1%), 85 (44.3%), and 53 (27.6%) had bilateral mild glaucoma, mild glaucoma in 1 eye and moderate/severe glaucoma in the other, and bilateral moderate/severe glaucoma, respectively. In multivariate analyses, compared with patients with mild glaucoma in both eyes, those with (a) mild glaucoma in 1 eye and moderate/severe in other; and (b) moderate/severe glaucoma in both eyes, reported significantly poorer functioning (ß-coefficient=-8.20; confidence interval, -14.36 to -2.04; P<0.05) and (ß=-21.05; confidence interval, -28.06 to -14.04; P<0.05), respectively. A similar independent association was found for POAG and PACG. These associations were also considered to be clinically significant while comparing bilateral mild glaucoma with bilateral moderate/severe glaucoma. We however, found no significant difference for functioning and severity of glaucoma between PACG and POAG patients (P<0.05). CONCLUSIONS: Bilateral glaucoma is worse than the mild form in any eye and is significantly associated with poor glaucoma-specific functioning in this Singaporean Chinese sample. These data emphasize the need for strategies to identify patients early and prevent deterioration beyond the mild form of the condition.

Acceptance, attitudes, and beliefs of Singaporean Chinese toward an ocular implant for glaucoma drug delivery.

PURPOSE: We investigated patients' attitudes and perceptions toward a subconjunctival implant as a novel ocular drug delivery method for glaucoma. METHODS: We recruited 344 Chinese patients with primary open angle or angle closure glaucoma currently on topical antiglaucoma medication for a minimum of six months from specialist glaucoma clinics. Sociodemographic data, and information about patients' general and ocular health were collected. Beliefs about medicines, glaucoma, eye drops, and self-reported adherence were assessed by trained interviewers using validated questionnaires. A description about the implant was provided and patients subsequently were assessed on their understanding and acceptance. RESULTS: Of the 344 Chinese patients enrolled, 216 (62.8%) would accept the implant as a replacement for their current eye drops. Of those who accepted the implant, 99 (45.8%) were willing to accept it at similar costs, while 40 (18.5%) and 20 (9.3%) patients were willing to pay 1.5 and 2 times the cost of their present medication, respectively. Patients who accepted the implant had more severe glaucoma (P = 0.015) and felt that the implant was more helpful than eye drops (P < 0.001). Beliefs toward medicines, glaucoma, eye drops, self-reported adherence, and sociodemographic factors did not have a significant impact on the patients' decisions. CONCLUSIONS: An ocular drug implant would be an acceptable alternative to topical eye drops for subgroups of glaucoma patients.

Losing sight under pressure.

A non-communicative patient with vascular dementia who was admitted to hospital with non-specific symptoms. Ophthalmic emergencies are rare, however they should be considered as part of a systemic work-up in unexplained non-specific presentations, particularly in patients who are not able to communicate as in the case we present here.

Utility assessment among patients of primary angle closure/glaucoma in China: a preliminary study.

AIM: To evaluate utility values among patients of primary angle closure/glaucoma (PAC/G) in a local hospital in China, and the factors influencing the quality of their lives. METHODS: A cross-sectional study. Utility values were measured using the time trade-off (TTO) and standard gamble (gamble for blindness) methods. Standard face-to-face interviews were conducted. Results of ophthalmic examinations were recorded. RESULTS: One hundred and six patients were recruited, 16 (15.1%) male and 90 (84.9%) female, mean age 63.21 years (SD 7.46). Fifty-five (50.9%) patients had a history of acute angle closure (AAC). The mean duration from glaucoma diagnosed to the day of interview was 7.69 (3.30) months. All participants underwent laser therapy, and 12 patients (11.3%) also received trabeculectomies. The mean utility value was 0.75 (0.14) (95% CI 0.73 to 0.78) with the TTO technique and 0.80 (0.08) (95% CI 0.78 to 0.81) with the standard gamble (SG) technique. The correlation between the two values was significant (p<0.001). Age, educational status, better best-corrected visual acuity (BCVA), worse BCVA and better visual field had significant effects on the utility values. Patients' self-evaluation of the impact of PAC/G upon their lives correlated with the TTO utility values (p = 0.008) and not with the SG utility values (p = 0.652). CONCLUSION: The mean TTO utility score of the studied population is 0.75. The utility value is directly dependent on age, the degree of visual function loss and educational status. It is likely that patients find the TTO method easier to comprehend than the SG method.

Characteristics of patients who dropout from a glaucoma clinic.

PURPOSE: To find the dropout rate and identify the clinical characteristics of patients who drop out in the first year of follow-up from a glaucoma clinic. DESIGN: Descriptive hospital-based study at a tertiary hospital eye department. METHODS: Clinical characteristics of consecutive patients newly diagnosed with glaucoma who dropped out (n=452) were compared with patients who did not drop out (n=295) within 12 months. RESULTS: The rate of dropout from follow-up was 60.5% within 1 year; 43.1% of the study group dropped out after their first follow-up visit. The dropout rate was high in all age groups, but higher in the age groups 21 to 30 years, 41 to 50 years, and over 70 years. Males had a higher dropout rate than females (78.6% vs. 34.5%). Dropout rate was higher among those with mild/moderate glaucoma than those with severe disease (88.2% vs. 37.2%); those who lived further away from the hospital than those who lived nearer to the hospital (72.5% vs. 40.8%), those who were referred from screening clinics for nonblinding eye disease compared with those referred because of a blinding eye disease (72.2% vs. 58.9%). More patients (63.8%) unsure of their family eye disease history dropped out, compared with 34.3% of those with positive family history of glaucoma and other potentially blinding diseases. More patients who had no systemic disease dropped out, than those with systemic disease (54.6% vs. 39.6%); whereas patients on 2 medications or more had a higher dropout rate than those on less than 2 medications (68.1% vs. 52.1%). Of the study factors, those that were statistically significantly associated with dropping out of follow-up from the glaucoma clinic were age, sex, place of domicile, diagnosis at referral, severity of disease, family history, and polydrug use. CONCLUSIONS: The dropout rate from this glaucoma clinic in the first year was high (60.5%). Patients who were more likely to dropout were younger patients, male, those who travelled far distances to the clinic, those with mild to moderate glaucoma, those with no family history of blinding eye diseases, and patients taking 2 or more eyedrops. Patients who seem to perceive their problems as not serious dropped out of follow-up. These findings have great implications in planning future studies and intervention to improve the follow-up of glaucoma patients in the study area.

Utility values in Singapore Chinese adults with primary open-angle and primary angle-closure glaucoma.

PURPOSE: To evaluate utility values in Chinese glaucoma patients. PATIENT AND METHODS: Singapore Chinese residents (n = 213) with primary open-angle glaucoma or primary angle-closure glaucoma were recruited from a single tertiary ophthalmic center. Standard face-to-face interviews were conducted to ask about utility values (time trade-off and standard gamble for both death and blindness). Ocular information, including current visual acuity, intraocular pressure, visual field defect, and cup-disc ratio were also obtained. RESULTS: The mean time trade-off utility value was 0.88 (95% confidence interval 0.85, 0.91), and standard gamble for death and blindness were 0.94 (95% confidence interval 0.93, 0.96) and 0.95 (95% confidence interval 0.93, 0.97), respectively. Only 35.7% of patients were willing to trade time, and 34.3% willing to risk blindness in return for perfect vision. Both primary angle-closure glaucoma and primary open-angle glaucoma patients had similar utility values. After adjusting for age, gender, language spoken, educational level, and diagnosis, patients with better eye visual field PSD > 10 were 2.52 times (95% confidence interval 1.13, 5.61) more willing to trade time. In a multivariate model, the odds ratio of willingness to risk blindness for a complete hypothetical glaucoma cure was 9.88 (95% confidence interval 1.65, 59.23) for patients who had only visited an ophthalmologist 15 years or more ago, and 0.53 (95% confidence interval 0.27, 1.02) for patients who had previous trabeculectomy. CONCLUSION: Most Chinese glaucoma patients in Singapore are not willing to trade time or risk blindness. Patients with worse visual fields in the better-seeing eye are more willing to trade time; whereas patients who have not seen an ophthalmologist for at least 15 years or who had no history of a previous trabeculectomy are more willing to risk blindness.

Awareness of glaucoma, and health beliefs of patients suffering primary acute angle closure.

AIM: To evaluate the factors associated with lack of awareness of glaucoma and late presentation to the doctor in Singapore Chinese patients with acute angle closure (AAC) METHODS: A prospective, hospital based case series of 105 patients aged 35 years and above who presented with a first attack of AAC in a tertiary hospital in Singapore was conducted. A research assistant interviewed all patients face to face in clinic and recorded demographic factors, awareness of glaucoma, and subjective barriers to seeing a doctor. The time from onset of symptoms to presentation at the clinic was noted. RESULTS: Overall, 22.9% of patients had heard of glaucoma. The multivariate adjusted odds ratio (OR) of unawareness of glaucoma in older people (> 60 years) was 1.5 (95% confidence interval (CI) 0.5 to 4.6), 3.2 (95% CI 1.1 to 9.2) for adults who were not working, and 13.8 (95% CI 1.3 to 146.7) for patients who had less than a pre-university education. A significant proportion (31.7%) of patients presented to the doctor 24 hours or more after symptoms occurred. In a multiple logistic regression model, the adjusted OR of late presentation was 8.5 (95% CI 1.04 to 69.5) if there was no car access, 5.0 (95% CI 1.0 to 24.6) if the patients spoke Chinese, and 3.3 (95% CI 0.9 to 11.9) if there was nobody to accompany to hospital. CONCLUSION: Glaucoma awareness among patients suffering AAC was not high. Lack of awareness was associated with increasing age, lack of formal education, and unemployment. A significant proportion of patients seek medical attention late. Risk factors for late presentation include lack of car access, nobody to accompany the patient, and speaking the Chinese language primarily. Health education programmes may help increase the knowledge and awareness of glaucoma.

Comparison of Yatabe-Guilford personality test results in retinitis pigmentosa and glaucoma patients.

PURPOSE: To determine the psychological state and personality traits of patients with retinitis pigmentosa (RP) or glaucoma so that a closer and better relationship can be developed with the patients. METHODS: The Yatabe-Guilford personality test was administered to 75 RP patients and 42 glaucoma patients. The latter group included 29 cases of primary open-angle glaucoma, 6 of primary angle-closure glaucoma, and 7 of normal-tension glaucoma. The patients were being treated at the Department of Ophthalmology, Chiba University Hospital. As controls, 47 age-matched volunteers were tested. RESULTS: A comparison of these three groups showed that the proportions of patients with cyclic tendency, rhathymia, and lack of cooperativeness traits were significantly higher in the RP group than in the glaucoma group. The lack of cooperativeness value was especially higher in the RP than in the glaucoma group and the control group (Fisher exact test, P <.05). On the other hand, the nervousness value was significantly higher in the glaucoma group than in the RP group and than in controls (Fisher exact test, P <.05). Factors of sex, age, type of disease, corrected visual acuity, and central visual fields did not influence the profiles of the RP and glaucoma groups. CONCLUSION: RP patients had relatively well-stabilized personalities and were optimistic, while glaucoma patients tended toward nervousness in comparison with RP patients and controls.

[Predisposing factors in angle closure]. / Factori declansatori în închiderea unghiului.

The authors present the study of 443 cases of closed-angle glaucoma patients, hospitalized between 1989-1995, which represent 2.45% of the patients hospitalized in this period. The particular anatomic configuration of the anterior pole of the ocular globe (small anterior chamber and big lens), especially in women's case, explains the great number of female patients. According to the age, the greatest incidence was noticed at the age group 61-70 years (170 cases). Only 12 cases were registered for the age group under 40 years. The greater incidence was also remarked during months with low sun lighting 57 in November, 48 in December, 59 in January), due to the mydriasis. The study of 130 cases of closed-angle glaucoma through intumescent lens shows that the increase of antero-posterior lens diameter is just a starting factor for a potential primary closed-angle glaucoma.