Additive effect of age‐related macular degeneration and glaucoma on quality of life

Impaired visual ability, whether because of glaucoma, age-related macular degeneration (AMD) or other pathology, affects a patient’s quality of life. Reduced vision impacts a patient’s ability to perform a range of tasks, from the complex task of driving to the common tasks of reading or maintaining steady gait. Understanding the impact of ophthalmologic disease on quality of life and functional status is useful in clinical practice. It guides clinicians in explaining disease prognosis to patients who may be relatively asymptomatic in the early stages of the disease. It also aids clinicians in knowing when to recommend prudent safety interventions to patients with reduced visual ability. With this in mind, many studies have investigated the relationship between disease severity and quality of life. A variety of tools – including general health questionnaires, vision-specific quality of life instruments and disease-specific quality of life instruments – have been employed to elucidate the relationship between ocular disease and quality of life. In a longitudinal study, Medeiros, Gracitelli and colleagues found a statistically significant correlation between change in the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) Rasch scores during follow-up and change in binocular standard automated perimetry sensitivity, and eyes with more severe disease at baseline were also more likely to have a decrease in NEI VFQ-25 scores during follow-up. Goldberg, Clement and colleagues used the Glaucoma Quality of Life-15 Questionnaire and found that patients with glaucoma had significantly poorer glaucoma-related quality of life than controls. Summary scores differed significantly among patients with mild, moderate and severe glaucoma demonstrating a trend of poorer quality of life with increasing disease severity. Ramulu, West and colleagues examined data from the Salisbury Eye Evaluation and found that glaucoma was associated with slower reading and increased reading impairment with advanced bilateral field loss. Haymes, Leblanc and colleagues found that compared with control subjects, patients with glaucoma were over three times more likely to have fallen in the previous year, over six times more likely to have been involved in one or more MVCs in the previous 5years and more likely to have been at fault. Gothwal, Bagga and colleagues showed a decrease in quality of life of 19% among patients with glaucoma, and 59%were willing to trade lifetime in return of perfect vision. Wolfram and colleagues used the Health Utility Index (HUI3) and the NEI-VFQ-25 and found that different stages of ocular hypertension and glaucoma have various implications for the patients’ experience of health-related and vision-related quality of life. Burton, Crabb and colleagues showed that an average reduction in reading speed caused by a difference in letter contrast is significantly more apparent in patients with glaucoma when compared with visually healthy people with a similar age and similar cognitive and reading ability. Many studies have further investigated the relationship between glaucoma and co-morbid ocular conditions, such as aphakia, cataract and ocular surface diseases, and have found that the addition of a co-morbid ocular condition reduces the quality of life among patients with glaucoma. It is therefore not difficult to imagine that comorbid AMD and glaucoma may exert a cumulative effect on quality of life, especially given that many daily tasks have been shown to be affected by both diseases. However, to the best of our knowledge, no prior studies have specifically examined the additive effect of AMD and glaucoma on quality of life. In this edition of the Journal, Skalicky and colleagues use the Rasch-analysed Glaucoma Activity Limitation-9 and the Visual Function Questionnaire Utility Index to measure the impact of AMD on vision-related activity limitation and preference based status for glaucoma patients. In this cross-sectional study, they find that vision-related activity limitation and preference-based status are negatively impacted by severe glaucoma and AMD and that patients with both conditions perceive increased difficulty walking safely compared with patients with glaucoma alone. The findings suggest that clinicians should be particularly aggressive in assisting patients with both AMD and glaucoma in terms of referring to rehabilitation and recommending home safety precautions. Competing/conflicts of interest: None.