Quality of Life of Medically versus Surgically Treated Glaucoma Patients

Ricardo Augusto Paletta Guedes, MD, MPH; Vanessa Maria Paletta Guedes, MD; Sirley Maria Freitas, RN; Alfredo Chaoubah, PhD


J Glaucoma. 2013;22(5):369-373. 

In This Article

Abstract and Introduction


Purpose: To assess and compare the impact of medical and surgical glaucoma treatments on patients' health-related Quality of Life (QoL).

Materials and Methods: We used the 25-question version of the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) for this cross-sectional study. Patients were divided into 3 groups: 1 (medical treatment); 2 (surgical treatment), and 3 (medical and surgical treatment). Comparisons among groups were carried out for demographic and clinical characteristics and for the NEI VFQ-25 scores.

Results: Of the 240 invited patients, 225 were enrolled for this study. Groups were homogenous for age, sex, race, type of glaucoma, and level of education. The mean overall score was 78.46, 65.85, and 60.51 for groups 1, 2, and 3, respectively (P<0.001). Type of therapy, visual acuity, and comorbidity were associated with QoL scores. When controlled by glaucoma stages, surgery had a negative impact on the QoL only in early glaucoma.

Conclusions: Glaucoma surgery is associated with a lower QoL in patients with early glaucoma due mainly to the psychological burden. In moderate and advanced glaucomas, the QoL scores did not differ between the surgical and the medical therapy groups.


Glaucoma is the leading cause of irreversible blindness in the world.[1] The main goal of glaucoma treatment is to maintain the patient's quality of life (QoL), which includes preservation of visual function, at a reasonable cost.[2]

Glaucoma patients can have a low QoL for several reasons: worry and anxiety due to the diagnosis of a chronic illness, functional loss, inconvenience of the treatment, side effects, and the cost of therapy.[2]

Glaucoma therapy, whether medical or surgical, can directly influence a patient's QoL. Few studies have compared the QoL of medically versus surgically treated patients.[3] A Cochrane review identified only 1 randomized-controlled trial that directly compared medications versus surgery.[3] The Collaborative Initial Glaucoma Treatment Study (CIGTS) randomized patients to either medications or trabeculectomy as the initial glaucoma therapy. One of the outcome measures of this study was the health-related QoL of patients, which was obtained using various instruments. This QoL assessment was possible because patients received the same treatment for both eyes. The results showed that no significant differences were present between the 2 groups, except for more localized eye symptoms after trabeculectomy.[3,4]

Health-related QoL is an important outcome in glaucoma, and it can be measured using either generic or vision-specific instruments.[5] Generic instruments include the Medical Outcomes Study Short Form-36, the Sickness Impact Profile, the EuroQoL Health Questionnaire, and utility values, among others.[5–7] The most-used vision-specific instrument is the 25-question version of the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25).[8] Several studies have used this to investigate the correlation of the glaucoma visual function loss and its scores.[5,9,10] However, to our knowledge, there is no evidence of the impact of different glaucoma therapies on the NEI VFQ-25 score.

Our purpose is to assess the impact of medical and surgical treatments on the QoL of glaucoma patients using the Brazilian-validated version of the NEI VFQ-25.