Quality of life in newly diagnosed glaucoma patients - The Collaborative Initial Glaucoma Treatment Study

Objective: The Collaborative Initial Glaucoma Treatment Study (CIGTS) was d esigned to determine whether patients with newly diagnosed open-angle glauc oma are better treated initially by medicine or immediate filtering surgery . This paper describes the quality-of-life (QOL) measurement approach, inst ruments included, and the CIGTS participants' QOL findings at the time of d iagnosis. Design: Baseline results from a randomized, controlled clinical trial. Participants: Six hundred seven patients from 14 clinical centers were enro lled. Intervention: Patients randomized to initial medication received a stepped medical regimen (n = 307), Those randomized to initial surgery underwent a trabeculectomy (n = 300). The baseline interview was conducted before treat ment initiation. All baseline and posttreatment QOL assessments were conduc ted by telephone from a centralized interviewing center. Main Outcome Measures: The primary outcome measure described in this paper was QOL, The QOL instrument is multidimensional and incorporates both disea se-specific and generic measures, including the Visual Activities Questionn aire. Sickness Impact Profile, and a Symptom and Health Problem Checklist. Results: The correlations between QOL measures and clinical outcomes were i n the expected direction, but relatively weak. At initial diagnosis, diffic ulty with bright lights and with light and dark adaptation were the most fr equently reported symptoms related to visual function, whereas visual disto rtion was the most bothersome. Approximately half of the patients reported at least some worry or concern about the possibility of blindness. Within t he Visual Activities Questionnaire, higher scores on the Peripheral Vision subscale were associated with more field loss (P < 0.01). In regression ana lyses controlling for sociodemographics and nonocular comorbidities, increa sed visual field loss was significantly associated with higher dysfunction among five disease-specific QOL measures (P < 0.05). Conclusions: Newly diagnosed glaucoma patients reported experiencing some v isual function symptoms at the time of diagnosis that would not be intuitiv ely expected based on clinical testing. Some discussion about the associati on between clinical presentation and worry about blindness may reduce unnec essary concern. These results provide the basis for long-term comparisons o f the QOL effects of initial medical and surgical treatment for open-angle glaucoma. Ophthalmology 2001;108:887-898 (C) 2001 by the American Academy o f Ophthalmology.