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Philip Y Sun, Jonathan M Holmes, David A Leske, Cheryl L Khanna; Assessment of Health-Related Quality of Life in Diplopic and Non-Diplopic Glaucoma Surgery Patients Using the AS-20 and VFQ-25. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3709.
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Diplopia and strabismus occur in patients who undergo glaucoma surgery, and may have profound effects on health-related quality of life (HRQOL). We evaluated HRQOL in diplopic vs non-diplopic patients who had undergone glaucoma surgery using the strabismus-specific AS-20 and the VFQ-25.
We prospectively studied 23 patients following glaucoma drainage device (GDD) surgery (15 Baerveldt and/or 9 Ahmed FP7) and 26 following trabeculectomy. At least 1 month after surgery, patients completed 3 questionnaires - the NEI 25-Item Visual Function Questionnaire (VFQ-25), the Adult Strabismus-20 questionnaire (AS-20), and the Diplopia Questionnaire (DQ). We defined diplopia as “Sometimes,” “Often,” or “Always” in distance straight ahead and/or reading positions on the DQ. We compared AS-20 and VFQ-25 subscale scores (each scaled 0 to 100, worst to best HRQOL) between diplopic and non-diplopic patients.
Diplopia was reported in 8 of 49 patients (16%). Compared with non-diplopic glaucoma patients, diplopic glaucoma patients had lower AS-20 subscale scores (worse HRQOL) for self-perception (74.5±26.9 vs 87.1±20.1), interactions (77.9±28.3 vs 91.1±16.8), reading function (52.9±35.9 vs 70.3±24.5), and general function (55.8±35.8 vs 78.2±19.1). Some VFQ subscale scores were also lower for diplopic patients: general vision (65.0±31.6 vs 67.8±15.4), ocular pain (76.6±30.9 vs 82.3±18.7), near activities (55.2±30.2 vs 69.3±19.0), distance activities (68.2±31.8 vs 76.4±17.1), vision-specific (VS) social functioning (78.1±33.2 vs 89.3±17.1), VS mental health (58.6±42.2 vs 71.5±25.2), VS role difficulties (57.8±43.8 vs 74.1±25.1), VS dependency (64.6±44.7 vs 85.6±21.3), and peripheral vision (59.4±35.2 vs 71.3±22.1). Other VFQ subscales were not lower: general health (65.6±39.9 vs 64.0±23.1), driving (78.3±26.1 vs 67.4±25.8), and color vision (89.3±19.7 vs 88.8±17.9). Differences for 2 of 4 AS-20 subscales, but no VFQ-25 subscale, reached statistical significance (P<0.05) using one-sided tests.
Diplopia following GDD or trabeculectomy surgery negatively affects HRQOL. The strabismus-specific AS-20 is more sensitive than the VFQ-25 in detecting such issues.
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