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Leanne McDonald, Fiona Glen, David Crabb; Self-monitoring visual symptoms in glaucoma: a feasibility study of a web-based diary tool. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2590.
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Patients spend only a few hours a year in the eye clinic having their glaucoma monitored, but they spend 5000+ waking hours each year engaged in everything else. We propose patients could be encouraged to self-monitor changes in their visual symptoms with the aim of making them more engaged in their ‘glaucoma journey’ and providing valuable between-clinic information; we test the hypothesis that this is feasible using a web-based diary tool.
Ten glaucoma patients (median age: 70 [interquartile range [IQR]: 66-76] years) with a range of visual field loss (best eye Humphrey mean deviation (MD): -9 [-13, -4] dB) took part in a prospective mixed-methods study lasting 8 weeks. Participants completed an eye examination and validated questionnaires assessing visual function, personality and coping traits. Participants were asked to complete symptom monitoring questions every 3 days and were invited to complete a diary about their vision during daily life. Responses to the latter were qualitatively analysed using a thematic approach. Response to an end of study questionnaire about usefulness and acceptability of the web-based diary tool was used as a main outcome measure.
Eight of the 10 patients rated the monitoring scheme to be ‘valuable’ or ‘very valuable’ with the majority expressing a preference of using a web-based tool. Completion rate to items was excellent (96%) and median (IQR) number of diary words recorded per patient was 1858 (703, 4094). Average scores from the items did change temporally in some patients over the study period. There was no evidence of an association between responses to personality (r=-0.37, p=0.29) and coping (r=-0.10, p=0.79) questionnaires, or disease severity (MD) (r=-0.34, p=0.33) when compared to diary completion. Most themes emerging from the qualitative synthesis were related to behavioural aspects that might be overlooked in typical patient-clinician consultations. One patient concluded that a focus on monitoring symptoms led to negative feelings.
Volunteer patients, with a range of disease severity and personality types, adhered remarkably well to using a web-based diary tool to monitor their glaucoma symptoms. A web-based diary intervention for the self-monitoring of glaucoma may therefore be feasible. The monitoring tool must be carefully designed in order to ensure participants are benefitting, and it is not increasing anxiety.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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