Improving quality of life in glaucoma patients

Atlanta-David Friedman, MD, says glaucoma has a major impact on a patient’s quality of life, but shared his tips for treating these concerns.

“The question that I ask myself every day when I’m taking care of patients is, ‘What am I doing here? Am I preventing patients from functional loss? Am I treating the eye pressue? Am I helping patients cope with changes in their lives’ And I think it’s a little bit of all of the above. But really, the ultimate goal of almost all eye care is to maintain quality of life,” says Dr. Friedman.

Assessing quality of life

One of the key problems with quality of life measures is that by the time glaucoma patients come in, they usually have very severe vision loss, he says, and adaptations occur with chronicity.

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“Most patients who develop glaucoma develop it very slowly-over decades-and if you lose vision at that rate, you’re very unlikely to notice it. You don’t remember what your vision was like 10 minutes ago, no less 10 years ago,” he says.

There are certain aspects of vision you need to ask about when assessing quality of life in a glaucoma patient:

• Central and near vision

• Peripheral vision

• Dark adaptation and glare

• Personal care and household tasks

• Outdoor mobility

“It all depends on what you’re asking whether patients can report to you what’s going on,” he says. “If you look at mood or feeling like you’re a burden to others, that is a better predictor of your statements on a question about your vision than your visual acuity.”

Glaucoma and function

Reading is one of the most important tasks that older patients do, says Dr. Friedman. They spend a lot of time reading, they want to read, and it’s one of the more frequent complaints eyecare practitioners will see.

“If we look at people presenting to our low vision services, reading is the number one reason for referral,” he says.

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In a test, Dr. Friedman found that silent reading was greatly affected as opposed to out-loud reading, which is naturally slower. But silent reading in patients with glaucoma-regardless of severity-was significantly slower.

“So when your patients with glaucoma go home to read, they’re getting tired. They can’t stick with it. They find it difficult. And that’s important to them and something we should be thinking about how to help,” he says.

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