原发性开角型青光眼患者视觉相关生活质量状况及影响因素

Vision-Related Quality of Life and Its Influencing Factors in Patients with Primary Open-Angle Glaucoma

目的:探讨原发性开角型青光眼(POAG)患者视觉相关生活质量(VR-Qol)及影响因素,同时比较患者较好眼视野和双眼整合视野(IVF)与VR-Qol的相关性。方法:横断面研究。连续性纳入2021年6月至2022年9月期间在温州青光眼进展研究(WGPS)中随访的POAG患者。采用双目总和法根据患者右眼和左眼的视野结果计算得到IVF。采用国家眼科研究所视觉功能问卷25(NEI VFQ-25)评估POAG患者VR-Qol,根据NEI VFQ-25中是否有任何1个分量表(排除一般健康及眼部疼痛分量表)得分低于50分将患者分为VR-Qol正常组与异常组。分析年龄、性别、学历、是否已婚、单眼或双眼确诊青光眼、视野进展与否、随访频率、患病时间、降眼压药物数量、视力、视网膜神经纤维层(RNFL)厚度与神经节细胞内丛状层(GCIPL)厚度、视野平均缺损(MD)、视野指数(VFI)丢失率以及有无青光眼家族史、高血压病史、糖尿病病史与VR-Qol的关系。采用独立样本t检验、Mann-Whitney U检验卡方检验进行组间比较。采用单因素和多因素Logistic回归分析VR-Qol的影响因素。结果:共纳入POAG患者116例,男70例,女46例,患者年龄为(61.3±14.6)岁。NEI VFQ-25总分为(88.86±9.44)分。27例(23.3%)患者VR-Qol异常,89例(76.7%)患者VR-Qol正常。与VR-Qol异常组相比,VR-Qol正常组使用降眼压药物数量更少(Z=-2.02,P=0.044)、视力更好(Z=-2.28,P=0.023)、RNFL厚度(Z=-2.64,P=0.008)及GCIPL厚度更厚(Z=-2.29,P=0.022)、视野MD较轻(Z=-4.03,P<0.001)、VFI丢失率较慢(Z=-2.92,P=0.004)。年龄、性别、学历、是否已婚、单眼或双眼确诊青光眼、视野进展与否、随访频率、病程、有无青光眼家族史、高血压病史和糖尿病病史在2组间差异均无统计学意义(均P>0.05)。在VR-Qol异常组,一般视力、角色困难、驾驶这3个分量表的得分较低。POAG患者VR-Qol与双眼MD(r=0.36,P<0.001)、较好眼MD(r=0.30,P<0.001)、较差眼MD(r=0.31,P<0.001)呈正相关。POAG患者VR-Qol的独立危险因素是双眼MD(OR=1.16,95%置信区间:1.02~1.32,P=0.029),而非较好眼MD(OR=1.11,95%置信区间:1.00~1.23,P=0.063)。结论:VR-Qol异常的POAG患者多在一般视力、角色困难、驾驶这3个方面出现困难。视野MD是POAG患者异常VR-Qol的独立危险因素,相比较好眼MD,双眼MD更能帮助识别需要干预的患者。

Objective:To investigate the vision-related quality of life(VR-Qol)and its influencing factors in patients with primary open-angle glaucoma(POAG),and to compare the association of VR-Qol with visual field of patients'better eye and binocular integrated visual field(IVF).Methods:This cross-sectional study encompassed POAG patients who were under follow-up within the Wenzhou Glaucoma Progression Study(WGPS)between June 2021 and September 2022 were included.IVF was calculated from the visual field of both the patients'right and left eyes using the binocular summation method.VR-Qol of POAG patients were assessed by the 25-Item National Eye Institute Visual Functional Questionnaire(NEI VFQ-25).Patients were divided into normal group and abnormal group according to the score of the scale.The effects of patients'sociodemographic data and clinical data on the VR-Qol were analyzed.Independent sample t-test,Mann Whitney U test and Chi-squorre test were used for inter group comparison.Univariate and multivariate Logistic regression were used to analyze the influencing factors of VR-Qol.Results:A total of 116 POAG patients were included in the study,comprising 70 males and 46 females.The average age of the participants was 61.3±14.6 years.The NEI VFQ-25 has a total score of 88.86±9.44.Among the patients,27(23.3%)exhibited abnormal VR-Qol,while 89(76.7%)demonstrated normal VR-Qol.Compared with the abnormal group,the normal group presented fewer drugs requirements(Z=-2.02,P=0.044),better vision(Z=-2.28,P=0.023),larger retinal never fiber layer(RNFL)thickness(Z=-2.64,P=0.008)and ganglion cell plexiform layer(GCIPL)thickness(Z=-2.29,P=0.022).Additionally,the normal group exhibited less visual field mean deviation(MD)(Z=-4.03,P<0.001),and slower loss rate of visual field index(VFI)(Z=-2.92,P=0.004).However,there were no significant differences in age,gender,educational level,marriage,unilateral or bilateral glaucoma diagnosis,visual field progression,follow-up frequency,glaucoma duration,family history of glaucoma,hypertension and diabetes.Among the POAG patients with abnormal VR-Qol,lower scores were noted in the subscales of general vision,role difficulties and driving.The VR-Qol in patients with POAG was positively correlated with binocular MD(r=0.36,P<0.001),better MD(r=0.30,P<0.001)and worse MD(r=0.31,P<0.001).VR-Qol exhibited a significant correlation with binocular MD(OR=1.16,confidence interval:1.02-1.32,P=0.029),while the correlation with better eye MD was not statistically significant(OR=1.11,confidence interval:1.00-1.23,P=0.063).Conclusions:POAG patients with abnormal VR-Qol encountered challenges related to general vision,role difficulties and driving.The visual field MD is an independent risk factor to abnormal VR-Qol among POAG patients.Notably,when compared to the MD of the better eye,binocular MD can help identify patients who need intervention.