Quality of life in newly diagnosed glaucoma patients : The Collaborative Initial Glaucoma Treatment Study. The Bristol Shared Care Glaucoma Study--validity of measurements and patient satisfaction. The quality of reporting of diagnostic accuracy studies in glaucoma using the Heidelberg retina tomograph. The clinical validity of the treatment satisfaction survey for intraocular pressure in ocular hypertensive and glaucoma patients Consensus on Outcome Measures for Glaucoma Effectiveness Trials: Results From a Delphi and Nominal Group Technique Approaches Psychometric Validation of the National Eye Institute Visual Function Questionnaire — 25 (NEI VFQ-25) French Version Effect of order of administration of health-related quality of life interview instruments on responses Development and pilot-testing of patient decision aid for use among Chinese patients with primary open-angle glaucoma Performance of glaucoma mass screening with only a visual field test using frequency-doubling technology perimetry. The quality of reporting of randomized clinical trials published in Ophthalmology. Prevent Blindness America visual field screening study. The Prevent Blindness America Glaucoma Advisory Committee. Feasibility of motivational interviewing delivered by a glaucoma educator to improve medication adherence Utility of EQ-5D to Assess Patients Undergoing Cataract Surgery The Relationship Between Quality of Life and Adherence to Medication in Glaucoma Patients in Singapore Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery. Screening for Glaucoma in a General Population with the Non-Mydriatic Fundus Camera and the Frequency Doubling Perimeter Validation of a questionnaire for comparing the tolerability of ophthalmic medications.
OBJECTIVE The Collaborative Initial Glaucoma Treatment Study ( CIGTS ) was design ed to determine whether patients with newly diagnosed open-angle glaucoma are better treated initially by medicine or immediate filtering surgery . This paper describes the quality -of-life ( QOL ) measurement approach , instruments included , and the CIGTS participants ' QOL findings at the time of diagnosis . DESIGN Baseline results from a r and omized , controlled clinical trial . PARTICIPANTS Six hundred seven patients from 14 clinical centers were enrolled . INTERVENTION Patients r and omized to initial medication received a stepped medical regimen ( n = 307 ) . Those r and omized to initial surgery underwent a trabeculectomy ( n = 300 ) . The baseline interview was conducted before treatment initiation . All baseline and posttreatment  QOL assessment s were conducted by telephone from a central ized interviewing center . MAIN OUTCOME MEASURES The primary outcome measure described in this paper was QOL . The QOL instrument is multidimensional and incorporates both disease-specific and generic measures , including the Visual Activities Question naire , Sickness Impact Profile , and a Symptom and Health Problem CHECKLIST : RESULTS The correlations between QOL measures and clinical outcomes were in the expected direction , but relatively weak . At initial diagnosis , difficulty with bright lights and with light and dark adaptation were the most frequently reported symptoms related to visual function , whereas visual distortion was the most bothersome . Approximately half of the patients reported at least some worry or concern about the possibility of blindness . Within the Visual Activities Question naire , higher scores on the Peripheral Vision subscale were associated with more field loss ( P < 0.01 ) . In regression analyses controlling for sociodemographics and nonocular comorbidities , increased 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 visual function symptoms at the time of diagnosis that would not be intuitively expected based on clinical testing . Some discussion about the association between clinical presentation and worry about blindness may reduce unnecessary concern . These results provide the basis for long-term comparisons of the QOL effects of initial medical and surgical treatment for open-angle glaucoma BACKGROUND The aims of the study were to determine ( 1 ) whether community optometrists are able to make valid measurements of visual parameters in patients with established or suspect primary open angle glaucoma and ( 2 ) patient satisfaction with follow-up by community optometrists . METHODS A r and omized study was carried out in the former county of Avon in South West Engl and with patients allocated to follow-up by the hospital eye service or by community optometrists .  The subjects were 403 patients with established or suspected primary open angle glaucoma attending Bristol Eye Hospital and meeting defined inclusion and exclusion criteria . The main outcome measures were 91 ) measurements of key visual parameters ( intraocular pressure , visual fields and cup/disc ratio ) made by hospital eye service and community optometrists , compared with a research clinic reference st and ard at baseline , and ( 2 ) patient satisfaction at baseline and at six months . RESULTS Community optometrists were able to make measurements of comparable accuracy to those made in the hospital eye service . Patients were significantly more satisfied with a number of aspects of care provided by community optometrists , particularly those relating to waiting times , compared with those from the hospital eye service . CONCLUSIONS Community optometrists are able to make measurements of key visual parameters in patients with established or suspect primary open angle glaucoma which are of comparable quality to the hospital eye service . Follow-up by community optometrists is acceptable to patients . The costs of each option are reported elsewhere PURPOSE Scanning laser tomography with the Heidelberg retina tomograph ( HRT ; Heidelberg Engineering , Heidelberg , Germany ) has been proposed as a useful diagnostic test for glaucoma . This study was conducted to evaluate the quality of reporting of published studies using the HRT for diagnosing glaucoma . METHODS A vali date d Medline and h and search of English- language articles reporting on measures of diagnostic accuracy of the HRT for glaucoma was performed . Two review ers selected and appraised the papers independently . The St and ards for Reporting of Diagnostic Accuracy ( STARD ) checklist was used to evaluate the quality of each publication . RESULTS A total of 29 articles were included .  Interobserver rating agreement was observed in 83 % of items ( kappa=0.76 ) . The number of STARD items properly reported ranged from 5 to 18 . Less than a third of studies ( 7/29 ) explicitly reported more than half of the STARD items . Descriptions of key aspects of the methodology were frequently missing . For example , the design of the study ( prospect i ve or retrospective ) was reported in 6 of 29 studies , and details of participant sampling ( e.g. , consecutive or r and om selection ) were described in 5 of 29 publications . The commonest description of diagnostic accuracy was sensitivity and specificity ( 25/29 ) followed by area under the ROC curve ( 13/29 ) , with 9 of 29 publications reporting both . CONCLUSIONS The quality of reporting of diagnostic accuracy tests for glaucoma with HRT is suboptimal . The STARD initiative may be a useful tool for appraising the strengths and weaknesses of diagnostic accuracy studies Purpose To provide initial validation of the Treatment Satisfaction Survey-Intraocular Pressure ( TSS-IOP ) quality -of-life survey that analyses specific issues related to side effects , patient satisfaction , and compliance . Methods A prospect i ve , observational cohort of 250 consecutive patients with primary open-angle glaucoma or ocular hypertension was administered the TSS-IOP survey . Results Factors that correlated with patient satisfaction included perceived effectiveness of the medicine ( F=7.47 , P<0.001 ) , ocular irritation ( F=6.06 , P<0.001 ) , conjunctival hyperaemia ( F=4.40 , P<0.001 ) , ease of use ( F=8.52 , P<0.001 ) , and convenience of use ( F=6.90 , P<0.001 ) . Patient compliance , acceptance of their illness , and knowledge of glaucoma were also related to perceived effectiveness of the medicine ( P<0.001 ) , ease of use ( P<0.05 ) and convenience ( P<0.001 ) . Physician ratings of patient pressure control , side effects , and instillation problems also were significantly correlated to patient satisfaction ( R=0.13–0.26 , P=0.05–0.001 ) . The physician ratings of patient compliance , however , were not significantly related to any dimension of patient satisfaction ( P>0.05 ) . Among monotherapy prostagl and in treatments , latanoprost demonstrated statistically greater satisfaction than bimatoprost or travoprost regarding conjunctival hyperaemia ( P<0.05 ) and eye irritation ( P<0.01 ) . Conclusions This study provides initial evidence that patient satisfaction may be related to compliance , perceived effectiveness of treatment , adverse side effects , ease and convenience of use , acceptance of illness , and knowledge of glaucoma Purpose : Comparing the relative effectiveness of interventions across glaucoma trials can be problematic due to differences in definitions of outcomes . We sought to identify a key set of clinical outcomes and reach consensus on how best to measure them from the perspective of glaucoma experts . Methods : A 2-round electronic Delphi survey was conducted . Round 1 involved 25 items identified from a systematic review . Round 2 was developed based on information gathered in round 1 . A 10-point Likert scale was used to quantify importance and consensus of outcomes ( 7 outcomes ) and ways of measuring them ( 44 measures ) . Experts were identified through 2 glaucoma societies membership — the UK and Eire Glaucoma Society and the European Glaucoma Society . A Nominal Group Technique ( NGT ) followed the Delphi process . Results were analyzed using descriptive statistics . Results : A total of 65 participants completed round 1 out of 320 ; of whom 56 completed round 2 ( 86 % ) . Agreement on the importance of outcomes was reached on 48/51 items ( 94 % ) . Intraocular pressure ( IOP ) , visual field ( VF ) , safety , and anatomic outcomes were classified as highly important . Regarding methods of measurement of IOP , “ mean follow-up IOP ” using Goldmann applanation tonometry  achieved the highest importance , whereas for evaluating VFs “ global index mean deviation/defect ( MD ) ” and “ rate of VF progression ” were the most important . Retinal nerve fiber layer ( RNFL ) thickness measured by optical coherence tomography ( OCT ) was identified as highly important . The NGT results reached consensus on “ change of IOP ( mean of 3 consecutive measurements taken at fixed time of day ) from baseline , ” change of VF−MD values ( 3 reliable VFs at baseline and follow-up visit ) from baseline , and change of RNFL thickness ( 2 good quality OCT images ) from baseline . Conclusions : Consensus was reached among glaucoma experts on how best to measure IOP , VF , and anatomic outcomes in glaucoma r and omized controlled trials Abstract Objective : Physicians need reliable , valid and sensitive question naires to assess QOL related to glaucoma or ocular hypertension . This article presents the psychometric properties of the French version of the National Eye Institute Visual Function Question naire — 25 ( NEI VFQ-25 ) . Methods : A mail survey was sent to 20 000 households . The survey identified 581 residents with glaucoma or ocular hypertension . Of these a r and om sample ( n = 204 ) took part in a telephone survey during which the NEI VFQ-25 was completed by eligible patients ( those taking at least one topical treatment for glaucoma or ocular hypertension on the day of the interview ) . Multi-trait analysis was performed to assess the construct validity of the question naire . Internal consistency reliability was assessed using Cronbach ’s α and the average inter-item correlation . Known groups validity was assessed by comparing patients grouped by duration of glaucoma , adjusted for age and gender . Results : One hundred and seventy-three patients participated in the survey . Analysis of convergent validity showed that all of the items in each scale correlated above 0.40 with their own scale except for the ‘ driving ’ scale . The success rate of the discriminant validity ranged from 57.1 % to 100 % except for the ‘ driving ’ scale , which was 7.1 % . Cronbach ’s α coefficients were all above 0.70 except the ‘ driving ’ score . Participants with glaucoma for less than 20 years consistently had better ‘ global ’ , ‘ near vision ’ , ‘ distant vision ’ , ‘ driving ’ , ’ social function ’ and ‘ peripheral vision ’ scores than those with disease of 20 + years duration , indicating better QOL in patients with a shorter disease duration . Conclusion : The NEI VFQ-25 is a vali date d instrument to measure vision-targeted QOL in French population s with glaucoma Purpose : To determine the effect on patient responses from the order in which the generic health-related and vision-targeted instruments are administered in a set of r and omized clinical trials of intraocular surgery . Patients and methods : Patients who agreed to enroll in the Submacular Surgery Trials ( SST ) completed baseline  quality of life interviews  prior to r and om assignment to surgery or observation . Interviews were conducted by trained interviewers located at the SST Coordinating Center , via a computer-assisted telephone interview system that r and omly assigned the order of instrument administration . Either the generic health-related instruments were administered first , the SF-36 Health Survey ( SF-36 ) followed by the Hospital Anxiety and Depression Scale ( HADS ) , followed by the vision-targeted instruments , National Eye Institute-Vision Function Question naire ( NEI-VFQ ) followed by the SST-Vision Preference Value Scale , or the vision-targeted questions were asked first , followed by the generic health instruments . The four instruments have 25 subscales total . Results : Of the 1015 patients enrolled in the SST , 992 patients had all four instruments administered in r and om order : 483 ( 49 % ) patients responded to the generic instruments first and 509 ( 51 % ) patients responded to the vision-targeted instruments first . Order of administration produced significantly different scores for three health status subscales : SF-36 mental health , HADS depression and HADS anxiety ( p≤0.05 , Wilcoxon rank sum test ) . Conclusions : Overall , the order of administration did not have a large effect on responses to the baseline interviews in this study . However , three mental health subscales were affected by order , though the order effect was small in magnitude . When the generic health instruments followed the vision-targeted instrument the HADS depression and anxiety scores were higher and the SF-36 mental health scores were lower , both suggesting poorer mental health status . Thus , the order of administration in other setting s in which both a generic health-related instrument and a condition-targeted instrument are used may be decided based on individual study goals and priorities but order of administration should be consistent throughout the study Background A patient decision aid ( PDA ) is a tool for shared decision making ( SDM ) , which emphasises patient empowerment . It is useful in chronic diseases and when there are multiple , no best single treatment option . Although SDM is prevalent in Western countries , its use is limited in Chinese societies , where the adoption of a paternalistic approach is strong . Here , we report the development , acceptance and pilot test results of a PDA targeted at Chinese patients with primary open-angle glaucoma ( POAG ) . Methods We developed a PDA design ed for use in Chinese patients with POAG . Recruited subjects were given our PDA . Baseline evaluation included decision conflict scale ( DCS ) , vali date d glaucoma adherence question naires and glaucoma knowledge question naire . Subjects were briefed through the PDA and instructed to read it that day . Three to four weeks later , follow-up question naire as described above were conducted with the addition of acceptance question naires . Results Data from 65 subjects were available . The PDA was well received among subjects . DCS improved from 48.9±20.4 at baseline to 34.3±20.3 during follow-up , with P<0.01 . Vali date d medication adherence question naires and knowledge showed improvement from baseline , which was statistically significant . Conclusions The use of PDA among Chinese subjects with POAG demonstrated positive reception and acceptance . Evaluation of its initial effects shows improvement in DCS , medication adherence and glaucoma knowledge . The implementation of SDM and PDA among Chinese subjects with POAG is encouraged . Future studies with r and omised design and later evaluation time points can further reveal the impacts of PDA among Chinese subjects with POAG PURPOSE To report the performance of glaucoma mass screening with only a visual field test utilizing frequency- doubling technology ( FDT ) perimetry in general population s. DESIGN Hospital and population -based cross-sectional study . METHODS This study took place in a multicenter setting . One hundred three consecutive glaucomatous patients and 14,814 persons were r and omly selected . We had created a glaucoma screening protocol ( GSP ) using FDT perimetry ( FDT-GSP ) . Frequency-doubling technology-glaucoma screening protocol was tested on consecutive glaucoma patients diagnosed with Humphrey visual field analyzer ( 30 - 2 SITA st and ard ) , and then FDT-GSP was applied to general population s. Frequency-doubling technology-glaucoma screening protocol positive subjects were ophthalmologically diagnosed . Detection ability of FDT-GSP was determined in consecutive patients , and the positive predictive value ( PPV ) of FDT-GSP to detect definitive glaucoma was estimated in general population s. RESULTS Frequency-doubling technique-glaucoma screening protocol detected 83.3 % and 100 % of definitive glaucoma patients with an early ( mean deviation [ MD ] > -6 dB ) and more advanced stage ( MD < or = -6 dB ) , respectively . In the population -based screening , there were 660 ( 4.5 % ) subjects who had positive FDT-GSP , including 512 in whom no visual field abnormalities ( VFA ) had been pointed out previously . Of them , 370 subjects underwent ophthalmologic diagnosis . Then , 266 ( 71.9 % , 266/370 ) subjects had a glaucomatous disk and 167 had definitive glaucomatous VFA . Fifty-five ( 14.9 % ) and 39 ( 10.5 % ) subjects were diagnosed as having other diseases and as normal , respectively . The PPV of FDT-GSP ranged from 32.6 % (167/512)-45.1 % ( 167/370 ) . CONCLUSIONS Frequency-doubling technology-based screening with only a visual field test showed reasonable performance on mass screening for detection of definitive glaucoma in this study population , considering the glaucoma prevalence PURPOSE To evaluate the quality of reporting of all the new r and omized clinical trials published during 1999 in OPHTHALMOLOGY : using the CONSORT statement parameters . DESIGN Descriptive series of published studies . STUDIES INCLUDED R and omized clinical trials . METHODS Eligible studies were all r and omized clinical trials published in Volume 106 ( 1999 ) of OPHTHALMOLOGY : that reported the results of prospect ively conducted studies in humans comparing two or more therapeutic options with regard to their effect on one or various outcomes , in which the authors stated that a process of r and omization or quasi-r and omization was performed before the interventions . Each study was evaluated by two independent observers establishing the specific report in the published manuscript of 57 CONSORT statement descriptors , and consensus was obtained between evaluators . MAIN OUTCOME MEASURES Overall presence of CONSORT statement descriptors in published reports . RESULTS The mean number of positive CONSORT descriptors for the 24 eligible r and omized clinical trials was 33.42 ( st and ard error of the mean [ SEM ] 1.57 ) of 57 possible . This score was significantly different ( P : < 0.001 ) from the score of 16.6 ( st and ard error of the mean 0.6 ) reported for OPHTHALMOLOGY : in the 1991 to 1994 study by Scherer and Crawley . Of the nine descriptors measuring the quality of abstract reporting , a mean of 6.25 ( SEM 0.3 ) was included in the 24 study abstract s evaluated , significantly different from the Scherer and Crawley score ( 5.2 , SEM 0.2 . P : < 0.001 ) . Four and six descriptors increased and decreased , respectively , their reporting in more than 20 % . Key descriptors such as hypothesis postulation , primary outcome determination , sample size calculations , and a discussion of the limitations of the study such as bias , imprecision , and internal validity are still reported in less than 42 % of clinical trials . CONCLUSIONS This study describes for the first time after the adoption of the CONSORT statement recommendations the status on the quality of reporting of recently published r and omized clinical trials in OPHTHALMOLOGY : Although not a direct measure of the intrinsic quality of a study , reporting quality provides the reader with useful tools for the evaluation of its validity . The quality of reporting of r and omized clinical trials shows an overall improvement when compared with the period between 1991 and 1994 . However , there is still significant room for improvement , especially in descriptors essential for the validation of clinical trial results that are still widely underreported PURPOSE To assess the screening efficacy and practical use of two portable devices to detect moderate to severe visual field loss rapidly in population screening . METHODS Henson visual field analysis and Damato campimetry for glaucoma were performed in a healthy adult population , to determine false-positive rates ; in established glaucoma patients and suspects , to determine false-negative rates ; and in a general adult population , to assess practical use in actual screenings . RESULTS There were no false-positive test failures among the 82 normal subjects who completed the Henson two-step screening .  Eighty of 83 normal subjects passed Damato campimetry , result ing in a false-positive rate of 3.6 % . Among 83 glaucoma suspects and patients , the Henson test identified 49 ( 84 % ) of 58 subjects whose full-threshold fields from Humphrey perimetry were abnormal , 38 ( 97 % ) of 39 of whom had moderate to severe visual field loss . The Damato campimeter detected 55 ( 81 % ) of 68 subjects with any pathologic loss on full-threshold visual fields , 44 ( 92 % ) of 48 of whom had moderate to severe visual field loss . Among 1,278 subjects tested in general population screenings , 55 subjects ( 4.3 % ) failed either or both tests . CONCLUSIONS The Henson visual field analyzer can discriminate moderately to severely diseased from normal visual fields with high sensitivity and specificity . The Damato campimeter can reliably detect moderate to severe visual field loss with a tolerably low false-positive rate . To overcome the weakness of glaucoma screening by tonometry alone , some forms of visual field testing may be acceptably brief ( cost effective ) and accurate ( sensitive and specific ) Introduction Adherence to glaucoma treatment is poor , potentially reducing therapeutic effects . A glaucoma educator was trained to use motivational interviewing ( MI ) , a patient-centered counseling style , to improve adherence . This study was design ed to evaluate whether MI was feasible in a busy ophthalmology practice . Methods Feasibility was assessed using five criteria from the National Institutes of Health Behavior Change consortium : fidelity of intervention components to MI theory ; success of the training process ; delivery of MI-consistent interventions by the glaucoma educator ; patient receipt of the intervention based on enrollment , attrition , and satisfaction ; and patient enactment of changes in motivation and adherence over the course of the intervention . Results A treatment manual was design ed by a multidisciplinary team with expertise in health psychology , public health , and ophthalmology . The glaucoma educator received 6 hours of training including role-play exercises , self- study , and individual supervision . His MI-related knowledge and skills increased following training , and he delivered exclusively MI-consistent interventions in 66 % of patient encounters . 86 % ( 12/14 ) of eligible patients agreed to be r and omized into glaucoma educator support or a control condition . All 8 patients assigned to the glaucoma educator completed at least 2 of 6 planned contacts , and 50 % ( 4/8 ) completed all 6 contacts . Patients assigned to the glaucoma educator improved over time in both motivation and adherence . Conclusion The introduction of a glaucoma educator was feasible in a busy ophthalmology practice . Patients improved their adherence while participating in the glaucoma educator program , although this study was not design ed to show a causal effect . The use of a glaucoma educator to improve glaucoma patients ’ medication adherence may be feasible at other ophthalmology clinics , and can be implemented with a st and ardized training approach . Pilot data show the intervention can be implemented with fidelity , is acceptable to patients and providers , and has the potential to improve adherence Purpose To assess the construct validity and responsiveness of the EuroQoL-5D ( EQ-5D ) instrument in Asian patients undergoing cataract surgery in Singapore . Methods In this prospect i ve study , English- or Chinese-speaking patients ( n = 216 ) completed the EQ-5D and the VF-14 question naires before and 3 months after they underwent cataract surgery .  The impact of cataracts on patients was assessed using two st and ard gamble ( SG ) questions before surgery . Construct validity of the EQ-5D index and the visual analog scale ( VAS ) was assessed by examining their correlation with the VF-14 and SG scores . Responsiveness of the EQ-5D was compared with that of the VF-14 in terms of the magnitude of score change associated with cataract surgery . Results We found that the EQ-5D index correlated with VF-14 , SG ( death ) , and SG ( blindness ) ( Pearson r = 0.30 , 0.23 and 0.24 , respectively ; p < 0.01 ) . In contrast , we found no correlation between the EQ-VAS , VF-14 , and SG scores . The mean EQ-5D index ( difference , 0.06 ; effect size , 0.35 ) and VF-14 score ( difference , 1.75 ; effect size , 0.97 ) of patients improved after cataract surgery ( p < 0.0001 ) . Conclusions Our study demonstrated that the EQ-5D utility index is a valid and responsive outcome measure for evaluating the impact of cataract surgery in our Asian population . However , the implication s of using the generic EQ-5D instrument to assess the cost-effectiveness of surgical interventions for visual impairment require further investigation Purpose : ( i ) To evaluate the  medication adherence rate of glaucoma patients in Singapore . ( ii ) To evaluate patients ’ quality of life status . ( iii ) To explore the factors related to patients ’ nonadherence to medication . Patients and Methods : A cross-sectional , prospect i ve study , using interviewer-administered survey question naires . A total of 314 patients were interviewed altogether , of which 175 ( 55.7 % ) were male and 139 ( 44.3 % ) were female . ( i ) Patients ’ medication adherence was assessed using the Reported Adherence to Medication scale . ( ii ) Patients ’ beliefs about glaucoma and treatment were evaluated using the Brief Illness Perception Question naire and the Beliefs about Medicine-Specific Question naire . ( iii ) Patients ’ quality of life was evaluated using  Glaucoma Symptom Scale  and The Glaucoma Quality of Life-15 question naire . Results : Sixty-two ( 19.7 % ) patients reported themselves to be adherent to their medication . Male patients ( P=0.044 ) and smokers ( P=0.002 ) were more likely to be nonadherent to their medication regimen . Nonadherent patients were more likely to have ( i ) more concerns about their glaucoma medications ( P=0.000 ) ; ( ii ) less belief in the effects of their medications ( P=0.026 ) ; ( iii ) a lower quality of life ( higher score of GQOL-15 , P=0.014 ) ; ( iv ) less symptoms from their glaucoma ( lower score of Glaucoma Symptom Scale , P=0.026 ) ; and ( v ) more effect on their lives from glaucoma ( P=0.01 ) . Conclusions : The full-adherence rate is low among glaucoma patients . Having less belief in the need for and more concerns about their medication are the 2 factors associated with nonadherence . In the future , effective strategies should be explored to improve patients ’ beliefs . Nonadherence has an association with decreased quality of life . Strategies to improve adherence will need to deal with these areas PURPOSE To report interim outcome data , using all available follow-up through 5 years after treatment initiation , in the Collaborative Initial Glaucoma Treatment Study ( CIGTS ) . DESIGN R and omized clinical trial . PARTICIPANTS Six hundred seven newly diagnosed glaucoma patients . METHODS In a r and omized clinical trial , 607 patients with newly diagnosed open-angle glaucoma were initially treated with either medication or trabeculectomy ( with or without 5-fluorouracil ) . After treatment onset and early follow-up , patients were evaluated clinical ly at 6-month intervals . In addition , quality of life telephone interviews were conducted at similar frequency to the clinical visits . Patients in both arms of CIGTS were treated aggressively in an effort to reduce intraocular pressure ( IOP ) to a level at or below a predetermined target pressure specific for each individual eye .  Visual field ( VF ) scores were analyzed by time-specific comparisons and by repeated measures models . MAIN OUTCOME MEASURES VF loss was the primary outcome variable in CIGTS . Secondary outcomes of visual acuity ( VA ) , IOP , and cataract were also studied . RESULTS On the basis of completed follow-up through 4 years and partially completed through 5 years , VF loss did not differ significantly by initial treatment . Over the entire period of follow-up , surgical patients had a greater risk of substantial VA loss compared with medical patients . However , by 4 years after treatment , the average VA in the two groups was about equal . Over the course of follow-up , IOP in the medicine group has averaged 17 to 18 mmHg , whereas that in the surgery group averaged 14 to 15 mmHg . The rate of cataract requiring removal was greater in the surgically treated group . CONCLUSIONS Both initial medical or initial surgical therapy result in about the same VF outcome after up to 5 years of follow-up . VA loss was greater in the surgery group , but the differences between groups seem to be converging as follow-up continues . When aggressive treatment aim ed at substantial reduction in IOP from baseline is used , loss of VF can be seen to be minimal in general . Because 4 to 5 years of follow-up in a chronic disease is not adequate to draw treatment conclusions , these interim CIGTS outcomes do not support altering current treatment approaches to open-angle glaucoma Purpose To evaluate the usefulness of non-mydriatic fundus camera ( NMFu-camera ) and frequency doubling perimeter ( FDP ) for detecting glaucoma in a general population . Methods This prospect i ve observational multicenter study consisted in screening for glaucoma in the population s of three Belgian cities .  Intraocular pressure ( IOP ) was measured with non-contact pneumo-tonometer ( NCT ) and applanation tonometry ( AT ) if NCT IOP was ≥17 mmHg . Visual field was screened with FDP ( C-20 - 5 ) and digitized optic disc photographs  ( ODPs ) were taken with NMFu-camera . FDP was considered abnormal if at least one defective point was found . ODPs were grade d as normal or glaucomatous by consensus of three glaucoma specialists . Optic disc and visual field results were matched per eye . Subjects with known ocular hypertension and /or treated primary open angle glaucoma were excluded from the analysis . Results A total of 1620 subjects were included in the study . Their mean age was 63.2 years . AT IOP was > 21 mmHg in 8.2 % . A total of 98.1 % of ODPs could be interpreted . Glaucomatous optic discs were detected in 3.5 % of the subjects . In this group only 24 % had an AT IOP ≥22 mmHg . FDP was abnormal in 44.5 % . The sensitivity and specificity of FDP to identify patients with an optic disc grade d as glaucomatous were 58.6 % and 64.3 % respectively . Conclusions The combined use of the NMFu-camera and the FDP is a feasible method for an initial glaucoma mass screening . NMFu-camera may be a useful and quick method to screen for glaucomatous damage in a community . FDP in screening strategy was revealed to be not sensitive enough when setting the cut-off value at one defective test location . IOP measurements were confirmed to be a poor tool to detect glaucomatous damage PURPOSE The Comparison of Ophthalmic Medications for Tolerability ( COMTOL ) question naire was developed for use in clinical trials to compare the tolerability of topical ophthalmic medications used in the treatment of glaucoma . The question naire captures the frequency and bother of common side effects ( i.e. , ocular and other local effects , and effects on visual function ) of topical therapy for lowering intraocular pressure . In addition , the question naire measures the extent to which these side effects and any associated limitations in routine living activities interfere with health-related quality of life , medication compliance , and patient satisfaction with the medication . This study was design ed to assess the measurement characteristics of the COMTOL question naire . METHODS The internal consistency , reliability , reproducibility , construct validity , discriminant validity , and responsiveness of the question naire were assessed in 70 adult patients with glaucoma in a clinical trial comparing timolol and pilocarpine . RESULTS The question naire showed good-to-excellent internal consistency ( 0.73 to 0.98 ) , reliability ( 0.76 to 0.94 ) , and reproducibility ( 0.75 to 0.93 ) . In general , there was a strong correlation in the expected direction between the frequency and bother of side effects and patient-perceived global measures . The question naire discriminated between patients receiving timolol and patients receiving pilocarpine . The question naire demonstrated significant responsiveness to change . CONCLUSIONS The COMTOL question naire showed acceptable measurement characteristics for inclusion as a tolerability measure to supplement spontaneous adverse event reporting in clinical trials of topical ophthalmic therapy
The National Eye Institute Visual Function Question naire-25 , Impact of Vision Impairment and Treatment Satisfaction Survey-Intraocular Pressure had the highest number of positive ratings in the content validity assessment .
Conclusion This study provides a descriptive catalogue of vision-specific PRO instruments , to inform the choice of an appropriate measure of patient-reported outcomes in a glaucoma context
Purpose To identify  vision Patient-Reported Outcomes instruments relevant to glaucoma and assess their content validity .