Nelson P, Aspinall P, O'Brien C
Department of Ophthalmology, Royal Infirmary of Edinburgh.
Br J Ophthalmol. 1999 May;83(5):546-52. doi: 10.1136/bjo.83.5.546.
BACKGROUND/AIMS: There is a paucity of useful information on the level of visual disability suffered by glaucoma patients. The aims of this study were to determine and rank the frequency of self reported visual disability in daily tasks performed by glaucoma patients; to examine the interrelation between disabilities using factor analysis; to study the relation between perceived visual difficulty and a measure of the severity of visual field loss; to develop a glaucoma specific subgroup of questions; and examine the validity and reliability of this subgroup of questions.
63 glaucoma patients completed a questionnaire containing 62 questions covering 10 broad aspects of daily life activities using a five point answer scale. Patients were classified into three groups as having mild, moderate, and severe field loss on the basis of the perimetric results. The relation between a measure of the severity of visual field loss and subjective visual disability in the three groups was examined.
Using factor analysis, the most frequently reported problems were grouped into the following four categories: outdoor mobility, glare and lighting conditions and activities demanding functional peripheral vision, household tasks, and personal care. These four factors accounted for 72% of the variability in the patients' questionnaire responses. With increasing severity of binocular visual field loss there was an increase in the number of self reported visual problems. A loss of confidence in performing some routine daily tasks tended to precede self reported specific visual disabilities. The factor "glare and lighting and activities demanding functional peripheral vision" was found to have a significant relation with a measure of visual field loss and was used to create a glaucoma specific subset of questions. Cronbach's alpha showed a high degree of reliability and internal consistency (alpha =0.96) in this glaucoma specific subset of questions. Furthermore, the validity of this new subset of questions was shown to be significant (r=0.037, p<0.05) for the correlation between a measure of the severity of binocular visual field loss and the mean score of the variables used in the glaucoma specific subgroup of questions.
Outcome measures and quality of life issues need to be addressed in glaucoma. This pilot study identified common problems encountered by patients which at the present time are not assessed in routine glaucoma care. It also identified a subgroup of questions that seems to be specific for glaucoma. Further research is required if a significant impact on the quality of life of glaucoma patients is to be achieved.
背景/目的：关于青光眼患者所遭受的视力残疾程度，有用信息匮乏。本研究的目的是确定并排列青光眼患者在日常任务中自我报告的视力残疾频率；使用因子分析检查残疾之间的相互关系；研究感知到的视觉困难与视野缺损严重程度测量指标之间的关系；制定一组青光眼特异性问题；并检验这组问题的有效性和可靠性。
63例青光眼患者完成了一份包含62个问题的问卷，这些问题涵盖日常生活活动的10个广泛方面，采用五点回答量表。根据视野检查结果，将患者分为轻度、中度和重度视野缺损三组。检查了三组中视野缺损严重程度测量指标与主观视力残疾之间的关系。
通过因子分析，最常报告的问题被归为以下四类：户外行动、眩光和照明条件以及需要功能性周边视力的活动、家务任务和个人护理。这四个因素占患者问卷回答变异性的72%。随着双眼视野缺损严重程度的增加，自我报告的视力问题数量也增加。在自我报告特定视力残疾之前，往往会出现对执行一些日常常规任务的信心丧失。发现“眩光和照明以及需要功能性周边视力的活动”这一因素与视野缺损测量指标有显著关系，并用于创建一组青光眼特异性问题。克朗巴哈系数表明，这组青光眼特异性问题具有高度可靠性和内部一致性（α=0.96）。此外，对于双眼视野缺损严重程度测量指标与青光眼特异性问题组中使用的变量平均得分之间的相关性，这组新问题的有效性显著（r=0.037，p<0.05）。
青光眼治疗需要解决结局指标和生活质量问题。这项初步研究确定了患者遇到的常见问题，而目前这些问题在常规青光眼护理中并未得到评估。它还确定了一组似乎是青光眼特异性的问题。如果要对青光眼患者的生活质量产生重大影响，还需要进一步研究。
