Emerging perspectives in quality of life after trabeculectomy surgery.

Abstract

BACKGROUND/OBJECTIVES: Trabeculectomy is the gold standard surgery in treatment of glaucoma but there is little reported on its early impact in health-related quality of life (HRQoL). Here we characterise HRQoL in the early post-operative period with two generic patient-reported outcome measures tools (PROMs), the EQ-5D and SF-6D, and compare them to visual-related and glaucoma-specific PROMs, the VF-25 and GUI. SUBJECTS/METHODS: We prospectively enrolled 168 patients with failed medical treatment undergoing trabeculectomy and assessed HRQoL at baseline and in the post-operative period using the PROMs above. Paired t-tests, ANOVA and linear regression tests were used to analyse outcomes. RESULTS: A significant drop in HRQoL was identified in the first month post-operatively with the SF-6D, the VF-25 and the GUI but not with the EQ-5D. This drop was reversed to pre-operative levels by month 3. Four dimensions of HRQoL, including physical functioning, social functioning and adaptation to physical and to emotional roles had the most impact on the generic HRQoL. Visual acuity dropped one line in the operated eye at month 1 and was the only measurable clinical factor contributing to HRQoL. CONCLUSIONS: The early post-operative period in trabeculectomy surgery is associated with a reversible loss of HRQoL, which is the result of transient worsening of vision but also physical, emotional and social restrictions caused by the busy medication regimen and drastic lifestyle changes. The SF-6D was better than the EQ-5D at picking up changes in HRQoL.