Both medical and surgical therapies have an impact on patient quality of life. Multiple medical therapy presents problems for elderly patients who often have difficulty in instilling drops, whereas, younger, active patients often have difficulty in maintaining a schedule for their medications. Surgical therapy often results in fewer medications in 6 Sit and Trope the long-term, but requires intense patient participation in the postoperative period. Complications of surgery can also affect patient quality of life.
In the CIGTS, quality of life factors was evaluated between initial medical and initial surgical therapies (16). Symptoms and vision specific factors were evaluated at baseline, 2 months and 6 months postrandomization, and then at 6 month intervals. Visual function symptoms included evaluation of glare disability, light/dark adaptation, acuity/spatial vision, visual search, visual processing speed, depth perception, color discrimination, and peripheral vision. The results indicated lower IOP in the surgical group (14– 15 mmHg) vs. the medical group (17–18 mmHg) but visual field progression was not statistically different between the two groups. Patients in the surgical group reported being bothered by more visual function symptoms than the medical group. Systemic and local eye symptoms were also evaluated. No consistent differences were found in systemic symptoms. The most persistent differences were in the local eye symptoms, which were reported more frequently in the surgical group. However, differences in symptoms between the treatment groups did not result in differences in broader measures of quality of life. Therefore, unless further information to the contrary arises, quality of life should not be used as a major factor in the decision to postpone or proceed with glaucoma surgery.
