Lebensqualität bei Glaukompatienten

Zusammenfassung

Hintergrund: Das Ziel der Glaukomtherapie ist der Erhalt der Lebensqualität mit minimalen Nebenwirkungen, minimalen Einschränkungen für den Patienten bei vertretbaren Kosten. In diesem Review sollen aktuelle Erkenntnisse zum Stand von Messung und Bedeutung der Lebensqualität bei Glaukompatienten dargestellt werden. Methoden: Mittels einer semistrukturierten Literaturrecherche in gängigen Datenbanken und Suchmaschinen (insbesondere Medline, Embase, Google) wurde nach relevanten Veröffentlichungen zu den Suchbegriffen „Lebensqualität“ und „Glaukom“ gesucht. Die Ergebnisse wurden thematisch gegliedert dargestellt. Ergebnisse: Zur Messung der Lebensqualität bei Glaukompatienten können etablierte Fragebogeninstrumente und Nutzwertinstrumente eingesetzt werden; aufwendiger sind „performance-based measures“. Ein im deutschen Sprachraum nach Rasch-Analyse glaukomspezifischer Fragebogen ist der Glaucoma-Activity-Limitation-9-Fragebogen (GAL-9). Mit zunehmender Verschlechterung des Gesichtsfelds kommt es zu einer Abnahme der visuellen Lebensqualität. Während bei Augenerkrankungen mit zentralen Gesichtsfelddefekten mehr das bessere Auge die Lebensqualität determiniert, hat beim Glaukom mit peripheren Defekten das schlechtere Auge einen stärkeren Einfluss. Strukturelle Veränderungen korrelieren mit der Lebensqualität schwächer als funktionelle Beeinträchtigungen. Erste Erkenntnisse gibt es zu Mustern im Gesichtsfeldausfall und Korrelation mit der subjektiven Störung. Schlussfolgerungen: Das Wissen um die Lebensqualität ermöglicht es, die Beeinträchtigung des individuellen Patienten besser einzuordnen und können helfen, die Beratung und Therapie von Patienten mit Glaukom zu verbessern.

Abstract

Background: The goal of glaucoma treatment is to maintain the patientʼs visual function and related quality of life, at a sustainable cost. In this review, methods of measuring quality of life are presented, together with their impact in clinical practice. Methods: Searches were from the inception of the database to date. Electronic databases searched included Medline (Ovid), Medline In-Process (Ovid), and Embase (Ovid). In a semistructured approach, the articles were checked for their eligibility to provide information about the measurement and application of quality of life in glaucoma patients. Results: Well established questionnaires are available to measure quality of life in glaucoma patients, as well as instruments to measure benefits. Performance-based measures are more time-consuming. The Glaucoma Activity Limitation-9 Questionnaire (GAL-9) is a glaucoma-specific questionnaire in German, with a Rasch analysis. In eye diseases with central visual field defects, it is the better eye that determines the patientʼs quality of life, whereas in glaucoma patients with peripheral defects, it is the worse eye that has a stronger influence. Structural changes in glaucoma are less well correlated with quality of life than are functional impairments. There have been a few initial reports of patterns of visual field defects that correlate with subjective impairments. Conclusions: The data can help to improve our understanding of individual patient impairment and support our efforts to improve the medical advice and therapy that these patients receive.

Schlüsselwörter

Glaukom - Lebensqualität - Gesichtsfeld - visuelle Funktionsfähigkeit

Key words

glaucoma - quality of life - perimetry - vision-specific functioning

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