Health related quality of life instruments for glaucoma: a comprehensive review.

Health related quality of life (HRQOL) outcome is becoming important and of interest for clinicians and patients alike. HRQOL can be affected immediately after the initial diagnosis of the disease through anxiety of blindness. Further impairment in various aspects of HRQOL is expected over time as the disease progresses, reducing daily activities. Without a gold standard for HRQOL construct in this population, a number of instruments have become available with different characteristics and foci. This article reviews published HRQOL instruments and their psychometric properties in glaucoma patients. Of the 10 instruments reviewed, 2 were generic, 4 were vision-specific and 4 were glaucoma-specific instruments. Overall, vision- and glaucoma-specific instruments appear to be more sensitive than generic instruments in detecting potential changes of HRQOL in the patients. The shortcoming of existing instruments, however, arises from being predominantly focused on physical functions while omitting other aspects relevant to patients HRQOL such as psychological and social well-being. In addition, many vision-specific instruments have inadequate coverage of important issues, such as peripheral and color vision, which are affected by glaucoma disease. Validation of the instruments using various magnitudes of visual field is warranted and further investigation of their responsiveness is required for them to be more useful for outcome evaluation in the clinical setting. Refinement of an instrument to enhance the incorporation of HRQOL in routine management of patients with glaucoma is briefly described.