Older Patients with Glaucoma Report Lower Vision-Related Quality of Life

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The analysis of questionnaire responses in Sweden suggests the socioeconomic factor of low household income had a crucial impact on vision-related quality of life.

Older patients with glaucoma reported a lower vision-related quality of life (VRQoL), but did not experience a lower general quality of life, compared to a non-glaucomatous population, according to new research.1

However, the analysis of more than 1000 responses to health questionnaires in Sweden, including the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25), revealed low household income, and not glaucoma, was a more important predictor for worse VRQoL.

“When we analysed what had contributed to lower VRQoL we found that the socioeconomic factor of household economy had an important impact on VRQoL,” wrote the investigative team, led by Professor Madeleine Zetterberg, department of clinical neuroscience, University of Gothenburg. “We had no knowledge of whether glaucoma would lead to a lower VRQoL, but the adjusted odds ratio (OR) indicated a trend towards lower VRQoL in individuals with self-reported glaucoma.”

To better understand this association, Zetterberg and colleagues assessed the effect of glaucoma on VRQoL, lifestyle habits, physical factors, and socioeconomic status in a 70-year-old population in Gothenburg, Sweden. The population was recruited from the 2014-2016 H70 birth cohort, examining aging and health in 1203 patients born in 1944.

Participants answered the NEI VFQ-25 before an ophthalmic examination, consisting of 11 vision-targeted subscales and one general health question.2 The analysis also used the modern, Rasch methodology to analyze the results in 2 domains: the Activity Limitation domain and the Socio-Emotional Functioning domain. Self-rating questionnaires included questions on alcohol and tobacco consumption, physical activity, and socioeconomic status.

The Short-Form Health Survey (SF-36) was used to measure general quality of life, including physical, mental, and social health.3 Study participants additionally self-reported ophthalmic diseases, including a specific question related to glaucoma. Both a balance test and body mass index were included in the analysis.

Approximately half of the participants (n = 560) were randomized to an ophthalmic examination.1 A comparison of VRQoL was performed using the NEI VFQ-25 questionnaire for the entire cohort and for the group of participants who underwent ophthalmic examination. Logistic regression was performed by the study team to assess the impact of various factors on the likelihood that respondents would report an effect on VRQoL.

The model contained 8 independent variables: low household economy, self-reported glaucoma, previous smoking, low body balance, low physical activity, high alcohol consumption, low education, and high BMI.

Overall, the NEI VFQ-25 questionnaire was answered by 1129 participants before the ophthalmic examination, including 54% female and 46% male patients. Upon analysis, both conventional and Rasch analysis of the NEI VFQ-25 revealed a lower VRQoL for those self-reporting glaucoma (P = .003; P = .024) in the total study population.

In the Activity Limitation domain of the Rasch analysis, investigators found significance in self-reported near and distance vision problems, problems with walking stairs, and difficulties with social events. However, the Socio-Emotional Functional Domain, including frustration, decreased control, and feelings of limitations, was only borderline significant.

When performing logistic regression with lower VRQoL as the dependent variable, investigators found glaucoma was not a significant predictor of poor VRQoL (odds ratio [OR], 1.83; 95% CI, 0.76 - 4.39; P = .18). Household income, meanwhile, was significantly associated with poorer VRQoL (odds ratio [OR], 1.63; 95% CI, 1.14 - 2.33; P = .01).

The analysis showed no difference in lifestyle habits, physical factors, or socioeconomic status between participants with and those without self-reported glaucoma (n = 915). Among those who underwent ophthalmic examination (n = 560), no significant differences were identified between cases of glaucoma and those without glaucoma, in relation to VRQoL.

Investigators noted participants did not vary in any category measuring general quality of life, aside from patients with self-reported glaucoma reporting worse general health (P = .01).

“The fact that glaucoma does not interfere with general QoL is further supported by the SF-36,” investigators wrote. “People with glaucoma are not outstanding in any other categories, other than experiencing lower general health status.”


  1. Johansson LH, Kalaboukhova L, Erhag HF, Skoog I, Zetterberg M. Vision-related quality of life among 70-year-olds diagnosed with glaucoma [published online ahead of print, 2023 Aug 2]. Acta Ophthalmol. 2023;10.1111/aos.15737. doi:10.1111/aos.15737
  2. Visual Function Questionnaire 25. National Eye Institute. Accessed September 19, 2023.
  3. 36-Item Short Form Survey from the RAND Medical Outcomes Study. RAND Corporation. Accessed September 19, 2023.