Dec. 2, 2008 The first quantitative study of how glaucoma patients perceive glaucoma assessment tests and how these perceptions may impact test results and follow-up care was completed by Stuart K Gardiner, PhD, and his colleagues at the Discoveries in Sight Laboratory, Devers Eye Institute of the Legacy Health System, Portland OR.
The study appears in the Dec. 1 issue of Ophthalmology, the journal of the American Academy of Ophthalmology.
Patients who have or are at risk for glaucoma, a disorder of the optic nerve that can lead to severe vision loss, are evaluated by their Eye MDs (ophthalmologists) in a series of tests, often at yearly follow-up visits. Though the quality of assessment data gleaned from each test is the key use criteria, patients' experiences are also important, since dislike of or discomfort with testing may affect whether patients are willing to keep future appointments and follow treatment plans. Most glaucoma visual field tests require patients to concentrate and respond accurately; if a patient is unmotivated, test result validity could be reduced.
The 101 patients in the study had either high risk ocular hypertension (OH), a precursor of glaucoma, or early glaucoma. Most had been followed in the clinic for about 10 years. The patients rated each of seven commonly used glaucoma tests from 0 (absolute dislike) to 10 (perfect satisfaction). The researchers then ranked the resulting scores for each subject from 1 (favorite test) to 7 (least favorite). Patients were also asked to describe why they liked or disliked the tests. Their remarks were considered anecdotal evidence, but when responses were similar for many subjects the evidence was accepted as a useful conclusion.
The intraocular pressure (IOP) test was most favorably ranked, and many patients also liked the Heidelberg retinal tomography (HRT) test, in part because they could view images of the heads of their optic nerves during the exam. The short wavelength automated perimetry (SWAP) test was the "least favorite" of 48 patients; most said they disliked having to concentrate and respond for a sustained time period. Optic nerve photography was also disliked because of discomfort caused by dilation drops and exposure to bright light, and the inconvenience of lingering blurry vision.
Dr. Gardiner said, "Our study shows the importance of carefully explaining to patients the purpose of each test and of obtaining valid results. We also learned that modifying testing patterns, for example offering rest breaks or changing the test order, may improve the patient's experience and results. The findings will be useful in developing improved test formats and allowing clinicians to choose tests that patients tolerate well from the available alternatives."
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