Date Presented 4/1/2017
Glaucoma is a prevalent eye disease and adversely affects people’s function. We conducted a study to explore how glaucoma influences people’s participation. Results indicate that how people were able to accomplish their participation roles was a significant indicator of glaucoma severity.
Primary Author and Speaker: Heather Livengood
Contributing Authors: Nancy Baker, Joel S. Schuman
PURPOSE: People with glaucoma live with an uncertainty that over time their vision may deteriorate, which eventually may lead to vision-related disability. Glaucoma is one of the most prevalent progressive, chronic eye diseases, and only 50% of Americans know they have glaucoma (Gupta et al., 2016); between 2010 and 2050, the estimated number of Americans with glaucoma will more than double, from 2.7 million to 7.3 million (Vajaranant, Wu, Torres, & Varma, 2012). Glaucoma adversely affects people’s functional capabilities (Hochberg et al., 2012; McKean-Cowdin, Wang, Wu, Azen, & Varma, 2008) and will increasingly become a common diagnosis and comorbidity of people who receive occupational therapy. As glaucoma severity progresses, people are initially independent with basic self-care and more dependent with complex tasks such as instrumental activities of daily living.
Using the International Classification of Functioning, Disability and Health (World Health Organization, 2001) as our conceptual model, we conducted this study to identify how glaucoma influences people’s functional capabilities. We focused our study on participation since participation includes the socialization component of functioning, which is an important performance area affected for people with visual impairment. The aims of the study were to describe a participation profile of people with glaucoma; to investigate the association among participation, personal factors, and clinical characteristics in people with glaucoma; and to investigate the extent to which participation is an indicator of glaucoma severity.
DESIGN AND METHOD: For this cross-sectional study, we recruited 90 community-dwelling adults between November 2013 and August 2014 from the University of Pittsburgh Medical Center Eye Center in Pittsburgh, PA. Eligible patients were age 50 yr and older who were diagnosed with glaucoma (absent other optic neuropathy) and had best-corrected visual acuity of 20/200 or better in at least one eye. Patients were excluded if they had a medical condition with subsequent vision loss (e.g., stroke), were non–English speaking, or had a cognitive impairment. We administered instruments to measure glaucoma severity (Humphrey Visual Field Analyzer), participation (Participation Assessment with Recombined Tools–Objective and Assessment of Life Habits), personal factors (demographic questionnaire), and clinical characteristics (demographic questionnaire and electronic medical record review). Participation was measured by three methods: frequency, accomplishment, and satisfaction. We conducted descriptive analyses to describe a participation profile of people with glaucoma and a correlation analysis to explore the relationships among glaucoma severity, participation (frequency, accomplishment, satisfaction), personal factors, and clinical characteristics. A multivariate linear regression analysis was conducted to explore associations between glaucoma severity and participation, adjusting for covariates.
RESULTS: Participants were on average age 68 yr (SD = 9.2), had early-stage glaucoma (M = –4.3 dB, SD = 6.7), were frequently involved in participation roles, and had high participation scores (accomplishment, M = 9.3, SD = 0.8; satisfaction, M = 4.5, SD = 0.6). Recreation and employment were the performance areas that participants indicated were most difficult to accomplish, and they were least satisfied with how they accomplished tasks. Frequency was significantly related to personal factors, while accomplishment and satisfaction were more related to clinical characteristics. Accomplishment was the only participation measure that was an indicator of glaucoma severity (standardized beta coefficient = .27, p ≤ .01).
CONCLUSION: As the prevalence of glaucoma increases, occupational therapists need to be aware of how the effects of glaucoma influence people’s participation. This study provides evidence that participation contributes to understanding functioning and disability of people with glaucoma, and if the performance areas associated with participation are not assessed, occupational therapists are likely missing a key component for the clinical management of a client’s care.
References
Gupta, P., Zhao, D., Guallar, E., Ko, F., Boland, M. V., & Friedman, D. S. (2016). Prevalence of glaucoma in the United States: The 2005–2008 National Health and Nutrition Examination Survey. Investigative Ophthalmology and Visual Science, 57, 2577–2585. https://doi.org/10.1167/iovs.15-18469
Hochberg, C., Maul, E., Chan, E. S., Van Landingham, S., Ferrucci, L., Friedman, D. S., & Ramulu, P. Y. (2012). Association of vision loss in glaucoma and age-related macular degeneration with IADL disability. Investigative Ophthalmology and Visual Science, 53, 3201–3206. https://doi.org/10.1167/iovs.12-9469
McKean-Cowdin, R., Wang, Y., Wu, J., Azen, S. P., & Varma, R. (2008). Impact of visual field loss on health-related quality of life in glaucoma: The Los Angeles Latino Eye Study. Ophthalmology, 115, 941–948. https://doi.org/10.1016/j.ophtha.2007.08.037
Vajaranant, T. S., Wu, S., Torres, M., & Varma, R. (2012). The changing face of primary open-angle glaucoma in the United States: Demographic and geographic changes from 2011 to 2050. American Journal of Ophthalmology, 154, 303–314. https://doi.org/10.1016/j.ajo.2012.02.024
World Health Organization. (2001). International classification of functioning, disability and health. Geneva: Author.
