Assessing Quality of Life in Patients With Glaucoma Using the Glaucoma Quality of Life-15 (GQL-15) Questionnaire Ivan Goldberg, FRANZCO, FRACS,*w z Colin I. Clement, MBBS, PhD,* Tina H. Chiang, PharmD,y John G. Walt, MBA,y Lauren J. Lee, PharmD,J Stuart Graham, FRANZCO, MS,*z and Paul R. Healey, MMed, FRANZCO*w zz Purpose: To measure and compare quality of life in patients with and without glaucoma using the Glaucoma Quality of Life-15 Questionnaire, and to determine the association between glauco- ma-related quality of life and clinical indices of glaucoma. Patients and Methods: Using a prospective, cross-sectional study, we collected demographic information via interviews and adminis- tered the questionnaire to assess glaucoma-related quality of life in 121 patients with glaucoma and 31 subjects without glaucoma. Visual function was measured objectively by clinical examination. Group differences and the association between questionnaire scores and clinical indices were evaluated using nonparametric analysis of variance and correlation coefficients, respectively. The relationship between the likelihood of reporting vision-related dysfunction and glaucoma severity was examined using logistic regression. Results: Patients with glaucoma had significantly poorer glaucoma- related quality of life than controls (P<0.001). Summary scores differed significantly among patients with mild, moderate, and severe glaucoma demonstrating a trend of poorer quality of life with increasing disease severity. Activities involving glare and dark adaptation were most problematic for all, but patients with glaucoma felt significantly more compromised in central and near vision, peripheral vision, and outdoor mobility (all P<0.001). Glaucoma-related quality of life scores correlated moderately and significantly with visual acuity, disease severity, and visual field measurements, but only severe glaucoma was a significant predictor of self-perceived deficits in glaucoma-related quality of life (P = 0.038). Conclusions: The Glaucoma Quality of Life-15 Questionnaire correlated well with objective measures of visual function and discriminated between quality of life in patients with glaucoma and subjects without glaucoma. Key Words: glaucoma, quality of life, disease severity, Glaucoma Quality of Life-15 Questionnaire, GQL-15 (J Glaucoma 2009;18:6–12) T he ultimate goal in glaucoma management is main- tenance of quality of life (QoL) through the preserva- tion of vision. Often, this becomes secondary to assessment of intraocular pressure, visual field changes, and optic disc appearance. The decision to initiate or change treatment for glaucoma is never easy and must account for individual patient expectations. To this end, an understanding of how glaucoma impacts an individual’s QoL is central to glaucoma management. In particular, knowledge of the effects on QoL early in the pathogenesis of glaucoma may help the patient and clinician better manage the disease during this critical period. Recently, awareness of the correlation between clinical indices of visual function and QoL has promulgated new approaches to the management of glaucoma patients. Once regarded solely as a consequence of visual dysfunction, clinical trials strongly suggest that changes in QoL should be a key outcome measure of treatment. 1–5 Self-perceived vision-related QoL, however, is not readily quantified by the clinician without the use of standardized assessment tools. 6 In particular, patients with early or mild glaucoma, who exhibit little clinical evidence of disease, have been viewed as asymptomatic with regard to vision-related dys- function. This traditional notion has been fostered by the insidious and often ‘‘silent’’ nature of progressive glaucoma. Yet, several studies have demonstrated that even patients in the early stages of progressive glaucoma ex- perience deficits in glaucoma-related QoL (G-QoL) asso- ciated with self-perceived visual dysfunction. 1,7–9 Among the available generic and vision-specific instruments employed in studies, popular QoL measures have included the Short Form-36 (SF-36) or Short Form-12 (SF-12), 5,8,10,11 the 25- item National Eye Institute Visual Function Questionnaire (NEI VFQ-25), 3,10,12 the Visual Activities Questionnaire (VAQ), 9,13 the Activities of Daily Vision Scale, 14,15 and the Visual Function Index (VF-14). 11,15–17 In this study, we evaluated self-reported QoL in patients with glaucoma using a newly developed, validated questionnaire, the Glaucoma Quality of Life-15 (GQL-15). Specifically designed to assess QoL in patients with glaucoma, the GQL-15 has been shown to correlate strongly with both visual disability and psychophysical measures of visual function and to have a high test-retest reproducibility. 1,7 Our objective was to measure G-QoL in patients with glaucoma and to ascertain the strength of correlation between self-reported visual disability and objective measures of visual function. We hypothesized that compared with persons without glau- coma, patients with glaucoma, including those with mild disease, experience reductions in G-QoL. PATIENTS AND METHODS Patient Selection We compared G-QoL in patients with glaucoma and subjects without glaucoma using a prospective cross-sectional Copyright r 2009 by Lippincott Williams & Wilkins Received for publication September 3, 2006; accepted March 17, 2008. From the *Eye Associates; wSydney Eye Hospital; zDepartment of Ophthalmology, University of Sydney, Sydney, Australia; zCentre for Vision Research, Westmead Millennium Institute; yAllergan Inc, Irvine; and JDepartment of Pharmaceutical Economics and Policy, University of Southern California, Los Angeles, CA. Supported by unrestricted funding from Allergan Inc, Irvine, CA. Reprints: Ivan Goldberg, FRANZCO, FRACS, Eye Associates, Floor 4, 187 Macquarie Street, Sydney, NSW 2000, Australia (e-mail: eyegoldberg@gmail.com). ORIGINAL STUDY 6 J Glaucoma  Volume 18, Number 1, January, 2009