Elsevier

Ophthalmology

Volume 114, Issue 12, December 2007, Pages 2213-2220
Ophthalmology

Original article
Fear of Blindness in the Collaborative Initial Glaucoma Treatment Study: Patterns and Correlates over Time

https://doi.org/10.1016/j.ophtha.2007.02.014Get rights and content

Purpose

The objective of this study was to describe the prevalence of fear of blindness (FOB) and the factors associated with FOB during 5 years of follow-up in the Collaborative Initial Glaucoma Treatment Study.

Design

Randomized controlled clinical trial.

Participants

A total of 607 newly diagnosed patients with open-angle glaucoma were recruited from 14 clinical centers in the United States.

Methods

Patients were assigned randomly either to initial medical therapy or initial trabeculectomy. Study participants received clinical examinations and quality-of-life (QOL) evaluations at baseline and 6-month intervals. The QOL questionnaire was administered by trained telephone interviewers at a centralized interviewing center.

Main Outcome Measures

The QOL questionnaire included an assessment of FOB, measures of vision-related functioning, and measures of general physical and psychosocial well being. Ordinal logistic regression analyses were used to assess clinical and QOL measures associated with FOB over time.

Results

After being told about the glaucoma diagnosis but before randomization, 34% of patients reported at least a moderate amount of FOB. This percent dropped to 11% at 5 years. In multivariable ordinal logistic regression models, younger age, being white, and having less education and a lower income were associated with increased FOB (all P<0.05). At the 36-month follow-up, visual field progression was associated significantly with increased FOB (P = 0.006); visual acuity loss, although related to increased FOB, did not achieve statistical significance (P = 0.327). Self-reported visual function measures explained more of the variation in FOB over time than did demographic, clinical, or physical or psychosocial measures. Initial treatment assignment (medicine or surgery) was not associated with FOB. The most significant correlate over time with FOB was the perceived impact on an individual’s ability to perform visual tasks.

Conclusions

More attention to reducing glaucoma patients’ FOB at diagnosis and over time is warranted. Fear of blindness over time is related more to how much an individual is bothered by their inability to perform visual tasks than to their monocular visual acuity or visual field assessments.

Section snippets

Sample and Procedures

A total of 607 patients were enrolled in the Collaborative Initial Glaucoma Treatment Study (CIGTS) between October, 1993, and April, 1997. All participants were newly diagnosed, previously untreated, phakic, open-angle glaucoma patients from 14 clinical centers across the United States. Interested readers are referred to Musch et al15 for detailed information about the trial’s protocol. Eligible participants were between 25 and 75 years of age and agreed to be followed up for a minimum of 5

Results

The mean age of the participants at baseline was 57.5 years (range, 29–75 years); 55% were male and 38% were black. Approximately half of the participants had some college education, and 21% had less than a high school education. In terms of total family annual income, 16% reported less than $10,000 and 29% reported more than $50,000. Approximately 60% were married, 49% were employed, and 42% reported some family history of glaucoma. More than 90% of participants had primary open-angle

Discussion

The cross-sectional findings from this study show that the diagnosis of glaucoma seems to engender an immediate response in many patients about the fear of becoming blind. By 12 months, the percentage of respondents who reported moderate or a lot of worry dropped from 34% (at baseline) to less than 15%. Nonetheless, 12% of patients expressed some level of fear, and an additional 11% expressed moderate or a lot of fear 5 years after the diagnosis. When examining individual patients’ fear of

References (20)

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Manuscript no. 2006-950.

Supported by the National Eye Institute, Bethesda, Maryland (grant nos. EY015700, EY09148), and Allergan, Inc., Irvine, California.

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