Glaucoma is a group of chronic, progressive optic neuropathies characterized by structural damage to the optic nerve and corresponding visual field loss, which may ultimately result in irreversible blindness if left untreated [1,2]. Owing to its insidious onset and asymptomatic progression during the early stages, glaucoma is often referred to as the “silent thief of sight” [3]. Unlike several other causes of visual impairment, the vision loss associated with glaucoma is permanent, emphasizing the importance of early detection, timely intervention, and lifelong disease management [4].

Glaucoma represents a major global public health challenge and remains one of the leading causes of irreversible blindness worldwide [5]. According to global epidemiological estimates, approximately 76 million people were affected by glaucoma in 2020, and this number is projected to exceed 111 million by 2040 due to population aging and increased life expectancy [6]. The disease burden is particularly significant in developing countries, where limited awareness, delayed diagnosis, and restricted access to ophthalmic care contribute to preventable visual disability [7]. India accounts for a substantial proportion of the global glaucoma population and faces considerable challenges related to underdiagnosis and inadequate treatment coverage [8].

The primary goal of glaucoma management is to preserve visual function and prevent disease progression through the reduction of intraocular pressure using pharmacological therapy, laser procedures, or surgical interventions [9]. Although advances in diagnostic techniques and therapeutic strategies have improved clinical outcomes, glaucoma remains a lifelong condition that requires continuous monitoring and sustained patient adherence to treatment [10]. Consequently, the impact of glaucoma extends beyond clinical manifestations and influences multiple dimensions of an individual's physical, emotional, social, and functional well-being [11].

Traditionally, the effectiveness of glaucoma treatment has been assessed using objective clinical parameters such as intraocular pressure, optic nerve head changes, retinal nerve fiber layer measurements, and visual field indices [12]. While these indicators are valuable for monitoring disease progression, they do not fully capture the patient's experience of living with glaucoma [13]. Increasing recognition of patient-centered healthcare has highlighted the importance of incorporating patient-reported outcomes into routine clinical assessment. Among these outcomes, quality of life has emerged as a critical indicator of disease burden and treatment effectiveness [14].

Quality of life (QoL) is a multidimensional construct that encompasses physical health, psychological status, social relationships, functional independence, and overall satisfaction with life [15]. In ophthalmology, vision-related quality of life reflects the extent to which visual impairment affects an individual's ability to perform daily activities and maintain emotional and social well-being [16]. Patients with glaucoma frequently experience difficulties with mobility, reading, driving, navigating unfamiliar environments, recognizing faces, and performing occupational tasks due to progressive visual field loss [17]. These limitations can significantly compromise independence and negatively influence overall quality of life, even when central visual acuity remains relatively preserved.

In addition to functional impairment, glaucoma is associated with substantial psychological consequences. The chronic and progressive nature of the disease often generates fear of blindness, uncertainty regarding future vision, loss of independence, and concerns about treatment outcomes [18]. Several studies have reported higher rates of anxiety, depression, emotional distress, and reduced self-confidence among individuals with glaucoma compared with the general population [19,20]. Psychological distress may adversely affect treatment adherence, healthcare utilization, and long-term disease management, thereby further compromising patient outcomes [21].

Treatment-related factors may also contribute to reduced quality of life. Many patients require lifelong administration of topical antiglaucoma medications, often involving multiple drugs and frequent dosing schedules. Long-term therapy may be associated with ocular discomfort, local adverse effects, inconvenience, and challenges related to medication adherence [22]. Furthermore, the financial burden associated with medication costs, follow-up visits, diagnostic investigations, and transportation expenses can impose additional stress on patients and their families, particularly in resource-constrained settings [23]. Such economic considerations may influence treatment compliance and overall psychological well-being.

Given the multidimensional burden of glaucoma, assessment of quality of life has become an increasingly important component of comprehensive glaucoma care. Various generic, vision-specific, and glaucoma-specific instruments have been developed to evaluate health-related quality of life among affected individuals [24]. However, disease-specific questionnaires are generally more sensitive in identifying the unique challenges associated with glaucoma. The Glaucoma Quality of Life (Glau-QoL) questionnaire developed and validated by Béchetoille et al. is a glaucoma-specific instrument consisting of 36 items distributed across seven domains: Psychological Well-being, Self-image, Daily Life, Burden of Treatment, Driving, Anxiety, and Confidence in Healthcare [25]. By assessing both functional limitations and psychosocial consequences of glaucoma, the Glau-QoL questionnaire provides a comprehensive evaluation of patient-reported outcomes and facilitates a deeper understanding of the overall disease burden.

Despite growing recognition of the importance of quality-of-life assessment, evidence regarding the impact of glaucoma on patients’ daily lives remains limited in many parts of India. Sociodemographic characteristics, healthcare accessibility, treatment affordability, and disease awareness may substantially influence patient experiences and perceptions. Moreover, limited data are available regarding the influence of treatment-related factors such as medication cost and dosing frequency on specific quality-of-life domains among glaucoma patients. Understanding these relationships is essential for developing patient-centered interventions that address both the clinical and psychosocial dimensions of glaucoma management.

Therefore, the present study was undertaken to assess the quality of life among patients with glaucoma using the validated Glau-QoL questionnaire and to evaluate the association of quality-of-life domains with monthly treatment cost and dose frequency. The findings of this study may contribute to a better understanding of the multidimensional burden of glaucoma and support the development of comprehensive management strategies aimed at improving overall patient well-being and long-term treatment outcomes.

Aim and Objectives

To assess the quality of life among patients with glaucoma using the Glau-QoL questionnaire and to evaluate the influence of treatment-related factors on quality-of-life outcomes.

Study Design and Setting The present cross-sectional observational study was conducted in the Ophthalmology outpatient Department at American International Institute of Medical Sciences, a tertiary care institution, Udaipur, Rajasthan, India between December 2024 to December 2025. The study was undertaken to assess the quality of life among patients diagnosed with glaucoma using a glaucoma-specific quality-of-life instrument. Study Population Adult patients diagnosed with glaucoma and receiving treatment in the Ophthalmology Outpatient Department during the study period were considered eligible for inclusion. Inclusion Criteria • Patients diagnosed with glaucoma attending the Ophthalmology Outpatient Department . • Patients admitted to the Ophthalmology ward for glaucoma management. • Patients of either gender aged 18 years and above. • Patients receiving antiglaucoma drug treatment. • Patients willing to participate in the study. • Patients providing written informed consent. Exclusion Criteria • Patients with uncertain or incomplete diagnosis of glaucoma. • Patients undergoing exclusive surgical or laser treatment without pharmacological therapy. • Patients unable to comprehend or complete the Glau-QoL questionnaire. Sample Size and Sampling Technique A total of 127 patients fulfilling the eligibility criteria were included in the study. Participants were recruited using consecutive sampling during the study period. Data Collection Data were collected using a structured data collection form and patient interviews. Demographic variables including age, gender, educational status, occupation, and monthly income were recorded. Clinical information such as type of glaucoma, duration of disease, treatment regimen, dosing frequency, and monthly treatment cost was obtained from patient records and prescriptions. Assessment of Quality of Life Quality of life was assessed using a 36-item glaucoma-specific questionnaire adapted from the Glau-QoL instrument developed by Béchetoille et al. The questionnaire comprised seven domains: Psychological Well-being, Self-image, Daily Life, Burden of Treatment, Driving, Anxiety, and Confidence in Healthcare. Responses were recorded on a five-point Likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). Domain scores were calculated as the mean of the item scores within each domain. Higher domain scores indicated a greater perceived impact of glaucoma on the respective quality-of-life domain. Statistical Analysis Data were entered and analysed using statistical software. Descriptive statistics were used to summarize demographic and clinical characteristics. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Quality-of-life domain scores were analysed using descriptive statistics. One-way Analysis of Variance (ANOVA) was used to evaluate the association between monthly treatment cost and quality-of-life domains. Independent samples t-test was used to compare quality-of-life scores according to dosing frequency. A p-value of less than 0.05 was considered statistically significant. Ethical Considerations Ethical approval was obtained from the Institutional Ethics Committee (IEC Approval No.: PMU/PMCH/IEC/2024/228). Site permission for data collection was granted by the competent authority at American international institute of medical sciences, Udaipur, to conduct the research and collect data from patients attending the Ophthalmology Outpatient Department. written informed consent was collected from participants. Patient confidentiality and privacy were strictly maintained throughout the study.

A total of 127 patients diagnosed with glaucoma were included in the study.

Demographic Characteristics

The demographic characteristics of the study population are presented in Table 1. Among the participants, 70 (55.1%) were females and 57 (44.9%) were males. Regarding educational status, 44 (34.6%) participants were graduates, 42 (33.1%) had primary education, and 41 (32.3%) had secondary education. The study population comprised participants from urban (36.2%), semi-urban (32.3%), and rural (31.5%) areas. With respect to monthly income, 37 (29.1%) participants reported an income below ₹10,000, followed by 33 (26.0%) in the ₹10,000–30,000 category, 30 (23.6%) in the ₹30,001–50,000 category, and 27 (21.3%) earning more than ₹50,000 per month.

Table 1: Demographic Distribution of Study Population

Females constituted a slightly higher proportion of the study population than males. Participants represented diverse educational, residential, and socioeconomic backgrounds, indicating a heterogeneous study population.

Quality of Life Assessment

Quality of life was assessed using the Glau-QoL questionnaire across seven domains. The domain-wise quality-of-life scores are presented in Table 2.

Table: 2 Domain-wise Quality of Life Scores Among Glaucoma Patients

 The mean scores for psychological well-being, self-image, daily life, burden of treatment, driving, anxiety, and confidence in healthcare were 3.13±0.65, 3.02±0.69, 3.09±0.55, 3.06±0.63, 3.05±0.86, 3.06±0.70, and 3.13±0.74, respectively. Psychological well-being and confidence in healthcare demonstrated the highest mean scores, whereas self-image showed the lowest mean score. Overall, the findings indicate a moderate impact of glaucoma on psychological, functional, and treatment-related aspects of quality of life.

Association Between Monthly Treatment Cost and Quality of Life

The association between monthly treatment cost and quality-of-life domains was evaluated using one-way ANOVA. The results are presented in Table 3.

Table:3 Association Between Monthly Treatment Cost and Quality-of-Life Domains

A statistically significant association was observed between monthly treatment cost and psychological well-being (p=0.012) as well as anxiety (p=0.029). No significant association was observed for self-image, daily life, burden of treatment, driving, or confidence in healthcare (p>0.05). These findings suggest that financial burden may adversely affect the psychological dimensions of quality of life among glaucoma patients.

Association Between Dose Frequency and Quality of Life

The association between dose frequency and quality-of-life domains was assessed using the independent samples t-test. The results are presented in Table 4.

Table: 4  Association Between Dose Frequency and Quality-of-Life Domains

No statistically significant differences were observed between once-daily and twice-daily dosing regimens across any of the quality-of-life domains (p>0.05). This indicates that dosing frequency did not significantly influence patient-reported quality-of-life outcomes in the study population.

Overall, glaucoma demonstrated a moderate impact across multiple quality-of-life domains. Monthly treatment cost was significantly associated with psychological well-being and anxiety, whereas dose frequency showed no significant association with quality-of-life outcomes.

The present study evaluated quality of life among patients with glaucoma using the Glau-QoL questionnaire and examined the influence of treatment-related factors on different quality-of-life domains. The findings demonstrated that glaucoma exerts a moderate impact on multiple dimensions of quality of life, including psychological well-being, self-image, daily life, burden of treatment, driving, anxiety, and confidence in healthcare. The mean scores across all quality-of-life domains ranged from 3.02 to 3.13. Psychological well-being and confidence in healthcare demonstrated the highest mean scores (3.13 each), whereas self-image showed the lowest mean score (3.02), indicating a moderate overall impact of glaucoma on patient-reported outcomes. These findings support the growing recognition that glaucoma influences not only visual function but also broader aspects of physical, emotional, and social well-being.

The psychological well-being and anxiety domains revealed that many patients experienced concerns regarding disease progression, visual loss, and long-term treatment requirements. Psychological distress is a well-recognized consequence of chronic ophthalmic diseases and may significantly affect patient experiences. Quaranta et al [11] reported that emotional stress and fear of blindness are important contributors to reduced quality of life among glaucoma patients, while Sen et al [29] highlighted the influence of treatment burden and disease-related concerns on patient-reported outcomes. The findings of the present study further emphasize the need to address psychological health as an integral component of glaucoma management.

Assessment of daily life activities demonstrated a moderate impact of glaucoma on routine functioning. Patients reported difficulties with reading small print, locating objects, identifying people at a distance, and performing visually demanding tasks. Similar findings were reported by Sherwood et al [26], who demonstrated that visual field loss adversely affects reading, mobility, and driving performance. In addition, McKean-Cowdin et al [27] reported a significant association between visual field impairment and reduced health-related quality of life. These findings suggest that even when visual acuity remains relatively preserved, functional limitations associated with glaucoma may negatively influence daily living and independence.

The burden of treatment domain also demonstrated a moderate effect on quality of life. Long-term use of topical medications, regular administration of eye drops, and adaptation to treatment schedules may contribute to inconvenience and treatment-related stress. Kumar et al [28] reported that ocular surface disease associated with chronic topical therapy significantly reduces quality of life among glaucoma patients. Medication-related discomfort and treatment fatigue may therefore influence patient satisfaction and overall treatment experience, even when adequate intraocular pressure control is achieved.

The present study further evaluated the association between monthly treatment cost and quality-of-life domains. A statistically significant association was observed between treatment cost and both psychological well-being (p = 0.012) and anxiety (p = 0.029). These findings suggest that financial burden may contribute to poorer psychological well-being and increased anxiety among glaucoma patients. Lifelong expenditure on medications, consultations, and follow-up investigations can create additional stress for patients, particularly in resource-limited settings. Similar observations were reported by Sen et al [29] who identified treatment cost and healthcare accessibility as important determinants of quality-of-life outcomes among glaucoma patients.

In contrast, dose frequency did not demonstrate a statistically significant association with any quality-of-life domain. Psychological well-being, self-image, daily life, burden of treatment, driving, anxiety, and confidence in healthcare were comparable between patients receiving once-daily and twice-daily treatment regimens. This finding suggests that patients may adapt to different dosing schedules over time and that quality-of-life outcomes may be influenced more strongly by disease-related factors and treatment tolerability than by dosing frequency alone.

The findings of the present study have important clinical implications. Quality-of-life assessment should be incorporated into routine glaucoma care to facilitate a more comprehensive understanding of patient experiences. Gazzard et al [24] emphasized the importance of patient-reported outcome measures in glaucoma research and clinical practice, highlighting their value in guiding patient-centred care. Previous studies demonstrated that appropriate therapeutic interventions can improve patient-reported outcomes and overall quality of life. The use of validated disease-specific instruments such as the Glau-QoL questionnaire enables clinicians to identify areas of impairment and develop individualized management strategies.

Overall, the findings of the present study indicate that glaucoma management should extend beyond intraocular pressure control and preservation of visual function. A comprehensive approach that addresses psychological well-being, functional limitations, treatment burden, and financial concerns may contribute to improved quality of life and better long-term outcomes among glaucoma patients.

The present study demonstrated that glaucoma has a moderate impact on multiple dimensions of quality of life, including psychological well-being, self-image, daily functioning, treatment burden, driving ability, anxiety, and confidence in healthcare. Among the factors evaluated, monthly treatment cost was significantly associated with psychological well-being and anxiety, indicating the potential influence of financial burden on patient-reported outcomes. In contrast, dose frequency did not show a significant association with any quality-of-life domain. These findings highlight that the impact of glaucoma extends beyond visual impairment and encompasses important psychological, functional, and treatment-related aspects of patient well-being. Therefore, routine assessment of quality of life using validated instruments such as the Glau-QoL questionnaire may facilitate a more comprehensive and patient-centred approach to glaucoma management. Addressing psychological concerns and treatment-related financial burden may contribute to improved patient experiences and overall quality of life. LIMITATIONS This study has certain limitations. The cross-sectional design limits the ability to establish causal relationships between treatment-related factors and quality-of-life outcomes. The study was conducted at a single tertiary care centre, which may limit the generalizability of the findings. In addition, quality-of-life assessment was based on patient-reported responses and may be subject to recall and response bias. Future multicentre longitudinal studies with larger sample sizes are warranted to further explore determinants of quality of life among glaucoma patients.

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