Delhi: A recent study conducted by the All India Institute of Medical Sciences (AIIMS), Jodhpur, has shown that patients with moderate to advanced glaucoma experience a marked improvement in their quality of life (QoL) following trabeculectomy, compared to those managed solely with prolonged medical therapy.
Glaucoma, a chronic and progressive eye disorder for which no definitive cure exists, imposes a profound physical, emotional and economic burden on patients. As visual function declines, individuals often struggle with routine activities, leading to growing dependence on family members or caregivers. The lifelong nature of treatment, coupled with persistent medication use, frequently results in psychological distress, anxiety and depression, while also placing sustained financial pressure on households.
The disease is characterised by gradual and irreversible damage to the optic nerve at the back of the eye, ultimately resulting in permanent blindness if left unchecked. Although glaucoma is commonly associated with elevated intraocular pressure (IOP), vision loss can also occur in patients with normal pressure, making early detection and effective control critical.
Evidence from large, population-based longitudinal studies further highlights the gravity of the condition. Patients with glaucoma-related visual impairment have been shown to face a higher risk of premature mortality, with major contributors including metabolic, cardiovascular and respiratory illnesses, as well as suicide-related causes—underscoring the urgent need for strategies that prevent or slow vision loss.
The prospective study from AIIMS, Jodhpur, carried out between October 2022 and December 2023 at the institute’s Department of Ophthalmology, evaluated 46 patients involving 54 eyes who underwent trabeculectomy after failing to achieve target IOP despite receiving maximum tolerated medical therapy. The findings have been published in the Indian Journal of Medical Research (IJMR).
At the time of enrolment, most participants were using three or more topical anti-glaucoma medications, and several also required systemic drugs to control eye pressure. Following surgery, the average number of topical medications dropped dramatically from 2.57 to 0.35, with none of the patients requiring systemic treatment thereafter. This substantial reduction in medication burden, lead author Dr. Kirti Jaisingh noted, likely played a key role in improving patients’ quality-of-life scores.
Trabeculectomy also achieved a sustained and clinically meaningful reduction in IOP, with average pressure levels declining from 18.9 mmHg at baseline to nearly 12 mmHg at six months, while visual acuity remained largely unchanged—an important consideration in assessing treatment success.
Across disease severity categories—mild, moderate and severe—patients who underwent surgical intervention recorded significantly lower GQL-15 scores than those managed medically, reflecting better perceived quality of life. Notably, individuals with severe glaucoma, who began with the poorest QoL scores, demonstrated the most substantial post-surgical improvement.
The study documented statistically significant gains in several key functional domains, including peripheral vision, adaptation to low-light conditions, sensitivity to glare and outdoor mobility, all of which are crucial for independent living and daily functioning.
Previous research comparing surgical and medical management of glaucoma has yielded mixed results with regard to quality-of-life outcomes. However, the AIIMS team addressed potential bias by evaluating the same group of patients before and after surgery, offering a clearer and more reliable assessment of trabeculectomy’s impact.
Co-author Dr. Kavita R. Bhatnagar emphasised that trabeculectomy can lead to meaningful improvements in quality of life for patients with moderate to severe glaucoma by reducing dependence on multiple medications, easing ocular surface discomfort and providing more consistent IOP control. The authors also stressed the importance of incorporating quality-of-life measures into routine clinical decision-making, particularly in resource-limited settings, where long-term adherence to complex drug regimens can be challenging.
The research team included Dr. Tapasya Rajpurohit, Dr. Jyoti Shakrawal, Dr. Seema Meena, Dr. Nikhil Agrawal and Dr. Manogya Jain, all from AIIMS, Jodhpur.
Glaucoma encompasses a group of eye disorders that damage the optic nerve, most commonly due to elevated intraocular pressure, leading to progressive loss of peripheral vision and eventual blindness if untreated. While vision already lost cannot be restored, early diagnosis through comprehensive eye examinations and timely intervention can slow disease progression and preserve remaining sight. Regular screening is advised for individuals at higher risk, including those over 40 years of age, people with a family history of glaucoma, certain ethnic groups and individuals with diabetes.
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