Assessing quality of life in patients with cataract and glaucoma: Insights from north India

India accounts for a significant 23.5% of the global population affected by blindness and visual impairment. The National Blindness and Visual Impairment Survey (2015–2019) identified cataract and glaucoma as the leading causes of blindness.[1] These conditions profoundly impact both physical and mental health, diminishing individuals’ functionality and productivity. Effectively addressing these challenges demands a health system that prioritizes patient needs and adopts a patient-centered approach. In this regard, health-related quality of life (HRQoL) has gained prominence as it quantifies patients’ subjective health perceptions and aligns treatments with factors influencing HRQoL. Therefore, HRQoL measures are indispensable for patients, healthcare practitioners, policymakers, and researchers alike. Despite the importance of HRQoL, there is a notable lack of evidence on its assessment for cataract and glaucoma patients using generic measures. This gap has significant implications. First, it hinders disease-specific economic evaluations for decision-making on resource allocations, as generic HRQoL measures are crucial for calculating quality-adjusted life years (QALYs), a key metric for health technology assessments (HTAs) in India.[2] Second, the absence of robust generic HRQoL estimates hampers the ability to compare HRQoL across different diseases and treatments, given that these tools are designed for cross-condition applicability. Third, although disease-specific tools are more sensitive to HRQoL changes, they are primarily developed for clinical research and face challenges in integration into routine clinical practice due to time and budget constraints.[3] Thus, validated generic HRQoL tools offer a more practical solution for clinical settings. To bridge these gaps, we conducted a descriptive cross-sectional study to evaluate HRQoL and its determinants among patients with glaucoma and cataract. This study was conducted in the outpatient department of a government tertiary institution in northern India from January to June 2024. Trained research assistants conducted face-to-face interviews using a semi-structured instrument, which encompassed socio-demographic details, clinical profiles, and HRQoL assessment using the EQ-5D-5L generic instrument. Our study included 541 participants: 297 with glaucoma and 244 with cataract. The mean EQ-5D-5L utility scores were 0.74 (95% CI: 0.71–0.77) for patients with glaucoma and 0.87 (95% CI: 0.85–0.89) for patients with cataract, respectively. Mobility issues and difficulties in performing usual activities were the most frequently reported problems, highlighting the necessity for healthcare teams to provide psychosocial support to address these issues and enhance HRQoL. Our analysis indicated that visual acuity in the worse eye was significantly associated with HRQoL for both conditions [Table 1]. This underscores the critical importance of early detection and treatment to prevent vision loss and improve HRQoL. Additionally, ongoing treatment for glaucoma was linked to better HRQoL. However, treatment-related side effects negatively affected HRQoL, emphasizing the need for comprehensive follow-up care to manage these effects effectively. This reinforces the necessity of integrated care systems that ensure continuity from early detection through treatment and follow-up.Table 1: Health-related quality of life and its determinants among patients with glaucoma and cataractAnother notable finding was that HRQoL was not significantly impacted by systematic comorbidities, suggesting that these eye disorders reduce self-assessed quality of life, irrespective of other health conditions. This aligns with existing literature and highlights the necessity of targeted interventions for eye disorders within health benefit packages. The Government of India has made strides by including glaucoma- and cataract-related diagnoses and inpatient treatments under the Ayushman Bharat–Pradhan Mantri Jan Aarogya Yojana (AB–PMJAY).[4] Ensuring early detection of these diseases through primary healthcare teams and expanding AB–PMJAY to incorporate ambulatory care for chronic eye disorders like glaucoma could further improve HRQoL at the population level.[4,5] In conclusion, the study highlights the significant reduction in HRQoL among patients with cataract and glaucoma and advocates for policy initiatives that prioritize early detection and effective management of these conditions.