Quality of life and visual function in children with glaucoma in Spain | Archivos de la Sociedad Española de Oftalmología (English Edition)

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Existe una correlación lineal positiva entre el resultado de la encuesta GQL-15 y la agudeza visual del mejor ojo. Tanto los pacientes como sus cuidadores reportaron peores puntaciones en el test de calidad de vida a medida que aumentaba el defecto medio del campo visual." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.N. Moreno, L. Morales Fernández, M. Ruiz Medrano, J.M. Martínez de la Casa, R. Madrigal Sánchez, E. Hernández García, R. Gómez de Liaño, J. García Feijoo" "autores" => array:8 [ 0 => array:2 [ "nombre" => "M.N." "apellidos" => "Moreno" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Morales Fernández" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Ruiz Medrano" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Martínez de la Casa" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Madrigal Sánchez" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "Hernández García" ] 6 => array:2 [ "nombre" => "R." 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Moreno, L. Morales Fernández, M. Ruiz Medrano, J.M. Martínez de la Casa, R. Madrigal Sánchez, E. Hernández García, R. Gómez de Liaño, J. García Feijoo" "autores" => array:8 [ 0 => array:4 [ "nombre" => "M.N." "apellidos" => "Moreno" "email" => array:1 [ 0 => "marianievesmoreno@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Morales Fernández" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Ruiz Medrano" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Martínez de la Casa" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Madrigal Sánchez" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "Hernández García" ] 6 => array:2 [ "nombre" => "R." "apellidos" => "Gómez de Liaño" ] 7 => array:2 [ "nombre" => "J." "apellidos" => "García Feijoo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Glaucoma, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio de la calidad de vida y la función visual en niños con glaucoma en España" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 944 "Ancho" => 1600 "Tamanyo" => 73166 ] ] "descripcion" => array:1 [ "en" => "Linear correlation between visual field and mean defect and GQL-15 test results in children and caregivers. There is a positive linear correlation between the result of GQL-15 and best eye visual acuity. Both patients and caregivers reported worse scores in the quality of life test in correspondence with the increase of visual field mean defect." ] ] ] "textoCompleto" => "IntroductionChildhood glaucoma is an infrequent disease associated to increased intraocular pressure that could potentially lead to blindness.<a class="elsevierStyleCrossRefs" href="#bib0080">1,2</a> The most frequent causes of childhood glaucoma include primary defects in the development of aqueous humor drainage associated to systemic diseases, and glaucoma secondary to congenital cataract surgery. Childhood glaucoma treatment is surgical but frequently patients require topical treatments to maintain intraocular pressure within normal limits.<a class="elsevierStyleCrossRef" href="#bib0080">1</a>Diagnosing glaucoma in a child produces a stressful situation for the family as well as for the patient. Frequently, it involves multiple hospital visits, examinations under anesthesia, surgery and topical treatments which, glaucoma being a chronic disease, must be maintained throughout the entire life of the patient. In addition, childhood glaucoma entails a significant impact in the development of children due to the special support they need at school and to the difficulties they experience in social integration and independence.<a class="elsevierStyleCrossRefs" href="#bib0080">1,3</a>According to the World Health Organization, quality of life is defined as the perception an individual has of his place in existence, in the context of the environmental culture and value system in relation to his expectations, rules and interests. This is a broad concept regulated in various ways by the physical and psychological health of the individual, level of independence, social relationships as well as the relationship with the essential elements in his environment.<a class="elsevierStyleCrossRef" href="#bib0095">4</a>At present, knowledge about the quality of life of children with glaucoma and their family is short. It is important to know the implications on the quality of life as it relates to the visual function in childhood glaucoma, because we must not forget that our interventions will impact the social dynamics of the family. Accordingly, studying said circumstances is a key factor to improve the approach toward glaucoma in children.The main objective of the present study is to evaluate quality of life and subjective visual function of children with glaucoma as well as the quality of life perceived by caregivers. A secondary objective is to research the correlation between quality of life results with different secondary variables such as visual acuity (VA) or the number of eyedrops utilized every day.Material and methodsAn observational and prospective study was designed, selecting 24 patients consecutively diagnosed with glaucoma among patients in follow-up in the glaucoma unit of the San Carlos Clinic Hospital (Madrid, Spain). The study was approved by the Ethics Committee of said hospital in compliance with the guidelines of the Helsinki declaration.The study included patients diagnosed with childhood uni/bilateral primary or secondary glaucoma, with ages comprised between 4 and 16 years. Informed consents were obtained from the parents or legal custodians as well as verbal consent of the patients to participate in the study. The adults that escorted the child filled in the Glaucoma quality of life test (GQL-15) independently, replying the questions therein on the basis of their perception of the child's quality of life. When both parents visited the practice, the replies were agreed between both. Patients with delayed mental development, poor cooperation or no understanding of the questions included in the questionnaires were excluded from the study.Secondly, by means of a personal interview conducted by one of the study researchers, the children were read the questions included in the GQL-15 and Visual functioning (VFQ-25) questionnaires, helping them in their understanding but without inducing responses. In case a question was not understood, it was removed from the final count. The parents were present during the interview but they were not allowed to explain the questions or suggest responses to the children.The following variables of clinic records that could influence the quality of life and visual function of patients were obtained: age at diagnostic, best eye VA, worse eye VA, number of visits in the past 2 years, number of surgeries, and time since last surgery, number of eyedrops instilled daily and mean defect (MD) in the visual field of the best eye.Visual functioning questionnaire 25This visual function questionnaire assesses the impact of the visual diseases on a patient's subjective quality of life perception. It comprises 25 easily understandable questions that evaluate 11 vision-dependent areas and one general health area: general health, ocular pain, near vision activities, far vision activities, social function, mental health, general vision, difficulties at work, dependency, driving, color vision and peripheral vision. Considering the age of the study patients and following questionnaire indications, questions about driving were excluded.The questionnaire numerical values were obtained for calculating the score (higher scores for higher functionality). Subsequently, each item was converted to a scale from 0 to 100, after which the items of each subscale were averaged to develop the 11 subscale scores. When calculating the overall score of the test, the subscale scores were averaged, excluding the score on general health.Glaucoma quality of life questionnaire 15This quality of life questionnaire is specifically designed for studying patients with glaucoma. It comprises 15 questions in which the patient is requested to evaluate his/her skills to carry out daily tasks. The questions subjectively evaluate visual function at 4 levels: central vision, peripheral vision, adaptation to light and darkness and outdoor mobility. The patient is asked to respond on the basis of a scoring scale from 1 to 5, where 1 represents no difficulty, 2 means slight difficulty, 3 indicates some difficulty, 4 means a lot of difficulty and 5 severe difficulty. If some of the activities are not carried out for nonvisual reasons, the respondents are asked to enter 0. The final score of the test was calculated as the sum of the scores of the 15 items.This questionnaire was applied independently to parents as well as patients.Statistical analysisThe results of a descriptive analysis are presented as mean and standard deviation. The differences between the results of the GQL-15 questionnaire of patients and their parents were analyzed with the Wilcoxon test. The correlation between the results of the questionnaires and different variables of clinic records which could affect quality of life were studied by means of linear correlation analysis. A value of p<0.05 was taken as statistically significant. All the statistical analyses were carried out using the SPSS version 15 15 application (SPSS Inc., Chicago, IL, USA).ResultsThe study included 24 patients, although one who did not fill in the questionnaire, leaving a total figure of 23 patients (17 males and 6 females) with a mean age of 9.13±3.08 years at the time of filling in the questionnaire.Twenty of the 23 patients were diagnosed with primary congenital glaucoma, 2 with unilateral compromise. One patient was diagnosed with iridoendothelial syndrome, another one exhibited the Axenfeld Rieger syndrome and a further one was diagnosed with unilateral anterior segment dysgenesis.The results of the GQL-15 questionnaire for children obtained a mean score of 32.30±11.56, while the result of the GQL-15 for parents had a mean score of 37.52±14.59. This difference was statistically significant with p=0.01 (W for Wilcoxon).The linear correlation between different variables and the results of the GQL-15 questionnaire applied to caregivers and children was analyzed. The results are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. <a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a> graphically illustrate the correlation between the VA of the best eye and the MD of the best eye with the results of the GQL-15 questionnaire filled in by children and caregivers.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the results of the VFQ-25 questionnaire filled in by children. When studying the correlation between the various sections of the questionnaire and the studied variables that could affect quality of life, a statistically significant negative correlation was found between the MD of the visual field in the best eye and the score obtained in the following sections: near activities (R=−0.64; p<0.001), far activities (R=−0.53; p=0.01), social function (R=−0.48; p=0.03), dependency (R=−0.54; p=0.03) and peripheral vision (R=−0.47; p=0.04).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>DiscussionChildhood glaucoma management is mainly focused on controlling clinical variables such as intraocular pressure, corneal size measurement and corneal transparency, as well as optic nerve glaucomatous damage.<a class="elsevierStyleCrossRefs" href="#bib0100">5,6</a> However, when assessing the success of childhood glaucoma treatment, the impact caused by the disease on the quality of life of patients and caregivers should also be assessed because the repercussion of the disease on the quality of life of the latter could come to bear on the quality of the care provided to the patient.<a class="elsevierStyleCrossRef" href="#bib0110">7</a>In the present study, parents reported worse quality of life than children, according to results for the GQL-15 survey of 32.30±11.56 for children vs. 37.52±14.59 for caregivers (p=0.001). The parameter that was most closely related to quality of life and visual function was visual field MD for the best eye, with a statistically significant correlation between the result of GQL-15 and visual field MD (children: R=0.63; p<0.01 and caregivers: R=0.81; p<0.001). In addition, a statistically significant negative correlation was found between visual field MD and the score for near activities (R=−0.64; p<0.001), far activities (R=−0.53; p=0.01), social function (R=−0.48; p=0.03), dependency (R=−0.54; p=0.03) and peripheral vision (R=−0.47; p=0.04).Childhood glaucoma patients frequently receive multiple surgical treatments which must be repeated even at an early age and in all cases under general anesthesia. This means that both patient and parents, custodians or caregivers must make a high number of hospital visits which have an influence on the jobs of parents and the school activities of children. This could impact their education, particularly in the first few months after diagnostic and surgery.<a class="elsevierStyleCrossRefs" href="#bib0080">1,7</a> In some occasions, childhood glaucoma is associated to a systemic disease that will require treatment, thus increasing the need for checkups.<a class="elsevierStyleCrossRef" href="#bib0115">8</a>At present, in order to assess the impact of chronic diseases such as pediatric asthma<a class="elsevierStyleCrossRef" href="#bib0120">9</a> or oncological diseases,<a class="elsevierStyleCrossRef" href="#bib0125">10</a> the caregivers are asked to fill in quality of life questionnaire and the financial impact that said diseases can have on family resources as well as the physical stress that could influence the care given to cover the medical as well as physical and social needs of the children.<a class="elsevierStyleCrossRef" href="#bib0130">11</a>Caregivers of children with primary congenital glaucoma bear a significant emotional and psychological burden. In one third of cases, studies report moderate or severe depression according to a questionnaire analyzing the emotional and psychological burden on caregivers.<a class="elsevierStyleCrossRef" href="#bib0135">12</a> Gothwal et al.<a class="elsevierStyleCrossRef" href="#bib0110">7</a> developed a questionnaire on the quality of life of caregivers of children with primary congenital glaucoma after surgery in order to assess their quality of life, reporting on the problems they faced in daily life. Said authors analyzed the results of a cohort of 119 caregivers consecutively selected with 93% participation rate.<a class="elsevierStyleCrossRef" href="#bib0140">13</a> The mean age of caregivers was 25.3 years and, in 95% of cases, the survey was replied by the patient's mother. In the group of patients, 24% exhibited unilateral glaucoma against 76% of bilateral cases. Caregivers or parents filled in the questionnaire prior to surgery of the child and 6 weeks later. The results demonstrated an association between improved quality of life of caregivers and surgery: quality of life improved 6–8 weeks after the operation.Other 3 publications by Zhang et al.,<a class="elsevierStyleCrossRef" href="#bib0145">14</a> Freedman et al.<a class="elsevierStyleCrossRef" href="#bib0150">15</a> and Gothwal et al.<a class="elsevierStyleCrossRef" href="#bib0140">13</a> utilized validated tools to explore the quality of life in children with glaucoma and their caregivers. According to the results of these studies, children with glaucoma refer lower scores in quality of life tests related to vision when compared to healthy children. And as with the results of the present study, said authors observed that better VA is associated to better vision-related quality of life.Recently, Dahlmann-Noor et al.<a class="elsevierStyleCrossRef" href="#bib0115">8</a> published a study on health-related quality of life, vision-related quality of life and VA-dependent social skills in children with glaucoma. According to the Pediatric quality of life inventory questionnaire, scores referring to psychosocial areas were lower than those referring to physical areas. Children with higher ages reported less impairment in the Cardiff visual ability questionnaire for children, Impact of vision impairment for children and Pediatric quality of life inventory questionnaire when compared to children with less age. In turn and as in the present study, parents/caregivers reported higher impact on the quality of life related to the health of the children than the impact reported by the children. The results of said study evidence a significant impact of childhood glaucoma on visual function and quality of life perceived by the patient as well as by caregivers. The results of said study evidence that the VA of the best eye is crucial for quality of life when compared to the rest of the factors, as demonstrated in the present study as well.The limitations of the present study include the difficulty for comparing results due to the shortage of published data on the impact of glaucoma on children and their families. It is difficult to measure the visual capacity of a child, his quality of life and the subjective impression perceived related to basic aspects of life. The present series comprises a small number of cases, and the validation of the tests applied to children was not carried out in the authors’ environment. It should also be pointed out that the present study has not carried out a reproducibility analysis in the children or caregivers, and that it did not include a control group of healthy children for comparative purposes.Childhood glaucoma comprises a range of diseases such as amblyopia and refractive defects, dry eye, corneal and lens opacity as well as ocular motility alterations. And even though these diseases could have a significant impact on the quality of life of these patients, they have not been analyzed in the present study. The authors considered that new studies including said factors would be of great interest.In accordance to the results of the present study, it can be concluded that glaucoma and its management entail a significant impact on the quality of life and visual function of children, despite the fact that the quality of life perceived by caregivers is worse than that perceived by the patients. In any case, studies with higher numbers of patients are necessary to confirm the present results.Conflict of interestsThe authors have not received financial support and have no commercial interests." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1157242" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1084464" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1157241" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1084463" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Visual functioning questionnaire 25" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Glaucoma quality of life questionnaire 15" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-05-14" "fechaAceptado" => "2018-09-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1084464" "palabras" => array:3 [ 0 => "Childhood glaucoma" 1 => "Quality of life" 2 => "Visual function" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1084463" "palabras" => array:3 [ 0 => "Glaucoma de la infancia" 1 => "Calidad de vida" 2 => "Función visual" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo evaluate the effect of glaucoma on visual function, as well as quality of life in children and quality of life perceived by caregivers in children up to 16 years of age. Material and methodsAn observational and prospective study was designed using the questionnaire GQL-15 (Glaucoma Quality of Life) and conducted on children and caregivers. The questionnaire VFQ-25 (Visual Functioning Questionnaire) was conducted on children. Different variables of the clinical history that could influence the quality of life and visual function were recorded. ResultsThe study included 24 patients with a mean age of 9.13±3.08 years, and included 3 with unilateral involvement, and 20 diagnosed with primary congenital glaucoma. Parents reported a worse quality of life than children. The result of the GQL-15 survey was 32.3±11.56 points in children and 37.52±14.59 points in caregivers (p=0.001). The parameter most related to quality of life and visual function was the mean deviation (MD) of the visual field in the best eye. A statistically significant correlation was found between the result of GQL-15 and the mean deviation of the visual field (children: R=0.63, p<0.01, caregivers: R=0.81, p<0.001). ConclusionsFunctional loss has an impact on the quality of life and visual function in children with glaucoma, although the quality of life perceived by the caregivers is worse than that perceived by the child." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoEvaluar el efecto del glaucoma en la función visual, la calidad de vida en los niños y la calidad de vida percibida por los cuidadores en niños de hasta 16 años. Material y métodosSe diseñó un estudio observacional y prospectivo. Se aplicó el cuestionario GQL-15 (Glaucoma Quality of Life) a los niños y a los cuidadores, y el cuestionario VFQ-25 (Visual Functioning Questionnarie) a los niños. Se registraron diferentes variables de la historia clínica que podrían influir en la calidad de vida y la función visual. ResultadosSe incluyó a un total de 24 pacientes con una edad media de 9,13±3,08 años, de los cuales 3 tenían afectación unilateral y 20 presentaban glaucoma congénito primario. Los padres reportaron una peor calidad de vida que los niños: el resultado de la encuesta GQL-15 fue de 32,30±11,56 puntos en los niños y de 37,52±14,59 puntos en los cuidadores (p=0,001). El parámetro que más se relacionó con la calidad de vida y la función visual fue el defecto medio del campo visual en el mejor ojo. Se encontró una correlación estadísticamente significativa entre el resultado de GQL-15 y el defecto medio del campo visual (niños: R=0,63; p<0,01 y cuidadores: R=0,81; p<0,001). ConclusionesEl daño funcional visual producido por el glaucoma tiene un impacto importante en la calidad de vida y en la función visual de los niños con glaucoma, si bien la calidad de vida percibida por los cuidadores es peor que la percibida por el niño." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Moreno MN, Morales Fernández L, Ruiz Medrano M, Martínez de la Casa JM, Madrigal Sánchez R, Hernández García E, et al. Estudio de la calidad de vida y la función visual en niños con glaucoma en España. Arch Soc Esp Oftalmol. 2019;94:119–124." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 948 "Ancho" => 1608 "Tamanyo" => 75534 ] ] "descripcion" => array:1 [ "en" => "Linear correlation between visual acuity of the best eye and the GQL-15 test results in children and caregivers. There is a negative linear correlation between the result of the GQL-15 and the visual acuity of the best eye. Both patients and caregivers reported worse scores in the quality of life test in correspondence with the worsening of the best eye visual acuity." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 944 "Ancho" => 1600 "Tamanyo" => 73166 ] ] "descripcion" => array:1 [ "en" => "Linear correlation between visual field and mean defect and GQL-15 test results in children and caregivers. There is a positive linear correlation between the result of GQL-15 and best eye visual acuity. Both patients and caregivers reported worse scores in the quality of life test in correspondence with the increase of visual field mean defect." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col">Mean (standard deviation) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">GQL-15 child</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">GQL-15 caregiver</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">R \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">R \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Current age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.13 (3.08) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VA best eye \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.64 (0.34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VA worse eye \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.28 (0.32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age at diagnostic (months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.14 (18.58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.63 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"># of visits in pasta 2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.65 (3.17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.84 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"># of surgeries \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.77 (2.52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.08 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Months since last Qx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.70 (39.24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.56 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"># of eyedrops \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.57 (2.46) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Best MD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.67 (7.26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1975941.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Linear correlation analysis between different variables of patient clinic records and GQL-15 results in children and caregivers." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VFQ-25 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Standard deviation \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">General health \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">General vision \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ocular pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Near activities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Far activities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.71 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Social performance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.88 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mental health \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.56 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Difficulties at work \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dependence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; 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Quality of life and visual function in children with glaucoma in Spain

Estudio de la calidad de vida y la función visual en niños con glaucoma en España

M.N. Moreno

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marianievesmoreno@gmail.com

Corresponding author.

, L. Morales Fernández, M. Ruiz Medrano, J.M. Martínez de la Casa, R. Madrigal Sánchez, E. Hernández García, R. Gómez de Liaño, J. García Feijoo

Unidad de Glaucoma, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Childhood glaucoma is an infrequent disease associated to increased intraocular pressure that could potentially lead to blindness&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;2</span></a> The most frequent causes of childhood glaucoma include primary defects in the development of aqueous humor drainage associated to systemic diseases&#44; and glaucoma secondary to congenital cataract surgery&#46; Childhood glaucoma treatment is surgical but frequently patients require topical treatments to maintain intraocular pressure within normal limits&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Diagnosing glaucoma in a child produces a stressful situation for the family as well as for the patient&#46; Frequently&#44; it involves multiple hospital visits&#44; examinations under anesthesia&#44; surgery and topical treatments which&#44; glaucoma being a chronic disease&#44; must be maintained throughout the entire life of the patient&#46; In addition&#44; childhood glaucoma entails a significant impact in the development of children due to the special support they need at school and to the difficulties they experience in social integration and independence&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">According to the World Health Organization&#44; quality of life is defined as the perception an individual has of his place in existence&#44; in the context of the environmental culture and value system in relation to his expectations&#44; rules and interests&#46; This is a broad concept regulated in various ways by the physical and psychological health of the individual&#44; level of independence&#44; social relationships as well as the relationship with the essential elements in his environment&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">At present&#44; knowledge about the quality of life of children with glaucoma and their family is short&#46; It is important to know the implications on the quality of life as it relates to the visual function in childhood glaucoma&#44; because we must not forget that our interventions will impact the social dynamics of the family&#46; Accordingly&#44; studying said circumstances is a key factor to improve the approach toward glaucoma in children&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The main objective of the present study is to evaluate quality of life and subjective visual function of children with glaucoma as well as the quality of life perceived by caregivers&#46; A secondary objective is to research the correlation between quality of life results with different secondary variables such as visual acuity &#40;VA&#41; or the number of eyedrops utilized every day&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">An observational and prospective study was designed&#44; selecting 24 patients consecutively diagnosed with glaucoma among patients in follow-up in the glaucoma unit of the San Carlos Clinic Hospital &#40;Madrid&#44; Spain&#41;&#46; The study was approved by the Ethics Committee of said hospital in compliance with the guidelines of the Helsinki declaration&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The study included patients diagnosed with childhood uni&#47;bilateral primary or secondary glaucoma&#44; with ages comprised between 4 and 16 years&#46; Informed consents were obtained from the parents or legal custodians as well as verbal consent of the patients to participate in the study&#46; The adults that escorted the child filled in the <span class="elsevierStyleItalic">Glaucoma quality of life</span> test &#40;GQL-15&#41; independently&#44; replying the questions therein on the basis of their perception of the child&#39;s quality of life&#46; When both parents visited the practice&#44; the replies were agreed between both&#46; Patients with delayed mental development&#44; poor cooperation or no understanding of the questions included in the questionnaires were excluded from the study&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Secondly&#44; by means of a personal interview conducted by one of the study researchers&#44; the children were read the questions included in the GQL-15 and <span class="elsevierStyleItalic">Visual functioning</span> &#40;VFQ-25&#41; questionnaires&#44; helping them in their understanding but without inducing responses&#46; In case a question was not understood&#44; it was removed from the final count&#46; The parents were present during the interview but they were not allowed to explain the questions or suggest responses to the children&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The following variables of clinic records that could influence the quality of life and visual function of patients were obtained&#58; age at diagnostic&#44; best eye VA&#44; worse eye VA&#44; number of visits in the past 2 years&#44; number of surgeries&#44; and time since last surgery&#44; number of eyedrops instilled daily and mean defect &#40;MD&#41; in the visual field of the best eye&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Visual functioning questionnaire 25</span><p id="par0050" class="elsevierStylePara elsevierViewall">This visual function questionnaire assesses the impact of the visual diseases on a patient&#39;s subjective quality of life perception&#46; It comprises 25 easily understandable questions that evaluate 11 vision-dependent areas and one general health area&#58; general health&#44; ocular pain&#44; near vision activities&#44; far vision activities&#44; social function&#44; mental health&#44; general vision&#44; difficulties at work&#44; dependency&#44; driving&#44; color vision and peripheral vision&#46; Considering the age of the study patients and following questionnaire indications&#44; questions about driving were excluded&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The questionnaire numerical values were obtained for calculating the score &#40;higher scores for higher functionality&#41;&#46; Subsequently&#44; each item was converted to a scale from 0 to 100&#44; after which the items of each subscale were averaged to develop the 11 subscale scores&#46; When calculating the overall score of the test&#44; the subscale scores were averaged&#44; excluding the score on general health&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Glaucoma quality of life questionnaire 15</span><p id="par0060" class="elsevierStylePara elsevierViewall">This quality of life questionnaire is specifically designed for studying patients with glaucoma&#46; It comprises 15 questions in which the patient is requested to evaluate his&#47;her skills to carry out daily tasks&#46; The questions subjectively evaluate visual function at 4 levels&#58; central vision&#44; peripheral vision&#44; adaptation to light and darkness and outdoor mobility&#46; The patient is asked to respond on the basis of a scoring scale from 1 to 5&#44; where 1 represents no difficulty&#44; 2 means slight difficulty&#44; 3 indicates some difficulty&#44; 4 means a lot of difficulty and 5 severe difficulty&#46; If some of the activities are not carried out for nonvisual reasons&#44; the respondents are asked to enter 0&#46; The final score of the test was calculated as the sum of the scores of the 15 items&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">This questionnaire was applied independently to parents as well as patients&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">The results of a descriptive analysis are presented as mean and standard deviation&#46; The differences between the results of the GQL-15 questionnaire of patients and their parents were analyzed with the Wilcoxon test&#46; 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2 with unilateral compromise&#46; One patient was diagnosed with iridoendothelial syndrome&#44; another one exhibited the Axenfeld Rieger syndrome and a further one was diagnosed with unilateral anterior segment dysgenesis&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The results of the GQL-15 questionnaire for children obtained a mean score of 32&#46;30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;56&#44; while the result of the GQL-15 for parents had a mean score of 37&#46;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;59&#46; This difference was statistically significant with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01 &#40;<span class="elsevierStyleItalic">W</span> for Wilcoxon&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The linear correlation between different variables and the results of the GQL-15 questionnaire applied to caregivers and children was analyzed&#46; The results are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; <a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a> graphically illustrate the correlation between the VA of the best eye and the MD of the best eye with the results of the GQL-15 questionnaire filled in by children and caregivers&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the results of the VFQ-25 questionnaire filled in by children&#46; When studying the correlation between the various sections of the questionnaire and the studied variables that could affect quality of life&#44; a statistically significant negative correlation was found between the MD of the visual field in the best eye and the score obtained in the following sections&#58; near activities &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;64&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; far activities &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;53&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; social function &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;48&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#44; dependency &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;54&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41; and peripheral vision &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;47&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Childhood glaucoma management is mainly focused on controlling clinical variables such as intraocular pressure&#44; corneal size measurement and corneal transparency&#44; as well as optic nerve glaucomatous damage&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5&#44;6</span></a> However&#44; when assessing the success of childhood glaucoma treatment&#44; the impact caused by the disease on the quality of life of patients and caregivers should also be assessed because the repercussion of the disease on the quality of life of the latter could come to bear on the quality of the care provided to the patient&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In the present study&#44; parents reported worse quality of life than children&#44; according to results for the GQL-15 survey of 32&#46;30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;56 for children vs&#46; 37&#46;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;59 for caregivers &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The parameter that was most closely related to quality of life and visual function was visual field MD for the best eye&#44; with a statistically significant correlation between the result of GQL-15 and visual field MD &#40;children&#58; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;63&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01 and caregivers&#58; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;81&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; In addition&#44; a statistically significant negative correlation was found between visual field MD and the score for near activities &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;64&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; far activities &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;53&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; social function &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;48&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#44; dependency &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;54&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41; and peripheral vision &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;47&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Childhood glaucoma patients frequently receive multiple surgical treatments which must be repeated even at an early age and in all cases under general anesthesia&#46; This means that both patient and parents&#44; custodians or caregivers must make a high number of hospital visits which have an influence on the jobs of parents and the school activities of children&#46; This could impact their education&#44; particularly in the first few months after diagnostic and surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;7</span></a> In some occasions&#44; childhood glaucoma is associated to a systemic disease that will require treatment&#44; thus increasing the need for checkups&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">At present&#44; in order to assess the impact of chronic diseases such as pediatric asthma<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> or oncological diseases&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> the caregivers are asked to fill in quality of life questionnaire and the financial impact that said diseases can have on family resources as well as the physical stress that could influence the care given to cover the medical as well as physical and social needs of the children&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Caregivers of children with primary congenital glaucoma bear a significant emotional and psychological burden&#46; In one third of cases&#44; studies report moderate or severe depression according to a questionnaire analyzing the emotional and psychological burden on caregivers&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> Gothwal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> developed a questionnaire on the quality of life of caregivers of children with primary congenital glaucoma after surgery in order to assess their quality of life&#44; reporting on the problems they faced in daily life&#46; Said authors analyzed the results of a cohort of 119 caregivers consecutively selected with 93&#37; participation rate&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> The mean age of caregivers was 25&#46;3 years and&#44; in 95&#37; of cases&#44; the survey was replied by the patient&#39;s mother&#46; In the group of patients&#44; 24&#37; exhibited unilateral glaucoma against 76&#37; of bilateral cases&#46; Caregivers or parents filled in the questionnaire prior to surgery of the child and 6 weeks later&#46; The results demonstrated an association between improved quality of life of caregivers and surgery&#58; quality of life improved 6&#8211;8 weeks after the operation&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Other 3 publications by Zhang et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> Freedman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> and Gothwal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> utilized validated tools to explore the quality of life in children with glaucoma and their caregivers&#46; According to the results of these studies&#44; children with glaucoma refer lower scores in quality of life tests related to vision when compared to healthy children&#46; And as with the results of the present study&#44; said authors observed that better VA is associated to better vision-related quality of life&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Recently&#44; Dahlmann-Noor et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> published a study on health-related quality of life&#44; vision-related quality of life and VA-dependent social skills in children with glaucoma&#46; According to the <span class="elsevierStyleItalic">Pediatric quality of life inventory</span> questionnaire&#44; scores referring to psychosocial areas were lower than those referring to physical areas&#46; Children with higher ages reported less impairment in the <span class="elsevierStyleItalic">Cardiff visual ability questionnaire for children</span>&#44; <span class="elsevierStyleItalic">Impact of vision impairment for children</span> and <span class="elsevierStyleItalic">Pediatric quality of life inventory</span> questionnaire when compared to children with less age&#46; In turn and as in the present study&#44; parents&#47;caregivers reported higher impact on the quality of life related to the health of the children than the impact reported by the children&#46; The results of said study evidence a significant impact of childhood glaucoma on visual function and quality of life perceived by the patient as well as by caregivers&#46; The results of said study evidence that the VA of the best eye is crucial for quality of life when compared to the rest of the factors&#44; as demonstrated in the present study as well&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The limitations of the present study include the difficulty for comparing results due to the shortage of published data on the impact of glaucoma on children and their families&#46; It is difficult to measure the visual capacity of a child&#44; his quality of life and the subjective impression perceived related to basic aspects of life&#46; The present series comprises a small number of cases&#44; and the validation of the tests applied to children was not carried out in the authors&#8217; environment&#46; It should also be pointed out that the present study has not carried out a reproducibility analysis in the children or caregivers&#44; and that it did not include a control group of healthy children for comparative purposes&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Childhood glaucoma comprises a range of diseases such as amblyopia and refractive defects&#44; dry eye&#44; corneal and lens opacity as well as ocular motility alterations&#46; And even though these diseases could have a significant impact on the quality of life of these patients&#44; they have not been analyzed in the present study&#46; The authors considered that new studies including said factors would be of great interest&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In accordance to the results of the present study&#44; it can be concluded that glaucoma and its management entail a significant impact on the quality of life and visual function of children&#44; despite the fact that the quality of life perceived by caregivers is worse than that perceived by the patients&#46; In any case&#44; studies with higher numbers of patients are necessary to confirm the present results&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interests</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors have not received financial support and have no commercial interests&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the effect of glaucoma on visual function&#44; as well as quality of life in children and quality of life perceived by caregivers in children up to 16 years of age&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An observational and prospective study was designed using the questionnaire GQL-15 &#40;Glaucoma Quality of Life&#41; and conducted on children and caregivers&#46; The questionnaire VFQ-25 &#40;Visual Functioning Questionnaire&#41; was conducted on children&#46; Different variables of the clinical history that could influence the quality of life and visual function were recorded&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The study included 24 patients with a mean age of 9&#46;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;08 years&#44; and included 3 with unilateral involvement&#44; and 20 diagnosed with primary congenital glaucoma&#46; Parents reported a worse quality of life than children&#46; The result of the GQL-15 survey was 32&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;56 points in children and 37&#46;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;59 points in caregivers &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The parameter most related to quality of life and visual function was the mean deviation &#40;MD&#41; of the visual field in the best eye&#46; A statistically significant correlation was found between the result of GQL-15 and the mean deviation of the visual field &#40;children&#58; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;63&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#44; caregivers&#58; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;81&#44; <span class="elsevierStyleItalic">p</span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Functional loss has an impact on the quality of life and visual function in children with glaucoma&#44; although the quality of life perceived by the caregivers is worse than that perceived by the child&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar el efecto del glaucoma en la funci&#243;n visual&#44; la calidad de vida en los ni&#241;os y la calidad de vida percibida por los cuidadores en ni&#241;os de hasta 16 a&#241;os&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se dise&#241;&#243; un estudio observacional y prospectivo&#46; Se aplic&#243; el cuestionario GQL-15 &#40;Glaucoma Quality of Life&#41; a los ni&#241;os y a los cuidadores&#44; y el cuestionario VFQ-25 &#40;Visual Functioning Questionnarie&#41; a los ni&#241;os&#46; Se registraron diferentes variables de la historia cl&#237;nica que podr&#237;an influir en la calidad de vida y la funci&#243;n visual&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a un total de 24 pacientes con una edad media de 9&#44;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;08 a&#241;os&#44; de los cuales 3 ten&#237;an afectaci&#243;n unilateral y 20 presentaban glaucoma cong&#233;nito primario&#46; Los padres reportaron una peor calidad de vida que los ni&#241;os&#58; el resultado de la encuesta GQL-15 fue de 32&#44;30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;56 puntos en los ni&#241;os y de 37&#44;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;59 puntos en los cuidadores &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; El par&#225;metro que m&#225;s se relacion&#243; con la calidad de vida y la funci&#243;n visual fue el defecto medio del campo visual en el mejor ojo&#46; Se encontr&#243; una correlaci&#243;n estad&#237;sticamente significativa entre el resultado de GQL-15 y el defecto medio del campo visual &#40;ni&#241;os&#58; R<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;63&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01 y cuidadores&#58; R<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;81&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El da&#241;o funcional visual producido por el glaucoma tiene un impacto importante en la calidad de vida y en la funci&#243;n visual de los ni&#241;os con glaucoma&#44; si bien la calidad de vida percibida por los cuidadores es peor que la percibida por el ni&#241;o&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Moreno MN&#44; Morales Fern&#225;ndez L&#44; Ruiz Medrano M&#44; Mart&#237;nez de la Casa JM&#44; Madrigal S&#225;nchez R&#44; Hern&#225;ndez Garc&#237;a E&#44; et al&#46; Estudio de la calidad de vida y la funci&#243;n visual en ni&#241;os con glaucoma en Espa&#241;a&#46; Arch Soc Esp Oftalmol&#46; 2019&#59;94&#58;119&#8211;124&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Linear correlation between visual acuity of the best eye and the GQL-15 test results in children and caregivers&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">There is a negative linear correlation between the result of the GQL-15 and the visual acuity of the best eye&#46; Both patients and caregivers reported worse scores in the quality of life test in correspondence with the worsening of the best eye visual acuity&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Linear correlation between visual field and mean defect and GQL-15 test results in children and caregivers&#46; There is a positive linear correlation between the result of GQL-15 and best eye visual acuity&#46; Both patients and caregivers reported worse scores in the quality of life test in correspondence with the increase of visual field mean defect&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col">Mean &#40;standard deviation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">GQL-15 child</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">GQL-15 caregiver</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">R</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">R</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Current age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;13 &#40;3&#46;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VA best eye&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;64 &#40;0&#46;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VA worse eye&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;28 &#40;0&#46;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age at diagnostic &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;14 &#40;18&#46;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#35; of visits in pasta 2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;65 &#40;3&#46;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#35; of surgeries&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;77 &#40;2&#46;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Months since last Qx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#46;70 &#40;39&#46;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#35; of eyedrops&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;57 &#40;2&#46;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Best MD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;67 &#40;7&#46;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VFQ-25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">General health&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">General vision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ocular pain&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Near activities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Far activities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Social performance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mental health&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Difficulties at work&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dependence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chromatic vision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peripheral vision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Results for each VFQ-25 domain of children&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
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            0 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The British Infantile and childhood Glaucoma &#40;BIG&#41; Eye Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Papadopoulos"
                            1 => "N&#46; Cable"
                            2 => "J&#46; Rahi"
                            3 => "P&#46;T&#46; Khaw"
                            4 => "BIG Eye Study Investigators"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1167/iovs.06-1350"
                      "Revista" => array:6 [
                        "tituloSerie" => "Invest Ophthalmol Vis Sci"
                        "fecha" => "2007"
                        "volumen" => "48"
                        "paginaInicial" => "4100"
                        "paginaFinal" => "4106"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17724193"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                ]
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              "identificador" => "bib0085"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence and clinical characteristics of childhood glaucoma&#58; a population-based study"
                      "autores" => array:1 [
                        0 => array:2 [
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