Evaluating measurement properties of Patient Reported Outcome Measures (PROMs) in glaucoma: a systematic review.

TOPIC: The purpose of the current study was to systematically identify and evaluate existing Patient-Reported Outcome Measures (PROMs) for clinical glaucoma practice. CLINICAL RELEVANCE: Understanding and incorporating patient preferences into decision-making is now recognized as critical for optimal resource allocation, especially in technologically advancing areas such as minimally invasive surgeries. PROMs are instruments designed to evaluate the health outcomes that are most important to patients. Despite their recognized importance, especially in the era of patient-centred care, their routine use in clinical settings remains low. METHODS: Systematic literature search was conducted in 6 databases (EMBASE, MEDLINE, PsycINFO, Scopus, BIOSIS, WebOfScience) from the date of inception. Studies were included in the qualitative review if they reported measurement properties of PROMs in adult glaucoma patients. Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines were used to assess included PROMs. The study protocol is registered with PROSPERO (registration number CRD42020176064). RESULTS: The literature search yielded 2,661 records. After deduplication, 1,259 studies entered level 1 screening, and based on title and abstract review, 164 records proceeded to full-text screening. In 48 included studies, 70 instrument reports discuss 43 distinct instruments in 3 major categories: glaucoma-specific, vision-specific, and general health-related quality of life. Most used measures were glaucoma-specific: Glaucoma Quality of Life (GQL) and Glaucoma Symptom Scale (GSS); and vision-specific: National Eye Institute Visual Function Questionnaire (NEI VFQ-25). All three have sufficient validity (especially construct), with GQL and GSS having sufficient internal consistency, cross-cultural validity, and reliability, with reports suggesting high methodological quality. CONCLUSION: GQL, GSS, and NEI VFQ-25 are the 3 most used questionnaires in a research setting, having considerable validation in a glaucoma patient population. Limited reports on interpretability, responsiveness, and feasibility in all 43 identified instruments make identifying a single optimal questionnaire for clinical use challenging and highlight the need for further studies.