Glaucoma: qualidade de vida e plano de ação educativa em saúde

Abstract

Glaucoma is defined as a progressive, chronic optic neuropathy characterized by typical alterations of the optic disc and retinal nerve fiber layer, with characteristic repercussions in the visual field. There are about 60 million glaucomatous in the world. Annually, there are 2.4 million cases and the estimate for 2020 is 80 million glaucomatous people. Glaucoma impairs quality of life (QOL) for several reasons: loss of visual function; difficulty in the daily routine of treatment; side effects and cost of treatment; anxiety and fear linked to the diagnosis of a chronic disease that threatens vision. This dissertation aimed to analyze the QOL according to the intensity of the visual field impairment between glaucomatous and to present an experience report of educational actions elaborated for this public. Two research methods were used: transversal analysis and experience report. Both are conducted in a specialized ophthalmology unit, Glaucoma Project, based in Montes Claros, Minas Gerais, Brazil and will be presented individually, due to their particularities. In the cross-sectional analytical study, QOL was measured by the National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25). The Mean Deviation (MD) parameter of the best eye was used to classify visual field defects in mild, moderate and severe. 400 patients participated, 60.5% female. The participants' ages ranged from 19 to 80 years, most of them over 60 years old (55.8%) and had an early visual field defect, regardless of whether they came from the public or private sector. The mean QOL score was 77.62 (± 18.00) points. The subdomain with worse mean was 'ocular pain' (53.06 ± 26.08) and with better mean was 'color vision' (94.13 ± 19.20). A negative linear correlation was observed between the QOL scores and the MD of the visual field, both the right and left eye. Among the sub-domains of QoL, 'dependence' explained the variation of visual field defect better, being the factor determining this variation in 7.2% for MD-OD and 8.4% for MD-OE. The findings show that visual field loss negatively impacts the QOL of glaucomatous. Therefore, it is recommended to provide early diagnosis to favor treatment and delay the progression of the disease. For the experience report, an educative health action plan was elaborated for the conduction of two meetings structured from the Freirean dialogical perspective and in compliance with the guidelines and principles of the National Humanization Policy. 25 glaucomatous subjects participated in the educational activity. The contents worked were concept, risk factors, clinical picture and treatment of glaucoma. Different educational resources were used, such as figures, macromodels, paper cones, group dynamics and conversation wheels. Educational activities help to build knowledge about the disease, which can positively impact adherence to treatment and improve self-care to prevent glaucoma-related illnesses. It is considered that the conduction of educational activities represents an important initiative in specialized sectors, whether public or private, to allow the empowerment of the subjects, health literacy and coresponsibility in health care.