We read with interest the study by Hall et al1 on health-related quality of life (HRQOL) in patients with benign essential blepharospasm (BEB) and hemifacial spasm (HFS). Hall and colleagues demonstrated that those with BEB experienced a greater reduction in a vision-targeted HRQOL and greater anxiety and depressive symptoms compared with patients with HFS.1 Their choice of HFS as a comparison group rather than healthy controls or controls with non-eye-related disease raises the question of whether their findings could be solely explained by the hypothesis that unilateral symptoms in HFS are better tolerated than the bilateral symptoms in BEB. Instead, the poorer HRQOL in BEB could reflect a referral bias to ophthalmology centers, as ophthalmologists may be seeing the more severe BEB cases compared with HFS. Although eyelid closure is the most common initial manifestation in HFS, the condition almost always involves the lower facial muscles, and the platysma muscles are also frequently affected. In our previous study of HRQOL measures in HFS,2 difficulty with speech and oral communication were among the many non-vision-related complications highlighted by patients with HFS. The patients with more severe HFS with such symptoms are more likely to be seen in a neurological or movement disorders service rather than in an ophthalmology referral center. Hence, unless Hall and colleagues are able to provide standardized assessment of the severity of BEB and HFS in their study, cautious interpretation of a direct comparison between these 2 conditions should be exercised. Correlation of the severity of disease with HRQOL measures and the timing of administration of the survey (during a period of maximal response or the wearing off of the effect of botulinum toxin), which is an important confounding factor, were also not mentioned.
Tan E, Seah A. Health-Related Quality of Life in Blepharospasm and Hemifacial Spasm. Arch Ophthalmol. 2007;125(8):1141. doi:10.1001/archopht.125.8.1141-a