Do patients with primary open-angle glaucoma with disproportionately diminished vision-related quality of life relative to the 24-2 visual field have undetected 10-2 visual field damage?
In this cross-sectional study of 113 patients with glaucoma, the integrated 10-2 visual field model had a stronger association with the National Eye Institute Visual Function Questionnaire than the integrated 24-2 model. Furthermore, patients with 10-2 sensitivities of outliers with the lowest quality of life relative to patients with 24-2 had the strongest association with the National Eye Institute Visual Function Questionnaire and the best fit to the data.
These results suggest that patients with disproportionately low vision-related quality of life relative to 24-2 visual field may have damage on the central field missed by the 24-2 grid.
Recent evidence supports the presence of macular damage (within 8° of the central field) to retinal ganglion cells and associated central visual field (VF) defects in glaucoma, even in early stages. Despite this, to our knowledge, the association of 10-2 VF damage with vision-related quality of life (QOL) has not been well studied.
To determine the association between QOL and visual function as measured by 24-2 and 10-2 VFs in patients with primary open-angle glaucoma and to test the hypothesis that patients with vision-related QOL disproportionate to their 24-2 VF status may exhibit 10-2 damage overlooked by the 24-2 test.
Design, Setting, and Participants
In this cross-sectional analysis of observational cohort study data taken from a tertiary care specialty practice, 113 patients with glaucoma with the entire range of 24-2 VF damage completed the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Data were collected from May 2014 to January 2015 and were analyzed from March 2016 to May 2016.
Standardized binocular 24-2 and 10-2 VF sensitivities were calculated for each patient.
Main Outcomes and Measures
Association of binocular 24-2 and 10-2 VF sensitivity with Rasch-calibrated NEI VFQ-25 scores. Detection of outliers was based on Cook distance of the regression of binocular 24-2 and NEI VFQ-25 score. Outlier association with QOL was then assessed using a linear regression model, with binocular 10-2 VF sensitivity as the independent variable.
Of the 113 patients, the mean (SD) age was 70.1 (10.9) years, and 51 (45.1%) were male and 71 (62.8%) were white. The composite NEI VFQ-25 score was associated with both binocular 24-2 (β = 1.95; 95% CI, 0.47-3.43; P = .01) and 10-2 (β = 2.57; 95% CI, 1.12-4.01; P = .001) sensitivities, but the 10-2 VF univariable model showed an almost 2-fold better fit to the data (R2 = 9.2% vs 4.9%). However, the binocular 10-2 sensitivities of 24-2 outliers had the strongest association with the composite NEI VFQ-25 scores (β = 2.78; 95% CI, 0.84-4.72; P = .006.) and the best fit to the data (R2 = 18.2%.)
Conclusions and Relevance
The 10-2 VF model showed a stronger association with NEI VFQ-25 score than the 24-2 VF model. Patients with disproportionately low quality of vision relative to patients with 24-2 VF damage may have damage on the central field missed by the 24-2 grid. Future prospective testing, including additional dimensions of quality of life, is indicated.
Blumberg DM, De Moraes CG, Prager AJ, Yu Q, Al-Aswad L, Cioffi GA, Liebmann JM, Hood DC. Association Between Undetected 10-2 Visual Field Damage and Vision-Related Quality of Life in Patients With Glaucoma. JAMA Ophthalmol. Published online May 25, 2017. doi:10.1001/jamaophthalmol.2017.1396