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Original Investigation
June 8, 2017

Association of Glaucoma-Related, Optical Coherence Tomography–Measured Macular Damage With Vision-Related Quality of Life

Author Affiliations
  • 1Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
  • 2Department of Psychology, Columbia University, New York, New York
JAMA Ophthalmol. Published online June 8, 2017. doi:10.1001/jamaophthalmol.2017.1659
Key Points

Question  What is the association of structural macular retinal ganglion cell plus inner plexiform layer (RGC+IPL) loss measured by spectral-domain optical coherence tomography (SD-OCT) with vision-related quality of life among individuals with primary open-angle glaucoma?

Finding  In this cross-sectional study of 214 eyes of 107 patients with glaucoma, diffuse macular RGC+IPL loss, as measured by SD-OCT, was associated with diminished vision-related quality of life. Participants with diffuse RGC+IPL loss reported lower scores on the National Eye Institute Visual Function Questionaire-25 than those with focal RGC+IPL damage.

Meaning  Deviation maps generated with SD-OCT may be used to estimate vision-related quality of life self-reported by individuals with glaucoma.

Abstract

Importance  Little is known about the association between structural macular damage and self-reported visual function of people with glaucoma.

Objective  To determine the association between vision-related quality of life among patients with primary open-angle glaucoma with structural macular retinal ganglion cell plus inner plexiform layer (RGC+IPL) loss identified by spectral-domain optical coherence tomography (SD-OCT) machine-generated deviation maps and thickness measurements.

Design, Setting, and Participants  This cross-sectional prospective study was conducted from March 1, 2014, to March 30, 2015, at the Department of Ophthalmology at Columbia University Medical Center. The participants were 107 patients who were enrolled in the study and represented the entire range of glaucomatous damage. All 214 eyes of the 107 participants underwent 10-2 visual field tests and SD-OCT scans, and all participants completed the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). They also received ophthalmologic examination, including medical history review, best-corrected visual acuity, slitlamp biomicroscopy, intraocular pressure measurement, gonioscopy, dilated ophthalmoscopy, and standard automated perimetry. Macular RGC+IPL loss was determined by diffuse or focal patterns on SD-OCT–generated deviation maps (probability map that compared patients with aged-matched normative database) and thickness measurements.

Main Outcomes and Measures  Regression analyses to assess the association of NEI VFQ-25 scores (score range: 41.9-99.5; higher scores indicate better functioning) with patterns of RGC+IPL loss and with RGC+IPL thickness measurements.

Results  Of the 107 patients, 48 (45%) were men and the mean (SD) age was 65 (11) years. The self-reported race/ethnicity of participants consisted of 45 (46%) black, 47 (48%) white, and 6 (6%) “other” individuals. In the univariable analyses, patients with diffuse macular RGC+IPL loss had mean composite Rasch-calibrated NEI VFQ-25 scores that were 6.15 points lower than the scores of patients with focal damage (β = −6.15; 95% CI, −11.7 to −0.59; P = .03). The effect remained significant even after controlling for mean RGC+IPL thickness (β = −7.64; 95% CI, −14.2 to −1.03; P = .02).

Conclusions and Relevance  Characteristic patterns of glaucoma-related macular RGC+IPL loss appeared to be more important predictors of vision-related quality of life than thickness measures, with diffuse RGC+IPL loss as an indicator for diminished vision-related quality of life.

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