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Invited Commentary
December 2013

How to Measure Vision in Glaucoma

Author Affiliations
  • 1Shiley Eye Center, University of California–San Diego, La Jolla, California
JAMA Ophthalmol. 2013;131(12):1563-1564. doi:10.1001/jamaophthalmol.2013.5747

How well do your patients with glaucoma see? In clinic with our patients, symptoms and signs of visual decline do not match. Some patients measure poorly on visual field testing but tell us they are doing just fine with their daily activities. Others seem to do well on the eye chart and display only modest defects on perimetry but report significant visual limitations in their lives. How to explain these discrepancies? Are we not measuring actual vision?

Certainly the visual needs of each patient strongly influence their symptoms, which lends a strongly subjective element to the reporting of visual quality of life. Patients with glaucoma who are still active and require fine acuity and high-quality peripheral vision at work or at home might be more likely to notice and report small degradations in their visual experience. On the other hand, patients who are less visually active, have otherwise given up activities such as driving, or perhaps spend more time watching television than reading may be less likely to notice or report visual limitations, even if their measured defects appear severe.

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