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Editors Selection IGR 13-4

General Aspects: Lifetime visual prognosis

Comment by Rohit Varma on:

48349 Lifetime visual prognosis of patients with glaucoma, Goh YW; Ang GS; Azuara-Blanco A, Clinical and Experimental Ophthalmology, 2011; 39: 766-770

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This is a retrospective case series of 77 patients seen at the glaucoma clinic of a University hospital in Scotland to determine the visual function at the end of their lifetime. Goh et al.(1701) extracted best corrected visual acuity data from clinic charts. Based on information from the clinic visit at presentation and the last clinic visit before death, the authors find that the mean best corrected visual acuity at presentation was 0.78 and at the last visit was 0.61. At the final visit, based on visual acuity criteria, 35.1% did not fulfil UK driving criteria and 5.2% were blind registrable. Based on these results, the authors conclude that a majority of patients maintained good visual function at the end of their lifetime. As with all retrospective chart reviews, this study has certain strengths and weaknesses. The strengths include: easy and inexpensive to perform as it uses existing records, able to easily assess relatively rare outcomes ‐ death in patients with glaucoma, and can generate hypotheses that can be tested in a prospective manner. The disadvantages of such studies include: relies on accuracy of the medical record (if visual acuity information is not accurate, then these data may not be useful), standardized relevant data may not be available to make an accurate assessment of the outcome (standardized visual field data to assess visual function), since there is no randomization or masking it is difficult to control bias and confounders (such as medication use, latency between visual acuity and visual fields assessment and death, lack of follow-up due to advanced vision loss, representativeness of the sample). Given these potential weaknesses, these data can serve at best to develop hypotheses that can be tested in future prospective studies. Based on this study, one hypothesis that should be considered for a prospective assessment is: visual function is stable in a majority of patients with glaucoma (who are under care) by the end of their lifetime.

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