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Editors Selection IGR 24-3

Quality of Life: Assessing the effect of visual loss on the ability to perform daily activities

Comment by Pradeep Ramulu on:

48892 A clinical method to assess the effect of visual loss on the ability to perform activities of daily living, Wei H; Sawchyn AK; Myers JS et al., British Journal of Ophthalmology, 2012; 96: 735-741

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The impact of glaucoma on the person can be understood in many ways, including objective measurement of ability using performance based measures. In previous papers, Spaeth and colleagues have described the impact of glaucoma using a set of nine performancebased measures which take over one hour to administer. In the current report, Wei and colleagues examine whether a small subset of these measures can be used to estimate ability in an accurate, time-efficient manner. The authors found that a compressed battery of four tests (recognizing facial expressions, detecting motion, identifying street signs, and locating objects) required 15 minutes to perform, and showed results highly correlated (r = 0.93) with the full set of measures. Correlation coefficients were exclusively utilized to compare scores from the compressed and full set of measures ‐ a concern given that many significant differences can exist between measurements even when high correlations are present.

There are additional issues which may limit the utility of the compressed test. Evaluation of performance requires a masked, trained grader to assign scores for each task, and the procedures for grader training and score assignment are not described. Testing may not be possible in certain settings, and may need to be redesigned when dealing with different racial/ethnic groups. Finally, there are both benefits and dangers to scoring something as complex as 'visual ability' into a single number. Such an approach may be required in studies where disability is a secondary measure, but obscures the fact that glaucoma is a complex disease which affects many different daily activities in ways that cannot be neatly summarized into a single value.

Glaucoma is a complex disease which affects many different daily activities in ways that cannot be neatly summarized into a single value

With greater standardization, the described testing can be useful in clinical trials, where objective testing of ability would complement self-reported disability to help us understand the benefit of treatments beyond IOP-lowering and visual field loss.

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