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Editors Selection IGR 19-3

Quality of Life: Impact of progression rate on quality of life

Comment by Vincent Michael Patella on:

52995 Association between rates of binocular visual field loss and vision-related quality of life in patients with glaucoma, Lisboa R; Chun YS; Zangwill LM et al., JAMA ophthalmology, 2013; 131: 486-494

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Lisboa et al. have shown that patients having faster rates of deterioration in their binocular visual field may be at higher risk for reporting abnormal vision-related quality of life (VRQOL) scores.

In this study, rates of change in binocular mean deviation for patients 2 Editor's Selection having normal VRQOL scores averaged -0.06 db/year, which is approximately equal to the normal aging rate for visual field sensitivity. The rate of change for patients having abnormal VRQOL scores averaged -0.18 dB/year ‐ three times the rate of the normal VRQOL group ‐ but still quite low compared to monocular rates reported in other longitudinal studies of glaucoma patients ‐ which fell in the range between -1.12 and -1.56 db/y.¹ In the present study, binocular mean deviation in the abnormal VRQOL group averaged -2.15 dB, which, by any measure, must be viewed as representing early damage. Taken together, these observations may suggest that relatively modest rates of binocular glaucomatous visual field progression, even in the very early stages of visual field loss, may be associated with significant quality of life effects.

Relatively modest rates of binocular glaucomatous visual field progression, even in the very early stages of visual field loss, may be associated with significant quality of life effects

While visual function effects upon quality of life may be more accurately assessed through binocular estimates, we have little experience in applying such information to clinical care. If patients indeed adjust after a period of time to changes in their vision, as measured by VRQOL, what is the relative importance of progression rate versus severity of damage? Is rate important in and of itself or does its importance lie in the levels of functional disability that it may portend? If rates of change in glaucomatous damage really are more predictive of quality of life than we have heretofore appreciated, what steps should we now be taking to make our clinical rate-measuring methods more precise and/or more timely?

Further work is required in order to explore how best to integrate these important new findings into clinical care.

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