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Editors Selection IGR 17-3

Quality of Life: Impact of retinal damage on Quality of Life

Comment by Shan Lin & Marissé Masís on:

60235 Association between progressive retinal nerve fiber layer loss and longitudinal change in quality of life in glaucoma, Gracitelli CP; Abe RY; Tatham AJ et al., JAMA ophthalmology, 2015; 133: 384-390

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The ultimate goal in glaucoma management should be the maintenance of a person's quality of life. Visual acuity and visual fields are not the only factors that need to be taken into consideration when evaluating the real visual functionality of a glaucoma patient. Daily activities of glaucoma patients could be affected even in the absence of a clearly diagnosed scotoma. Peripheral scattered vision loss, dark adaptation, glare and difficulty with outdoor mobility are pathological findings that could be present even in early stages of the disease and these outcomes are difficult to detect by standard automated perimetry.

To assess and detect concrete changes in the patient, visual functionality despite adjustment for visual field progression is a very interesting step towards new clinical considerations

It is well known that measuring the rate of change in RNFL thickness is a helpful tool, mainly in early stages, for observing and managing patients with glaucoma.¹ In this observational cohort study of 260 eyes of 130 patients, the authors evaluated the relationship between rates of retinal nerve fiber layer (RNFL) loss and longitudinal changes in quality of life in glaucoma. Using a non-specific quality of life scale for glaucoma, the authors show a strong association with binocular RNFL loss and decrease in the quality of life. They report that a one-µm-per-year loss in binocular RNFL thickness corresponded to a change of 1.1 units per year in the NEI VFQ-25 scores, even after adjustment for the degree of visual field loss as measured by standard perimetry and statistical modeling.

There have been a number of attempts to develop quality of life scales for glaucoma. Many of the instruments specific for glaucoma assess symptoms of glaucoma and effects on activities, but do not include assessment of the importance of such impacts for the individual². Also vision specific instruments, such as the NEI VFQ-25, might leave out of the equation more specific evaluation of glare, peripheral vision, outdoor mobility and contrast. Although this instrument is not specific for glaucoma, it is likely the best existing validated tool for visual function assessment.

Although this was a longitudinal study, the follow-up time was relatively short and more evidence should be added in the future to confirm the findings.

As mentioned by the authors, there is no previous study describing the association between progressive RNFL loss and changes in quality of life. To assess and detect concrete changes in the patient, visual functionality despite adjustment for visual field progression is a very interesting step towards new clinical considerations when diagnosing and making therapeutic decisions.

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