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Editors Selection IGR 11-1

Quality of Life: Assessing Activity Limitation in Glaucoma Patients

Comment by Pradeep Ramulu on:

75778 Objective Assessment of Activity Limitation in Glaucoma with Smartphone Virtual Reality Goggles: A Pilot Study, Goh RLZ; Kong YXG; McAlinden C et al., Translational vision science & technology, 2018; 7: 10

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In their very nice article, Goh and colleagues examine if simulated task ability could be gauged in glaucoma patients using a virtual reality goggle system. To test this hypothesis, patients with varying degrees of glaucoma performed three series of tasks involving: (1) finding an object within a stationary scene; (2) identifying a ball moving into their field of view; and (3) identifying a dangerous situation while driving. For each test, items were graded as 'seen' or 'unseen' and then subject to Rasch analysis. Only the object finding and moving ball tasks fit the Rasch model well, and of these two, only the object finding test became more difficult with greater VF damage. The object finding test was also associated with glaucoma utility measures, further suggesting its validity.

The article raises the possibility that meaningful objective functional measures may be captured with a simple, low-cost set-up (the goggles employed cost only US$ 20) and might be implemented as part of routine clinical care. The authors suggest that such testing could be used to help patients understand their disability and highlight for physicians, caregivers, and patients themselves the need to address their disability, i.e., through low vision rehabilitation or environmental modification. A more intriguing possibility is that in-clinic functional testing might eventually serve as an adjunct to current clinical measures. One challenge would be that age was also associated with worse performance in the study, and might also hasten functional declines more in persons with advanced damage independent of disease progression. Other time-dependent factors (i.e., cognitive impairment) may also produce functional declines indistinguishable from vision-related declines. Thus, while understanding the functional status of the patient is clearly important, as with any new information, significant thought and consideration is needed to determine how it can be optimized and integrated into a clinically useful tool.

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