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Editors Selection IGR 19-4

Quality of Life: Which Visual Function affects Glaucoma Patients most?

Comment by George Lambrou on:

76940 Predicting Visual Disability in Glaucoma With Combinations of Vision Measures, Lin S; Mihailovic A; West SK et al., Translational vision science & technology, 2018; 7: 22

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Why is it that we diagnose so many patients with significant perimetric damage and they are surprised to find out that their vision is so much affected without them experiencing any noticeable visual disability? Is it just that perceptive mechanisms in the brain are so efficient in compensating for field loss? Or is it that perimetry is not the most relevant vision measure to assess disability? In which case, what are the best measures to predict visual disability in glaucoma?

This is the question that Lin et al. have sought to address, by comparing the outcomes of seven visual measures with the patient-reported Glaucoma Quality of Life (GQL-15) score in 150 glaucoma patients. More specifically, they analyzed integrated (binocular) visual field sensitivity, visual acuity, contrast sensitivity (CS), area under the log CS function, color vision, stereo-acuity and visual acuity with noise. As prior work indicates that the correlation between single visual measures and patient-reported disability is moderate at best, they explored (a) the correlation between the individual measures and (b) whether a combination of several measures (a 'multidimensional visual space') would provide a better predictor of visual disability.

Their reported results are that indeed the investigated visual measures do correlate with each other, supporting the concept of such a space, but that the contributions of each measure to the GQL-15 score is variable: the highest contributing function was CS, while integrated visual fields came third, after visual acuity with noise. Modelling various combinations of visual measures showed that two-measure models were the best in predicting visual disability, provided that CS was one of the two measures.

The authors recognize that the study may have been limited by the patient sample being representative of their institution's glaucoma clinic patients but not of the wider glaucoma population, by the exclusive use of functional and not structural parameters like OCT and by the use of the GCL-15 scale, which is mostly mobility-focused. Nevertheless, it provides significant insights in the visual mechanisms underlying disability in glaucoma patients and suggesting a more prominent role of contrast sensitivity, alongside visual fields in its assessment and prediction.

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