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Editors Selection IGR 19-4

Quality of Life: Quality of Life Impact in Early Glaucoma

Comment by George Lambrou on:

78204 Macular Damage, as Determined by Structure-Function Staging, Is Associated With Worse Vision-related Quality of Life in Early Glaucoma, Garg A; Hood DC; Pensec N et al., American Journal of Ophthalmology, 2018; 194: 88-94

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How does macular damage impact quality of life in early glaucoma? Traditionally glaucomatologists have focused on arcuate functional loss, assuming that central vision was minimally affected by the disease and that quality of life would therefore depend essentially on mid-peripheral visual field defects. However, macular damage is becoming increasingly recognized as a common disease feature and may have significant implications on vision-related quality of life (VRQoL).

It is those implications that Garg et al. sought to investigate, by exploring the relationship between the NEI Visual Function Questionnaire (NEI-VFQ25) and macular damage in both eyes of 44 patients with early POAG (i.e. with 24-2 MD better than -6dB). Macular damage was defined as the concomitant presence of corresponding structural (SD-OCT) and functional (VF) defects in the central 8°. Of the 44 patients, 12 had bilateral, 15 had unilateral and 17 had no macular damage.

The authors found a strong association between calibrated NEI-VFQ25 scores and the presence of macular damage. Although significant in both cases, this association was much stronger with macular damage in the worse than in the better eye ("better" and "worse" defined by the 24-2 Mean Defect), while the concomitant presence of peripheral field loss improved the correlation only marginally. Interestingly, the presence or absence of peripheral field loss in eyes without macular damage seemed uncorrelated to VRQoL. Additionally, there seemed to be no difference in QoL scores between eyes with "diffuse" and "focal" macular damage.

Macular damage is not uncommon, even in early glaucoma, and is much more impactful on VRQoL than peripheral damage

What are the take-home messages of this study? First, macular damage is not uncommon, even in early glaucoma, and is much more impactful on VRQoL than peripheral damage, which is the focus and main driver of disease management today. Second, diffuse visual field damage – often dismissed as dry eye or cataract – impacts VRQoL in a similar manner to focal loss and should be evaluated through combined VF and OCT assessment. Finally, that macular damage in the worse eye may contribute more to VRQoL deterioration than currently believed.

Overall, the authors' findings suggest that macular damage should be evaluated in patients with early glaucoma and possibly prompt a more aggressive treatment in order to alleviate the impact of the condition on their quality of life.

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