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Editors Selection IGR 9-2

Quality of Life

Comment by Pamela Sample on:

18059 Severity of visual field loss and health-related quality of life, McKean-Cowdin R; Varma R; Wu J et al., American Journal of Ophthalmology, 2007; 143: 1013-1023

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As the population ages, the number of individuals with vision loss increases. It is therefore becoming more important to understand the impact of reduced visual acuity and visual field impairment on daily functioning.

Although studies have described the impact of visual field loss on quality of life, McKean-Cowdin et al. (399) in the Los Angeles Latino Eye Study (LALES) are the first to describe this among a prospective population-based observational cohort. LALES includes Latino participants with glaucoma and/or a variety of other eye disorders, as well as those with no vision impairment.

Of the 7,789 LALES participants, 5,213 had the ophthalmological exam, visual field measurements and quality of life assessment needed for this analysis. Standard Humphrey 24-2 SITA fields were categorized into three severity categories (none, mild, moderate-severe) based on the MD and whether loss was unilateral or bilateral. Quality of life was measured with the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12).

The analyses accounted for demographic and health factors of age, gender, education, employment status, income, acculturation, co-morbidities, health insurance, vision insurance, and visual acuity impairment.

Even mild four to five dB differences in visual field MD were associated with a five-point difference in the VFQ composite score and most subscale scores

Worse VFQ and SF scores were linearly associated with visual field loss. Even mild four to five dB differences in visual field MD were associated with a five-point difference in the VFQ composite score and most subscale scores. The greatest differences were found for driving activities, dependency measures, mental health, distance vision, and importantly for glaucoma, in peripheral vision. Effect sizes (moderate to large) for the impact of visual field loss on the VFQ were greatest when comparing participants with moderate to severe bilateral visual field loss to those with none. However, a moderate effect for the peripheral vision subscale was present even for participants with moderate unilateral loss.

This study highlights the importance of: 1) improving our ability to predict which of our glaucoma patients is at risk for progressive visual field loss; 2) more effective monitoring of progression; and 3) improved therapies to halt or reverse glaucoma progression.

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