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Editors Selection IGR 12-4
Health and Quality of Life: VF loss and visual function priorities
Comment by Rohit Varma on:
21000 Evaluation of quality of life and priorities of patients with glaucoma, Aspinall PA; Johnson ZK; Azuara-Blanco A et al., Investigative Ophthalmology and Visual Science, 2008; 49: 1907-1915
In this paper by Aspinall et al. (478), the investigators assessed the visual function priorities of glaucoma patients with varying severity of visual field loss. They also determined the utility of vision loss in persons with glaucoma. The investigators gave a series of three questionnaires to 72 patients with glaucomatous visual field loss ranging from mild (no defect in the central 20 degrees), to moderate (1-5 points with sensitivities ≤ 10 dB in the central 20 degrees) and severe (≥ 6 points with sensitivities ≤ 10 dB in the central 20 degrees). Fifty seven percent of the patients had mild loss, 28% moderate loss and 15% severe loss. The three questionnaires that each patient completed were the EQ-5D (EuroQuol), the TTO (time trade off) and a choice based conjoint analysis. The findings of this study suggested that the priorities of patients with mild visual field loss were more likely to be outdoor mobility whereas those with more severe visual field loss identified reading and seeing detail to be of a higher priority. The investigators also noted that only 17% of patients (those with poor visual acuity) were willing to trade time for a return to normal vision. This study is important in that it provides an assessment of the priorities of patients with varying degrees of visual field loss and also provides insight into the value of visual field loss and visual acuity loss in glaucoma patients. However, there are some issues to consider when evaluating the validity of this assessment. The distribution of persons with visual field loss was skewed towards mild loss and thus it is difficult to get a good assessment of the impact of advanced visual field loss on priorities and more importantly on the utility of visual field loss. If more patients with advanced visual field loss and visual acuity loss were included, a more robust assessment would have been possible. It is likely that persons with advanced visual field loss would value their peripheral visual field more than those with mild visual field loss. Furthermore, one of the activities that is impacted by early visual field loss is driving. It would be useful if the investigators had assessed this function particularly in persons with mild and moderate visual field loss. Finally, this study is a cross-sectional assessment and therefore does not provide insight into what may occur over time in persons who have progressive visual field loss. A prospective longitudinal assessment would provide such data. In summary, this paper provides us with some interesting initial findings. These data now need to be assessed more comprehensively in a larger sample of glaucoma patients with adequate representation of the entire spectrum of visual field loss.
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