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Editors Selection IGR 11-1

General Aspects: VF loss and Quality of Life

Comment by Rohit Varma on:

26945 The relationship between visual field loss in glaucoma and health-related quality-of-life, A van Gestel; CAB Webers; HJM Beckers et al., Eye, 2010; 24: 1759-1769

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In this cross-sectional study investigating the relationship between visual field loss and health-related quality of life (HRQOL) in persons with ocular hypertension (OHT) and primary openangle glaucoma (POAG), Van Gestel et al. (1511) asked patients seen at the ophthalmology departments of seven Dutch hospitals to complete four questionnaires by mail ‐ the Glaucoma Quality of Life Questionnaire, the National Eye Institute Visual Function Questionnaire ‐ 25, the Health Utility Index mark 3, and the EQ-5D (another utility questionnaire). Clinical data including Humphrey Visual Field data (30-2 SITA Fast or SITA Standard) was abstracted from patient charts. Of the 654 persons invited to participate, data are presented on 81% (528 participants). Of these 528 participants (Table 1), 339 had POAG and 189 had OHT. The authors state that when assessing the relationship between visual field loss and HRQOL using multiple linear regression, a linear relationship was noted between mean deviation (MD) and HRQOL. 'Binocular MD and MD in the better seeing eye had similar impact on HRQOL whereas MD in the worse seeing eye had an independent effect.' Visual field loss in the inferior hemi-field had a greater impact on HRQOL than superior hemi-field loss. While this relationship was present across the entire spectrum of visual field loss ‐ from mild to severe visual field loss, health related utility was only impacted in participants with severe visual field loss (MD worse than -25 decibels in the better eye). The authors conclude that visual field loss in progressing glaucoma is independently associated with generic and disease specific HRQOL.

Also, that it is important to prevent progression both in early and advanced glaucoma. These results support the results of numerous previous studies including those from the Collaborative Initial Glaucoma Treatment Study, the Salisbury Eye Evaluation and the Los Angeles Latino Eye Study. While the goals of this study are important, there are several weaknesses with the methodology that make it difficult to draw the authors conclusions.

Visual field loss in progressing glaucoma is independently associated with generic and disease specific health related quality of life

This is a cross-sectional study and thus it is not appropriate to draw conclusions with regard to 'progressing' disease or 'increasing' visual field loss. It is appropriate to draw conclusions regarding the association of severity of visual field loss and HRQOL ‐ more severe visual field defects are associated with poorer HRQOL. It is unclear why over 189 persons with OHT were included in this study. Since persons with OHT do not have glaucomatous visual field loss, their inclusion does not provide insight into the glaucomatous disease process. Of the 339 persons with glaucoma included in this study, it appears that over two-third have minimal visual field loss (MD 0 dB to -5dB)(Figure 1). Thus, the power to draw conclusions in persons with moderate visual field loss is reduced. Finally, important variables that likely impact the relationship between generic HRQOL and glaucoma such as systemic co-morbidities, depression, educational status have not been adjusted for. Despite these weaknesses, this study provides additional evidence on the relationship between HRQOL and glaucoma.

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