Is Vision-Related Quality of Life Impaired in Patients with Preperimetric Glaucoma?

Abstract

Purpose : Previous studies have shown that patients with glaucomatous visual field loss may show significant loss in vision-related quality of life (QoL). However, many patients may develop structural glaucomatous damage before visual field loss is detectable and it is uncertain whether this might be associated with loss in QoL. The purpose of this study was to investigate vision-related QoL in patients with preperimetric glaucoma.

Methods : The study included 19 patients with preperimetric glaucoma and 176 control subjects. All patients had normal results on standard automated perimetry in both eyes at the time of QoL assessment and were also tested with spectral-domain optical coherence tomography (SDOCT). Preperimetric glaucoma was defined based on the presence of statistically significant decreased retinal nerve fiber layer (RNFL) thickness, with SDOCT average RNFL thickness with P<5% in at least 1 eye. Patient-reported QoL was assessed by the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and item response theory analysis was performed to obtain a summary score representing questionnaire responses. QoL scores of patients with preperimetric glaucoma were compared to those of control subjects after adjustment for potentially demographic and socio-economic confounding factors.

Results : Mean age was similar in the preperimetric and control groups (64.7±9.7 years vs. 60.7±9.9 years, respectively; P=0.088). SAP MD of the better eye was 1.11±0.8 dB vs. 0.84±0.69 dB, respectively (P=0.121). Global average RNFL thickness of the better eye was 78.2±8.6 μm vs. 96.9±9.8 μm, respectively (P<0.001). There was no significant difference in NEI VFQ-25 scores between the preperimetric and control groups (0.15±0.80 units vs. -0.09±0.87 units, respectively; P=0.263). When, the model was adjusted for confounding factors, diagnosis (preperimetric or not) remained non-significant (P=0.977).

Conclusions : There was no significant difference in vision-related QoL as measured by the NEI VFQ-25 questionnaire in patients with preperimetric glaucoma compared to healthy subjects. This finding suggests that some patients with glaucoma may have significant loss of RNFL detectable by SDOCT before development of significant functional limitations.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.