The Impact of Bilateral Visual Field Patterns on Quality of Life Parameters

Abstract

Purpose : Visual field (VF) is the gold standard for assessing visual function. Archetypal analysis has been applied to unilateral VF to define specific patterns of loss. However, bilateral VF changes have larger impact on patient function. Therefore, we aim to 1) generate distinct archetypes of bilateral VF loss, and 2) assess the impact of archetypes of bilateral VF loss on patient function.

Methods : To develop archetypes for bilateral VF loss, we assessed 15,663 unique patients with bilateral 24-2 VFs obtained on the same day. Included VFs had false positives <15%, false negative <25% for moderate glaucoma and <50% for severe glaucoma, and fixation losses <10%. We decomposed each bilateral VF into 25 distinct archetypes (i.e. distinct patterns of bilateral VF loss) using elbow plot analysis. To assess the impact of the bilateral VF loss on patient function, we used an independent dataset with 229 patients who had bilateral VF data and had undergone functional testing to generate quality of life (QOL) data on reading speed and composite scores. We performed linear regression with projected archetype coefficients as the independent variable and QOL metrics as the dependent variable and applied Bonferroni correction for multiple testing.

Results : Among the 25 archetypes derived from bilateral VF data, twelve show VF defects in similar spatial locations in two eyes (Figure 1). The most represented archetypes are AT 3 (normal), AT10 (superior peripheral OD), and AT 21 (superior peripheral OS, Figure 2). In the clinical evaluation cohort, AT3 (normal, p = .002), AT5 (bilateral superior and inferior arcuate defects, p = .001), AT7 (diffuse bilateral loss p = .001), and AT11 (inferior bilateral loss, p = .001) are significantly associated composite score, while AT3 (p = .04), AT7 (p = .04), and AT11 (p = .04) are associated with reading speed.

Conclusions : Patients with a greater percentage of bilateral normal archetype tend to have improved QOL and higher reading speed. Whereas, patients with greater amounts of diffuse bilateral depression and inferior VF loss have worse QOL and lower reading speed. Bilateral VF archetypal analysis presents a useful framework to characterize subgroups of glaucoma patients, which can allow clinicians to better understand the impact of glaucoma on individual patients.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

Twenty-five archetypes learned from bilateral VF data.

 

Mean projection coefficients for the 25 archetypes in the discovery cohort.