Abstract
Purpose :
Visual crowding is characterized by the difficulty to recognize an object when in clutter, and a key component of performance in a broad array of daily tasks. In a previous study, we showed that a pronounced visual crowding effect is observed in glaucoma, even with mild visual field loss. The study aims to assess whether visual crowding is linked to quality of life (QoL) in glaucoma.
Methods :
Subjects were presented with target Sloan letters on a screen with 2 other letters positioned radially (flankers). The target was placed at 10 degrees eccentricity in all 4 quadrants of the visual field, with 1 quadrant tested at a time. Subjects were asked to identify the target letter, and the critical spacing (Scritical), i.e., the minimum distance between the target and the flankers that allowed correct discrimination of the target, was recorded. An average Scritical was obtained for each subject by averaging measurements from both eyes. QoL was assessed by the National Eye Institute Visual Function Questionnaire (NEI-VFQ25). The relationships between mean Scritical and Rasch-adjusted NEI-VFQ25 scores were examined using generalized estimating equations while accounting for multiple visits of a patient. Models were adjusted for age, race, gender, and standard automated perimetry binocular mean sensitivity.
Results :
291 visits of 107 eyes from 57 glaucoma patients and 27 eyes from 14 healthy subjects were included (mean age of 69.1±8.7 years). Univariable regression analysis revealed a significant impact of mean Scritical on patient-reported QoL outcomes, with 4.2% (95%CI: 1.0-7.3%) worse Rasch-adjusted NEI-VFQ25 score per 1-degree higher Scritical(P=0.009). After adjusting for confounding factors, the effect of Scritical in QoL scores remained statistically significant (2.6% per 1-degree worse Scritical; P=0.038). Such relationship of crowding Scritical and worse QoL outcomes persisted when evaluating glaucoma subjects only (3.1% worse QoL score per 1-degree worse in Scritical; P=0.013) in the multivariable model (R2=15%)
Conclusions :
Our findings indicate that visual crowding significantly affects vision-related QoL in patients with glaucoma. The relationship between mean Scritical and worse QoL outcomes remained significant even when adjusted for binocular mean sensitivity, which suggests an independent effect of visual crowding on QoL, not explained by SAP mean sensitivity.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.