Gradually Then Suddenly? Decline in Vision-Related Quality of Life as Glaucoma Worsens

Jones, L., Bryan, S. R. & Crabb, D. P. (2017). Gradually Then Suddenly? Decline in Vision-Related Quality of Life as Glaucoma Worsens. Journal of Ophthalmology, 2017, 1621640. doi: 10.1155/2017/1621640

Abstract

Purpose: To evaluate the relationship between self-reported vision-related quality of life (VRQL) and visual field (VF) loss in people from glaucoma clinics.

Methods: A postal survey using the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was administered to people with a range of VF loss identified from a UK hospital-based glaucoma service database. Trends were assessed in a composite score from NEI VFQ-25 against better-eye mean deviation (BEMD) using linear regression and a spline-fitting method that can highlight where a monotonic relationship may have different stages.

Results: A total of 636 patients (median [interquartile range] BEMD −2.1 [−5.2, −0.4] dB, median age 70 [60, 77] years) were analysed. Analysis of trends in the data revealed an average patient loses approximately 2 units (out of 100) on NEI VFQ-25 for every loss of 1 dB (BEMD) as VF defects first become bilateral, up to BEMD −5 dB. NEI VFQ-25 deterioration then appears to slow before a more rapid phase of change (4–5 units per 1 dB loss) after BEMD worsens beyond −15 dB.

Conclusions: Relationship between decline in VRQL and VF worsening in glaucoma is unlikely to be linear; it more likely has different phases, and these should be further explored in longitudinal studies.