City Research Online

Abstract

Purpose
Progressive visual field (VF) loss resulting from glaucoma affects quality of life (QoL). Although treatments aim to preserve vision, the extent to which slowing VF loss translates into QoL changes in advanced disease is not understood fully. We compare the 5-year rate of VF and QoL change and examined their correlation in the Treatment for Advanced Glaucoma Study.

Design
Multicenter randomized clinical trial (27 secondary care glaucoma departments in the UK).

Participants
Adults (n = 453) with newly diagnosed advanced open-angle glaucoma in at least 1 eye were randomized to trabeculectomy (n = 227) or medical management (n = 226) as initial treatment. One eligible index eye was identified per participant.

Main Outcome Measures
Mean difference in rate of change in monocular index eye VF (24-2 SITA Standard), binocular integrated (BI) VF, and the 25-item Visual Function Questionnaire (VFQ-25) composite score over 5 years (intention to treat) using a Bayesian longitudinal hierarchical model.

Results
Data from 442 patients with reliable VF (false-positive rate ≤15%) or VFQ-25 data from >2 time points were included (221 patients in the trabeculectomy-first arm). Baseline characteristics were similar between arms. The rate of index eye VF loss was faster in the medications-first arm (–0.75 [95% credible interval (CrI), –0.90 to –0.59] dB/year) compared with the trabeculectomy-first arm (–0.37 [95% CrI, –0.53 to –0.22] dB/year; P = 0.002). Differences between groups were not statistically significant for BI VF decline (P = 0.062) or VFQ-25 change (P = 0.392). Correlations between VF and QoL were stronger for BI VF for baseline (0.41 [95% CrI, 0.32–0.49]; P < 0.001) and rate of change (0.56 [95% CrI, 0.41–0.70]; P < 0.001) than for index eye VF (0.22 [95% CrI, 0.12–0.32]; P < 0.001 and 0.43 [95% CrI, 0.26–0.58]; P < 0.001, respectively).

Conclusions
Trabeculectomy more effectively reduced the rate of VF loss compared with medical treatment in advanced glaucoma. Despite a moderately strong correlation with the BI VF, no difference was found in the measured QoL, suggesting that the VFQ-25 might not be reactive or sensitive enough to monocular glaucoma interventions.

Publication Type:	Article
Additional Information:	© 2026 The Author(s). Optometry and Vision Science published by Wiley Periodicals LLC on behalf of American Academy of Optometry. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Publisher Keywords:	Glaucoma, Quality of life, Trabeculectomy, VFQ-25, Visual field
Subjects:	R Medicine > RE Ophthalmology
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Optometry & Visual Science
SWORD Depositor:	Symplectic Administrator

Export

Downloads