Impact of Visual Field Loss on Health-Related Quality of Life in Glaucoma: The Los Angeles Latino Eye Study

doi:10.1016/j.ophtha.2007.08.037

Ophthalmology

Volume 115, Issue 6, June 2008, Pages 941-948.e1

https://doi.org/10.1016/j.ophtha.2007.08.037 Get rights and content

Purpose

To examine the association between health-related quality of life (HRQOL) and visual field (VF) loss in participants with open-angle glaucoma (OAG) in the Los Angeles Latino Eye Study (LALES).

Design

Population-based cross-sectional study.

Participants

Two hundred thirteen participants with OAG and 2821 participants without glaucoma or VF loss.

Methods

Participants in the LALES—a population-based prevalence study of eye disease in Latinos 40 years and older, residing in Los Angeles, California—underwent a detailed eye examination including an assessment of their VF using the Humphrey Automated Field Analyzer (Swedish interactive thresholding algorithm Standard 24-2). Open-angle glaucoma was determined by clinical examination. Mean deviation scores were used to assess severity of VF loss. Health-related QOL was assessed by the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) and 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Linear regression and analysis of covariance were used to assess the relationship between HRQOL scores and VF loss after adjusting for sociodemographic variables and visual acuity.

Main Outcome Measures

The 25-item NEI-VFQ and SF-12 scores.

Results

A trend of worse NEI-VFQ-25 scores for most subscales was observed with worse VF loss (using both monocular and calculated binocular data). Open-angle glaucoma participants with VF loss had lower scores than participants with no VF loss. This association was also present in participants who were previously undiagnosed and untreated for OAG (N = 160). Participants with any central VF loss had lower NEI-VFQ-25 scores than those with unilateral or bilateral peripheral VF loss. There was no significant impact of severity or location of VF loss on SF-12 scores.

Conclusion

Greater severity of VF loss in persons with OAG impacts vision-related QOL. This impact was present in persons who were previously unaware that they had glaucoma. Prevention of VF loss in persons with glaucoma is likely to reduce loss of vision-related QOL.

Section snippets

Materials and Methods

Data for this analysis were collected as part of the LALES, a population-based prevalence study of eye disease in Latinos living in Los Angeles, California and 40 years or older. Details of the study design and data collected have been described previously.⁶ Briefly, a census of all residential households in 6 census tracts in La Puente, California was completed to identify individuals eligible to be included in the study. Eligibility included men and women 40 or older who were Latinos

Description of Study Cohort

A total of 7789 participants were identified as eligible for LALES; of these, 82% (6357) completed the ophthalmic examination and 291 were identified with OAG. Of the original 291 OAG participtants, 73 were excluded because they had VFL in the nonglaucomatous eye (19), had no measure of VF (6), did not answer the question on history of glaucoma (5), or did not complete the NEI-VFQ-25 (48), leaving 213 (73%) of all identified OAG participants available for inclusion in the analyses.

Discussion

In the LALES population, we found that loss of VF among glaucoma participants was associated with worse NEI-VFQ-25 and SF-12 PCS scores. A monotonic trend was observed between VFL and most NEI-VFQ-25 subscale scores, such that glaucoma cases with severe VFL had lower QOL scores than participants with no VFL. This pattern was present when using monocular (better seeing or worse seeing eyes) or calculated binocular data. These findings suggest that adults with glaucoma experience a measurable

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Glaucoma patients may be considered to have normal vision as long as each point of visual space is perceived by at least 1 eye, that is, with an intact binocular visual field (VF). We aimed to investigate the effect of nonoverlapping VF defects on vision-related quality of life (VR-QoL) in glaucoma.
We evaluated VR-QoL of glaucoma patients (n = 269) and controls (n = 113) using 4 different questionnaires (National Eye Institute visual function questionnaire [NEI-VFQ-25], NEI-VFQ neuro-ophthalmology supplement, Glaucoma Quality of Life-15, and a luminance-specific questionnaire). We defined “differential VF” (DVF) as a measure of location-specific differences in the VFs of both eyes. Within the group of glaucoma patients, we analyzed the relationship between different aspects of VR-QoL and DVF using ordinal multiple regression analysis. Analyses were adjusted for age, sex, integrated VF (IVF; an estimate of the binocular VF from the monocular VFs), and higher visual acuity of both eyes, and corrected for multiple hypothesis testing.
Glaucoma patients had lower VR-QoL than controls. Among the glaucoma patients, DVF was significantly associated with general vision (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.54–0.89), peripheral vision (OR, 0.68; 95% CI, 0.54–0.86), walking on uneven ground (OR, 0.73; 95% CI, 0.58–0.93), crossing the street (OR, 0.61; 95% CI, 0.46–0.83), seeing other road users coming from the side (OR, 0.67; 95% CI, 0.52–0.85), cycling during the day (OR, 0.64; 95% CI, 0.46–0.89) and seeing outside on a sunny day (OR, 0.73; 95% CI, 0.57–0.94). In general, IVF was a stronger predictor of VR-QoL than DVF.
Nonoverlapping VF defects affect VR-QoL. Although IVF is strongly associated with VR-QoL, basing clinical decisions only on IVF leads to overlooking vision problems that patients may have.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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To evaluate the performance of an intensive, clustered testing approach in identifying eyes with rapid glaucoma progression over 6 months in the Fast Progression Assessment through Clustered Evaluation (Fast-PACE) Study.
Prospective cohort study.
A total of 125 eyes from 65 primary open-angle glaucoma (POAG) subjects.
Subjects underwent 2 sets of 5 weekly visits (clusters) separated by an average of 6 months and then were followed with single visits every 6 months for an overall mean follow-up of 25 months (mean of 17 tests). Each visit consisted of testing with standard automated perimetry (SAP) 24-2 and 10-2, and spectral-domain OCT (SD-OCT). Progression was assessed using trend analyses of SAP mean deviation (MD) and retinal nerve fiber layer (RNFL) thickness. Generalized estimating equations were applied to adjust for correlations between eyes for confidence interval (CI) estimation and hypothesis testing.
Diagnostic accuracy of the 6-month clustering period to identify progression detected during the overall follow-up.
A total of 19 of 125 eyes (15%, CI, 9%–24%) progressed based on SAP 24-2 MD over the 6-month clustering period. A total of 14 eyes (11%, CI, 6%–20%) progressed on SAP 10-2 MD, and 16 eyes (13%, CI, 8%–21%) progressed by RNFL thickness, with 30 of 125 eyes (24%, CI, 16%–34%) progressing by function, structure, or both. Of the 35 eyes progressing during the overall follow-up, 25 had progressed during the 6-month clustering period, for a sensitivity of 71% (CI, 53%–85%). Of the 90 eyes that did not progress during the overall follow-up, 85 also did not progress during the 6-month period, for a specificity of 94% (CI, 88%–98%). Of the 14 eyes considered fast progressors by SAP 24-2, SAP 10-2, or SD-OCT during the overall follow-up, 13 were identified as progressing during the 6-month cluster period, for a sensitivity of 93% (CI, 66%–100%) for identifying fast progression with a specificity of 85% (CI, 77%–90%).
Clustered testing in the Fast-PACE Study detected fast-progressing glaucoma eyes over 6 months. The methodology could be applied in clinical trials investigating interventions to slow glaucoma progression and may be of value for short-term assessment of high-risk subjects.
Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article.
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College students have similar visual work intensity and environment, resulting in idiosyncratic light environment perception. This study investigated the retinal light sensitivity characteristics of the college student group, and the relationship between retinal light sensitivity of different eccentricity ranges on visual perceptual performance in three typical behavioral modes of classrooms. The group characteristics of low mean light sensitivity (MS) and high pattern standard deviation (PSD) were obtained. 57.4% MS of them was lower than the normal threshold of the whole visual field. Moreover, the degree and irregularity of light sensitivity defect gradually increased from the center to the periphery. Light sensitivity indicators have significant effects on visual perceptual performance under typical classroom artificial light condition. Regression analysis was used to screen the “effective visual field indicators” and “optimal visual field indicators” for each visual perceptual performance. It was found that the visual perceptual performance of the desktop, blackboard, and changing-over modes relied primarily on the central, full-field, and peripheral visual fields, respectively. Further, the influence mechanism models and weight relationships between optimal indicators and visual perceptual performance were developed. Potential public visual health problems were quantified, leading to theoretical guide for classroom artificial lighting design oriented to visual perception.
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To investigate the association between stereoacuity and the presence of central visual field defects (CVFDs) due to glaucoma.
A prospective, cross-sectional cohort study.
Participants with early-to-moderate glaucoma with a visual acuity better than 20/40, less than a 2-line difference in visual acuity between eyes, and 2 reliable Humphrey visual fields (VFs) (24-2 SITA standard) with mean deviation (MD) in the worse eye better than − 12 dB.
Stereoacuity was measured using the Titmus stereo test. Participants with a significant field defect (P < 0.005) in any 1 of the central 4 points in the 24-2 SITA standard total deviation map in either eye were classified as having a CVFD. Vision-related quality of life (VR-QOL) was measured using 25-item National Eye Institute Visual Function Questionnaire scores. Logistic regression was used to determine the associations between the level of stereoacuity and age, sex, race, glaucoma type, presence of CVFDs, visual acuity, contrast sensitivity, and VF MD.
Stereoacuity in the CVFD and non-CVFD groups.
Sixty-five participants met the inclusion criteria. The mean age of the participants was 64.3 ± 8.0 years, and 64.6% were women. The median stereoacuity was 60 arc seconds (interquartile range [IQR], 40–120 arc seconds). Forty-two (65%) patients had CVFDs, and 23 (35%) patients did not. The median stereoacuity of the CVFD group was worse than that of the non-CVFD group (60 arc seconds [IQR, 50–140 arc seconds] vs. 40 arc seconds [IQR, 40–80 arc seconds], respectively; P = 0.001). The non-CVFD group had a higher percentage of participants with normal stereopsis than the non-CVFD group (61% vs. 21%, respectively; P = 0.001). A multivariable analysis found that the presence of CVFDs was associated with worse stereopsis levels (odds ratio, 4.49; P = 0.021). The CVFD group had a lower Visual Functioning Questionnaire-25 (VFQ-25) composite score (84.0 vs. 91.4; P = 0.004) and lower VFQ-25 subscale scores for general vision, near activities, and mental health (P < 0.05).
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View all citing articles on Scopus

: Manuscript no. 2007-462.

: This work was supported by grants from the National Eye Institute, Bethesda, Maryland (no. NEI U10 EY-11753), and National Institutes of Health, Bethesda, Maryland (no. EY-03040).

: No conflicting relationship exists for any author.

^⁎: For Study Group members, see “Appendix” (available at http://aaojournal.org).

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Original articleImpact of Visual Field Loss on Health-Related Quality of Life in Glaucoma: The Los Angeles Latino Eye Study

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusion

Section snippets

Materials and Methods

Description of Study Cohort

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

The number of people with glaucoma worldwide in 2010 and 2020

Br J Ophthalmol

Influence of glaucomatous visual field loss on health-related quality of life

Arch Ophthalmol

Correlation of quality of life with clinical symptoms and signs at the time of glaucoma diagnosis

Trans Am Ophthalmol Soc

Associations between glaucomatous visual field loss and participation in activities of daily living

Clin Experimental Ophthalmol

Visual function and quality of life among patients with glaucoma

Arch Ophthalmol

Using focus groups to develop a culturally sensitive methodology for epidemiological surveys in a Latino population: findings from the Los Angeles Latino Eye Study (LALES)

Ethn Dis

Acculturation, access to care, and use of preventive services by Hispanics: findings from HHANES 1982-84

Am J Public Health

Health risk behaviors of Hispanics in the United States: findings from HHANES, 1982–84

Am J Public Health

Cumulative illness rating scale

J Am Geriatr Soc

Original article
Impact of Visual Field Loss on Health-Related Quality of Life in Glaucoma: The Los Angeles Latino Eye Study