Optometry
Partner With Us
Advertisement
From the Journals

Disc Changes Did Not Impact Vision-Related QoL in OHTS

One in four patients with bilateral glaucoma-related visual field loss reported significant visual difficulties, compared to just one in ten without field damage, in a 20-year study of vision-related quality of life.

Conexiant

Preperimetric primary open-angle glaucoma, diagnosed by optic disc progression without visual field loss, did not significantly impact vision-related quality of life as measured by the National Eye Institute Visual Function Questionnaire and Glaucoma Quality of Life survey in the Ocular Hypertension Treatment Study, according to a cross-sectional analysis of 20-year follow-up data. However, bilateral visual field loss was associated with substantially worse vision-related quality of life scores.

The study, published in JAMA Ophthalmology, included 679 Ocular Hypertension Treatment Study (OHTS) participants (60.7% female, mean age 73.8 years) who completed the Visual Function Questionnaire (VFQ-25) and Glaucoma Quality of Life survey (GQL-15) between 2016-2019, approximately 22 years after initial enrollment and a median of 8 years after primary open-angle glaucoma (POAG) diagnosis.

POAG, determined by masked reading centers, was defined as reproducible glaucomatous optic disc deterioration, reproducible visual field (VF) abnormalities, or both. Of 321 POAG participants, 91 had unilateral and 60 bilateral optic disc POAG without VF loss in either eye, while 106 had unilateral and 64 bilateral VF loss with or without disc changes. The 358 participants without POAG served as controls.

Mean Rasch-calibrated VFQ-25 scores (0-100 scale) were 72.5 for no POAG, 72.7 and 73.4 for unilateral and bilateral disc POAG, 69.2 for unilateral VF loss, and 58.5 for bilateral VF loss (P<0.001 vs no POAG). GQL-15 scores showed similar patterns, with no significant differences between disc POAG and controls. Multivariable models explained 32% and 26% of the variance in VFQ-25 and GQL-15 scores, respectively, using the R-squared statistic.

Factors associated with lower vision-related quality of life (VRQoL) in multivariable models included bilateral VF loss (6.42 and 5.95 points lower on VFQ-25 and GQL-15, respectively, compared to no POAG), worse mean deviation (2.30 and 3.29 points lower per 3-dB decrement in the better eye), reduced contrast sensitivity and visual acuity, nonglaucoma ocular procedures, more systemic comorbidities, and female sex.

On the GQL-15, 25% of bilateral VF loss participants reported "some," "quite a lot," or "severe" visual difficulty overall vs 12.8% with unilateral VF loss, 10.2% unilateral and 10.0% bilateral disc POAG, and 10.1% without POAG. Specific task difficulties were 2-fold or greater in the bilateral VF loss group compared to controls.

Strengths of this multicenter study included standardized diagnostic criteria, independent reading centers determining POAG endpoints, and detailed clinical and patient-reported data over 20 years. Limitations included potential selection bias from incomplete follow-up (e.g., if participants with worse VRQoL were less likely to complete the surveys), limited generalizability to patients with advanced glaucoma, and unmeasured confounders like socioeconomic status.

The lack of meaningful impact of preperimetric POAG on VRQoL was the study's primary novel finding, while the decrements associated with bilateral VF loss were more consistent with previous research. The findings may help inform monitoring and treatment decisions in early glaucoma.

Conflict of interest disclosures can be found in the study.