Is vision-related quality of life impaired in patients with preperimetric glaucoma?

To investigate whether subjects with preperimetric glaucoma exhibit decline in patient-reported vision-related quality of life (QoL) compared with healthy individuals.

This cross-sectional study included 45 patients with preperimetric glaucoma, 102 patients with perimetric glaucoma and 81 healthy controls. Perimetric glaucoma was defined by the presence of repeatable abnormal standard automated perimetry tests and corresponding optic nerve damage in at least one eye. Preperimetric glaucoma was defined based on the presence of retinal nerve fibre layer (RNFL) loss as detected by spectral-domain optical coherence tomography in the absence of visual field loss. Patient-reported QoL was measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25).

Patients with preperimetric glaucoma had significantly thinner average RNFL in the better eye compared with controls (79.9±9.2 µm vs 97.8±8.6 µm; p<0.001). There was no significant difference in Rasch-calibrated NEI VFQ-25 scores between the preperimetric and control groups (72.8±16.8 vs 73.7±20.2, respectively; p=0.964). The average NEI VFQ-25 score in the perimetric glaucoma group was 58.9±18.6 and was significantly different than the average score in the preperimetric glaucoma and healthy groups (p<0.001 for both comparisons).

Contrary to patients with perimetric damage, preperimetric glaucoma does not seem to be associated with loss in QoL. Prevention of disability from glaucoma may benefit from early diagnosis during a 'window of opportunity' given by detecting structural loss before visual field damage.