Assessing Functional Disability in Glaucoma: The Relative Importance of Central Versus Far Peripheral Visual Fields

Area of Science:

• Ophthalmology
• Vision Science
• Gerontology

Background:

• Glaucoma is a leading cause of irreversible blindness worldwide.
• Visual field (VF) loss in glaucoma can affect central and peripheral vision.
• The differential impact of central versus peripheral VF loss on daily functioning is not fully understood.

Purpose of the Study:

• To evaluate the distinct contributions of central and far peripheral visual field (VF) loss to disability in patients with glaucoma.
• To determine which VF region is more critical for specific functional outcomes.

Main Methods:

• 231 patients with glaucoma or suspected glaucoma underwent comprehensive visual field testing (central 24-2 and automated peripheral).
• Functional outcomes including fear of falling, quality of life, instrumental activities of daily living, gait, and reading speed were assessed using questionnaires and objective measures.
• Multivariable regression models were used to analyze the independent effects of central and peripheral VF damage on each outcome.

Main Results:

• Greater central VF damage was significantly associated with increased fear of falling, poorer quality of life, reduced daily steps, and difficulties with instrumental activities of daily living.
• Greater peripheral VF damage was significantly associated with impaired gait measures, including shorter steps, shorter strides, and increased step length variability.
• Including both central and peripheral VF damage in models did not substantially improve the explained variability compared to models with only one region of VF damage.

Conclusions:

• The impact of glaucoma-related visual field loss on disability varies by functional domain.
• Central VF damage is a stronger predictor of most disability outcomes, including quality of life and daily activities.
• Peripheral VF damage is more specifically linked to gait impairments, highlighting the need for domain-specific assessments in evaluating functional limitations.