Association of Quality of Life and Visual Function in Glaucoma With Tests of Structure and Function

In addition to standard automated perimetry tests, contrast sensitivity (CS) testing and macular analyses may predict changes in the quality of life (QOL) in patients at different stages of glaucoma.

To examine the relationship between functional and structural tests of visual function and the 25-item National Eye Institute-Visual Function Questionnaire (NEI-VFQ-25) and the 36-item Short Form (SF-36) Health Survey in patients with different stages of glaucoma.

Standard automated perimetry tests, optical coherence tomography scans, and CS testing were prospectively performed in 160 patients with glaucoma. The Hoddap-Parrish-Anderson staging system was used for glaucoma staging. Health-related QOL questionnaires (NEI-VFQ-25, SF-36) were also administered to all patients.

The study group comprised 29 patients with suspected glaucoma, 104 with mild glaucoma, 15 with moderate glaucoma, and 12 with severe glaucoma. The mean total score of the NEI-VFQ-25 was 88.8 ± 8.2. The SF-36 did not show a significant correlation with the data on functional and structural tests of visual function, whereas the NEI-VFQ-25 showed a low to moderate correlation ( r = 0.212 to -0.492). Vision parameters can explain up to 18.6% of the total score of the NEI-VFQ-25. CS was the only function significantly correlated with glaucoma suspects, whereas, in the early stages, visual acuity was the strongest correlated function with the NEI-VFQ-25 total score ( P = 0.003 and r = 0.551; P = 0.001 and r = 0.343, respectively). The impact of the visual field on vision-related QOL increased in the advanced stages ( P = 0.013, r = 0.688). The macular retinal ganglion cell plus inner plexiform layer thickness remained associated with NEI-VFQ-25 at all stages of glaucoma ( r = 0.335 to 0.802). The NEI-VFQ-25 total score and most of the subscales were correlated with the physical and mental component summary scores of the SF-36 ( r = 0.159 to 0.587).

Visual acuity correlated the most with QOL in patients with glaucoma, as measured with the NEI-VFQ-25 to assess QOL in glaucoma. The impact of visual functions on QOL varies at different stages of glaucoma.