Differential Impact of Central and Global Visual Field Progression on Quality of Life in Glaucoma

To determine the impact of progression of central visual field (VF) and global VF on vision-related quality of life (VRQOL).

Retrospective cohort study.

This study included 364 eyes of 235 primary open-angle glaucoma participants who had at least five 24-2 VF tests over a minimum of 2-year follow-up. The slopes of global mean deviation (MD) and central mean total deviation (MTD₁₀) (12 test points within the central 10° of 24-2) were calculated. Analyses were conducted using different slope thresholds to define VF-based progression, and mean composite National Eye Institute Visual Function Questionnaire Rasch-calibrated scores associated with these progression thresholds were quantified using linear mixed-effects models.

The baseline 24-2 VF MD of all participants was -5.6 (95% CI -6.4, -4.9) decibels (dB). At baseline, eyes with MTD₁₀ progression had significantly worse 24-2 VF MD compared to those without MTD₁₀ progression. When fast progression was defined as MTD₁₀ slope <-0.50 dB/y, fast progressors had a mean baseline 24-2 MD of -9.71 dB (95% CI -11.89, -7.53) compared to -5.24 dB (95% CI -6.02, -4.46) in slow progressors (P < .001). Eyes exhibiting MTD₁₀ progression consistently displayed worse mean composite VRQOL scores across various thresholds compared to global MD. Notably, a similar level of VRQOL impairment was observed at a lower threshold for MTD₁₀ compared to MD, consistent across all glaucoma severity groups. In the overall cohort, eyes progressing at a rate of -0.5 dB/y or faster for MTD₁₀ had a mean composite VRQOL score comparable to those progressing at -1.0 dB/y or faster for global MD.

Central VF change had a greater impact on VRQOL compared to global VF change. Conventional assessments based on global MD may underestimate the effect of central VF changes. Refining progression detection strategies to include central VF is necessary to better reflect changes in patient-centered outcomes like VRQOL.