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Longitudinal Visual Field and Quality-of-Life Change in the Treatment for Advanced Glaucoma Study.

Giovanni Montesano1, Giovanni Ometto1, Riccardo Cheloni2

  • 1NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom; Optometry and Visual Sciences, City St George's, University of London, London, United Kingdom.

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|April 26, 2026
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Summary

Trabeculectomy surgery slowed visual field loss more effectively than medication in advanced glaucoma patients over five years. However, this did not significantly improve quality of life scores, indicating potential limitations of the VFQ-25 questionnaire.

Keywords:
GlaucomaQuality of lifeTrabeculectomyVFQ-25Visual field

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Area of Science:

  • Ophthalmology
  • Clinical Trials
  • Glaucoma Research

Background:

  • Glaucoma causes progressive visual field (VF) loss, impacting patient quality of life (QoL).
  • The relationship between slowing VF loss and QoL changes in advanced glaucoma is not fully understood.
  • The Treatment for Advanced Glaucoma Study (TAGS) investigated this relationship.

Purpose of the Study:

  • To compare the 5-year rates of VF and QoL change in advanced glaucoma patients.
  • To examine the correlation between VF changes and QoL in this population.
  • To evaluate the effectiveness of trabeculectomy versus medical management in preserving vision and QoL.

Main Methods:

  • A multicenter randomized clinical trial involving 453 adults with newly diagnosed advanced open-angle glaucoma.
  • Participants were randomized to initial trabeculectomy (227) or medical management (226).
  • Monocular index-eye VF, binocular integrated VF (BI-VF), and VFQ-25 composite scores were analyzed over 5 years using a Bayesian longitudinal hierarchical model.

Main Results:

  • Trabeculectomy-first group showed a slower rate of index-eye VF loss (-0.37 dB/year) compared to the medications-first group (-0.75 dB/year) (p=0.002).
  • No statistically significant differences were found between groups for BI-VF decline (p=0.062) or VFQ-25 change (p=0.392).
  • Correlations between VF and QoL were stronger for BI-VF than for index-eye VF, both at baseline and for the rate of change.

Conclusions:

  • Trabeculectomy was more effective than medical treatment in reducing the rate of VF loss in advanced glaucoma.
  • Despite moderate correlations with BI-VF, no significant QoL differences were observed.
  • The VFQ-25 may lack sensitivity to detect QoL changes from monocular glaucoma interventions.