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

Progressive visual field (VF) loss resulting from glaucoma affects quality of life (QoL). Although treatments aim to preserve vision, the extent to which slowing VF loss translates into QoL changes in advanced disease is not understood fully. We compare the 5-year rate of VF and QoL change and examined their correlation in the Treatment for Advanced Glaucoma Study.

Multicenter randomized clinical trial (27 secondary care glaucoma departments in the UK).

Adults (n = 453) with newly diagnosed advanced open-angle glaucoma in at least 1 eye were randomized to trabeculectomy (n = 227) or medical management (n = 226) as initial treatment. One eligible index eye was identified per participant.

Mean difference in rate of change in monocular index eye VF (24-2 SITA Standard), binocular integrated (BI) VF, and the 25-item Visual Function Questionnaire (VFQ-25) composite score over 5 years (intention to treat) using a Bayesian longitudinal hierarchical model.

Data from 442 patients with reliable VF (false-positive rate ≤15%) or VFQ-25 data from >2 time points were included (221 patients in the trabeculectomy-first arm). Baseline characteristics were similar between arms. The rate of index eye VF loss was faster in the medications-first arm (-0.75 [95% credible interval (CrI), -0.90 to -0.59] dB/year) compared with the trabeculectomy-first arm (-0.37 [95% CrI, -0.53 to -0.22] dB/year; P = 0.002). Differences between groups were not statistically significant for BI VF decline (P = 0.062) or VFQ-25 change (P = 0.392). Correlations between VF and QoL were stronger for BI VF for baseline (0.41 [95% CrI, 0.32-0.49]; P < 0.001) and rate of change (0.56 [95% CrI, 0.41-0.70]; P < 0.001) than for index eye VF (0.22 [95% CrI, 0.12-0.32]; P < 0.001 and 0.43 [95% CrI, 0.26-0.58]; P < 0.001, respectively).

Trabeculectomy more effectively reduced the rate of VF loss compared with medical treatment in advanced glaucoma. Despite a moderately strong correlation with the BI VF, no difference was found in the measured QoL, suggesting that the VFQ-25 might not be reactive or sensitive enough to monocular glaucoma interventions.

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