A view on glaucoma—are we seeing it clearly?

Abstract

Successful clinical management of glaucoma should not simply be about control of intraocular pressure, but must equate to correct decisions about intensifying treatment when patients are at risk of developing 'visual disability'. Yet little is known about what visual field defects, at different stages of glaucoma, specifically affect patients' abilities to perform everyday visual tasks. One way to do this is to measure patient performance in tasks in a lab setting. Another way is to ask patients themselves. The latter can be revealing and demystify views about how patients perceive the world. This short commentary highlights some of the current research in this area.

Does the World Health Organization criterion adequately define glaucoma blindness?

“…It also gives a better view on functioning in daily life activities, as in some cases, visual field loss seams to appear worse in monocular assessment compared with binocular assessment 13,20,21. Another parameter would be the driver’s license eligibility requirements, as losing this has an important impact on patients quality of life as mentioned earlier 5,7,9–12. Parameters that indicate the quality of life on the basis of questionnaires should be used as well.…”

“…Thus, most glaucoma patients, even before advanced visual field loss develops, will not meet these requirements. Losing one’s driver’s license has a great impact on patients, and it leads to immobility, social dependence, and a greater risk for developing depressive symptoms 5,7,9–12. These consequences of visual impairment not only have an impact on patients’ quality of life (eg, difficulty with walking, reading, balance, and driving) but also on patients’ caregivers and society at large 5,9–13…”

“…However, defining blindness with only these parameters would not be an appropriate method either, as the MD distribution does not give any clue of the location of the defect, which has an important value. And in fact, it has been reported that considering only the MD, results in losing information on visual loss, such as in patients with defects in the lower hemifield 7. Nevertheless, it has been shown previously that progressive visual field loss (in terms of MD) is associated with loss in health-related quality of life 6.…”

STARD 2015 was reproducible in a large set of studies on glaucoma

“…Its early diagnosis may be challenging but still essential since visual field loss cannot be reversed and treatment only aims to reduce progression [9,10]. Diagnostics tests that are objective and reliable can be used in primary care to improve glaucoma diagnosis [8,9].…”

“…Its early diagnosis may be challenging but still essential since visual field loss cannot be reversed and treatment only aims to reduce progression [9,10]. Diagnostics tests that are objective and reliable can be used in primary care to improve glaucoma diagnosis [8,9]. Tests which investigate retinal nerve fiber layer (RNFL) thickness have the advantage of providing objective and reliable anatomic measures, and have been proposed as triage tests for patients referred from primary eye care [11].…”