Longitudinal Changes in Quality of Life and Rates of Progressive Visual Field Loss in Glaucoma Patients

Abstract

Purpose To evaluate the association between longitudinal changes in quality of life and rates of progressive visual field loss in glaucoma. Design Prospective observational cohort study. Participants 322 eyes of 161 patients with glaucomatous visual field loss recruited from the Diagnostic Innovations Glaucoma Study (DIGS) followed for an average of 3.5 ± 0.7 years. Methods All subjects had NEI VFQ-25 performed annually and standard automated perimetry (SAP) at 6-month intervals. Subjects were included if they had a minimum of 2 NEI VFQ-25 and at least 5 standard automated perimetry (SAP) during follow up. Evaluation of rates of visual field change was performed using the mean sensitivity (MS) of the integrated binocular visual field. Rasch analysis was performed to obtain final scores of disability as measured by the NEI VFQ-25. A joint longitudinal multivariate mixed model was used to investigate the association between change in NEI VFQ-25 Rasch-calibrated scores and change in binocular visual field sensitivity. Potentially confounding socio-economic and clinical variables were also analyzed. Main outcome measures The relationship between change in NEI VFQ-25 Rasch-calibrated scores and change in binocular SAP MS. Results There was a statistically significant correlation between change in the NEI VFQ-25 Rasch scores during follow-up and change in binocular SAP sensitivity. Each 1db change in binocular SAP MS per year was associated with a change of 2.9 units per year in the NEI VFQ-25 Rasch scores during the follow-up period (R2=26%; P<0.001). Eyes with more severe disease at baseline were also more likely to have a decrease in NEI VFQ-25 scores during follow-up (P<0.001). For subjects with the same amount of change in SAP sensitivity, those with shorter follow-up times had larger changes in NEI VFQ-25 scores (P=0.005). A multivariable model containing baseline and rate of change in binocular MS had an adjusted-R2 of 50% in predicting change in NEI VFQ-25 scores. Conclusion Baseline severity, magnitude and rates of change in binocular visual field sensitivity were associated with longitudinal changes in quality of life of glaucoma patients. Assessment of longitudinal visual field changes may help identify patients at higher risk for developing disability from the disease.

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