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

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-05-05 DOI:10.1016/j.ajo.2025.04.031

Gopikasree Gunasegaran , Sasan Moghimi , Evan Walker , Takashi Nishida , Jeffrey M. Liebmann , Massimo A. Fazio , Christopher A. Girkin , Linda M. Zangwill , Robert N. Weinreb

{"title":"Differential Impact of Central and Global Visual Field Progression on Quality of Life in Glaucoma","authors":"Gopikasree Gunasegaran , Sasan Moghimi , Evan Walker , Takashi Nishida , Jeffrey M. Liebmann , Massimo A. Fazio , Christopher A. Girkin , Linda M. Zangwill , Robert N. Weinreb","doi":"10.1016/j.ajo.2025.04.031","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the impact of progression of central visual field (VF) and global VF on vision-related quality of life (VRQOL).</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Methods</h3><div>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 (MTD<sub>10</sub>) (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.</div></div><div><h3>Results</h3><div>The baseline 24-2 VF MD of all participants was –5.6 (95% CI –6.4, –4.9) decibels (dB). At baseline, eyes with MTD<sub>10</sub> progression had significantly worse 24-2 VF MD compared to those without MTD<sub>10</sub> progression. When fast progression was defined as MTD<sub>10</sub> 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 (<em>P</em> < .001). Eyes exhibiting MTD<sub>10</sub> 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 MTD<sub>10</sub> 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 MTD<sub>10</sub> had a mean composite VRQOL score comparable to those progressing at –1.0 dB/y or faster for global MD.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"276 ","pages":"Pages 327-335"},"PeriodicalIF":4.1000,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Ophthalmology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S000293942500217X","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

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

Design

Retrospective cohort study.

Methods

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.

Results

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.

Conclusions

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.

查看原文本刊更多论文

中央视野和全局视野进展对青光眼患者生活质量的不同影响。

目的探讨中央视野（central visual field， VF）和全局视野（global visual field， VF）进展对视觉相关生活质量（vision related life quality， VRQOL）的影响。设计回顾性队列研究。方法：本研究纳入了235例原发性开角型青光眼（POAG）患者的364只眼，这些患者在至少2年的随访期间进行了至少5次24-2 VF测试。计算全局平均偏差（MD）和中心平均总偏差（MTD10）（24-2中心10°内的12个测点）的斜率。使用不同的斜率阈值来定义基于视差的进展，并使用线性混合效应模型量化与这些进展阈值相关的美国国家眼科研究所视觉功能问卷（NEI-VFQ） rasch校准评分的平均值。结果所有参与者的基线24-2 VF MD为-5.6 (95% CI, -6.4, -4.9) dB。在基线时，与没有MTD10进展的眼睛相比，MTD10进展的眼睛有明显更差的24-2 VF MD。当MTD10斜率< -0.50 dB/年定义为快速进展时，快速进展者的平均基线24-2 MD为-9.71 dB (95% CI: -11.89, -7.53)，而缓慢进展者的平均基线24-2 MD为-5.24 dB (95% CI: -6.02, -4.46) （p < 0.001）。与MD相比，表现出MTD10进展的眼睛在不同阈值上的平均复合VRQOL评分始终较差。值得注意的是，与MD相比，在MTD10较低的阈值下观察到相似水平的VRQOL损害，这在所有青光眼严重程度组中都是一致的。在整个队列中，MTD10进展速度为-0.5 dB/年或更快的眼睛的平均复合VRQOL评分与全球md进展速度为-1.0 dB/年或更快的眼睛相当。结论与全球VF变化相比，中心VF变化对VRQOL的影响更大。基于全球MD的常规评估可能低估了中心VF变化的影响。为了更好地反映以患者为中心的结果（如VRQOL）的变化，有必要改进进展检测策略以包括中心VF。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.