The relationship between visual disability and visual field in patients with glaucoma

doi:10.1016/S0161-6420(02)01742-6

Ophthalmology

Volume 110, Issue 2, February 2003, Pages 332-339

https://doi.org/10.1016/S0161-6420(02)01742-6 Get rights and content

Abstract

Purpose

To evaluate the relationship between visual disability and the remaining visual field in glaucoma patients.

Design

Prospective noncomparative survey.

Participants

One hundred forty-seven Japanese patients with glaucoma were examined.

Methods

Using a previously developed questionnaire, we assessed the relationship between visual disability indices and both the visual field examined using program 30-2 of the Humphrey Field Analyzer and visual acuity.

Main outcome measures

Pearson’s correlation coefficients between visual disability indices and the 22 visual field and 2 visual acuity measurements were calculated. Multiple regression analysis with stepwise variable selection identified factors significantly contributing to visual disability.

Results

We identified a significant correlation between visual disability and both the visual field and visual acuity measurements collected. Of the factors examined, retinal sensitivity in the lower hemifield within 5° of the fixation and visual acuity in the better eye significantly contributed to all the item and total disability indices (DIs), measurements of the degree of visual disability as evaluated by the questionnaire; visual acuity in the worse eye contributed to two of the seven item DIs, as well as the total DI. The R value for total DI (R = 0.87, P < 0.0001) indicated that approximately 76% of the visual disability could be explained by these factors.

Conclusions

The Japanese glaucoma patients’ visual disability is explained primarily by retinal sensitivity in the lower hemifield within 5° of the fixation and visual acuity in the better eye and secondarily by visual acuity in the worse eye.

Section snippets

Subjects

We evaluated visual disability in 147 patients (75 male and 72 female) with glaucoma (69 patients with primary open-angle glaucoma [POAG], 56 patients with normal tension glaucoma [NTG], and 22 patients with primary angle-closure glaucoma). All patients involved in the study fulfilled the following criteria: (1) glaucoma was the only disease leading to visual field damage and/or visual acuity impairment; (2) patients were followed for more than 6 months at either Tokyo Teishin Hospital or

Relationship between visual disability assessed by the revised questionnaire and visual acuity

Visual disability in the 147 glaucoma patients was assessed using the revised questionnaire. The questionnaire, originally written in Japanese, contained 30 questions addressing 7 items: legibility of letters (letters), sentences, walking, using public transportation (going out), dining, dressing, and additional miscellaneous activities (miscellaneous) (Table 1, excluding the questions, written with italics). Each question had three possible responses, scored as follows, greatly disabled, 2

Relationship between visual disability assessed by the revised questionnaire and visual acuity

Visual acuity in the better and worse eye correlated significantly with all the disability indices (r = 0.46 to 0.74) (Table 2). Visual acuity in the better eye demonstrated the highest correlation with the item and total DIs (r = 0.63 to 0.74).

Using stepwise variable selection, the visual acuities in both the better and worse eyes were found to be significant predictors of total DI (P < 0.0001, P < 0.001). The standardized partial regression coefficients for visual acuity in the better and

Discussion

Previous questionnaires5, 6, 7, 8, 9, 10, 11, 12 assessing visual disability in patients with visual acuity or field impairment unanimously covered the seven items examined in our questionnaire: letters, sentences, walking, going out, dining, dressing, and miscellaneous. Driving, however, an important section in questionnaires developed in Western countries, was not included in this questionnaire. None of the patients involved in this study complained of any inconvenience in driving. In Japan,

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To describe the association between visual field loss and frailty in a nationally representative cohort of US adults.
Retrospective cross-sectional study.
The cohort included adults 40 years or older with complete eye examination data from the 2005-2006 and 2007-2008 National Health and Nutrition Examination Surveys (NHANES). Visual field loss (VFL) was determined by frequency doubling technology and a 2-2-1 algorithm. A 36-item deficit accumulation-based frailty index was used to divide subjects into 4 categories of increasing frailty severity.
Of the 4897 participants, 4402 (93.2%) had no VFL, 301 (4.1%) had unilateral VFL, and 194 (2.73%) had bilateral VFL. Within the sample, 2 subjects197 (53.1%) were categorized as non-frail, 1659 (31.3%) as vulnerable, 732 (11.3%) as mildly frail, and 312 (4.3%) as most frail. In multivariable models adjusted for demographics, visual acuity, and history of cataract surgery, subjects with unilateral VFL had higher adjusted odds of being in a more frail category (adjusted odds ratio [aOR], 2.07; 95% CI, 1.42-3.02) than subjects without VFL. Subjects with bilateral VFL also had higher odds of a more frail category compared to subjects without VFL (aOR, 1.74; 95% CI, 1.20-2.52).
In the 2005-2008 NHANES adult population, VFL is associated with higher odds of frailty, independent of central visual acuity loss. Frail individuals may be more susceptible to diseases that can cause VFL, and/or VFL may predispose to frailty. Additional studies are needed to determine the directionality of this relationship and to assess potential interventions.
Progressive Visual Field Loss and Subsequent Quality of Life Outcomes in Glaucoma
2023, American Journal of Ophthalmology
To evaluate the association between baseline severity of visual field (VF) damage and the initial rates of VF progression with quality of life (QOL) outcomes over an extended follow-up in glaucoma.
Retrospective cohort study.
Both eyes of 167 glaucoma or suspected glaucoma patients were followed for 10.0±0.3 years. The National Eye Institute Visual Function Questionnaire (NEI-VFQ)-25 was performed at the end of the follow-up. Separate linear regression models included the VF parameters of the better eye, the worse eye, and the central and peripheral points of the integrated binocular VF to evaluate the association of baseline and initial rates of change of VF parameters (first half of the follow-up) with NEI-VFQ-25 Rasch-calibrated disability scores over an extended follow-up.
All models demonstrated association of worse baseline severity of VF damage with worse subsequent NEI-VFQ-25 scores. Faster rates of decline in VF mean deviation of the better eye and the mean sensitivity of the central and peripheral test locations of the integrated binocular VF were significantly associated with worse subsequent NEI-VFQ-25 scores. VF parameters of the better eye performed better than those of the worse eye (R² of 0.21, and 0.15, respectively), and the VF parameters of the central test locations performed better than those of the peripheral test locations (R² of 0.25, and 0.20, respectively).
Baseline severity and initial rates of change of VF damage are associated with QOL outcomes over an extended follow-up. Assessment of longitudinal VF changes, especially in better eye, provides prognostic utility to identify glaucoma patients at a higher risk for developing disease-related disability.
Association of Visual Field Pattern Reversal with Paracentral Visual Field Loss
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Visual field (VF) results that show more test points outside normal limits on the pattern deviation map than on the total deviation map have been assumed to be evidence of unreliable VF results. We propose the term pattern reversal to describe this VF finding and explore its association with paracentral loss.
Retrospective cohort and case-control studies.
Glaucoma and glaucoma suspect patients who completed VF testing in Veteran’s Affairs ophthalmology or optometry clinics.
In the cohort study, VF results were included that demonstrated pattern reversal. The area of pattern reversal was categorized as peripheral, paracentral, or mixed (both peripheral and paracentral). In the case-control study, a group of patients with paracentral loss confirmed on 10-2 VF tests were compared with a control group whose VF results were without paracentral loss.
In the cohort study, the calculated false-positive (FP) error rates were compared among groups categorized by area of pattern reversal. In the case-control study, the rates of pattern reversal were compared between patients with and without paracentral loss.
Two hundred seventeen eyes of 145 patients were included in the cohort study. Visual field results with pattern reversal and mixed loss had significantly higher FP rates compared with those with paracentral or peripheral loss only (16.25% vs. 6.26% and 8.15%, respectively; P < 0.001). Fifty-five eyes of 41 patients were included in the case group and 55 eyes of 41 patients were included in the control group. Patients with paracentral loss were more likely to have history of pattern reversal compared with those without paracentral loss (58.2% vs. 29.1%; P = 0.004). Twelve eyes with paracentral loss had 24-2 VF results that showed defects on the pattern deviation map, but not on the total deviation map.
Pattern reversal may be associated with paracentral VF loss and is not always associated with elevated FP rates.
Factors Threatening Central Visual Function of Patients with Advanced Glaucoma: A Prospective Longitudinal Observational Study
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Citation Excerpt :
The criteria for judging VF deterioration using HFA have been reported in the literature, but most are based on the results of HFA 24-2 or 30-2 tests in eyes with mild or moderate glaucomatous damage30–34; however, in an eye with severely advanced damage, such as the eyes of the present participants, the accuracy of the evaluation of thresholds of test points with very low sensitivities is likely to be low.35 The central 10° VF covered by HFA 10-2 is more related to vision-related quality of life,21–23 and quite a few test points are relatively well spared in this subfield, even at the advancement of glaucomatous damage28,29; however, no criteria have been established for judging significant deterioration of the HFA 10-2 VF in eyes with advanced glaucoma. The specificity of the current criteria (the same 3 points with TD slope ≤–1.0 dB/year at P < 0.01 at 3 consecutive HFA 10-2 tests) was assessed in the simulated nonprogressing HFA 10-2 VF series, whose mean MD was very similar to that of the participants of the current study, and the assessed specificity was 99.99%.
To identify risk factors for further deterioration of central visual function in advanced glaucoma eyes.
Prospective, observational 5-year study.
Advanced glaucoma patients with well-controlled intraocular pressure (IOP), mean deviation (MD) of the Humphrey Field Analyzer (HFA) 24-2 program ≤–20 dB and best-corrected visual acuity (BCVA) of 20/40.
The HFA 10-2 test and BCVA examination were performed every 6 months, and the HFA 24-2 test was performed every 12 months for 5 years. The Cox proportional hazards model was used to identify risk factors for deterioration of HFA 10-2 and 24-2 results and BCVA.
Deterioration of HFA 10-2 results was defined by the presence of the same ≥3 points with negative total deviation slope ≤–1 dB/year at P < 0.01 on ≥3 consecutive tests, deterioration of HFA 24-2 results by an increase ≥2 in the Advanced Glaucoma Intervention Study score on ≥2 consecutive tests, and deterioration of BCVA by an increase of ≥0.2 logarithm of the minimum angle of resolution (logMAR) on ≥2 consecutive tests.
A total of 175 eyes of 175 patients (mean age, 64.1 years; mean baseline IOP, 13.2 mmHg; mean BCVA, 0.02 logMAR; mean HFA 24-2 and 10-2 MD, –25.9 and -22.9 dB, respectively) were included. The probabilities of deterioration in HFA 10-2 and 24-2 results and BCVA were 0.269 ± 0.043 (standard error), 0.173 ± 0.031, and 0.194 ± 0.033, respectively, at 5 years. Lower BCVA at baseline (P = 0.012) was associated significantly with further deterioration of HFA 10-2 results. Better HFA 24-2 MD (P < 0.001) and use of systemic antihypertensive agents (P = 0.009) were associated significantly with further deterioration of HFA 24-2 results, and a greater β-peripapillary atrophy area-to-disc area ratio (P < 0.001), use of systemic antihypertensive agents (P = 0.025), and lower BCVA (P = 0.042) were associated significantly with further deterioration of BCVA, respectively.
In advanced glaucoma eyes with well-controlled IOP, BCVA, β-peripapillary atrophy area-to-disc area ratio, and use of systemic antihypertensive agents were significant prognostic factors for further deterioration of central visual function.
Interventions to Improve Reading Performance in Glaucoma
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To evaluate whether changes to contrast, line spacing, or font size can improve reading performance in patients with glaucoma.
Cross-sectional study.
Thirty-five patients with glaucoma and 32 healthy control participants.
A comprehensive ophthalmologic examination was performed followed by reading speed assessment using the Minnesota Low Vision Reading (MNREAD) test under a range of contrasts (10%, 20%, 30%, 40%, and 50%), line spacings (1.0, 1.5, 2.0, 2.5, and 3.0 lines), and font sizes (0.8, 0.9, 1.0, 1.1, and 1.2 logarithm of the minimum angle of resolution), for a total of 15 tests. Regression analyses were performed to examine the effect of varying test conditions on reading speed (measured in words per minute [wpm]).
Participants’ mean age was 63.0 ± 12.6 years. Patients with glaucoma showed a visual field mean deviation in the better eye of –6.29 ± 6.35 dB. Reading speeds were significantly slower in patients with glaucoma versus control participants for 14 of the 15 MNREAD tests, despite no significant differences in age, gender, or education between groups. Increased contrast (from 10% to 50%) was associated with faster reading speed in patients with glaucoma (10.6-wpm increase per 10% increase in contrast; 95% confidence interval, 7.4–13.8 wpm; P < 0.001; R² = 0.211). No significant improvement was found in reading speed with increase in font size or line spacing.
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Citation Excerpt :
Recent studies have revealed that the HFA 24-2 test is not sufficient to assess damage in the central VF, and therefore, it is recommended also to measure the HFA 10-2 VF.62-67 In addition, damage to this area of the VF is associated more directly with patients’ vision related to the quality of life.68,69 A future study should be attempted to shed light on the usefulness of VF augmentation in the HFA 10-2 test.
To investigate whether OCT measurements can improve visual field (VF) trend analyses in glaucoma patients using the deeply regularized latent-space linear regression (DLLR) model.
Retrospective cohort study.
Training and testing datasets included 7984 VF results from 998 eyes of 592 patients and 1184 VF results from 148 eyes of 84 patients with open-angle glaucoma, respectively. Each eye underwent a series of 8 VF tests with the Humphrey Field Analyzer OCT series obtained within the same observation period.
Using pointwise linear regression (PLR), the threshold values of a patient’s eighth VF results were predicted using values from shorter VF series (first to second VF tests [VF1–2], first to third VF tests, . . . , to first to seventh VF tests [VF1–7]), and the root mean square error (RMSE) was calculated. With DLLR, OCT measurements (macular retinal nerve fiber layer thickness, the thickness of macular ganglion cell layer and inner plexiform layer, and the thickness of the outer segment and retinal pigment epithelium) that were obtained within the period of shorter VF series were incorporated into the model to predict the eighth VF.
Prediction accuracy of VF trend analyses.
The mean ± standard deviation RMSE resulting from PLR averaged 27.48 ± 16.14 dB for VF1–2 and 3.98 ± 2.25 dB for VF1–7. Significantly (P < 0.001) smaller RMSEs were obtained from DLLR: 4.57 ± 2.71 dB (VF1–2) and 3.65 ± 2.27 dB (VF1–7).
It is useful to include OCT measurements when predicting future VF progression in glaucoma patients, especially with short VF series.

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^☆: Manuscript no. 210734.

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The relationship between visual disability and visual field in patients with glaucoma☆

Abstract

Purpose

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Section snippets

Subjects

Relationship between visual disability assessed by the revised questionnaire and visual acuity

Relationship between visual disability assessed by the revised questionnaire and visual acuity

Discussion

Ophthalmology

Ophthalmology

Jpn J Ophthalmol

Status of newly registered visual handicapped person in Japan

J Health Welfare Stat

Available data on blindness (update 1994)

Ophthalmic Epidemiol

The sickness impact profileconceptual formulation and methodology for the development of a health status measure

Int J Health Serv

The MOS 36-item short-form health survey (SF-36)

Med Care

Visual functioning in cataract patients. Methods of measuring and results

Acta Ophthalmol (Copenh)

The VF-14. An index of functional impairment in patients with cataract

Arch Ophthalmol

Development of the ‘Activities of Daily Vision Scale’. A measure of visual functional status

Med Care