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Is vision-related quality of life impaired in patients with preperimetric glaucoma?
  1. Fábio B Daga1,2,3,
  2. Carolina P B Gracitelli2,3,
  3. Alberto Diniz-Filho3,
  4. Felipe A Medeiros1,3
  1. 1 Department of Ophthalmology, Duke Eye Center, Duke University, Durham, North Carolina, USA
  2. 2 Department of Ophthalmology and Vision Science, Federal University of São Paulo, São Paulo, Brazil
  3. 3 Department of Ophthalmology, University of California, San Diego, California, USA
  1. Correspondence to Professor Felipe A Medeiros, Department of Ophthalmology and Duke Eye Center, Duke University, Durham, NC 27710, USA; felipe.medeiros{at}


Background/aims To investigate whether subjects with preperimetric glaucoma exhibit decline in patient-reported vision-related quality of life (QoL) compared with healthy individuals.

Methods This cross-sectional study included 45 patients with preperimetric glaucoma, 102 patients with perimetric glaucoma and 81 healthy controls. Perimetric glaucoma was defined by the presence of repeatable abnormal standard automated perimetry tests and corresponding optic nerve damage in at least one eye. Preperimetric glaucoma was defined based on the presence of retinal nerve fibre layer (RNFL) loss as detected by spectral-domain optical coherence tomography in the absence of visual field loss. Patient-reported QoL was measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25).

Results Patients with preperimetric glaucoma had significantly thinner average RNFL in the better eye compared with controls (79.9±9.2 µm vs 97.8±8.6 µm; p<0.001). There was no significant difference in Rasch-calibrated NEI VFQ-25 scores between the preperimetric and control groups (72.8±16.8 vs 73.7±20.2, respectively; p=0.964). The average NEI VFQ-25 score in the perimetric glaucoma group was 58.9±18.6 and was significantly different than the average score in the preperimetric glaucoma and healthy groups (p<0.001 for both comparisons).

Conclusion Contrary to patients with perimetric damage, preperimetric glaucoma does not seem to be associated with loss in QoL. Prevention of disability from glaucoma may benefit from early diagnosis during a ‘window of opportunity’ given by detecting structural loss before visual field damage.

  • glaucoma
  • imaging
  • field of vision
  • public health
  • visual perception

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  • Contributors Substantial contributions to analyse the data draft and revise the manuscript (FBD, CPBG, ADF, FAM). Designed the study and wrote the statistical analysis plan (FBD, FAM).

  • Funding Supported in part by the National Institutes of Health/National Eye Institute (grant EY021818 to FAM).

  • Competing interests FAM: Alcon Laboratories (C, F, R), Bausch & Lomb (F), Carl Zeiss Meditec (C, F, R), Heidelberg Engineering (F), Merck (F), Allergan (C, F), Sensimed (C), Topcon (C), Reichert (C, R), National Eye Institute (C), nGoggle (I).

  • Patient consent Obtained.

  • Ethics approval Duke University Institutional Review Board and University of California San Diego Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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