Central inferior VF loss requires more aggressive treatment

Investigators have found that progressive decline in sensitivity in the central inferior area of the visual field had the strongest association with longitudinal decline in quality of life.

While these findings are unsurprising, since most activities of daily living involve performing tasks directly in front of us at chest or waist level, they do suggest more aggressive therapeutic measures should be undertaken for patients with central and inferior visual field loss compared to those with loss in the superior and more peripheral regions.

In this study, the authors administered the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) annually to 236 glaucoma patients for 4 years. Rates of VF change was monitored using standard automated perimetry at 6-month intervals.

Each 1 dB/year change in binocular mean sensitivity of the central inferior area was associated with a decline of 2.6 units/year in the NEI VFQ-25 scores (P<0.001).

Progressive decline in sensitivity in the central inferior area of the VF had the strongest association with longitudinal decline in quality of life, followed by the peripheral inferior, central superior and peripheral superior areas of the visual field. The association for the central inferior area was significantly stronger than those of the central superior area (P = 0.011) and peripheral superior area (P = 0.001), but was similar to the peripheral inferior area (P = 0.171).

Additionally, there was also a greater decline in NEI VFQ-25 scores in patients who had worse VF sensitivity at baseline.

Visual field defects in glaucoma are thought to progress by deepening or expansion of an existing scotoma, or a combination of both. Therefore, patients with greater inferior or central visual field defects at baseline are likely to need close monitoring and potentially more aggressive treatment.