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  • Glaucoma Macular Damage Patterns and Visual Disability

    By Jean Shaw
    Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, January 2021

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    Hirji et al. evaluated the link between diffuse and focal patterns of glauco­matous macular damage and visual disability experienced by patients with glaucoma. They found that diffuse macular damage was more likely to be associated with impairments in both contrast sensitivity (CS) and facial recognition. They noted that although diffuse damage may be more difficult to identify than focal damage, it is an im­portant determinant of visual function.

    For this prospective cohort study, the researchers evaluated 72 patients (144 eyes) with glaucoma and visual acuity of 20/40 or better in each eye. They excluded patients with visually significant cataract, posterior capsular opacification, severe dry eye, macular disease, or miotic pupils.

    Glaucomatous eyes were catego­rized as having focal, diffuse, or mixed macular damage, based on optic disc and macular spectral-domain optical coherence tomography (SD-OCT) scanning and 10-2 visual field (VF) test­ing. Better- and worse-acuity eyes were determined by 10-2 VF mean deviation (MD). Facial disability was defined as facial recognition scores at the 2% level of normal participants. Primary out­comes were monocular threshold and binocular facial recognition.

    Of the 72 better-seeing eyes, 44 (61%) had macular damage. Of those, 22 (50%) had focal damage, 15 (34%) had diffuse damage, and the remain­ing seven (16%) had mixed focal and diffuse damage. Of the 72 worse-seeing eyes, 63 (88%) had macular damage. Of those, 26 (41%) had focal damage, 19 (30%) had diffuse damage, and the re­maining 18 (29%) had mixed damage.

    After the researchers adjusted for a number of potential confounding factors, the results indicated that eyes with diffuse damage had greater CS impairment than did those with focal damage (b = –0.5; 95% confidence in­terval [CI], –0.7 to –0.3; p < .001). With regard to facial recognition scores, bet­ter-seeing eyes with focal damage rec­ognized 10 more faces than did those with diffuse damage (95% CI, 2-18.2; p = .001). Worse-seeing eyes with focal damage recognized 5.5 more faces than did those with diffuse damage (95% CI, 0.8-10; p = .02).

    Given the impact of macular damage on patients’ quality of life, the research­ers said that careful evaluation of the macular OCT and 10-2 VF and early detection of diffuse macular damage are critical to minimize glaucoma-related visual disability.

    The original article can be found here.