Predicting Vision-Related Disability for Patients With Glaucoma
By Lynda Seminara
Selected By: Stephen D. McLeod, MD
Ophthalmology, January 2018
The results of visual field assessments and self-reported questionnaires can help physicians assess the overall degree of vision-related disability in patients with glaucoma. However, translating the findings from these tools into clinical practice can be challenging. To help classify and analyze changes that occur with glaucoma, Abe et al. developed a novel methodology, which demonstrated that the risk of disability is associated with disease severity at baseline and the rate of deterioration over time. In addition, their method also may help determine how aggressive the treatment must be to slow visual decline and avoid disability.
For this prospective observational study, vision-related quality of life (QoL) was assessed at baseline and the end of follow-up using portions of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). A latent transition analysis (LTA) model was used to characterize NEI VFQ-25 results and to evaluate the probability of disability occurrence during follow-up. Standard automated perimetry (SAP) was conducted at 6-month intervals, and mean sensitivity (MS) of the integrated binocular visual field was used to determine rates of change. Predictors of future disability that were investigated included baseline glaucoma severity and rate of visual field loss.
At baseline, 67 (28%) of 236 patients with glaucoma were categorized as disabled and 169 (72%) as nondisabled based on NEI VFQ-25 results. According to the LTA model, nondisabled participants had a 14.2% likelihood of transitioning to the disabled state during follow-up (mean, 4.3 years). Binocular MS data showed that visual field loss occurred nearly 4 times faster in patients who became disabled. With adjustments for age, baseline visual acuity, and follow-up duration, each 1-dB lower baseline binocular MS was associated with 34% higher odds of future disability. Each 0.5-dB/year faster rate of loss of binocular MS increased the risk of developing disability more than 3.5 times.
The original article can be found here.