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Visual field testing of better eye in glaucoma may be predictive of patient functional ability
Amount of binocular visual field loss and status of better eye best predict functional ability and quality of life, study finds.
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Among eight clinical measures used for staging the amount of visual field loss in patients with glaucoma, the two that most accurately predicted functional ability and quality of life were the amount of binocular visual field loss and the status of the better eye, according to a study.
The prospective, cross-sectional study of 192 patients was conducted at Wills Eye Institute under the guidance of George L. Spaeth, MD, and published in the American Journal of Ophthalmology.
“There is a gap between what patients care about and what physicians care about,” first author Kaushal M. Kulkarni, MD, told Ocular Surgery News. “Patients care about how they feel and what they can do in life, whereas physicians detect and monitor disease using various clinical measures and then attempt to use the outcome of those measures to make clinical decisions.”
For glaucoma, these clinical measures — Snellen visual acuity, IOP, physical examination, automated visual fields, optical coherence tomography and scanning laser polarimetry — do not always give complete information about how patients feel or function.
“We do not truly know how these measures correlate to the main point: how the patient’s disease is actually affecting the patient,” Kulkarni said. “Visual fields are crucial. There are so many ways of evaluating a glaucoma patient’s visual field, both complicated and uncomplicated. Which of these ways tells us the most about how the patient is actually doing?”
Study details
Patients with various types of glaucoma were evaluated using eight standard visual field (VF) staging systems: mean defect, pattern standard deviation, Hodapp-Parrish-Anderson method, Glaucoma Staging System, Glaucoma Staging System 2, field damage likelihood scale for monocular and Esterman and Integrated VF (IVF) systems for binocular.
Partial Spearman correlations were then calculated between the eight VF staging scores and two visual function and quality of life measures: the Assessment of Disability Related to Vision (ADREV) and the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ 25), respectively. The correlations were adjusted for age, race and visual acuity.
The two VF staging systems that demonstrated the highest correlations with the total ADREV score were the IVF score (–0.49) and mean defect in the better eye (0.47), although the superiority of these methods did not reach statistical significance compared with other methods, such as the Hodapp-Parrish-Anderson score in the better eye (–0.46).
NEI-VFQ 25 scores showed a similar pattern with the various VF staging systems.
“With so many complex visual field staging systems out there, it is interesting that a parameter as simple as the mean defect in the better eye had one of the highest correlations with how the patient is able to visually function,” Kulkarni said.
Of the eight methods of staging VF field damage in glaucoma, Kulkarni believes the mean defect in the better eye and the binocular visual field systems may be the most meaningful with regard to the patient’s actual visual function.
“We purposely chose to focus on eight methods that are applicable to clinical practice,” Kulkarni said. “However, our study showed that simply evaluating the performance in the better eye and/or the binocular visual field will give you the best estimate of the patient’s ability to perform the activities of daily living.” – by Bob Kronemyer