Relationship between visual field loss and vision-specific quality of life

Purpose: To determine the influence of visual field loss on visual functioning and overall health-related quality of life (HR-QOL) for persons with glaucoma. Methods: We conducted a 5-site, cross-sectional study that included an interview with the 51-Item NEI-VFQ, the VF-14, ophthalmologic and medical history, and a clinical exam. Eligible persons with glaucoma from a range of treatment groups were identified by chart review. Each subject had a Humphrey threshold visual field (VF) within 6 months of enrollment. We calculated Advanced Glaucoma Intervention Study (AGIS) scores (range 0-20) and classified VFs from 228 eyes into 1 of 4 severity groupings: [(none=0 (n=30); mild=1-5 (n=66); moderate=6-11 (n=64); and severe to endstage=12-20 (n=68)]. Adjusted mean NEI-VFQ and VF-14 scores were compared by AGIS groupings for the better and worse eye while controlling for AGIS group in the other eye, visual acuity in both eyes, type of treatment, sex, race, age, and chronic medical problems in multiple linear regression models. NEI-VFQ and VF-14 scores ranged from 0 (worst possible) to 100 (best possible). Results: Overall, 114 patients (mean age 04 ± 12 years, 67% female, 39% African American) were enrolled. Median ETDRS visual acuity (VA) in the better eye was 81 (range: 93 to 0) and in the worse eye was 67 (range: 89 to 0). Mean±SD NEI-VFQ scores (0-100 scale, best = 100) included: near vision= 76±23, distance vision=76±23, general vision=66±17, limitations in social functioning due to vision=90±18, role limitations due to vision=72±24, dependency due to vision=87±20, mental health symptoms due to vision=70±21, future expectations for vision=45±22, driving difficulties=58±34, and ocular pain=80±20. Mean VF-14 scores were 80 ± 21. Out of the 11 NEI-VFQ sub-scales tested, VF loss in the better eye was associated with poorer driving scores (p<.05), and VF loss in the worse eye was associated with poorer expectations for future visual function (p<.05). Adjusted and unadjusted comparisons of mean VF-14 scores by AGIS category were not statistically significant. Conclusion: Although mean NEI-VFQ and VF-14 scores demonstrated visual disability across many dimensions of functioning, for the most part, these decrements were not associated with the magnitude of visual field loss as measured by AGIS category. Further analysis will evaluate the potential use of these surveys for monitoring progression of glaucoma over time or treatment side effects.