Editors Selection IGR 22-3

Quality of Life: How do patients perceive and report visual field loss?

Rohit Varma

Comment by Rohit Varma on:

95843 Patient-Reported Symptoms Demonstrating an Association with Severity of Visual Field Damage in Glaucoma, Shah YS; Shah YS; Cheng M; Mihailovic A et al., Ophthalmology, 2022; 129: 388-396

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A better understanding of patient reported symptoms in glaucoma would help physicians and patients communicate more effectively with each other and this has the potential for improved patient understanding of their disease, better acceptance of, and adherence to their treatment which ideally would lead to better patient outcomes and reduce the burden of blindness.

In this cross-sectional study Shah and colleagues administered a questionnaire to evaluate the frequency and severity of 28 patient symptoms (including cloudy vision, missing patches of vision, little peripheral vision), in 170 patients recruited from a glaucoma clinic at an academic medical center (95 patients were glaucoma suspects and 70 patients had glaucoma). Clinical data (visual acuity, visual fields, OCT retinal nerve fiber layer thickness) were abstracted from the most recent clinic visit. Multivariable regression analyses were used to identify which symptoms best differentiated between patients who were glaucoma suspects and those who had definite glaucoma of varying degrees of severity.

The investigators identified that compared to glaucoma suspects, the symptoms more common in glaucoma patients were: better vision in one eye, blurry vision, cloudy vision, glare, little peripheral vision and missing patches of vision. Furthermore, worse severity ratings for the symptom "little peripheral vision" explained the largest variance in visual field loss (43%). Finally, multivariable models that included symptoms explained a higher proportion of visual field loss (62%) as compared to those models that included retinal nerve fiber layer thickness in the worse eye (42%) or just sociodemographic factors (8%). These data highlight the value of assessing symptoms in patients with glaucoma as they provide both the patient and the physician with insight into the severity of vision loss in these patients.

The authors are to be congratulated on exploring patient symptoms and illuminating the value of assessing patient reported symptoms in the assessment and management of glaucoma patients.

While patients express their symptoms based on their experience from both eyes the models in this study utilizes data (visual field and nerve fiber thickness) from the worse eye

This study does however have some limitations which reinforce the need for additional study into this important area of research in glaucoma patients: (i) The study was conducted in an academic ophthalmology department on a number of patients who had severe visual field loss. Therefore, these symptoms may not be generalizable to other practice environments and on other patients with less severe disease. (ii) Since these were patients who had been undergoing treatment, their symptoms maybe either from the treatment (drops) or from learning about the nature of vision loss caused by glaucoma (peripheral vision loss). (iii) Finally while patients express their symptoms based on their experience from both eyes the models in this study utilizes data (visual field and nerve fiber thickness) from the worse eye. It may have been useful to assess visual field variability in a combined visual field from both eyes.

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