What do patients with glaucoma see? Visual symptoms reported by patients with glaucoma

Abstract

Background: Vision loss from glaucoma has traditionally been described as loss of "peripheral vision." In this prospective study, we aimed to improve our clinical understanding of the visual symptoms caused by glaucoma by asking patients specific detailed questions about how they see.

Methods: Patients who were clinically diagnosed with various types and stages of glaucoma were included. All had a comprehensive ocular examination, including Octopus visual field testing. Patients were excluded if they had other ocular conditions that affected their vision, including cornea, lens or retina pathologies. Patients responded to an oral questionnaire about their visual symptoms. We investigated the visual symptoms described by patients with glaucoma and correlated the severity of visual field loss with visual symptoms reported.

Results: Ninety-nine patients completed the questionnaire. Most patients (76%) were diagnosed with primary open-angle glaucoma. The most common symptoms reported by all patients, including patients with early or moderate glaucoma, were needing more light and blurry vision. Patients with a greater amount of field loss (Octopus mean defect >+9.4 dB) were more likely to report difficulty seeing objects to one or both sides, as if looking through dirty glasses and trouble differentiating boundaries and colors.

Conclusions: Vision loss in patients with glaucoma is not as simple as the traditional view of loss of peripheral vision. Needing more light and blurry vision were the most common symptoms reported by patients with glaucoma.

FIGURE 1

(A) Patient view with normal vision. (B) Patient view with glaucoma. Loss of vision in glaucoma has been traditionally described as “tunnel vision” or as if “looking through a straw” (courtesy: National Eye Institute and National Institutes of Health).

FIGURE 2

(A) Loss of “peripheral vision” can use an eye or a person as its central reference point. Loss of peripheral vision for the left eye means loss of vision toward the edges of the VF of that eye. (B) The same is true for the right eye. (C) Loss of peripheral vision for the person implies loss of sight off to the person's sides, either the right and left side (as shown) or above and below. VF, visual field.

FIGURE 3

A graphic illustration of a possible progression of visual loss in a patient with glaucoma. (A) Normal vision, early glaucoma. (B) Early loss of contrast sensitivity. (C) Severe loss of contrast sensitivity. (D) Light paracentral and arcuate scotomas. (E) Dense scotomas. (F) Advanced bilateral disease. (G) Very advanced bilateral disease.