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. 2015 Apr;133(4):384-90.
doi: 10.1001/jamaophthalmol.2014.5319.

Association between progressive retinal nerve fiber layer loss and longitudinal change in quality of life in glaucoma

Carolina P B Gracitelli  1 , Ricardo Y Abe  2 , Andrew J Tatham  3 , Peter N Rosen  4 , Linda M Zangwill  4 , Erwin R Boer  4 , Robert N Weinreb  4 , Felipe A Medeiros  4
Affiliations

Association between progressive retinal nerve fiber layer loss and longitudinal change in quality of life in glaucoma

Carolina P B Gracitelli et al. JAMA Ophthalmol. 2015 Apr.

Abstract

Importance: Evaluation of structural optic nerve damage is a fundamental part of diagnosis and management of glaucoma. However, the relationship between structural measurements and disability associated with the disease is not well characterized. Quantification of this relationship may help validate structural measurements as markers directly relevant to quality of life.

Objective: To evaluate the relationship between rates of retinal nerve fiber layer (RNFL) loss and longitudinal changes in quality of life in glaucoma.

Design, setting, and participants: Observational cohort study including 260 eyes of 130 patients with glaucoma followed up for a mean (SD) of 3.5 (0.7) years. All patients had repeatable visual field defects on standard automated perimetry (SAP) at baseline. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was performed annually, and spectral-domain optical coherence tomography and SAP were performed at 6-month intervals. A joint model was used to investigate the association between change in NEI VFQ-25 Rasch-calibrated scores and change in RNFL thickness, adjusting for confounding socioeconomic and clinical variables.

Main outcomes and measures: Association between change in binocular RNFL thickness (RNFL thickness in the better eye at each point) and change in NEI VFQ-25 scores.

Results: Progressive binocular RNFL thickness loss was associated with worsening of NEI VFQ-25 scores over time. In a multivariable model adjusting for baseline disease severity and the rate of change in binocular SAP sensitivity, each 1-μm-per-year loss of RNFL thickness was associated with a decrease of 1.3 units (95% CI, 1.02-1.56) per year in NEI VFQ-25 scores (P < .001). After adjusting for the contribution from SAP, 26% (95% CI, 12%-39%) of the variability of change in NEI VFQ-25 scores was associated uniquely with change in binocular RNFL thickness. The P value remained less than .001 after adjusting for potential confounding factors.

Conclusions and relevance: Progressive binocular RNFL thickness loss was associated with longitudinal loss in quality of life, even after adjustment for progressive visual field loss. These findings suggest that rates of binocular RNFL change are valid markers for the degree of neural loss in glaucoma with significant relationship to glaucoma-associated disability.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Mr Tatham reported receiving research support from Heidelberg Engineering. Dr Zangwill has received research support from Carl Zeiss Meditec, Heidelberg Engineering, Topcon, and Nidek. Dr Weinreb has received research support from Aerie, Carl Zeiss Meditec, Genentech, Heidelberg Engineering, National Eye Institute, Nidek, Novartis, Optovue, and Topcon and has served as a consultant for Alcon, Allergan, Bausch & Lomb, Carl Zeiss Meditec, Sensimed, and Topcon. Dr Medeiros has received research support from Alcon Laboratories, Bausch & Lomb, Carl Zeiss Meditec, Heidelberg Engineering, Merck, Allergan, Sensimed, Topcon, and Reichert and has served as a consultant for Allergan, Carl Zeiss Meditec, and Novartis. No companies were involved in the planning or executing of this work. Grants for participants’ glaucoma medications were provided by Alcon, Allergan, Pfizer, Merck, and Santen. No other disclosures were reported.

Figures

Figure 1
Figure 1
Association Between the Change in 25-Item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) Scores and Change in Retinal Nerve Fiber Layer (RNFL) Thickness Scatterplot with fitted regression line showing the relationship between the change in NEI VFQ-25 scores and change in binocular RNFL thickness (micrometers/year). The shaded area corresponds to the 95% CIs of the regression slope.
Figure 2
Figure 2
Association Between the Change in 25-Item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) Scores and Change in Binocular Mean Sensitivity Scatterplot with fitted regression line showing the relationship between the change in NEI VFQ-25 scores and change in standard automated perimetry binocular mean sensitivity (decibels/year). The shaded area corresponds to the 95% CIs of the regression slope.
See this image and copyright information in PMC

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