Predicting Vision-Related Disability in Glaucoma

Purpose: To present a new methodology for investigating predictive factors associated with development of vision-related disability in glaucoma. Design: Prospective, observational cohort study. Participants: Two hundred thirty-six patients with glaucoma followed up for an average of 4.3 +/- 1.5 years. Methods: Vision-related disability was assessed by the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) at baseline and at the end of follow-up. A latent transition analysis model was used to categorize NEI VFQ-25 results and to estimate the probability of developing vision-related disability during followup. Patients were tested with standard automated perimetry (SAP) at 6-month intervals, and evaluation of rates of visual field change was performed using mean sensitivity (MS) of the integrated binocular visual field. Baseline disease severity, rate of visual field loss, and duration of follow-up were investigated as predictive factors for development of disability during follow-up. Main Outcome Measures: The relationship between baseline and rates of visual field deterioration and the probability of vision-related disability developing during follow-up. Results: At baseline, 67 of 236 (28%) glaucoma patients were classified as disabled based on NEI VFQ-25 results, whereas 169 (72%) were classified as nondisabled. Patients classified as nondisabled at baseline had 14.2% probability of disability developing during follow-up. Rates of visual field loss as estimated by integrated binocular MS were almost 4 times faster for those in whom disability developed versus those in whom it did not (-0.78 +/- 1.00 dB/year vs. -0.20 +/- 0.47 dB/year, respectively; P < 0.001). In the multivariate model, each 1-dB lower baseline binocular MS was associated with 34% higher odds of disability developing over time (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.06-1.70; P=0.013). In addition, each 0.5-dB/year faster rate of loss of binocular MS during follow-up was associated with a more than 3.5 times increase in the risk of disability developing (OR, 3.58; 95% CI, 1.56-8.23; P = 0.003). Conclusions: A new methodology for classification and analysis of change in patient-reported qualityof- life outcomes allowed construction of models for predicting vision-related disability in glaucoma. (C) 2017 by the American Academy of Ophthalmology