PurposeTo determine the association between vision‐related quality of life (VRQOL) and levels of visual function loss in the Early Manifest Glaucoma Trial (EMGT).MethodsTwo hundred and fifty‐five patients were included in the EMGT between 1993 and 1997 and followed regularly by ophthalmic examinations. A Swedish translation of the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ‐25) was self‐administered at several follow‐up visits until 2014. We analysed the association between Rasch‐calibrated NEI VFQ‐25 scores and visual function in the best eye at the final follow‐up visit.ResultsNinety‐one per cent (233/255) of all participants completed the NEI VFQ‐25 at least once. In univariate logistic regression analysis, NEI VFQ‐25 scores were modestly associated with visual acuity (VA) (r 2 = 0.330, p < 0.001), visual field index (VFI) (r 2 = 0.200, p < 0.001) and perimetric mean deviation (MD) (r 2 = 0.193, p < 0.001). In multivariate analysis, VA and VFI together accounted for approximately 40% (r 2 = 0.380) of the NEI VFQ‐25 scores. NEI VFQ‐25 scores were significantly higher for patients with no visual impairment (mean 73 ± 22) than for visually impaired patients (mean 31 ± 15, p < 0.001). VFI worse than 50% or MD worse than −18 dB was significantly associated with low VRQOL scores (p < 0.001).ConclusionsOur results support the widespread, albeit arbitrary, use of a better‐eye visual field of <50% as an important threshold for a significant reduction in VRQOL.

Objective To elucidate the temporal relationship between detection of glaucomatous optic disc progression, as assessed by fundus photography, and visual field progression. Design Prospective, randomized, longitudinal trial. Subjects Three hundred and six study eyes with manifest glaucoma with field loss and 192 fellow eyes without any field defect at the start of the trial, of a total of 249 subjects included in the Early Manifest Glaucoma Trial (EMGT) were assessed. Methods Evaluation of visual field progression and optic disc progression during an 8-year follow-up period. Three graders independently assessed optic disc progression in optic disc photographs. Visual field progression was assessed using glaucoma change probability maps and the EMGT progression criterion. Main outcome measures Time to detection of visual field progression and optic disc progression. Results Among study eyes with manifest glaucoma, progression was detected in the visual field first in 163 eyes (52%), in the optic disc first in 39 eyes (12%) and in 1 eye (0%) it was found simultaneously with both modalities. Among fellow eyes with normal fields, progression was detected in the visual field first in 28 eyes (15%), in the optic disc first in 34 eyes (18%) and in 1 eye (1%) it occurred simultaneously. Conclusion In eyes with manifest glaucoma, progression in the visual field was detected first more than four times as often as progression in the optic disc. Among fellow eyes without visual field loss at baseline, progression was detected first as frequently in the optic disc as in the visual field.

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