Patient-Reported Symptoms Demonstrating an Association with Severity of Visual Field Damage in Glaucoma

Five-Year Visual Field Outcomes of the HORIZON Trial

“…Contrast sensitivity may be affected before white-on-white perimetric loss 65 , and worsens as visual field loss progresses from mild to moderate to severe 64,66 . Considering that contrast sensitivity loss may occur earlier than peripheral vision loss and its impact on patient related outcomes and quality of life 57 , protection even in mild-moderate disease, as in this study, is likely to provide a tangible benefit in patient symptomatology and function.…”

“…It has been postulated that as little as 10% reduction in the RoP might prevent blindness in thousands of eyes if broadly applied 55 . The effect observed in the CS-HMS arm was far greater (47% and 43% RoP reduction with the main and sensitivity analysis respectively, calculated from the RoP in Table 2 as Difference/CS) with important potential implications for preventing blindness and reduced quality of life from glaucoma 30,57,58 . Prior evidence suggests that disability increases with the severity of visual field damage across the full range of visual field sensitivity for a variety of daily activities including driving 59 , reading 59,60 , physical activity 61 , the ability of patients to leave their home 61 and increase the rate of hazardous falls 62,63 .…”

Distinguishing Glaucoma, Cataract, and Glaucoma Suspect Based on Visual Symptoms

“…Patients responded to a previously employed visual symptoms questionnaire rating the frequency and severity of 28 different visual symptoms on a scale of 1 to 4. 17 Symptom frequency was rated as (1) never, (2) rarely, (3) sometimes, or (4) very often; and symptom severity was rated as (1) not at all, (2) mild, (3) moderate, or (4) severe. A list of all symptoms used in the questionnaire and their respective sources was previously reported.…”

Identifying Glaucoma in Primary Care Offices

“…As methods to assess the impact of glaucoma on the life of patients develop, the precise linkage between clinical and life functions will be more apparent. 8 Those whose investigations tried to improve identification of undiagnosed glaucoma can agree with the USPSTF recommendation that "trials are needed that assess referral to an eye care specialist and use contemporary screening and diagnostic modalities (eg, spectral-domain OCT [optical coherence tomography] or swept-source OCT)." 1 Indeed, the US Food and Drug Administration has approved such a fundus image analysis device incorporating artificial intelligence methodology for the detection of diabetic retinopathy in primary care offices.…”

“…Mobility, automobile driving, prevention of injurious falls, and loss of reading ability have all been documented to be related to the degree of loss in structural and functional clinical measures of glaucomatous optic neuropathy. As methods to assess the impact of glaucoma on the life of patients develop, the precise linkage between clinical and life functions will be more apparent …”