Relationship among standard vision tests, quality of life, and ability to do daily activities in patients with glaucoma

Abstract

Background and Objectives: (1) To assess the quality of life (QoL) in patients with glaucoma by (a) clinical assessment, (b) subjective (Visual Functioning Questionnaire-25 [VFQ-25]), and (c) objective (Assessment of Disability Related to Vision [ADREV]) tests and (2) to find out the relationship between glaucoma stages and QoL. Materials and Methods: This cross-sectional study includes 100 patients attending the glaucoma clinic of a tertiary institution in Kerala. Best-corrected visual acuity, baseline intraocular pressure, slit-lamp and fundus examination, gonioscopy, and visual field examination were carried out. Patients were categorized as early, moderate, and advanced on the basis of disc damage likelihood scale (DDLS) and modified Hodapp–Parrish–Anderson criteria. QoL was assessed subjectively using VFQ-25 and objectively by ADREV test by assessing the ability to perform activities of daily living. Contrast sensitivity and stereopsis were the other parameters assessed. Results: Of the 100 patients, 50 (50%) were POAG, 46 (46%) were PACG, and 4 were secondary glaucoma. Based on the DDLS and Anderson criteria, there were 33 early, 34 moderate, and 33 advanced glaucoma cases. The mean ADREV/VFQ scores were as follows: early, 56.9/81.1; moderate, 54.9/75; and advanced, 45.8/52.6. In ADREV tasks, the lowest mean score was for motion detection (5.1) and maximum score was for ambulation (6.1) in the study population. Patients with advanced glaucoma have difficulty in detecting motion (4.1), recognizing street signs (4.3), and color matching (4.8). Stereopsis was seen in 60% of patients with early, 29% of moderate, and 6% of advanced glaucoma. Contrast sensitivity was also reduced with glaucoma progression. Conclusion: ADREV (objective) scores correlate significantly with VFQ (subjective) scores in all the three categories of glaucoma. ADREV (objective test) scores correlate better with the severity and stages of glaucoma and degree of impairment patients experience than VFQ-25 (subjective test). With respect to QoL, patients with glaucoma faced difficulty in performing fine tasks. However, even advanced glaucoma cases were able to carry out their daily activities without much help. Stereopsis and contrast sensitivity were the most affected with advancement of disease.