Impairment In Glaucoma Research Articles

Navigation performance in glaucoma: virtual-reality-based assessment of path integration

Navigation is essential for moving between locations in our daily lives. We investigated the relationship between visual impairment in glaucoma and path-integration-based navigation. Fourteen glaucoma and 15 controls underwent ophthalmological examination (including visual acuity (logMAR), visual field sensitivity (MD: mean deviation from matched reference cohort), and peripapillary retinal nerve fiber layer (pRNFL)). Both groups navigated physically in virtual reality (VR) environments during daylight and dawn conditions. Briefly, the participants traversed a path marked by three targets, subsequently pointing back to the path’s origin. Outcome measures included (i) travel-time, (ii) pointing-time, and (iii) Euclidian-distance error between indicated and starting position. Robust linear regression was conducted between visual function outcomes of the better eye and VR outcome measures. Glaucoma patients showed increase in travel-time (by 8.2 ± 1.7 s; p = 0.002) and in pointing-time (by 5.3 ± 1.6 s; p = 0.016). Predictors were MD for all outcome measures (p < 0.01) and pRNFL for travel-time (p < 0.01). The results suggest that the effect of glaucoma on the elapsed time depends on disease progression, i.e. people with stronger visual impairment need more time. This uncertainty during everyday navigation tasks may adversely affect their quality of life.

Inhibition of Caspase-3 Provides Neuroprotection for Retina Ganglion Cells againts NMDA-induced Exitotoxicity in Wistar Rats

Introduction &amp; ObjectivesGlaucoma is a disorder characterized by the presence of optic neuropathy. Visual impairment inglaucoma is caused by retinal ganglion cell (RGC) apoptosis associated with N-methyl-D-aspartate(NMDA)-mediated excitotoxicity. Excitotoxicity causes an increase in calcium in cells as well asactivation of caspase-3. Glaucoma therapy is currently given to reduce intraocular pressure (IOP),but the damage is still progressing progressively. Hesperidin is known as a neuroprotector that cansuppress calpain overactivation in NMDA-treated retina, thereby reducing the upregulation of TNF-,an inflammatory cytokine, inhibiting calpain activation by suppressing oxidative stress, andattenuating caspase-3 activation. The aim of this study to proving the effect of oral Hesperidin on theexpression of caspase-3 Retinal Ganglion Cell in Wistar rats model of NMDA-induced glaucoma.&#x0D; MethodsExperimental research with post test design only randomized control trial Wistar rats with NMDAinduction were divided into 2 treatment and control groups. The treatment group was given oralHesperidin at a dose of 100mg/kg/day while the control group was given Na-CMC 182 mg/kg/day for3 weeks. Retinal caspase-3 expression was examined by immunohistochemical staining. Data werecollected and processed and then the Mann- Whitney test was performed. (significant p&lt;0.05)&#x0D; ResultsThe mean percentage and intensity of RGC caspase-3 expression in the treatment group were 4.29 ±0.49 it was significantly lower than the control group 6.29 ± 0.95 (p value = 0.003).&#x0D; ConclusionHesperidin provides neuroprotection for RGC againts NMDA- induced exitotoxicity by inhibition ofcaspase-3.

BAFF deficiency aggravated optic nerve crush-induced retinal ganglion cells damage by regulating apoptosis and neuroinflammation via NF-κB-IκBα signaling

Loss of retinal ganglion cells (RGCs) is a primary cause of visual impairment in glaucoma, the pathological process is closely related to neuroinflammation and apoptosis. B-cell activating factor (BAFF) is a fundamental survival factor mainly expressed in the B cell lineage. Evidence suggests its neuroprotective effect, but the expression and role in the retina have not yet been investigated. In this study, we adopt optic nerve crush (ONC) as an in vivo model and oxygen-glucose deprivation/reoxygenation (OGD/R) of RGCs as an in vitro model to investigate the expression and function of BAFF. We found that BAFF and its receptors were abundantly expressed in the retina and BAFF inhibition exacerbated the caspase 3-mediated RGCs apoptosis, glial cell activation and pro-inflammatory cytokines expression, which may be caused by the activation of the NF-κB pathway in vivo. In addition, we found that BAFF treatment could alleviate RGCs apoptosis, pro-inflammatory cytokines expression and NF-κB pathway activation, which could be reversed the effect by blockade of the NF-κB pathway in vitro. Meanwhile, we found that microglia induced to overexpress BAFF in the inflammatory microenvironment in a time-dependent manner. Taken together, our results indicated that BAFF deficiency promoted RGCs apoptosis and neuroinflammation through activation of NF-κB pathway in ONC retinas, suggesting that BAFF may serve as a promising therapeutic target for the treatment of glaucoma.

Association Between Longitudinal 10-2 Central Visual Field Change and the Risk of Visual Acuity Loss in Mild-to-Moderate Glaucoma.

Faster worsening of 10-2 visual field (VF) was associated with the development of visual acuity (VA) loss in mild-to-moderate glaucoma, suggesting longitudinal 10-2 VF change is associated with the risk of VA impairment. To examine whether longitudinal 10-2 central VF change is associated with the risk of VA loss in glaucoma. Primary open angle glaucoma and glaucoma suspect eyes with ≥3 years and 5 visits of 10-2 VF examinations were included. Cox proportional hazard modeling with shared frailty was used to evaluate the hazard ratio (HR) of 10-2 VF mean deviation (MD), superior hemifield mean sensitivity (hemi-MS), and inferior hemi-MS worsening rates for developing VA loss, defined as a change in logMAR VA ≥95% test-retest variability. Among the 252 eyes (148 participants, mean follow-up = 5.8y), 30 eyes (21 participants, mean follow-up = 4.9y) developed VA loss. There was no difference in baseline VF between eyes with and without VA loss ( P > 0.05). Eyes with VA loss showed faster 10-2 VF MD worsening [-0.39 (95% CI: -0.60, -0.18) dB/y] and hemi-MS decrease (range: -0.42~-0.38 dB/y), as compared with no-VA loss eyes [10-2 VF MD change = -0.11 (-0.16, -0.07) dB/y; hemi-MS change: -0.12~-0.07 dB/y; P < 0.05]. In the multivariable model, faster 10-2 VF MD worsening [HR (95% CI) = 4.05 (1.61, 10.22), per 1dB/y faster], superior hemi-MS decrease [HR (95% CI) = 7.07 (2.48, 20.14), per 1dB/y faster], and inferior hemi-MS decrease [HR (95% CI) = 8.32 (1.99, 34.91), per 1dB/y faster] were all associated with increased risk of developing VA loss ( P < 0.05). Faster 10-2 VF MD and hemifield MS worsening are associated with the development of VA loss. Monitoring the longitudinal central 10-degree VF change may suggest that there is impending VA impairment in glaucoma.

Association Between Ganglion Cell Complex Thinning and Vision-Related Quality of Life in Glaucoma

Faster structural changes may be associated with worse vision-related quality of life in patients with glaucoma. To evaluate the association between the rate of ganglion cell complex thinning and the Vision Function Questionnaire in glaucoma. This retrospective analysis of a longitudinal cohort was designed in October 2021. Patients were enrolled from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Two hundred thirty-six eyes of 118 patients with diagnosed or suspected glaucoma were followed up with imaging for a mean of 4.1 years from September 2014 to March 2020. The Vision Function Questionnaire was evaluated using the 25-item National Eye Institute Visual Function at the last follow-up visit. Ganglion cell complex thickness was derived from macular optical coherence tomography scans and averaged within 3 circular areas (3.4°, 5.6°, and 6.8° from the fovea) and superior and inferior hemiregions. Linear mixed-effects models were used to investigate the association between the rate of ganglion cell complex thinning and Rasch-calibrated Vision Function Questionnaire score. The mean (SD) age was 73.2 (8.7) years, 65 participants (55.1%) were female, and 53 participants (44.9%) were African American. Race was self-reported by the participants. Mean composite Rasch-calibrated National Eye Institute Visual Function Questionnaire score was 50.3 (95% CI, 45.9-54.6). A faster annual rate of global ganglion cell complex thinning in the better eye was associated with a higher disability reflected by the composite National Eye Institute Visual Function Questionnaire score (-15.0 [95% CI, -28.4 to -1.7] per 1 μm faster; P = .03). When stratified by degrees from the fovea, the 5.6° and 6.8° areas were associated with the composite National Eye Institute Visual Function Questionnaire Rasch-calibrated score (-14.5 [95% CI, -27.0 to -2.0] per 1 μm faster; R2 = 0.201; P = .03; and -23.7 [95% CI, -45.5 to -1.9] per 1 μm faster; R2 = 0.196; P = .02, respectively), and -8.0 (95% CI, -16.8 to 0.8) per 1 μm faster for the 3.4° area (R2 = 0.184; P = .07) after adjusting for confounding factors. These findings suggest that faster and sectoral central location of ganglion cell complex thinning provides useful information in determining the risk of vision-related quality of life in glaucoma. Monitoring macular structure may be useful for determining the risk of functional impairment in glaucoma.

SIRT1 is required for the neuroprotection of resveratrol on retinal ganglion cells after retinal ischemia-reperfusion injury in mice.

Retinal ganglion cells (RGCs) loss is closely related to visual impairment in glaucoma, so the neuroprotection on RGCs is important and novel for glaucoma research. SIRT1, a family member of sirtuins, is implicated in many crucial processes of eye diseases. The purpose of this study is to determine the neuroprotection of SIRT1 on RGCs and to investigate the underlying mechanisms of these effects in an experimental model for acute glaucoma. Retinal ischemia-reperfusion (IR) injury was induced in C57BL/6J mice. Resveratrol (RSV, activator of SIRT1) and sirtinol (inhibitor of SIRT1) were injected intravitreally 1day before IR injury. RGCs survival rate was quantified by immunofluorescence staining. RGCs apoptosis was evaluated by the staining of TUNEL and cleaved caspase-3, and SIRT1 level was detected by western blot. Expressions of phospho-Akt, Akt, Bax, and Bcl-2 were further determined by western blot to investigate the neuroprotective mechanisms of SIRT1. RGCs survival rates and SIRT1 levels were decreased over time after IR injury. Intravitreal injection of RSV remarkably attenuated RGCs loss in a dose-dependent manner, and the most effective concentration of RSV was 100μM. Up-regulation of SIRT1 by RSV significantly inhibited RGCs apoptosis, increased p-Akt level, decreased Bax and cleaved caspase-3 expressions, and all these effects were diminished by 100μM sirtinol. Moreover, there were no significant changes in total Akt and Bcl-2 levels. SIRT1 activation by RSV confers neuroprotection on RGCs in retinal IR injury through the activation of Akt pathway and subsequent suppression of mitochondrial apoptotic pathway. Determination of the effective concentration of intravitreal injection of RSV also provides a theoretical basis for the clinical application of RSV.

The Association Between Visual Field Reliability Indices and Cognitive Impairment in Glaucoma Patients.

This prospective cross-sectional study found that patients with cognitive impairment (CI) are more likely to produce unreliable visual field (VF) tests, especially with higher false-negative (FN) responses and consequent overestimation of mean deviation (MD). Aging-associated CI can impair the ability of individuals to perform a VF test and compromise the reliability of the results. We evaluated the association between neurocognitive impairment and VF reliability indices in glaucoma patients. This prospective, cross-sectional study was conducted in the Ophthalmology Department, Hospital Kuala Pilah, Malaysia, and included 113 eyes of 60 glaucoma patients with no prior diagnosis of dementia. Patients were monitored with the Humphrey Visual Field Analyzer using a 30-2 SITA, standard protocol, and CI was assessed using the clock drawing test (CDT). The relationships between the CDT score, MD, pattern standard deviation, Visual Field Index (VFI), fixation loss (FL), false-positive values, and FN values were analyzed using the ordinal regression model. Glaucoma patients older than 65 years had a higher prevalence of CI. There was a statistically significant correlation between CDT scores and glaucoma severity, FL, FN, and VFI values (rs=-0.20, P=0.03; rs=-0.20, P=0.04; rs=-0.28, P=0.003; rs=0.21, P=0.03, respectively). In a multivariate model adjusted for age and glaucoma severity, patients with lower FN were significantly less likely to have CI (odds ratio, 0.91; 95% confidence interval, 0.89-0.93) and patients with higher MD were more likely to have CI (odds ratio, 1.10; 95% confidence interval, 1.05-1.16); false positive, FL, pattern standard deviation, and VFI showed no significant correlation. Cognitive decline is associated with reduced VF reliability, especially with higher FN rate and overestimated MD. Screening and monitoring of CI may be important in the assessment of VF progression in glaucoma patients.

Dark Adaptation Survey as a Predictive Tool for Primary Open-Angle Glaucoma

To study the extent to which patients with primary open-angle glaucoma (POAG) have subjective difficulties with dark (DA) adaptation and vision under low-luminance conditions and to correlate the reported difficulties with severity of disease, specifically visual field loss. Prospective, comparative case series. Two hundred twenty patients with and without POAG who sought treatment at an outpatient subspecialty glaucoma clinic between October 2016 and September2018. A questionnaire designed to assess difficulties with DA and vision under low luminance (the DA survey) was developed and given to patients during routine clinical evaluation in a hospital-based eye clinic. Retrospective data related to ocular health and glaucoma severity were abstracted from the medical record. A multiple regression analysis was performed to create a predictive model for POAG. Severity of glaucoma, specifically visual field loss, and classification of participants as glaucoma patients or control participants. Eighty-five patients with POAG and 127 control participants completed the questionnaire. Exploratory factor analysis of the DA survey using a principal components analysis showed that the items split into 2 dimensions: tasks that involved difficulty with vision under low luminance and those that required DA. Cronbach's α showed a high degree of internal consistency reliability (α= 0.88). Increasing DA survey score correlated with binocular visual field loss among patients with mild, moderate, and advanced POAG (P < 0.001). A model used to differentiate patients with POAG from control participants that included average and intereye difference in cup-to-disc ratio, family history of glaucoma, and DA survey score showed an accuracy, sensitivity, and specificity of 96.7%, 92.9%, and 99.2%, respectively. This pilot study revealed that problems with DA and vision under low luminance are commonly encountered by patients with POAG. These areas of visual disability are not assessed routinely in glaucoma care. A questionnaire assessing vision under low luminance and light-dark transitions may serve as a proxy for functional impairment in glaucoma. When paired with risk factors such as structural features of the optic nerve and family history, this survey instrument may be suitable to screen for patients with POAG.

Evaluation of Vision-related Quality of Life in Patients with Glaucoma: A Hospital-based Study.

ABSTRACTIntroductionQuality of life (QoL) is a broad concept that is affected in a complex way by many factors. Healthcare interventions are targeted now days to improve quality of life of affected individuals. Glaucoma is a major cause of irreversible blindness throughout the world and affects patient's quality of life in several ways. In present study, we aim to evaluate and quantify vision related quality of life in glaucoma patients in a tertiary care hospital setting.Materials and methodsVision related quality of life was evaluated in glaucoma patients using GQL-15 questionnaire, which compares the subjective performance of various vision related tasks in these patients. Fifty diagnosed cases of glaucoma and fifty healthy volunteers were included in the study. In both these groups, standard tests for visual function were done and both were assigned to complete the questionnaire. GQL-15 questionnaire includes 15 items divided between 4 factors pertaining to visual disability: central and near vision, peripheral vision, dark adaptation and glare, and outdoor mobility. Higher scores indicate greater difficulty in performing vision-related activities and poorer QoL.ResultsA total of 100 cases were enrolled out of which 50 were diagnosed glaucoma cases and 50 were controls. Almost three fourth of glaucoma patients, i.e., 72% were diagnosed as chronic open angle glaucoma where 24% were angle closure patients and rest 4% were normal tension glaucoma patients. The mean GQL score of glaucoma cases was 26.00 ± 10.84 and for controls it was 15.02 ± 0.14 (p value < 0.05). All subscale scores also showed a uniform rise in their value as we move from mild to severe cases thereby concluding that all visual parameters worsen with increase in severity pattern of disease.ConclusionsAs glaucoma patients have reduced vision related quality of life, so every effort should be made to preserve visual functions in these patients. Many activities that define independence and productivity in society require good vision and hence one of most devastating consequences of advancing visual impairment in glaucoma is progressive loss of independence thereby affecting patients quality of life.How to cite this articleDhawan M, Hans T, et al. Evaluation of Vision-related Quality of Life in Patients with Glaucoma: A Hospital-based Study. J Curr Glaucoma Pract 2019;13(1):9–15.

Assessing driving risk in patients with glaucoma.

Glaucoma is the leading cause of irreversible blindness worldwide and can affect a broad array of daily activities, including driving. Recently, studies investigating the relationship between driving performance and glaucoma have received a great deal of interest. Assessment of driving behavior is not straightforward because driving is a complex skill involving significant multi-tasking ability. In this review, we summarize recent work from clinical studies investigating how glaucoma can affect driving performance. Patients with glaucoma are more likely to be involved in motor vehicle collisions when compared to healthy subjects. Here we describe how conventional functional tests performed in glaucoma patients, such as visual field measurements via standard automatic perimetry, are associated with driving performance. However, the risk of motor vehicle collisions is not entirely attributable to visual field impairment in glaucoma, suggesting that other factors also account for both driving safety and performance. Finally, we show different studies suggesting that parameters from driving simulators can be helpful because they can identify the impact of visual loss on complex situations.

COMPARISON OF DIFFERENT METHODS OF PHYSIOTHERAPY TREATMENT IN THE MANAGEMENT OF PRIMARY OPEN-ANGLE GLAUCOMA

Background: Therapeutic action of physical therapy aims at the recovery of conductibility of optic tracts, improvement of microcirculation and hemodynamics, stimulation of regulatory brain structures and improvement of psycho-neurological status of patients. Aim: To assess efficacy of transcranial magnetic therapy, contemporary transcranial magnetic therapy/electrostimulation and magnetic sympathocorrection in the treatment of primary open-angle glaucoma. Materials and methods: 397 patients (634 eyes), aged 58–76 years, with verified diagnosis of stage I, II or III primary open-angle glaucoma, received transcranial magnetic therapy (group 1, 182 eyes), contemporary transcranial magnetic herapy/electrostimulation (group 2, 258 eyes) and magnetic sympathocorrection (group 3, 194 eyes). All patients underwent routine ophthalmological examination, visual evoked potential recording and assessment of ocular circulation. Results: In patients with initial stage of glaucoma, most prominent changes of electrophysiological parameters was demonstrated in the group 2: visual evoked potential amplitude increased from 8.4 ± 0.4 to 11.3 ± 0.2 mcV, latency decreased from 77.6 ± 1.3 to 70.4 ± 2.1 ms. Maximal improvement of ocular circulation (decrease of resistance index of posterior short ciliary arteries from 0.69 ± 0.02 to 0.51 ± 0.03) was registered in the group 3. In patients with evolved glaucoma (stage II), significant increase of P100 amplitude of visual evoked potentials (from 7.5 ± 0.2 to 9.8 ± 0.3 mcV) was found in the group 2; latency period decreased from 84.6 ± 1.5 to 74.8 ± 2.1 ms. In stage II glaucoma patients, prominent increase of systolic blood velocity was demonstrated in groups 3 and 2: from 11.26 ± 0.8 to 13.64 ± 0.63 cm/s and from 10.5 ± 0.2 to 13.9 ± 0.7 cm/s, respectively. Resistance index decreased from 0.76 ± 0.05 to 0.52 ± 0.02 and from 0.75 ± 0.02 to 0.65 ± 0.02 in groups 3 and 2, respectively. In advanced glaucoma (stage III), most prominent increase of P100 amplitude of visual evoked potentials was demonstrated in group 2: amplitude of visual evoked potentials increased from 6.5 ± 0.2 to 8.1 ± 0.2 mcV, latency decreased from 87.5 ± 2.3 to 80.1 ± 2.1 ms. Maximal improvement of ocular circulation (increase of systolic blood velocity from 9.2 ± 0.72 to 11.2 ± 0.6 cm/s) and decrease of resistance index (from 0.84 ± 0.04 to 0.66 ± 0.03) was found in patients with stage III glaucoma in the group 3. Conclusion: Use of different methods of magnetic therapy especially in combination with electrostimulation activates ocular hemodynamics and stimulates bioelectric activity of visual cortex and may prevent visual functions impairment in glaucoma.

Binocular Visual Field Impairment in Glaucoma and At-Fault Motor Vehicle Collisions

To evaluate the association between the binocular visual field defects in drivers with glaucoma and the risk of motor vehicle collision (MVC) involvement. A retrospective cohort study was conducted on 438 drivers with glaucoma aged 55 years or older using data from 1994 through 2000. Demographic, clinical, and driving characteristics were obtained from chart abstractions and patient survey. Binocular field measures were generated by combining data from the monocular (central 24-degree radius) fields whereby the binocular field measure was defined as the more sensitive point at each monocular field location. Measures included threshold (TH), total deviation (TD), and pattern deviation (PD); severe impairment in these measures was defined as falling into the worst quartile. MVC data were obtained from police records. Rate ratios (RR) and 95% confidence intervals (CI) were calculated. Drivers with severely impaired PD measures were twice as likely to have an at-fault MVC compared with those not severely impaired (RR, 2.13; 95% CI, 1.21-3.75); those with severely impaired TH (RR, 1.49; 95% CI, 0.81-2.74) and TD (RR, 1.50; 95% CI, 0.82-2.74) also had an increased rate of at-fault MVCs, although these were not significant. When the binocular central visual field was stratified into 9 regions, drivers with impaired TH, TD, or PD had similarly elevated MVC rates in all regions compared with those not severely impaired, though not all reached statistical significance. On the basis of clinical measures of visual field routinely used in the management of glaucoma, drivers with glaucoma with severe PD field defects in the binocular field have a higher rate of at-fault MVC compared with those with less impaired or unimpaired binocular visual fields.

Health- and Vision-Related Quality of Life in Patients with Ocular Hypertension or Primary Open-Angle Glaucoma

Background: The main objective of this analysis was to assess the impact of severity of disease on the quality of life (QoL) of patients with ocular hypertension (OHT) and early, moderate, or advanced primary open-angle glaucoma (POAG). Methods: This multicenter study was conducted at 2 university hospitals and 13 ophthalmology practices in Germany. QoL data were assessed by the Health Utility Index (HUI3) and the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Results: 154 patients (17.5% OHT, 27.9% early, 22.7% moderate, and 31.8% advanced POAG) were included. The HUI3 scores for OHT, early, moderate, and advanced POAG were 0.87 ± 0.09, 0.85 ± 0.15, 0.75 ± 0.23, and 0.58 ± 0.32, respectively. Compared to a normal population matched by age and gender, for moderate and severe POAG a difference of -0.06 ± 0.24 and -0.19 ± 0.28, respectively, was observed. NEI-VFQ-25 scores illustrate different dimensions of the impact on QoL; reduced peripheral vision or difficulties to drive a car were more crucial to glaucoma patients than social factors. Conclusions: The key difference for QoL impairment in glaucoma lies between OHT/early POAG versus moderate/severe POAG, hence every possible effort needs to be made to prevent disease progression over this threshold.

Association Between Rates of Binocular Visual Field Loss and Vision-Related Quality of Life in Patients With Glaucoma

It is reasonable to hypothesize that for 2 patients with similar degrees of integrated binocular visual field (BVF) loss, the patient with a history of faster disease progression will report worse vision-related quality of life (VRQOL) than the patient with slowly progressing damage. However, to our knowledge, this hypothesis has not been investigated in the literature. To evaluate the association between binocular rates of visual field change and VRQOL in patients with glaucoma. DESIGN Observational cohort study. Patients were recruited from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. The study included 796 eyes of 398 patients with diagnosed or suspected glaucoma followed up from October 1, 1998, until January 31, 2012, for a mean (SD) of 7.3 (2.0) years. The VRQOL was evaluated using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) at the last follow-up visit. The NEI VFQ-25 was completed for all patients during the period extending from December 1, 2009, through January 31, 2012. Integrated BVFs were calculated from the monocular fields of each patient. Linear regression of mean deviation values was used to evaluate rates of BVF change during the follow-up period. Logistic regression models were used to investigate the association between abnormal VRQOL and rates of BVF change, while adjusting for potentially confounding socioeconomic and demographic variables. Thirty-two patients (8.0%) had abnormal VRQOL as determined by the results of the NEI VFQ-25. Patients with abnormal VRQOL had significantly faster rates of BVF change than those with normal VRQOL (-0.18 vs -0.06 dB/y; P < .001). Rates of BVF change were significantly associated with abnormality in VRQOL (odds ratio = 1.31 per 0.1 dB/y faster; P = .04), after adjustment for confounding variables. Patients with faster rates of BVF change were at higher risk of reporting abnormal VRQOL. Assessment of rates of BVF change may provide useful information in determining risk of functional impairment in glaucoma.

Driving simulation as a performance-based test of visual impairment in glaucoma.

The fundamental goal of glaucoma management is to prevent patients from developing visual impairments sufficient to produce disability in their daily lives and impair their quality of life. Ultimately, patients are interested in how their vision will impact their ability to perform daily activities, such as driving. Although technologic advancements such as automated perimetry and devices for optic nerve imaging have resulted in great improvement in our ability to quantify structural and functional damage in glaucoma, the impact on vision-related quality of life of some of the information acquired from these tests remain elusive. In contrast, performance-based measures may be better correlated to traditional measures of vision health and, more importantly, they provide a more direct measure of disability. Driving simulators can be used as a performance-based test for evaluation of functional impairment in glaucoma. Their use can potentially help in the evaluation of driving safety and performance of diseased subjects and provide insight into the different mechanisms involved in causing driving impairment in this disease. The ability to do this in an experimentally controlled and standardized setting enables testing of a much larger number of hypotheses compared with on-road evaluations. Besides evaluating driver fitness, simulators could also potentially be used as a sophisticated test to evaluate cognitive impairment in the context of an everyday task (driving) that has not been available through traditional neuropsychologic assessment.

067 Glaucome et qualité de vie

The visual quality of life (QoL) is of increasing importance in ophthalmology. In patients with glaucoma quality of life measurements have also been performed. Main factors that diminish patients’ QoL with glaucoma are: the awareness to suffer from a chronic and progressive disease, the need of frequent treatment, the fear of blindness or severe visual field loss or to suffer from visual impairment in advanced disease. QoL measurements, in particular utility assessment, allow health economic evaluations. Medline was searched for relevant publications. Keywords used were: quality of life, glaucoma, value based medicine, time trade off (TTO), standard gamble (SG), VFQ-25. Furthermore, own QoL-data in a normal collective is used to illustrate the recent findings about QoL in glaucoma patients. Two major parameters can be assessed using QoL instruments in ophthalmology and glaucoma: the instrument-specific visual-QoL and the patients’ vision-related utility. Whereas the first gives a good insight in patients'subjective impairment due to glaucoma and smaller changes in different dimensions can be detected, utility values can serve well for economic evaluations. There are a number of well-documented questionnaires to quantify the subjective impairment in glaucoma. The glaucoma-specific instruments have the greatest power of discrimination between glaucoma patients and control. The two major instruments for utility assessment are SG and TTO. Compared to the visual QoL assessed by the Visual Function Questionnaire 25 (VFQ-25) in a normal collective, patients with glaucoma have a clearly diminished QoL. Visual QoL is strongly correlated with central vision, but also (less strongly) with the severity of visual field defects. The perfect QoL instrument for glaucoma has yet not been identified. The VFQ-25 appears to be the benchmark against which new glaucoma QoL instruments have to be compared. The Glaucoma Quality of Life 15 (GQL-15) is probably the most useful and clinically relevant tool. Utility instruments have the highest power for economic evaluations, whereas questionnaires have a better power to detect smaller changes in disease severity or progression. It is obvious, that current utility values in glaucoma differ markedly dependent on which method was used. Assessment of visual QoL is of increasing importance in patients with glaucoma. Individual assessment of patients’ impairment by the disease is an important factor in medical decision making for the clinician. QoL measurements allow to perform health economic analyses using utility values, which create well-founded arguments in medical and health-policy decision making.

Patients' Perception of Visual Impairment in Glaucoma: A Pilot Study

Patients' Perception of Visual Impairment in Glaucoma: A Pilot Study

Video color perimetry: impairment in glaucoma suspects.

To detect mild visual field impairment in asymptomatic glaucoma suspect patients. Color perception within the visual field was tested with customized color video perimetry. The key features of the system were stimuli color desaturation, low-level luminance and equiluminant gray background. Twenty patients with asymptomatic glaucoma were tested and compared with a group of age-matched control subjects. Automated perimetry test findings differed significantly in the two groups, particularly for short-wavelength sensitivity (blue). The severity of color impairment correlated directly with intraocular pressure. Desaturated low-luminance video perimetry will reliably detect and quantify asymptomatic visual field defects. A previous work on multiple sclerosis has detected a mild long-wavelength (red) impairment in asymptomatic patients after an episode of optic neuritis, even in clinically unaffected fellow eyes. Our findings in glaucoma suspect patients indicate that a mild blue impairment could be the initial sign of this disease.

Patients’ perception of visual impairment in glaucoma: a pilot study

BACKGROUND/AIMSThere is a paucity of useful information on the level of visual disability suffered by glaucoma patients. The aims of this study were to determine and rank the frequency of...

Psychophysical Studies of Visual Dysfunction in Glaucoma: Lessons Learned and Questions Raised

The study of visual dysfunction in ophthalmic disease is important for both elucidating the pathophysiological basis of visual loss and improving patient care. The application of psychophysical procedures in contemporary glaucoma research illustrates this point. Although achromatic automated perimetry (ie differential luminance thresholds) remains the ‘gold standard’ for the clinical diagnosis of glaucomatous optic neuropathy, psychophysical studies of other visual functions (motion discrimination, blue - yellow perimetry, temporal resolution, and contrast sensitivity) have led to the development of a more comprehensive framework for investigating the mechanisms underlying glaucoma-induced visual impairment. For example, psychophysical studies of the mechanisms mediating visual dysfunction in glaucoma suggest that neurodegenerative changes reduce redundancy in the neural circuitry in a manner that may be selective for, but possibly not specific to, particular neural pathways. In addition, psychophysical studies have significantly advanced our understanding of the nature and scope of visual deterioration in this disease. As a direct result of these studies new clinical tools have been designed which (1) increase sensitivity for detecting early signs of visual impairment, (2) more accurately predict which glaucoma suspects will develop the disease, and (3) provide a more precise metric for both monitoring disease progression and evaluating treatment efficacy (eg in clinical trials). In this presentation I describe the status of our knowledge of visual impairment in glaucoma and highlight the contributions of visual psychophysics to the evolution of this understanding.