Which symptoms contribute to severe visual field damage in glaucoma?

Variance in visual field (VD) damage is substantially driven by five patient-reported symptoms, according to a cross-sectional study.

A total of 170 adults diagnosed with glaucoma or suspicion of glaucoma (mean age 64 years, 58 percent female, 47 percent employed) rated their visual symptoms on questions collated from several published questionnaires, rating the frequency and severity of 28 symptoms on a scale of 1 (never/not at all) to 4 (very often/severe).

The investigators defined worse-eye VF damage based on perimetric testing and retinal nerve fibre layer (RNFL) thickness by optical coherence tomography imaging. Finally, they used multivariable regression models to identify patient-reported symptoms contributing to the highest variance in VF damage.

Of the patients, 95 were glaucoma suspects (control) and 75 glaucoma patients. In the latter, median mean deviation of VF damage in the worse eye was ‒19.3 decibels (range, ‒5.3 to ‒34.7). More common symptoms among glaucoma patients vs suspects were better vision in one eye, blurry vision, sensitivity to light, cloudy vision, missing patches of vision, and little peripheral vision.

Most variance in VF damage was driven by worse severity ratings for the symptom “little peripheral vision” (43 percent). A multivariable model including the frequency of cloudy vision, severity of having little peripheral vision, missing patches, one eye having better vision, and vision worsening, along with sociodemographic features, explained 62 percent of the variance in VF damage.

In comparison, 42 percent of the variance in VF damage was explained by a multivariable model of worse-eye RNFL thickness and sociodemographic features, while 8 percent of such variance was driven by a model including only sociodemographic features.

“Asking patients about their symptoms may optimize patient-physician communication and be a useful adjunct to clinical testing in some patients to estimate disease severity,” the investigators said.