Quality of Life According to Location of Integrated Binocular Visual Field Defect in Normal-Tension-Glaucoma Patients

Dong Ik Lee; In Ki Park; Jae Hoon Jeong; Yeoun Sook Chun

doi:10.3341/jkos.2016.57.1.86

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Lee, Park, Jeong, and Chun: Quality of Life According to Location of Integrated Binocular Visual Field Defect in Normal-Tension-Glaucoma Patients

Original Article

J Korean Ophthalmol Soc 2015;57(1):86-97.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2016.57.1.86

Quality of Life According to Location of Integrated Binocular Visual Field Defect in Normal-Tension-Glaucoma Patients

Dong Ik Lee, M.D¹, In Ki Park, M.D, PhD², Jae Hoon Jeong, M.D¹, Yeoun Sook Chun, M.D, PhD^1,

¹Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea

²Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea

Address reprint requests to Yeoun Sook Chun, MD, PhD Department of Ophthalmology, Chung-Ang University Hospital, #102 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea Tel: 82-2-6299-1665, Fax: 82-2-825-1666 E-mail: yschun100@hanmail.net

‗ This study was presented as a poster at the 113th Annual Meeting of the Korean Ophthalmological Society 2015.

Received 30 July 201530 September 2015 Accepted 12 December 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the relationship between vision-related quality of life (QOL) and integrated binocular visual field (IVF) de-fect and the difference in QOL based on the location of visual field defects in Korean normal tension glaucoma (NTG) patients.

Methods

Two hundred monocular visual fields from 100 patients diagnosed with normal tension glaucoma in at least one eye were integrated using the best location method, and the mean deviation (MD) of whole, superior, and inferior IVF was calculated. We analyzed the correlations between subscales of the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) and each calculated MD using Spearman correlation. After adjusting for confounding factors of age, visual acuity of the better eye, number of medications, and education level, the impact of IVF loss on the composite score of the NEI VFQ-25 was eval-uated using multivariate linear regression analysis.

Results

The MDs of whole and inferior IVF were significantly associated with 7 of 12 NEI VFQ-25 subscales, and the superior IVF was associated with 3 subscales ( p < 0.05). After adjusting confounding variables, the composite score of the NEI VFQ-25 showed significant correlation with whole, superior, and inferior IVF. The adjusted R² and β coefficient of the regression line were highest in the whole IVF (Adjusted R² = 0.451, β = 1.12), followed by the inferior and superior IVF (Adjusted R² = 0.438, 0.395, β = 0.95, 0.85).

Conclusions

The IVF of Korean NTG patients can effectively reflect patient QOL, and the inferior IVF was significantly asso-ciated with more subscales of NEI VFQ-25 than was the superior IVF. However, overall QOL of patients is thought to be de-termined by severity of visual field loss rather than its location.

Keywords: Integrated binocular visual field, Location, Normal tension glaucoma, Quality of life

References

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Figure 1.

Association between National Eye Institute Visual Function Questionnaire (NEI VFQ-25) composite score and the mean deviations (MD) of each integrated binocular visual fields (IVF) in Korean normal tension glaucoma patients. (A) Whole field IVF and composite score (β = 1.29, R² = 0.428, p < 0.001). (B) Inferior field IVF and composite score (β = 1.10, R² = 0.402, p < 0.001). (C) Superior field IVF and composite score (β = 1.02, R² = 0.363, p < 0.001).

Figure 2.

The effects of the superior and inferior field defect on word recognition in Korean and English. The upper half sentence can give clues to recognize the English letters be-cause English alphabets composed of one letter. In contrary, patients could encounter difficulties to understand a Korean sentence with just half of sentence because Korean letters are made by combinations of consonants and vowels.

Table 1.

Clinical and demographic characteristics of the subjects

	Data
Number of subjects	100
Age (years)	59.89 ± 14.06 (22 to 82)
Gender (female)	43
Bilateral NTG	88
Mean deviation (range, dB)
Better eye	-4.80 ± 6.58 (-30.56 to 1.38)
Worse eye	-8.66 ± 7.49 (-35.98 to 0.60)
Integrated binocular visual field MD (range, dB)
Whole visual field	-3.85 ± 5.98 (-29.01 to 2.30)
Superior visual field	-4.74 ± 6.99 (-28.79 to 2.68)
Inferior visual field	-3.85 ± 6.83 (-35.71 to 2.57)
log MAR visual acuity in the better eye (range)	0.09 ± 0.13 (0.00 to 0.60)
No. of using medication (range)	1.42 ± 0.62 (1 to 3)
Comorbidity index (range)	0.88 ± 1.01 (0 to 4)
Marital status, married	63
Education level, college graduated	46
Income, lower than ￦35,000,000	48
Follow-up time (months)	18.56 ± 26.13 (12 to 140)

Values are presented as mean ± SD unless otherwise indicated.

NTG = normal tension glaucoma; dB = decibels; MD = mean deviation.

Table 2.

Comparison of MDs of monocular and integrated binocular visual fields

Visual field	MDs (range, dB)	p-value^*	p-value^†	p-value^‡
Whole IVF	-3.85 ± 5.98 (-29.01 to 2.30)		0.001	0.985
Superior IVF	-4.74 ± 6.99 (-28.79 to 2.68)	0.001		0.044
Inferior IVF	-3.85 ± 6.83 (-35.71 to 2.57)	0.985	0.044
Better eye	-4.80 ± 6.58 (-30.56 to 1.38)	<0.001	0.792	0.003
Worse eye	-9.49 ± 7.94 (-35.98 to 0.60)	<0.001	<0.001	<0.001

MD = mean deviation; IVF = integrated binocular visual field; dB = decibels.

^* Wilcoxon signed ranks test, compared with whole IVF MD;

^† Wilcoxon signed ranks test, compared with superior IVF MD

^‡ Wilcoxon signed ranks test, compared with inferior IVF MD.

Table 3.

The correlation coefficients between MDs and subscales of the National Eye Institute Visual Function Questionnaire (NEI VFQ-25)

	Score	MD of whole IVF		MD of superior IVF		MD of inferior IVF
		Correlation coefficient^*	p-value	Correlation coefficient^*	p-value	Correlation coefficient^*	p-value
General health	39.4 ± 20.4	0.107	0.298	0.028	0.786	0.115	0.260
General vision	66.6 ± 20.4	0.378	<0.001	0.339	0.001	0.291	0.004
Ocular pain	78.9 ± 20.4	0.268	0.008	0.225	0.027	0.285	0.005
Near vision	82.3 ± 19.4	0.189	0.063	0.097	0.346	0.192	0.059
Distance vision	82.2 ± 18.3	0.265	0.009	0.173	0.090	0.262	0.009
Vision-specific social functioning	90.1 ± 15.8	0.214	0.035	0.195	0.055	0.194	0.057
Vision-specific mental health	78.1 ± 18.8	0.283	0.005	0.260	0.010	0.261	0.010
Vision-specific role difficulties	75.5 ± 29.1	0.225	0.027	0.194	0.057	0.263	0.009
Vision-specific dependency	90.2 ± 18.1	0.184	0.071	0.162	0.113	0.228	0.025
Driving	84.6 ± 18.1	-0.010	0.948	0.074	0.631	-0.014	0.928
Color vision	94.8 ± 13.9	0.040	0.697	0.021	0.840	0.067	0.516
Peripheral vision	88.1 ± 18.4	0.203	0.047	0.164	0.109	0.214	0.036
Composite score	82.7 ± 11.8	0.411	<0.001	0.341	0.001	0.407	<0.001

Values are presented as mean ± SD unless otherwise indicated.

MD = mean deviation; IVF = integrated binocular visual field.

^* Spearman’s rho.

Table 4.

Coefficients from a univariate linear regression analyses with composite score of the National Eye Institute Visual Function Questionnaire (NEI VFQ-25)

	R²	Coefficient (95% CI)	p-value
Age (per year)	0.042	-0.17 (-0.34 to -0.01)	0.044
Gender, female	0.009	2.25 (-2.60 to 7.11)	0.359
Integrated binocular MD
MD of the whole visual field (dB)	0.428	1.29 (0.99 to 1.60)	<0.001
MD of the superior visual field (dB)	0.363	1.02 (0.74 to 1.29)	<0.001
MD of the inferior visual field (dB)	0.402	1.10 (0.83 to 1.37)	<0.001
log MAR visual acuity in the better eye	0.129	-33.84 (-51.72 to -15.96)	<0.001
Comorbidity index	0.030	-2.03 (-4.38 to 0.33)	0.091
No. of using medication	0.061	-4.67 (-8.40 to -0.94)	0.015
Marital status, married	0.000	0.38 (-4.59 to 5.35)	0.880
Education level, at least high school degree	0.085	6.39 (2.29 to 11.53)	0.004
Income, lower than ￦35,000,000	0.016	2.01 (-1.19 to 5.20)	0.215
Follow-up time (months)	0.000	0.003 (-0.09 to 0.10)	0.948

CI = confidence interval; MD = mean deviation; dB = decibels.

Table 5.

Correlation coefficients from multiple regression models between the National Eye Institute Visual Function Questionnair (NEI VFQ-25) composite score and the mean deviations of integrated binocular visual fields

	Adjusted R²	Coefficient (95% CI)	p-value
Model 1	0.451
Constant		89.73 (79.06 to 100.41)	<0.001
Whole IVF MD (dB)		1.12 (0.79 to 1.45)	<0.001
Age		-0.03 (-0.18 to 0.11)	0.653
log MAR visual acuity		-15.47 (-30.79 to -0.16)	0.048
No. of using medication		-0.66 (-3.68 to 2.37)	0.667
Education, at least high school degree		2.73 (-1.31 to 6.76)	0.182
Model 2	0.395
Constant		89.04 (77.83 to 100.25)	<0.001
Superior IVF MD (dB)		0.85 (0.55 to 1.14)	<0.001
Age		-0.02 (-0.17 to 0.13)	0.803
log MAR visual acuity		-15.67 (-31.88 to 0.53)	0.058
No. of using medication		-1.24 (-4.40 to 1.91)	0.435
Education, at least high school degree		3.46 (-0.76 to 7.68)	0.107
Model 3	0.438
Constant		90.14 (79.33 to 100.94)	<0.001
Inferior IVF MD (dB)		0.95 (0.67 to 1.23)	<0.001
Age		-0.04 (-0.19 to 0.11)	0.582
log MAR visual acuity		-18.16 (-33.50 to -2.83)	0.021
No. of using medication		-0.82 (-3.88 to 2.23)	0.594
Education, at least high school degree		2.51 (-1.58 to 6.61)	0.226

CI = confidence interval; IVF = integrated binocular visual field; MD = mean deviation; dB = decibels.

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