Relationship between Binocular Visual Function and Quality of Life in Bilateral Normal Tension Glaucoma Patients

Hong Hyun Park; Yeoun Sook Chun

doi:10.3341/jkos.2017.58.2.171

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Park and Chun: Relationship between Binocular Visual Function and Quality of Life in Bilateral Normal Tension Glaucoma Patients

Original Article

J Korean Ophthalmol Soc 2017;58(2):171-177.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.2.171

Relationship between Binocular Visual Function and Quality of Life in Bilateral Normal Tension Glaucoma Patients

Hong Hyun Park, M.D., Yeoun Sook Chun, M.D., PhD

Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College 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: 82-2-6299-1666, Fax: 82-2-6299-3231 E-mail: yschun100@hamail.net

Received 13 October 20161 December 2016 Accepted 17 January 2017

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 analyze the effect of stereopsis and contrast sensitivity on the quality of life and to evaluate the relationship be-tween integrated binocular visual field (IVF) and binocular visual function in bilateral normal tension glaucoma (NTG) patients.

Methods

Stereopsis and contrast sensitivity tests were performed and compared among 44 NTG patients and 32 normal subjects. The IVF was integrated using the best location method. The correlation between visual function and subscales of the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) was evaluated using univariate linear regression.

Results

Stereopsis and contrast sensitivity for the bilateral NTG patients were decreased compared to the normal controls. Stereopsis and contrast sensitivity exhibited a significant correlation with social functions related to vision and color vision among subscales of NEI VFQ-25. IVF mean deviation (MD) and better eye MD showed a significant correlation with stereopsis and contrast sensitivity, while worse eye MD showed no association.

Conclusions

Deterioration of stereopsis and contrast sensitivity in NTG patients affects their quality of life related to social func-tions and color vision. Both IVF and better eye MDs are correlated with stereopsis and contrast sensitivity in NTG patients.

Keywords: Binocular visual function, Contrast sensitivity, Normal tension glaucoma, Quality of life, Stereopsis

References

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Figure 1.

Integrated visual field (IVF) of normal tension glaucoma. Schematic representation of the left (A), right (B) and IVF by best location (C). VF = visual field; MD = mean deviation; dB = decibels.

Table 1.

Demographic data for normal tension glaucoma (NTG) and control

	NTG (n = 44)	Control (n = 32)	p-value^*
Mean age (years)	59.02 ± 14.47	57.56 ± 14.07	0.672
Gender (male/female)	25/19	22/10	0.297
Visual acuity (logMAR)
Better eye	0.11 ± 0.11	0.09 ± 0.09	0.568
Worse eye	0.15 ± 0.11	0.13 ± 0.08	0.607
Intraocular pressure (mmHg)
Higher eye	14.02 ± 2.66	13.78 ± 2.35	0.683
Lower eye	12.93 ± 2.64	12.62 ± 2.56	0.614

Values are presented as mean ± standard deviation (SD) unless otherwise indicated.

^* p-value by independent t-test.

Table 2.

Clinical data for normal tension glaucoma (NTG) and control

	NTG (n = 44)	Control (n = 32)	p-value^*
MD of visual field (dB)
Binocular (IVF)	-3.99 ± 6.29	2.29 ± 1.5	<0.001
Better eye	-5.04 ± 6.71	0.97 ± 3.5	<0.001
Worse eye	-9.52 ± 8.39	-0.02 ± 2.4	<0.001
Stereopsis (sec)	174.09 ± 185.18	44.77 ± 11.71	<0.001
Contrast sensitivity test (Photopic, log)
3 cpd	1.67 ± 0.18	1.76 ± 0.17	0.039
6 cpd	1.90 ± 0.20	2.03 ± 0.18	0.006
12 cpd	1.57 ± 0.29	1.82 ± 0.18	<0.001
18 cpd	1.15 ± 0.25	1.42 ± 0.15	<0.001
Contrast sensitivity test (Mesopic, log)
3 cpd	1.67 ± 0.20	1.74 ± 0.14	0.129
6 cpd	1.85 ± 0.20	2.01 ± 0.14	<0.001
12 cpd	1.49 ± 0.31	1.69 ± 0.18	0.002
18 cpd	1.04 ±0.27	1.29 ± 0.18	<0.001

Values are presented as mean ± standard deviation (SD) unless otherwise indicated.

MD = mean deviation; dB = decibels; IVF = integrated binocular visual field by best location method; cpd = cycle per degree.

^* p-value by independent t-test.

Table 3.

Correlations of National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) subscale score with clinical visual function tests

NEI-VFQ-25 subscale	Score	Stereopsis	Photopic constrast sensitivity test				Mesopic constrast sensitivity test
NEI-VFQ-25 subscale	Score	Stereopsis	3 cpd	6 cpd	12 cpd	18 cpd	3 cpd	6 cpd	12 cpd	18 cpd
General health	36.58	-0.25	0.21	0.12	0.28	0.02	0.36 ( p = 0.023^*)	0.01	0.35 ( p = 0.026^*)	0.04
General VA	66.50	-0.33( p = 0.039^*)	0.08	0.03	0.08	-0.01	0.09	0.02	-0.11	-0.09
Ocular pain	80.79	-0.11	0.05	-0.16	-0.01	-0.04	0.14	-0.05	-0.03	0.15
Near acuity	81.70	-0.23	0.10	0.01	0.08	0.02	0.11	0.01	-0.10	0.07
Distance acuity	83.94	-0.35( p = 0.027^*)	0.14	0.15	0.16	0.15	0.27	0.04	0.02	0.15
Social functioning	91.46	-0.37 ( p = 0.016^*)	0.21	0.28	0.34 ( p = 0.034^*)	0.32 ( p = 0.047^*)	0.25	0.24	0.22	0.40 ( p = 0.010^*)
Mental health	77.59	-0.18	0.12	0.05	0.08	-0.15	0.19	0.04	0.01	0.04
Role difficulties	74.35	-0.29	0.08	0.02	0.11	0.01	0.31	0.15	0.05	0.08
Dependency	88.88	-0.12	-0.03	0.16	0.10	-0.09	0.17	0.13	-0.03	-0.01
Driving	82.01	-0.09	-0.29	0.04	0.01	0.01	-0.14	0.10	0.23	0.28
Color vision	93.90	-0.45 ( p = 0.003^*)	0.27	0.28	0.34 ( p = 0.033^*)	0.20	0.25	0.25	0.26	0.36 ( p = 0.022^*)
Peripheral vision	90.24	-0.21	0.34( p = 0.032^*	0.22)	0.24	0.20	0.25	0.26	0.10	0.30
Composite score	82.94	-0.40 ( p= 0.009^*)	0.23	0.12	0.20	0.11	0.25	0.12	0.02	0.20

Values are presented as Pearson’s correlation coefficient unless otherwise indicated.

cpd = cycle per degree; VA = visual acuity.

^* p-value by Pearson’s correlation coefficient; significance set at <0.05.

Table 4.

Correlation coefficient of a univariate linear regression between visual function test and MDs

	R²	Coefficient (95% CI)	p-value
Stereopsis (sec)
IVF MD	0.139	-10.94 (-15.15 to -6.73)	0.013
Better MD	0.107	-9.02 (-13.04 to -5.00)	0.030
Worse MD	0.073	-5.97 (-9.25 to -2.69)	0.076
Photopic contrast sensitivity test at 18 cpd
IVF MD	0.102	0.01 (0.01 to 0.02)	0.036
Better MD	0.101	0.01 (0.01 to 0.02)	0.038
Worse MD	0.016	0.00 (0.00 to 0.01)	0.425
Mesopic contrast sensitivity test at 18 cpd
IVF MD	0.233	0.02 (0.01 to 0.02)	0.001
Better MD	0.208	0.02 (0.01 to 0.02)	0.002
Worse MD	0.083	0.01 (0.00 to 0.01)	0.060

MD = mean deviation; CI = confidence interval; IVF = integrated binocular visual field by best location method; cpd = cycle per degree.

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