Relationships in Glaucoma Patients Between Standard Vision Tests, Quality of Life, and Ability to Perform Daily Activities

Abstract

Purpose: To determine the relationships among three methods of assessing visual loss caused by glaucoma: (1) standard clinical tests of vision, (2) self-reported quality of life, and (3) the ability to perform activities of daily living.

Methods: One hundred and ninety two glaucoma patients with a full range of glaucomatous visual loss were selected from the Glaucoma Service of Wills Eye Institute. Subjects were evaluated clinically by visual acuity, contrast sensitivity, visual field, stereopsis, the Disc Damage Likelihood Scale, and intraocular pressure. Subjects were evaluated subjectively by the 25-item National Eye Institute’s Visual Functioning Questionnaire (NEI-VFQ-25) and objectively by a performance-based measure of visual function, the Assessment of Disability Related to Vision (ADREV). Statistical analysis, including Spearman coefficients, was performed on the data from the clinical measures, NEI-VFQ-25, and ADREV.

Results: The clinical tests had higher correlations with ADREV than with the NEI-VFQ-25. There was a moderate, but not strong, connection between how patients rated their own visual ability with how they performed when objectively tested.

Conclusions: ADREV provides valid estimates of how visual loss due to glaucoma affects the ability to perform activities of daily living. Performance-based testing and quality of life evaluations are both independently important measures of health, which are related, but by no means the same.

KEYWORDS::

• Activities of daily living
• ADREV
• Disability
• Glaucoma
• NEI-VFQ-25
• Performance based measure
• Visual assessment
• Visual function

ACKNOWLEDGMENTS

The authors thank Pfizer, The Perelman Research Fund through Wills Eye Institute, The Pearle Vision Foundation, and The Glaucoma Service Foundation to Prevent Blindness for their financial support in this research. We would also like to thank Ben Leiby of Jefferson Medical College for statistical support.

Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

APPENDIX

Reading in Reduced Illumination

Near vision is checked by obtaining the smallest Jaeger line. Then one at a time, seven sentences with text size corresponding to two Jaeger lines larger than the smallest Jaeger line read, are presented. Light illumination is reduced after each sentence is read. The corresponding score is as follows: 1 point, able to read at 200 foot candles (FC), 2 at 150 FC, 3 at 100 FC, 4 at 50 FC, 5 at 25 FC, 6 at 10 FC, and 7 at 5 FC. The highest score is 7 and lowest score is 0.

Facial Expression Recognition

Seven full-face professional, colored photos of varying sizes and facial expressions (angry, sad, happy, or surprised) are presented on a computer screen at a distance of ½ m. The patient receives one point for recognizing the right facial expression. The highest score is 7 and lowest is 0.

Detecting Motion

A large black cross against a white background on a computer screen provides a point of fixation. Although fixating on the cross, one at a time, 14 balls of different sizes and colors move diagonally across the screen from either the right or the left side at a constant speed. Yellow, red, or blue balls are used. The patient is asked to count the number of moving balls. Each ball seen counts as ½ point. The highest score is 7 and lowest score is 0.

Recognizing Signs at a Distance

Seven written word signs ranging from large to small are read at a distance of 4 m. One character in each sign was changed from familiar phrases making the word difficult to guess. For example, the top sign reads SUGAR DANE, which is similar to the more familiar sugar cane. The patient is instructed not to guess. One point is given for each sign read correctly. The highest score is 7 and lowest score is 0.

Locating Objects

Fourteen red and beige boxes of different sizes are scattered around the testing room (4 × 2 m). Sample boxes are shown before the test is started. The patient attempts to locate the boxes while seated. Each box found is worth ½ point. The highest score is 7 and lowest is 0.

Ambulation Test

A 4.5 m predefined mobility course was designed, with taped horizontal, vertical and diagonal lines, and objects made of styrofoam in the path. Several objects were also suspended from the ceiling along the path. Patients were permitted to use a mobility aid (eg, cane).

The score is based on number of obstacles hit. Each obstacle successfully avoided is awarded 1/3 point. The highest score is 7 and lowest is 0.

Placing a Peg into Different Sized Holes

Seven (9 × 3 × 3/8 in) wooden boards were created with one hole of varying sizes and location. A wooden stand was created with slots to hold the boards one at time at different angles. The patient is asked to place the peg directly in the hole without touching the board. One point is awarded for successful completion. The highest score is 7 and lowest is 0.

Telephone Simulation

Seven calculators of different sizes are used to simulate dialing a telephone. The numbers are randomly rearranged to eliminate memory being used to locate the telephone numbers. The numbers are printed from different font sizes and presented to patients from largest to smallest. The patient is asked to press seven different numbers on each of the various sized calculators. The patient must find all seven numbers to receive a point for that calculator. For each number correctly “dialed,” the patient receives one point. The highest score is 7 and lowest is 0.

Matching Socks

Seven differently patterned, dark-colored socks were hung on a board with a gray background. The patients are not permitted to touch the socks hanging on the wall. The patient sits in front of a table 1 m wide so as to be 1 m from the socks. On the table is a group of 10 socks, 7 of which are the pairs for the hanging socks. The patient is asked to match the socks on the table with those on the board. One point is awarded for each correctly matched sock. The highest score is 7 and lowest is 0.