Patient-Reported Vision-Related Quality of Life Differences Between Superior and Inferior Hemifield Visual Field Defects in Primary Open-Angle Glaucoma

IMPORTANCE Previous studies have found that glaucoma is associated with impaired patient-reported vision-related quality of life (pVRQOL) but few, to our knowledge, have assessed how the visual field (VF) defect location impacts the pVRQOL. OBJECTIVE To investigate the associations of VF defects in the superior vs inferior hemifields with pVRQOL outcomes in patients with primary open-angle glaucoma. DESIGN, SETTING, AND PARTICIPANTS Prospective cross-sectional study at a tertiary referral center from March 1, 2012, to January 1, 2013, including patients with primary open-angle glaucoma who had a best-corrected visual acuity in the better eye equal to or better than 20/60 and reliable VF tests. The pVRQOL was assessed by a validated Taiwanese version of the 25-item National Eye Institute Visual Function Questionnaire. Reliable VF tests obtained within 3 months of enrollment were transformed to binocular integrated VF (IVF). The IVF was further stratified by VF location (superior vs inferior hemifield). MAIN OUTCOMES AND MEASURES The association between each domain of the 25-item National Eye Institute Visual Function Questionnaire and superior or inferior hemifield IVF was determined using multivariable linear regression analysis. RESULTS The analysis included 186 patients with primary open-angle glaucoma with a mean age of 59.1 years (range, 19-86 years) and IVF mean deviation (MD) of -4.84 dB (range, -27.56 to 2.17 dB). In the multivariable linear regression analysis, the MD of the full-field IVF showed positive associations with near activities (beta = 0.05; R-2 = 0.20; P < .001), vision-specific role difficulties (beta = 0.04; R-2 = 0.19; P = .01), vision-specific dependency (beta = 0.04; R-2 = 0.20; P < .001), driving (beta = 0.05; R-2 = 0.24; P < .001), peripheral vision (beta = 0.03; R-2 = 0.18; P = .02), and composite scores (beta = 0.04; R-2 = 0.27; P = .005). Subsequent analysis showed that the MD of the superior hemifield IVF was associated only with near activities (beta = 0.04; R-2 = 0.21; P < .001) while the MD of the inferior hemifield IVF was associated with general vision (beta = 0.04; R-2 = 0.12; P = .01), vision-specific role difficulties (beta = 0.04; R-2 = 0.20; P = .01), and peripheral vision (beta = 0.03; R-2 = 0.17; P = .03). CONCLUSIONS AND RELEVANCE Superior hemifield IVF was strongly associated with difficulty with near activities. Inferior hemifield IVF impacted vision-specific role difficulties and general and peripheral vision. The impact of a VF defect on a patient's pVRQOL may depend not only on its severity, but also on its hemifield location.