Medeiros Felipe A, Gracitelli Carolina P B, Boer Erwin R, Weinreb Robert N, Zangwill Linda M, Rosen Peter N
Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California.
Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
Ophthalmology. 2015 Feb;122(2):293-301. doi: 10.1016/j.ophtha.2014.08.014. Epub 2014 Oct 16.
To evaluate the association between longitudinal changes in quality of life (QoL) and rates of progressive visual field loss in glaucoma.
Prospective observational cohort study.
We recruited 322 eyes of 161 patients with glaucomatous visual field loss from the Diagnostic Innovations Glaucoma Study followed for an average of 3.5±0.7 years.
All subjects had National Eye Institute Visual Function Questionnaire (NEI VFQ)-25 performed annually and standard automated perimetry (SAP) at 6-month intervals. Subjects were included if they had a minimum of 2 NEI VFQ-25 and ≥5 SAP during follow-up. Evaluation of rates of visual field change was performed using the mean sensitivity (MS) of the integrated binocular visual field (BVF). Rasch analysis was performed to obtain final scores of disability as measured by the NEI VFQ-25. A joint longitudinal multivariate mixed model was used to investigate the association between change in NEI VFQ-25 Rasch-calibrated scores and change in BVF sensitivity. Potentially confounding socioeconomic and clinical variables also were analyzed.
The relationship between change in NEI VFQ-25 Rasch-calibrated scores and change in binocular SAP MS.
There was a significant correlation between change in the NEI VFQ-25 Rasch scores during follow-up and change in binocular SAP sensitivity. Each 1-dB change in binocular SAP MS per year was associated with a change of 2.9 units per year in the NEI VFQ-25 Rasch scores during the follow-up period (R(2) = 26%; P<0.001). Eyes with more severe disease at baseline were also more likely to have a decrease in NEI VFQ-25 scores during follow-up (P<0.001). For subjects with the same amount of change in SAP sensitivity, those with shorter follow-up times had larger changes in NEI VFQ-25 scores (P = 0.005). A multivariable model containing baseline and rate of change in binocular MS had an adjusted R(2) of 50% in predicting change in NEI VFQ-25 scores.
Baseline severity, magnitude, and rates of change in BVF sensitivity were associated with longitudinal changes in QoL of glaucoma patients. Assessment of longitudinal visual field changes may help to identify patients at greater risk for developing disability from the disease.
评估青光眼患者生活质量（QoL）的纵向变化与进行性视野缺损发生率之间的关联。
前瞻性观察队列研究。
我们从诊断创新青光眼研究中招募了161例患有青光眼性视野缺损的患者的322只眼睛，平均随访3.5±0.7年。
所有受试者每年进行一次国立眼科研究所视觉功能问卷（NEI VFQ）-25评估，并每6个月进行一次标准自动视野计检查（SAP）。如果受试者在随访期间至少有2次NEI VFQ-25评估和≥5次SAP检查，则纳入研究。使用双眼综合视野（BVF）的平均敏感度（MS）评估视野变化率。进行Rasch分析以获得由NEI VFQ-25测量的残疾最终得分。使用联合纵向多变量混合模型研究NEI VFQ-25 Rasch校准分数的变化与BVF敏感度变化之间的关联。还分析了潜在的社会经济和临床混杂变量。
NEI VFQ-25 Rasch校准分数的变化与双眼SAP MS变化之间的关系。
随访期间NEI VFQ-25 Rasch分数的变化与双眼SAP敏感度的变化之间存在显著相关性。随访期间，双眼SAP MS每年每变化1 dB，NEI VFQ-25 Rasch分数每年变化2.9个单位（R² = 26%；P<0.001）。基线疾病较严重的眼睛在随访期间NEI VFQ-25分数下降的可能性也更大（P<0.001）。对于SAP敏感度变化量相同的受试者，随访时间较短的受试者NEI VFQ-25分数变化较大（P = 0.005）。包含双眼MS基线和变化率的多变量模型在预测NEI VFQ-25分数变化时的调整后R²为50%。
BVF敏感度的基线严重程度、变化幅度和变化率与青光眼患者生活质量的纵向变化相关。评估纵向视野变化可能有助于识别因该疾病导致残疾风险更高的患者。
