Almidani Louay, Mihailovic Aleksandra, Yuan Zhuochen, Saini Chhavi, Ramulu Pradeep Y
Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
Ophthalmol Glaucoma. 2025 Jan-Feb;8(1):63-72. doi: 10.1016/j.ogla.2024.08.008. Epub 2024 Sep 6.
To investigate the relationship between baseline visual field (VF) severity and rates of visual field loss with changes in quality of life (QoL) and fear of falling (FoF) in adults with glaucoma.
Prospective cohort study, including participants from the Falls In Glaucoma Study. Quality of life and FoF were assessed annually using the Glaucoma Quality of Life-15 Questionnaire, and the University of Illinois at Chicago FoF Questionnaire, respectively, with higher Rasch-analyzed scores (in logits) indicating better QoL and greater FoF. Mean deviation (MD) values of each eye were collected, with better-eye MD taken as the primary exposure. Change rates in better-eye MD, QoL, and FoF were computed using linear regression. Separate regression models were employed to explore the relationship between baseline better-eye MD and its rate of change with rates of change in QoL and FoF.
The mean (standard deviation) rate of change in better-eye MD was -0.08 dB/year (0.5), rate of QoL change was -0.08 logits/year (0.4), and rate of FoF change was 0.16 logits/year (0.7). At baseline, better-eye MD (per dB worse) was significantly associated with worse baseline QoL (β = -0.10 logits [95% confidence interval [CI]: -0.13, -0.08]) and greater FoF (β = 0.06 logits [95% CI: 0.01, 0.10]). Baseline better-eye MD was associated with no significant change in QoL ( -0.004 logits/year, 95% CI: -0.02, 0.01) or FoF (-0.0001 logits/year, 95% CI: -0.02, 0.02) over time. Change rates in better-eye MD showed significant associations with faster increases in FoF over time (β = 0.26 logits/year [95% CI: 0.06, 0.45]; per dB loss/year), but not with changes in QoL (P = 0.79).
Patients with glaucoma generally showed worsening of QoL and FoF over time, though the degree of change was modest and not related to the degree of damage at baseline. Faster rates of better-eye MD change alone were associated with faster increases in FoF. Further studies are needed to evaluate the reasons (visual and nonvisual) for changes in QoL and functionality over time and find ways in which QoL and mobility can be improved for those with VF damage.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
探讨青光眼成年患者的基线视野（VF）严重程度与视野丧失率、生活质量（QoL）变化以及跌倒恐惧（FoF）之间的关系。
前瞻性队列研究，纳入青光眼跌倒研究的参与者。分别每年使用青光眼生活质量-15问卷和伊利诺伊大学芝加哥分校跌倒恐惧问卷评估生活质量和跌倒恐惧，经拉施分析的得分（以对数单位计）越高表明生活质量越好，跌倒恐惧越强。收集每只眼睛的平均偏差（MD）值，以较好眼的MD作为主要暴露因素。使用线性回归计算较好眼MD、生活质量和跌倒恐惧的变化率。采用单独的回归模型探讨基线较好眼MD及其变化率与生活质量和跌倒恐惧变化率之间的关系。
较好眼MD的平均（标准差）变化率为-0.08 dB/年（0.5），生活质量变化率为-0.08对数单位/年（0.4），跌倒恐惧变化率为0.16对数单位/年（0.7）。在基线时，较好眼MD每变差1 dB，与较差的基线生活质量（β=-0.10对数单位[95%置信区间[CI]：-0.13，-0.08]）和更强的跌倒恐惧（β=0.06对数单位[95%CI：0.01，0.10]）显著相关。基线较好眼MD与生活质量（-0.004对数单位/年，95%CI：-0.02，0.01）或跌倒恐惧（-0.0001对数单位/年，9%CI：-0.02，0.02）随时间的变化无显著关联。较好眼MD的变化率与跌倒恐惧随时间的更快增加显著相关（β=0.26对数单位/年[95%CI：0.06，0.45]；每dB/年的丧失），但与生活质量的变化无关（P=0.79）。
青光眼患者的生活质量和跌倒恐惧通常随时间恶化，尽管变化程度较小且与基线损伤程度无关。仅较好眼MD更快的变化率与跌倒恐惧的更快增加相关。需要进一步研究以评估生活质量和功能随时间变化的原因（视觉和非视觉），并找到改善视野受损患者生活质量和活动能力的方法。
本文末尾的脚注和披露中可能包含专有或商业披露信息。
