Functional Testing and Quality of Life in Glaucoma

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Project Summary / Abstract The goal of clinical management in eye care is to protect patients’ vision and consequent quality of life. Yet, the impact of vision loss on an individual’s quality of life depends not only on its severity, but also on its location within the visual field. Some tasks are predominantly impacted by central visual field loss, while others rely more on differing regions of the peripheral visual field. Thus, two individuals with the same disease severity could have very different experiences of that loss. This is particularly true for glaucoma, which causes localized loss in locations that can differ greatly between individuals. In this project, we will determine the regions of the visual field that most influence different aspects of quality of life. We will derive quantitative metrics of the likely real- world effects of an individual patient’s visual field defect that can be obtained without relying on time-consuming and variable questionnaires. These patient-centered metrics can aid clinicians in prioritizing care and choosing appropriate management strategies; and in explaining to an individual patient what the likely consequences are of their disease, both as motivation to maintain medication adherence and so that they can make necessary adjustments to their activities of daily living. In Aim 1, we will derive indices predicting the effect of an individual’s visual field loss on different patient-reported outcome measures, by parameterizing results from clinical standard automated perimetry, to maximize correlations with results of patient questionnaires from four large studies of ocular hypertension and glaucoma. In Aim 2, we will use similar analyses to predict the impact on visual search as measured by a custom-written test, performed on a tablet computer in glaucoma clinic waiting rooms and testing rooms. In Aim 3, we will predict the impact of an individual’s visual field loss on the visual contribution to balance and subsequent risk of falling, using objective measurements of balance in both high and low ambient light settings. Overall, the project will provide substantial advances in our understanding of the effects of localized visual field loss as caused by glaucoma, and provide invaluable new information for clinicians and patients.