Visual impairment and vision-related quality of life in the Early Manifest Glaucoma Trial after 20 years of follow-up

Acta Ophthalmol. 2015 Dec;93(8):745-52. doi: 10.1111/aos.12839. Epub 2015 Sep 18.


Purpose: To determine the association between vision-related quality of life (VRQOL) and levels of visual function loss in the Early Manifest Glaucoma Trial (EMGT).

Methods: Two hundred and fifty-five patients were included in the EMGT between 1993 and 1997 and followed regularly by ophthalmic examinations. A Swedish translation of the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) was self-administered at several follow-up visits until 2014. We analysed the association between Rasch-calibrated NEI VFQ-25 scores and visual function in the best eye at the final follow-up visit.

Results: Ninety-one per cent (233/255) of all participants completed the NEI VFQ-25 at least once. In univariate logistic regression analysis, NEI VFQ-25 scores were modestly associated with visual acuity (VA) (r(2) = 0.330, p < 0.001), visual field index (VFI) (r(2) = 0.200, p < 0.001) and perimetric mean deviation (MD) (r(2) = 0.193, p < 0.001). In multivariate analysis, VA and VFI together accounted for approximately 40% (r(2) = 0.380) of the NEI VFQ-25 scores. NEI VFQ-25 scores were significantly higher for patients with no visual impairment (mean 73 ± 22) than for visually impaired patients (mean 31 ± 15, p < 0.001). VFI worse than 50% or MD worse than -18 dB was significantly associated with low VRQOL scores (p < 0.001).

Conclusions: Our results support the widespread, albeit arbitrary, use of a better-eye visual field of <50% as an important threshold for a significant reduction in VRQOL.

Keywords: blindness; low vision; open-angle glaucoma; vision-related quality of life; visual impairment.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Exfoliation Syndrome / physiopathology
  • Exfoliation Syndrome / psychology
  • Female
  • Follow-Up Studies
  • Glaucoma, Open-Angle / physiopathology
  • Glaucoma, Open-Angle / psychology*
  • Humans
  • Intraocular Pressure
  • Male
  • Middle Aged
  • Prospective Studies
  • Quality of Life / psychology*
  • Sickness Impact Profile
  • Surveys and Questionnaires
  • Vision Disorders / physiopathology
  • Vision Disorders / psychology*
  • Visual Acuity / physiology
  • Visual Field Tests
  • Visual Fields / physiology
  • Visually Impaired Persons / psychology*