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. 2022 Aug 1;140(8):800-806.
doi: 10.1001/jamaophthalmol.2022.2140.

Association Between Ganglion Cell Complex Thinning and Vision-Related Quality of Life in Glaucoma

Takashi Nishida  1 , Sasan Moghimi  1 , Vahid Mohammadzadeh  1 , Jo-Hsuan Wu  1 , Maya L M Yamane  1 , Alireza Kamalipour  1 , Golnoush Mahmoudinezhad  1 , Eleonora Micheletti  1 , Jeffrey M Liebmann  2 , Massimo A Fazio  3 , Christopher A Girkin  3 , Linda M Zangwill  1 , Robert N Weinreb  1
Affiliations

Association Between Ganglion Cell Complex Thinning and Vision-Related Quality of Life in Glaucoma

Takashi Nishida et al. JAMA Ophthalmol. .

Abstract

Importance: Faster structural changes may be associated with worse vision-related quality of life in patients with glaucoma.

Objectives: To evaluate the association between the rate of ganglion cell complex thinning and the Vision Function Questionnaire in glaucoma.

Design, setting, and participants: This retrospective analysis of a longitudinal cohort was designed in October 2021. Patients were enrolled from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Two hundred thirty-six eyes of 118 patients with diagnosed or suspected glaucoma were followed up with imaging for a mean of 4.1 years from September 2014 to March 2020.

Main outcomes and measures: The Vision Function Questionnaire was evaluated using the 25-item National Eye Institute Visual Function at the last follow-up visit. Ganglion cell complex thickness was derived from macular optical coherence tomography scans and averaged within 3 circular areas (3.4°, 5.6°, and 6.8° from the fovea) and superior and inferior hemiregions. Linear mixed-effects models were used to investigate the association between the rate of ganglion cell complex thinning and Rasch-calibrated Vision Function Questionnaire score.

Results: The mean (SD) age was 73.2 (8.7) years, 65 participants (55.1%) were female, and 53 participants (44.9%) were African American. Race was self-reported by the participants. Mean composite Rasch-calibrated National Eye Institute Visual Function Questionnaire score was 50.3 (95% CI, 45.9-54.6). A faster annual rate of global ganglion cell complex thinning in the better eye was associated with a higher disability reflected by the composite National Eye Institute Visual Function Questionnaire score (-15.0 [95% CI, -28.4 to -1.7] per 1 μm faster; P = .03). When stratified by degrees from the fovea, the 5.6° and 6.8° areas were associated with the composite National Eye Institute Visual Function Questionnaire Rasch-calibrated score (-14.5 [95% CI, -27.0 to -2.0] per 1 μm faster; R2 = 0.201; P = .03; and -23.7 [95% CI, -45.5 to -1.9] per 1 μm faster; R2 = 0.196; P = .02, respectively), and -8.0 (95% CI, -16.8 to 0.8) per 1 μm faster for the 3.4° area (R2 = 0.184; P = .07) after adjusting for confounding factors.

Conclusions and relevance: These findings suggest that faster and sectoral central location of ganglion cell complex thinning provides useful information in determining the risk of vision-related quality of life in glaucoma. Monitoring macular structure may be useful for determining the risk of functional impairment in glaucoma.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Liebmann reported nonfinancial support from Bausch & Lomb, Carl Zeiss Meditec, Heidelberg Engineering, Novartis, Optovue, and Reichert Technologies; grants from the National Eye Institute and Research to Prevent Blindness; and personal fees from Alcon, Allergan, Carl Zeiss Meditec, and Heidelberg Engineering. Dr Fazio reported grants from the National Eye Institute, EyeSight Foundation of Alabama, and Research to Prevent Blindness and personal fees from Heidelberg Engineering. Dr Girkin reported grants from the National Eye Institute, EyeSight Foundation of Alabama, and Research to Prevent Blindness and personal fees from Heidelberg Engineering. Dr Zangwill reported grants from the National Eye Institute; grants and nonfinancial support from Heidelberg Engineering; and nonfinancial support from Carl Zeiss Meditec, Optovue, and Topcon. Dr Zangwill is a consultant for Abbvie. Dr Weinreb reported grants from the National Eye Institute and National Institute of Minority Health and Health Disparities, as well as nonfinancial support from Heidelberg Engineering, Carl Zeiss Meditec, Konan Medical, Optovue, Centervue, and Topcon; and personal fees from Abbvie, Aerie Pharmaceuticals, Allergan, Eyenovia, Nicox, and Topcon; and he also is a consultant for Toromedes, Iantrek, IOPtic, and Implandata; all outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Regions of Interest Using the Macular 8 × 8 Grid
A, The left image depicts the 3 areas defined to assess the macular thickness changes as a function of distance from the fovea: circle 1, 3.4°; circle 2, 5.6°; and circle 3, 6.8°. B, The right image depicts the inferior and superior hemiregions in this study.
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