Discrepancy Between Real-World Objective Functioning and Subjective Quality of Life in Visually Impaired Adults

Mariah Diaz; Aleksandra Mihailovic; Louay Almidani; Chhavi Saini; Pradeep Y Ramulu

doi:10.1097/IJG.0000000000002668

Discrepancy Between Real-World Objective Functioning and Subjective Quality of Life in Visually Impaired Adults

J Glaucoma. 2025 Dec 1. doi: 10.1097/IJG.0000000000002668. Online ahead of print.

Authors

Mariah Diaz¹, Aleksandra Mihailovic², Louay Almidani², Chhavi Saini³, Pradeep Y Ramulu²

Affiliations

¹ University of Illinois at Chicago, College of Medicine, Chicago, Illinois.
² Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
³ Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.

PMID: 41400979
DOI: 10.1097/IJG.0000000000002668

Abstract

Prcis: Discrepancy between objective measures of functioning and self-reported quality of life is predicted by depressive symptoms, females, and advanced field loss while significant variability between these measures remains unexplained.

Purpose: To determine the degree to which functional metrics and self-reported quality of life agree in glaucoma, and identify factors associated with discrepancies between the two.

Patients and methods: Individuals with glaucoma or suspected glaucoma (n=227) were evaluated. Subjective functioning was assessed with the Glaucoma Quality of Life-15 (GQL-15) questionnaire. Objective metrics of functioning included balance (total sway), gait (cadence), and reading speed, which were compiled into a z-scored composite measure of function. Discrepancy scores were defined as the difference between composite functioning and GQL-15 z-scores. Linear regression models were computed to identify patient-level and neighborhood-level factors associated with discrepancy between objective functioning and self-reported quality of life.

Results: Composite functioning and GQL-15 z-scores were poorly correlated (Pearson's coefficient r=0.15, P-value=0.024). In multivariable analyses, positive discrepancy (greater function than self-report) was associated with female gender (β=0.53, P<0.001), depressive symptoms (β=0.19, P<0.001), and greater visual field damage (β=0.28, P-value=0.001). The multivariable model including gender, depressive symptoms, and visual field sensitivity accounted for 20% of the variance in discrepancy scores.

Conclusions: Female gender, depressive symptoms, and greater visual field damage are associated with greater subjective vision-related disability than predicted by objective functional impairment. The overall ability of studied measures to predict agreement between function and self-report was poor, highlighting the complexity of both self-reported impairment and functional evaluation.

Keywords: discrepancy; functioning; glaucoma; quality of life.