Macular Damage, as Determined by Structure-Function Staging, Is Associated With Worse Vision-related Quality of Life in Early Glaucoma

Purpose: Macular damage is common early in glaucoma and has previously been identified as a significant factor affecting vision-related quality of life (VRQoL) across the spectrum of glaucomatous damage. This report uses structure-function correlation to identify early macular damage and assess its relationship with the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Design: Cohort study. Methods: SETTING: Institutional. STUDY POPULATION: Eighty-eight eyes of 44 participants with early open-angle glaucoma (24-2 mean deviation [MD] better than −6 dB). OBSERVATION PROCEDURE: Focal and diffuse macular defects were identified based on corresponding abnormal regions on probability maps from spectral-domain optical coherence tomography (SD-OCT) optic disc and macular cube scans, and 10-2 and 24-2 visual fields (VF). MAIN OUTCOME MEASURE: VRQoL, as measured by the NEI VFQ-25. Results: Twenty-five of 44 (57%) “worse” eyes (defined by 24-2 VF MD) and 13 of 44 (31%) “better” eyes had macular damage. Mean (±standard deviation) MD of worse and better eyes were −3.03 dB (±2.3) and −1.15 dB (±1.7), respectively. Compared to those without macular damage, lower NEI VFQ-25 scores were seen in patients with macular damage in the worse eye (85.4 [± 9.0] vs 94.6 [± 3.3]; P =.0001) and the better eye (84.8 [± 11.1] vs 91.3 [± 6.3]; P =.017). Arcuate damage outside the macula did not affect VRQoL (better eye, P =.40; worse eye, P =.87). Conclusions: Early glaucomatous macular damage, as detected by abnormal topographic regions on measures of structure and function, is associated with decreased VRQoL. Arcuate damage outside the macula does not have an association with VRQoL in early glaucoma.