Effect of change in retinal nerve fibre layer thickness on quality of life in patients with glaucoma
Reviewed by Lona Jawaheer

The authors investigated the relationship between structural changes in glaucoma (retinal nerve fibre layer (RNFL) thickness) and quality of life (as measured by the NEI VFQ-25 questionnaire) over a period of time. Two hundred and sixty eyes of 130 patients were included, and baseline measurements included spectral-domain optical coherence tomography (SD OCT) and standard automated perimetry (SAP) at six month intervals, and the 25-item National Eye Institute Visual Function questionnaire (NEI VFQ-25) on a yearly basis. The patients were followed up for a mean (SD) period of 3.5 (0.7) years, during which a minimum of two NEI VFG-25 questionnaires were filled in, and five SPA and five SD-OCT measurements were done. They found that progressive loss of RNFL thickness was associated with a reduction in the NEI VEF-25 score, even after accounting for possibly confounding variables such as severity of disease at baseline, and progressive visual field loss. This is the first study that demonstrates a correlation between a structural change (progressive loss in RNFL thickness) and quality of life in glaucoma. The authors highlight that the progression of glaucoma is best measured using a combination of both structural and functional aspects. This study was limited by the relatively short period of follow-up, given the usually slowly-progressive nature of glaucoma. There is also the assumption that the changes progress linearly over time, although in fact they might progress at different rates at different stages of the disease process.

Association between progressive retinal nerve fiber layer loss and longitudinal change in quality of life in glaucoma.
Gracitelli CP, Abe RY, Tatham AJ.
JAMA OPHTHALMOLOGY
2015;133(4):384-90.