title: Association between progressive retinal nerve fiber layer loss and longitudinal change in quality of life in glaucoma.
abstract: OBJECTIVE
  Evaluation of structural optic nerve damage is a fundamental part of diagnosis and management of glaucoma. However, the relationship between structural measurements and disability associated with the disease is not well characterized. Quantification of this relationship may help validate structural measurements as markers directly relevant to quality of life.
  
  
  OBJECTIVE
  To evaluate the relationship between rates of retinal nerve fiber layer (RNFL) loss and longitudinal changes in quality of life in glaucoma.
  
  
  METHODS
  Observational cohort study including 260 eyes of 130 patients with glaucoma followed up for a mean (SD) of 3.5 (0.7) years. All patients had repeatable visual field defects on standard automated perimetry (SAP) at baseline. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was performed annually, and spectral-domain optical coherence tomography and SAP were performed at 6-month intervals. A joint model was used to investigate the association between change in NEI VFQ-25 Rasch-calibrated scores and change in RNFL thickness, adjusting for confounding socioeconomic and clinical variables.
  
  
  METHODS
  Association between change in binocular RNFL thickness (RNFL thickness in the better eye at each point) and change in NEI VFQ-25 scores.
  
  
  RESULTS
  Progressive binocular RNFL thickness loss was associated with worsening of NEI VFQ-25 scores over time. In a multivariable model adjusting for baseline disease severity and the rate of change in binocular SAP sensitivity, each 1-μm-per-year loss of RNFL thickness was associated with a decrease of 1.3 units (95% CI, 1.02-1.56) per year in NEI VFQ-25 scores (P < .001). After adjusting for the contribution from SAP, 26% (95% CI, 12%-39%) of the variability of change in NEI VFQ-25 scores was associated uniquely with change in binocular RNFL thickness. The P value remained less than .001 after adjusting for potential confounding factors.
  
  
  CONCLUSIONS
  Progressive binocular RNFL thickness loss was associated with longitudinal loss in quality of life, even after adjustment for progressive visual field loss. These findings suggest that rates of binocular RNFL change are valid markers for the degree of neural loss in glaucoma with significant relationship to glaucoma-associated disability.
authors.affiliation: Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego2Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Carolina P B
authors.initials: CP
authors.lastname: Gracitelli
authors.affiliation: Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego3Department of Ophthalmology, University of Campinas, Campinas, Brazil.
authors.forename: Ricardo Y
authors.initials: RY
authors.lastname: Abe
authors.affiliation: Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego4Princess Alexandra Eye Pavilion, Department of Ophthalmology, University of Edinburgh, Edinburgh, Scotland.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Tatham
authors.affiliation: Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Rosen
authors.affiliation: Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Zangwill
authors.affiliation: Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego.
authors.forename: Erwin R
authors.initials: ER
authors.lastname: Boer
authors.affiliation: Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Weinreb
authors.affiliation: Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego.
authors.forename: Felipe A
authors.initials: FA
authors.lastname: Medeiros
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000175:diagnosis* / Q000523:psychology*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012165:Retinal Ganglion Cells / Q000473:pathology*; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D041623:Tomography, Optical Coherence; D014786:Vision Disorders / Q000523:psychology; D015348:Vision, Binocular; D058609:Visual Field Tests; D014794:Visual Fields