Elsevier

Ophthalmology

Volume 120, Issue 6, June 2013, Pages 1120-1126
Ophthalmology

Original article
How Does Glaucoma Look?: Patient Perception of Visual Field Loss

https://doi.org/10.1016/j.ophtha.2012.11.043Get rights and content

Objective

To explore patient perception of vision loss in glaucoma and, specifically, to test the hypothesis that patients do not recognize their impairment as a black tunnel effect or as black patches in their field of view.

Design

Clinic-based cross-sectional study.

Participants

Fifty patients (age range, 52–82 years) with visual acuity better than 20/30 and with a range of glaucomatous visual field (VF) defects in both eyes, excluding those with very advanced disease (perimetrically blind).

Methods

Participants underwent monocular VF testing in both eyes using a Humphrey Field Analyzer (HFA; Carl Zeiss Meditec, Dublin, CA; 24–2 Swedish interactive threshold algorithm standard tests) and other tests of visual function. Participants took part in a recorded interview during which they were asked if they were aware of their VF loss; if so, there were encouraged to describe it in their own words. Participants were shown 6 images modified in a variety of ways on a computer monitor and were asked to select the image that most closely represented their perception of their VF loss.

Main Outcome Measures

Forced choice of an image best representing glaucomatous vision impairment.

Results

Participants had a range of VF defect severity: average HFA mean deviation was −8.7 dB (standard deviation [SD], 5.8 dB) and −10.5 dB (SD, 7.1 dB) in the right and left eyes, respectively. Thirteen patients (26%; 95% confidence interval [CI], 15%–40%) reported being completely unaware of their vision loss. None of the patients chose the images with a distinct black tunnel effect or black patches. Only 2 patients (4%; 95% CI, 0%–14%) chose the image with a tunnel effect with blurred edges. An image depicting blurred patches and another with missing patches was chosen by 54% (95% CI, 39%–68%) and 16% (95% CI, 7%–29%) of the patients, respectively. Content analysis of the transcripts from the recorded interviews indicated a frequent use of descriptors of visual symptoms associated with reported blur and missing features.

Conclusions

Patients with glaucoma do not perceive their vision loss as a black tunnel effect or as black patches masking their field of view. These findings are important in the context of depicting the effects of glaucomatous vision loss and raising awareness for glaucoma detection.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients and Methods

The target population for this study was patients with glaucoma between 50 and 80 years of age with a range of VF loss in both eyes. Patients were recruited from a convenience sample from Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom, and all had an established clinical diagnosis of primary open-angle glaucoma in both eyes. Glaucomatous VF loss was defined as repeatable Glaucoma Hemifield Test results outside normal limits according to the Humphrey Field Analyzer (HFA;

Results

The mean age of the 50 patients was 70 years (standard deviation [SD], 7 years). Twenty-six of the patients (52%) were female. The patients had a range of VF defect severity: average HFA 24-2 MD was −8.7 dB (SD, 5.8 dB), −10.5 dB (SD, 7.1 dB), and −7.3 dB (SD, 5.7 dB) in the right eye, left eye, and best eye (BEMD), respectively. The mean binocular CS and visual acuity of the patients was 1.8 Pelli-Robson log CS (SD, 0.18 PR log CS) and 0.07 logarithm of the minimum angle of resolution units

Discussion

This study provided some evidence, from patients themselves, about the visual symptoms of glaucoma. The study sample represented a population of patients with a range of VF loss in both eyes (Fig 2B), with more than one fifth having quite advanced VF loss (MD worse than −12 dB in both eyes). Twenty-six percent of the patients (typically with better MD values) reported no visual symptoms, confirming the frequently reported asymptomatic nature of the disease even in the presence of diagnosed

Acknowledgments

The authors thank Ryo Asaoka for his help with patient recruitment and ophthalmic examinations.

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  • Cited by (0)

    Manuscript no. 2012-1146.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Supported by a research grant from the International Glaucoma Association. The sponsor had no role in the design or conduct of this research. Dr. Crabb's research laboratory is funded in part by unrestricted grants from Allergan, Inc., and the Investigator-Initiated Studies Programme of Merck Sharp & Dohme, Ltd. Dr. Garway-Heath was supported by the National Institute for Health Research Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and University College London Institute of Ophthalmology.

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