Quality of Life and Primary Open-Angle Glaucoma in the Ocular Hypertension Treatment Study

Importance: If preperimetric glaucoma reduces patient-reported vision-related quality of life (VRQoL), clinicians might consider earlier and more aggressive treatment of some patients with ocular hypertension and early glaucoma.

Objective: To determine the impact of preperimetric glaucoma and early glaucomatous visual field (VF) loss on participants’ VRQoL compared with participants who did not develop glaucoma in the Ocular Hypertension Treatment Study (OHTS).

Design, Setting and Participants: This cross-sectional study used data from participants enrolled in the OHTS from 1994 to 1996 who completed 20-year examination follow-up and VRQoL surveys from January 7, 2016, to November 19, 2019. Diagnosis of primary open-angle glaucoma (POAG) required reproducible changes in VFs or optic discs as determined by reading centers and attributed to glaucoma by a masked end point committee. Data analysis was performed from June 27, 2023 to March 7, 2024.

Exposure: Ocular hypertension and glaucoma.

Main Outcomes and Measures: Cross-sectional analysis of Rasch-calibrated total scores of the National Eye Institute Visual Function Questionnaire (VFQ) and the Glaucoma Quality of Life (GQL) survey was performed. Total scores were standardized from 0 (poor) to 100 (good). The main outcomes were differences in total VRQoL scores between participants who did not develop POAG (control) and 4 mutually exclusive POAG groups: unilateral or bilateral disc POAG with no glaucomatous VF loss in either eye and unilateral or bilateral VF POAG with or without disc changes. Differences in total VRQoL scores were analyzed using univariate and multivariate linear regression models.

Results: Of 1636 participants originally enrolled in the OHTS, 679 (42%) completed the 20-year examination and VRQoL surveys. Of those participants completing 20-year follow-up, mean (SD) participant age at follow-up was 73.8 (7.7) years, and 412 of 679 participants (60.7%) self-reported as female. The mean (SD) Rasch-calibrated total VFQ scores were 72.5 (13.4) in the no POAG group (control) vs 72.7 (13.8) in the unilateral disc POAG group (difference, 0.17; 95%CI, −3.17 to 3.41; P = .92), 73.4 (14.0) in the bilateral disc POAG group (difference, 0.92; 95%CI, −2.93 to 4.77; P = .64), 69.2 (14.5) in the unilateral VF POAG group (difference, 3.33; 95%CI, −6.38 to −0.27; P = .03), and 58.5 (16.9) in the bilateral VF POAG group (difference, −13.96; 95%CI, −17.73 to −10.19; P<.001). Similar results were found for the GQL questionnaire.

Conclusions and relevance: In this cross-sectional study, among the surviving participants of OHTS who completed the 20-year follow-up examination, those participants who developed preperimetric POAG but no glaucomatous VF loss did not report lower VFQoL compared with participants who did not develop POAG. This finding should allow clinicians and patients the time to determine the frequency of examinations and whether the initiation of treatment is appropriate.

*Author(s): Mae O. Gordon, PhD; Feng Gao, PhD; John Burkland, BS; Julia B. Huecker, MS; Stuart K. Gardiner, PhD; Pradeep Ramulu, MD; Linda M. Zangwill, PhD; Dale K. Heuer, MD; Eve J. Higginbotham, MD; Richard K. Parrish, MD; Michael A. Kass, MD

Doi:10.1001/jamaophthalmol.2024.3282

Clinical Paper of the Month manager: Rafael Correia Barão

Editors in Chief: Francesco Oddone, Manuele Michelessi