Downloaded from http://journals.lww.com/glaucomajournal by BhDMf5ePHKbH4TTImqenVHVWbIH6TTJXzezw8PhC2199mpgrJ7Gwf6mZ8d+FMt6uKquhBaSOBpw= on 10/09/2020 Correlations Between Subjective Evaluation of Quality of Life, Visual Field Loss, and Performance in Simulated Activities of Daily Living in Glaucoma Patients Line Azoulay-Sebban, MS,* Zhanlin Zhao, MD,†‡ Ariel Zenouda, MS,* Marco Lombardi, MD,*§ Emmanuel Gutman, MS,* Emmanuelle Brasnu, MD, PhD,§ Pascale Hamard, MD, PhD,§ José-Alain Sahel, MD,§∥ Christophe Baudouin, MD, PhD,§∥¶# and Antoine Labbé, MD, PhD§∥¶# Precis: Glaucoma patients displayed alterations in their quality of life (QoL) and their ability to perform activities of daily living. The visual field (VF) of the worse eye might serve as a good marker for QoL evaluation. Purpose: The purpose of this study was to explore the correlations between VF defects, performance in simulated activities of daily living, and subjective evaluation of QoL in glaucoma patients. Methods: Thirty-two patients with glaucoma and 10 age-matched control subjects were included. All participants answered a QoL questionnaire and underwent an assessment of visual function including monocular and binocular best-corrected visual acuity, binocular contrast sensitivity test (LogCS), and monocular and binocular VF. All subjects also carried out a series of simulated activities of daily living in a controlled environment. Results: Glaucoma patients had lower QoL scores compared with controls for the composite score, near and distance activities, social functioning, mental health, role difficulties, dependency, and color vision. With regard to performance in the simulated mobility task, the number of mobility incidents was higher for glaucoma patients than for control subjects. For the reaching and grasping tasks, the overall movement duration for small objects was significantly longer in glaucoma patients compared with controls. The VF mean devi- ation of the worse eye was correlated with most of the QoL sub- scores. Mobility incidents as well as the reaching and grasping task parameters were not significantly correlated with QoL scores. Conclusions: Glaucoma patients showed an alteration of performance in simulated daily living activities, associated with a decreased QoL. There was no clear correlation between alterations in QoL and ability to perform activities of daily living. The QoL related to vision was mostly correlated to the visual function of the worse eye. Key Words: Glaucoma, quality of life, visual field, activities of daily living, mobility, reaching and grasping (J Glaucoma 2020;29:970–974) G laucoma is one of the leading causes of irreversible blindness; it may affect up to 111.8 million people world- wide in 2040. 1 It is generally characterized by a progressive loss of retinal ganglion cell axons, associated with a reduction of visual field (VF). 2,3 The progressive visual function loss, as well as the medical or surgical treatment, or even the diagnosis of glaucoma itself, can affect the daily life of glaucoma patients and, con- sequently, their quality of life (QoL). 4 QoL is a complex and subjective concept that involves the individual perception of emotional, physical, material, and social factors. As the goal of glaucoma treatment is to preserve the patient’ s QoL, 5 direct or indirect evaluation of QoL is of central importance in the man- agement of the glaucoma patient. In contrast to visual impairment and stage of glaucoma, which can be measured precisely by objective tests such as visual acuity (VA) measurement, contrast sensitivity, and VF testing, evaluation of the impact of glaucoma on daily activities and QoL remains a challenge. 5 The monocular VF is the gold standard used in clinical practice to evaluate glaucoma patients’ visual function and glaucoma progression, so as to adjust treatment accordingly. 6 The better eye VF mean deviation (MD) has been directly correlated with visual function and is used in QoL studies in glaucoma. 7–9 As glaucoma patients use one eye to compensate for the other, binocular VFs, or systems integrating both mon- ocular VF tests to reproduce a binocular VF, are also used. 9–12 However, using a concomitant evaluation of 4 different activities of daily living, our group showed, consistently with several other studies, that neither monocular nor bilateral VFs can thoroughly describe the effect of glaucoma on a patient’ s everyday activities of daily living. 9,13–16 Although visual impairment due to glaucoma has a significant negative impact on patients’ ability to perform activities of daily living, the exact correlation between objective visual changes and their consequences on QoL are not fully understood and remain difficult to evaluate. Simply stated, patients with similar visual function might experience DOI: 10.1097/IJG.0000000000001597 Received for publication May 12, 2020; accepted June 13, 2020. From the *Streetlab, Institut de la Vision; §Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, INSERM-DOS CIC 1423; ∥iNSERM, U968; UPMC PARIS 06 University, UMR_S968, Institut de la Vision; CNRS, UMR 7210; Quinze-Vingts National Ophthalmology Hospital, INSERM-DHOS CIC 503; ¶Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT; #Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, Paris Saclay University, Paris, France; †Department of Ophthalmology, Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine; and ‡Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shang- hai, China. L.A.-S. and Z.Z. contributed equally. This study was conducted with an unrestricted grant from Klesia and the IHU FOReSIGHT. Disclosure: The authors declare no conflict of interest. Reprints: Antoine Labbé, MD, PhD, Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, 28 rue de Charenton, Paris 75012, France (e-mail: alabbe@15-20.fr). Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website, www. glaucomajournal.com. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. ORIGINAL STUDY 970 | www.glaucomajournal.com J Glaucoma  Volume 29, Number 10, October 2020 Copyright r 2020 Wolters Kluwer Health, Inc. All rights reserved.