Confirming a widely understood clinical insight about visual disability in glaucoma, a new study documented how the location of a patient’s visual field (VF) damage governs their ability to perform activities of daily living, according to research published in Investigative Ophthalmology & Visual Science. The researchers found central VF damage was strongly associated with more disabilities, including those thought to be highly dependent on peripheral vision, such as fear of falling. Conversely, they discovered peripheral damage was linked to a person’s gait.

The investigation included 231 glaucoma patients and suspects who completed 24-2 VF testing and automated peripheral VFs using supra-threshold 30° to 60° patterns. Patients filled out questionnaires that assessed fear of falling, quality of life, important daily activities and driving habits.

Greater central—but not peripheral—damage was associated with a greater fear of falling, worse quality of life, fewer daily steps and difficulty completing important daily activities. On the other hand, greater peripheral—but not central—damage was tied to shorter steps and strides, as well as greater variability in step length.

For many of the variables, the difference between central and peripheral VF damage was generally small. Patients were usually affected by both central and peripheral VF defects.

Studies relating VF damage in specific regions to disability should separately consider disability in different domains as opposed to evaluating summary measures of disability, the researchers concluded.

Odden JL, Mihailovic A, Boland MV, et al. Assessing functional disability in glaucoma: the relative importance of central versus far peripheral visual fields. Invest Ophthalmol Vis Sci. 2020;61(13):23.