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Patient Perception Compared With Objective Measurement

Ananth C. Viswanathan, FRCOphth; Andrew I. McNaught, FRCOphth; Darmalingun Poinoosawmy; Luigi Fontana, MD; David P. Crabb, PhD; Fred W. Fitzke, PhD; Roger A. Hitchings, FRCOphth

Arch Ophthalmol. 1999;117:450-454.

Objective  To elucidate the relationship between the subjective assessment in patients with glaucoma of (1) the severity of their visual loss, and (2) any deterioration in their visual function and their objective visual fields as measured by computed perimetry.

Design  First, patients completed a questionnaire relating to perceived visual disability and underwent binocular visual field testing. Second, a separate group of patients answered a question about perceived visual deterioration: their monocular visual field tests were analyzed retrospectively by pointwise linear regression to establish stability or deterioration.

Setting  The Glaucoma Service of a specialist eye hospital, which is a tertiary referral center and serves the local community.

Subjects  One hundred twenty-three patients with glaucoma including 62 for the severity arm of the study and 61 for the progression arm.

Main Outcome Measures  Questionnaire responses, Esterman binocular disability score, and objective visual field deterioration.

Results  Questions strongly associated with Esterman binocular disability scores related to bumping into things, problems with stairs, and finding things that have been dropped. There was a strong association between perceived visual deterioration and measured bilateral visual field deterioration (P<.01).

Conclusions  There is a strong association between some types of perceived visual disability and the severity of binocular field loss. A patient who notices gradual visual deterioration is twice as likely to have bilateral visual field deterioration as not. The findings in this sample of patients with mild-to-moderate glaucoma challenge the belief that glaucoma is an insidious process in which the symptoms do not appear until the end stage of the disease.

From the Institute of Ophthalmology (Drs Viswanathan, McNaught, Crabb, and Fitzke) and Moorfields Eye Hospital (Mr Poinoosawmy and Drs Fontana and Hitchings).

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