Ganglion Cell Complex Thinning Pace Predicts Quality-of-Life Reductions in Glaucoma

Retina, LM
Retina. Light micrograph (LM) of a section through a retina. The eye works by allowing light to be focused by the lens onto the retina. The retina contains specialised light sensitive photoreceptor cells (top) used to distinguish between colours (cone cells) and to see at night (rod cells). The light is relayed as electrical signals through sensory nerve cells, called bipolar cells ( centre purple cells). The two layers above and below the bipolar nerve cells are synaptic layers, where the dendrites and axons of the photoreceptors and neurons pass on the signals to others below them. The lowest layers are made up of ganglion nerve cells which pass the signals to the brain and the choroid layer that lines the inside of the eye underneath the retina and is pigmented to prevent light reflecting inside the eye distorting the image. Magnification: x120 when printed 10cm wide.
The study shows how monitoring the macula may provide insight into functional impairment.

Rapid ganglion cell complex (GCC) thinning in the sectoral central location may be associated with a precipitous drop in vision-related quality of life (VRQOL) among patients with glaucoma, according to a study published in JAMA Ophthalmology.

Patients (N=118; N=236 eyes) who were glaucoma suspect or had primary open angle glaucoma (POAG) from the Diagnostic Innovations in Glaucoma Study (DIGS) and African Descent and Glaucoma Evaluations Study (ADAGES) were included in this analysis. Participants underwent annual comprehensive ophthalmological evaluations and biannual optical coherence tomography (OCT) evaluations for a minimum of 2 years. Changes to eye structure were related with VRQOL assessed using the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ).

Patients (mean age 73.2±8.7 years, 65 women, 44.9% Black), had a visual acuity was 0.07 logMAR (95% CI, 0.04-0.09)  in the better eye and 0.10 logMAR  (95% CI, 0.07-0.13) in the worse eye, 61.0% had POAG in both eyes, and 39.0% had POAG in 1 eye and was glaucoma suspect in the other.

In the univariate model, global GCC thinning at a rate of 1 µm per year (mean coefficient, −19.0; 95% CI, −30.7 to −7.2; P <.001) and number of glaucoma medication in the better eye (mean coefficient, −4.5; 95% CI, −7.9 to −1.1; P =.01) were significant predictors of VRQOL. In the multivariate model, only global GCC remained significant (mean coefficient, −15.0; P =.03).

NEI VFQ scores significantly associated with changes in the global GCC slopes (mean coefficient, −15.0; 95% CI, −28.4 to −1.7; P =.03), inferior region slopes (mean coefficient, −28.4; 95% CI, −49.5 to −7.4; P =.01), 5.6° circle (mean coefficient, −14.5; 95% CI, −27.0 to −2.0; P =.02), and 6.8° circle (mean coefficient, −23.7; 95% CI, −45.5 to −1.9; P =.03), indicating that faster annual thinning in the better eye indicated greater disability.

Stratified by NEI VFQ subscales, social function associated with changes to GCC slopes in the global, inferior, superior, 3.4° circle, 5.6° circle, and 6.8° circle regions (all P <.01); driving with inferior, 5.6° circle, and 6.8° circle regions (all P <.05); distance vision with global, inferior, and 5.6° circle regions (all P <.05); near and peripheral vision with inferior regions (both P =.04); and general vision with the 3.4° circle region (P =.04).

The major limitation of this study was the subjective nature of the VRQOL evaluation.

The study authors concluded that a faster rate of GCC thinning, particularly in the central location, is associated with detriments to VRQOL among patients with glaucoma. Additional study is needed to understand the relationship between structural ophthalmologic changes and quality of life.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Nishida T, Moghimi S, Mahammadzadeh V, et al. Association between ganglion cell complex thinning and vision-related quality of life in glaucoma. JAMA Ophthalmol. Published online June 30, 2022. doi:10.1001/jamaophthalmol.2022.2140