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.

Continue Reading

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