Glaucoma-Related Quality of Life Linked With Severity, Demographic Factors

Ophthalmologist examining patient's eyes
Ophthalmologist examining patient’s eyes
Later stage disease significantly reduces quality of life survey scores.

Quality of life (QoL) metrics are significantly lower in patients with more severe glaucoma when compared with those who are glaucoma suspects or who have early visual field (VF) defects, according to research published in the British Journal of Ophthalmology. In addition to the clinical factors that can reduce a patient’s QoL, the researchers also established a number of demographic and social associations with lower scores.

These findings suggest that “patients with predisposing demographic and clinical factors are at a higher risk of worse QoL,” the investigators explain.

The researchers collected data using a novel computerized adaptive test called GlauCAT, which uses Likert-type scales to measure ocular comfort, activity limitation, mobility, emotional well-being, concerns, and treatment convenience. Information regarding participants’ vision, glaucoma treatment, and demographic characteristics was also collected. 

The study took into account survey responses from 206 participants (mean age 64.8±15.2 years, 56.7% women, 74.7% White). Their mean duration of glaucoma was 8.2±9.5 years and the BCVA in their better eyes ranged from -0.1 to 2 logMAR. Participants were divided into 3 groups: those who were glaucoma suspects or had early glaucomatous defects (74.1%), those with moderate glaucomatous defects (11.8%), and those with severe defects (11.3%). 

The GlauCAT survey results show the severe glaucoma group scored lower in activity limitation (74.3±21.9) and in mobility (80.0±25.3) than the other groups, suggesting greater limitations for these patients.

The severe group’s survey responses indicated more concerns about the course of their disease compared with the other groups (72.5±18.9 vs 82.2±13.9, P =.01), according to the publication. Additionally, poorer visual field mean deviation was linked with lower levels of emotional well-being (β=-2.4 points, 95% CI -4.6 to -0.3, P =.03).

However, the ocular comfort, emotional well-being and treatment convenience domains were not significantly different between the 3 groups (Kruskall-Wallis P =.23, P =.36, and P =.88, respectively). 

The findings show that patients who have early or moderate visual field deficits often have a higher QoL compared with those with severe glaucoma. 

The study also shows several demographic and societal factors associated with lower QoL. Patients who are Black had greater activity limitations and concerns, worse emotional well-being, and reduced treatment convenience compared with patients who are White, according to the report. Additionally, women had a lower ocular comfort domain score than men. Patients with less education had higher scores on questions about activity limitation, mobility, and concerns. 

“College education, in part a proxy for high socioeconomic status, may allow patients access to more resources such as assistive devices, and the ability to make modifications in their environment to reduce the impact of vision impairment on daily functioning,” the researchers explain.

A strength of this study is the use of GlauCAT, which is fast and allows researchers to collect a wide range of data on each participant. Limitations of the study include the recruitment of participants from tertiary clinics only on certain days of the week, limiting the generalization of these results. Additionally, the ability to assess differences in QoL based on severity and race was limited because of the small cohort of severe glaucoma patients and the lack of diversity in the study.


Halawa OA, Roldan AM, Meshkin RS, et al. Factors associated with glaucoma-specific quality of life in a US glaucoma clinic in a pilot implementation of an online computerised adaptive test (GlauCAT). Br J Ophthalmol. Published online May 20, 2022. doi:10.1136/ bjophthalmol-2022-321145