Published by:
Pardhan S et al. Invest Ophthalmol Vis Sci. 2017. doi: 10.1167/iovs.16-20273.
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Central vision loss affects daily tasks more than peripheral
Published by:
Pardhan S et al. Invest Ophthalmol Vis Sci. 2017. doi: 10.1167/iovs.16-20273.
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Patients with central vision loss due to age-related macular degeneration have greater difficulty in visually guided manual prehension and object placement as compared to patients with peripheral visual field loss caused by glaucoma, a study showed.
The study was conducted on 17 glaucoma patients with peripheral field loss (PFL), 17 AMD patients with central field loss (CFL) and 10 age-matched controls.
Participants had to reach toward and grasp a cylindrical object and transport and place it at a predefined peripheral location. Kinematic data were collected with Vicon 460 three-dimensional motion analysis system. Twenty-four trials were conducted for each participant, for a total of 1,056 trials.
Post-hoc analysis was divided in two phases: reach-to-grasp and transport-to-place. Collected data demonstrated significant differences between groups in the reach-to-grasp phase, with greater overall movement time, longer reaction time, longer deceleration time and slower velocity corrections as well as a slower aperture of the hand after maximum grip for the CFL group in comparison to the PFL group. No significant differences were registered in maximum grip aperture, peak velocity and time-to-reach peak velocity.
Significant differences were also reported in the transport-to-place phase, with greater transport duration, lateral velocity corrections, deceleration time and number of object-placing errors for the CFL group.
This study suggests that CFL will affect daily activities more than peripheral visual field loss.
“Manual prehension tasks that involve reaching and grasping an object and then transporting it to another location are important activities of daily living,” the authors wrote. “Health care professionals/care givers should be aware that, for patients with central field defects, however acquired, such tasks may be difficult, and this should be reflected in the health care they receive.” – by Michela Cimberle
Disclosure: The authors report no financial disclosures.
Perspective
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Derek MacDonald, OD, FAAO
It’s easy to get focused on the nitty-gritty of glaucoma management including target pressure, RNFL thickness and visual field index. While these details are important, we can’t lose sight of the ultimate goal: “… to enhance … quality of life by preserving visual function … at a sustainable cost … without causing untoward side effects from treatment …” (Weinreb and Khaw, 2004).
Pardhan and colleagues’ study of the impact of visual field loss on important activities of daily living is a welcome reminder that optometrists need to keep the bigger picture – the patient’s life outside our examination room – front of mind.
Patients with glaucoma are often elderly and afflicted with multiple ocular and systemic comorbidities. These conditions and their treatment may impact visual acuity and contrast sensitivity, binocular and visual field status, and ocular comfort, not to mention memory, cognition, stamina and physical mobility. Seniors may spend a lot of time in doctors’ offices and be on a first-name basis with their pharmacist, but many return to an empty apartment and have dinner alone.
As primary care practitioners, optometrists have the opportunity, indeed the obligation, to truly know our patients and their challenges and care for the entire person, not simply their optic nerves.
Reference:
Weinreb RN, et al. Lancet. 2004;363(9422):1711-1720. doi: 10.1016/S0140-6736(04)16257-0.
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