Perspectives on Glaucoma

Study: Glaucoma patients have lower reading ability, engagement

Patients with glaucoma read less and have a lesser reading ability, according to a study recently published in Investigative Ophthalmology & Visual Science.

As detailed in the study, 63 glaucoma patients and 59 control patients with a diagnosis of glaucoma suspect or ocular hypertension participated.

The study subjects engaged in 10 reading activities from the Activity Inventory, which was developed to assess patients with low vision. The reading tasks included word puzzles, bills, financial statements, handheld menus, magazines, religious texts, books, newspaper articles, typed mail and written notes or mail. Nguyen and colleagues then evaluated the participants with an oral questionnaire and analyzed their responses with Rasch analysis to determine ability.

To gauge reading engagement, researchers asked the participants about how many days per week they perform the reading tasks.

Researchers also measured visual acuity and visual field mean deviation as well as contrast sensitivity, depression and cognitive ability.

Results showed that glaucoma patients had a lower reading ability than control participants, which was associated with greater visual field loss and lower contrast sensitivity. Additionally, glaucoma patients reported a greater difficulty reading in all reading activities except puzzles.

As reported by the participants, the most difficult tasks included finances, books and puzzles, and the least difficult tasks included bills, notes and mail.

Researchers concluded that glaucoma patients have a lower reading ability and lower engagement, especially for tasks that require sustained reading. They recommended that future studies focus on what causes this to help glaucoma patients retain their reading abilities.

"While reading is a common complaint amongst glaucoma patients, only a small percentage of glaucoma patients are referred to rehabilitative services," the authors also noted. "One barrier to referrals may be the fact that physicians may not view glaucoma patients as requiring visual rehabilitation services, as they most often refer patients with central vision deficits.

An additional barrier to referral may be that glaucoma patients do not often express severe reading difficulty to the extent that reading would be impossible,” they continued. “Finally, rehabilitative services, including efforts to enable reading, are primarily tailored to serve patients with central vision loss – not those with visual field loss.”

The authors concluded: “Additional work is necessary to define the best methods for enabling reading in patients with glaucoma, perhaps by creating proper lighting to optimize contrast and reduce glare, correcting aberrant eye movements, employing visual aids to enlarge text and/or teaching strategies to mitigate fatigue.”

Patients with glaucoma read less and have a lesser reading ability, according to a study recently published in Investigative Ophthalmology & Visual Science.

As detailed in the study, 63 glaucoma patients and 59 control patients with a diagnosis of glaucoma suspect or ocular hypertension participated.

The study subjects engaged in 10 reading activities from the Activity Inventory, which was developed to assess patients with low vision. The reading tasks included word puzzles, bills, financial statements, handheld menus, magazines, religious texts, books, newspaper articles, typed mail and written notes or mail. Nguyen and colleagues then evaluated the participants with an oral questionnaire and analyzed their responses with Rasch analysis to determine ability.

To gauge reading engagement, researchers asked the participants about how many days per week they perform the reading tasks.

Researchers also measured visual acuity and visual field mean deviation as well as contrast sensitivity, depression and cognitive ability.

Results showed that glaucoma patients had a lower reading ability than control participants, which was associated with greater visual field loss and lower contrast sensitivity. Additionally, glaucoma patients reported a greater difficulty reading in all reading activities except puzzles.

As reported by the participants, the most difficult tasks included finances, books and puzzles, and the least difficult tasks included bills, notes and mail.

Researchers concluded that glaucoma patients have a lower reading ability and lower engagement, especially for tasks that require sustained reading. They recommended that future studies focus on what causes this to help glaucoma patients retain their reading abilities.

"While reading is a common complaint amongst glaucoma patients, only a small percentage of glaucoma patients are referred to rehabilitative services," the authors also noted. "One barrier to referrals may be the fact that physicians may not view glaucoma patients as requiring visual rehabilitation services, as they most often refer patients with central vision deficits.

An additional barrier to referral may be that glaucoma patients do not often express severe reading difficulty to the extent that reading would be impossible,” they continued. “Finally, rehabilitative services, including efforts to enable reading, are primarily tailored to serve patients with central vision loss – not those with visual field loss.”

The authors concluded: “Additional work is necessary to define the best methods for enabling reading in patients with glaucoma, perhaps by creating proper lighting to optimize contrast and reduce glare, correcting aberrant eye movements, employing visual aids to enlarge text and/or teaching strategies to mitigate fatigue.”

    Perspective
    Scott Anthony

    Scott Anthony

    As clinicians, we sometimes lose sight of the quality of life issues that our patients experience. Glaucoma especially is deceptive, as we often encounter patients with advanced disease who are seemingly unaware of their vision loss.

    In this study, Nguyen and colleagues dispel the notion that glaucoma is largely an asymptomatic condition by providing evidence that common tasks (reading, in this instance) can be significantly compromised. Studies such as these not only help develop methods to counter such deficiencies, but also give clinicians insight into the glaucoma experience.  

    • Scott Anthony, OD, FAAO
    • Adjunct assistant professor of clinical optometry, staff optometrist Cleveland VA Medical Center (Wade Park Campus)

    Disclosures: Anthony has no relevant financial disclosures.