Ganglion cell complex thinning to predict vision-related QoL in glaucoma: JAMA

USA: The faster and sectoral central location of ganglion cell complex (GCC) thinning helps determine the risk of vision-related quality of life in glaucoma, reports a retrospective analysis of a longitudinal cohort study published in The JAMA Ophthalmology.

Glaucoma is a common age-related eye problem that poses a serious public health concern as it is the second leading cause of blindness after cataracts, and this blindness is usually irreversible. It can significantly affect patients' quality of life (QoL) and impair their performance in a broad array of daily activities such as reading, walking, and driving. The ultimate goal of glaucoma management is the preservation of patients' visual function and their QoL.

Early diagnosis and treatment of glaucoma are important to reduce the risk of progressive and irreversible visual loss. The macular ganglion cell complex (GCC) includes all three innermost retinal layers potentially involved in the glaucomatous damage (RNFL, GCL, and IPL). The segmentation of the GCC thickness is traced from the inner limiting membrane and the outer intense pulsed light(IPL) boundary. Previous studies have confirmed that the GCC thickness is superior to macular thickness in detecting glaucomatous eyes.

Takashi Nishida, University of California, San Diego, and colleagues conducted a study to evaluate the association between the rate of ganglion cell complex thinning and the Vision Function Questionnaire in glaucoma.

Researchers enrolled Patients from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. 236 eyes of 118 patients with diagnosed or suspected glaucoma were followed up with imaging for a mean of 4.1 years. A 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ) was used at the last follow-up visit. Ganglion cell complex (GCC) thickness was derived from macular optical coherence tomography scans and averaged within 3 circular areas (3.4°, 5.6°, and 6.8° from the fovea) and superior and inferior hemiregions.

Key findings of the analysis,

• A faster annual rate of global ganglion cell complex thinning in the better eye was associated with a higher disability of the composite NEI VFQ score (−15.0 per 1 μm faster).

• When stratified by degrees from the fovea, the 5.6° and 6.8° areas were associated with the composite NEI VFQ score ( −14.5 per 1 μm faster; P = .03; and −23.7 per 1 μm faster respectively) and the 3.4" area was -8.0 per 1 μm faster (R2 = 0.184) after adjusting for confounding factors.

The authors conclude that in patients with glaucoma assessment of ganglion cell complex thinning may be important in predicting their vision-related QoL. Faster structural changes may be associated with worse vision-related QoL in such patients. Monitoring macular structures is important to determine the risk of functional impairment in glaucoma.

Reference:

Nishida T, Moghimi S, Mohammadzadeh 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