Evaluation of the association between macular damage and disability glare in patients with advanced glaucoma

Purpose This study aimed to investigate the factors associated with disability glare in patients with advanced glaucoma and evaluate the impact of disability glare on the vision-related quality of life. Methods We prospectively studied 225 eyes (225 patients) with advanced glaucoma. The visual function was evaluated using the 10–2 and 24–2 Humphrey visual field (VF) (Dublin, California) and contrast sensitivity test. Structural parameters were obtained using RTVue optical coherence tomography and angiography (Fremont, California). Significant loss of macular vessel density (mVD) was defined as VD < 30%. Each participant completed the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) and questions regarding subjective symptoms of glare. Results Fifty-six patients (24.9%) experienced glare and had a lower NEI-VFQ-25 composite score ( P = 0.017). The average retinal nerve fiber layer and ganglion cell complex thickness and mean deviation (MD) in the 24–2 VF test were not associated with glare. Significant superior or inferior mVD loss ( P < 0.001; odds ratio [OR], 3.45; and 95% confidence interval [CI], 1.83–6.55), lower logarithmic contrast sensitivity at 0.75 cycles/degree ( P < 0.001; OR, 0.27; and 95% CI, 0.13–0.56), and worse MD in the 10–2 VF test ( P < 0.001; OR, 0.93; and 95% CI, 0.89–0.97) showed an association with glare. Conclusion In advanced glaucoma, central VF defect and mVD loss are associated with disability glare, which negatively impacts vision-related quality of life.