Researchers proposed a new methodology for classifying patient-reported outcomes in glaucoma and quantifying the amount of visual field damage associated with disease disability, as part of a cross-sectional study of 263 individuals with glaucoma.

Researchers assessed vision-related disability by the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). They applied a latent class analysis model to analyze NEI VFQ-25 data, and divided individuals into mutually exclusive classes according to their responses to the questionnaires. And they investigated differences in standard automated perimetry mean deviation and integrated binocular mean sensitivity values between classes. The optimal number of classes was defined by fitting criteria, interpretability and clinical utility.

• The model with two classes—disabled and non-disabled—had the best fit with entropy of 0.965, indicating excellent separation of classes.
• A total of 48 (18 percent) individuals were disabled, while 215 (82 percent) were non-disabled.
• The average MD of the better eye was -5.98 dB in the disabled group vs. -2.51 dB in the non-disabled group (p<0.001).
• For the worse eye, corresponding values were -13.36 dB and -6.05 dB, respectively (p<0.001).

Researchers concluded that the LCA model enabled categorization of patient-reported outcomes and quantification of VF levels associated with disability in glaucoma. They added that damage of approximately -6 dB for SAP MD, indicating relatively early VF loss, might be associated with significant disability if occurring in the better eye.

Investigators wrote that disorganization of retinal inner layers (DRIL) has demonstrated significant correlations with visual acuity in center-involved diabetic macular edema. They hypothesized that DRIL might be a useful biomarker in determining VA outcomes in individuals with retinal vein occlusion and secondary macular edema. As such, they examined whether DRIL at baseline and after treatment was associated with VA in RVO.

Investigators conducted a retrospective records review of 147 individuals, 18 years or older, who presented to a tertiary ophthalmic center from Dec. 1, 2010, to Jan. 1, 2016. The patients suffered from treatment-naive branch RVO, central RVO or hemispheric RVO, and had a minimum of 12 months of follow-up. Exclusion criteria included active confounding retinal or ocular disease, history of pars plana vitrectomy or prior intravitreal injections. Two masked graders calculated a DRIL score based on DRIL presence in three predefined regions on spectral-domain optical coherence tomography at baseline, six months and 12 months. A third masked grader was used for discrepancies.

Exposures included anti-vascular endothelial growth factor therapy (ranibizumab, aflibercept or bevacizumab) determined by the treating physician. Main outcomes and measures included DRIL scores at baseline to determine VA outcomes and correlation with changes in DRIL burden as a result of AVF therapy.

• In the 147 participants (mean [SD] age, 68.9 [13.1] years; 75 [51 percent] female), baseline DRIL was seen in 91 eyes (61.9 percent).
• In the BRVO group, baseline DRIL was associated with lower baseline Early Treatment Diabetic Retinopathy Study score (score of 66.7 for no DRIL vs. 54.6 for DRIL; p=0.002).
• Absence of DRIL at baseline in the CRVO/HRVO group correlated with greater VA gains at six months, adjusting for baseline VA (score change of 19.50 for no DRIL vs. 12.72 for DRIL; p=0.04).
• During 12 months, DRIL presence in BRVO was associated with less VA gain up to six months (score change of 6.2 for the increase group vs. 18.6 for the decrease group and 2.9 for the stable group; p=0.02).
• Increased DRIL scores in CRVO/HRVO were associated with reduced VA improvement at six months (score change: -0.12 for the increase group vs. 16.90 for the decrease group and 8.45 for the stable group; p=0.002) and 12 months (score change: -1.91 for the increase group vs. 17.83 for the decrease group and 6.97 for the stable group; p<0.001).

Investigators wrote that baseline DRIL presence and burden change with AVF therapy for macular edema secondary to RVO might be useful biomarkers of ETDRS score improvements.