Ganglion Cell Complex Thinning Associated With Vision-Related Quality of Life

Faster and sectoral central location of ganglion cell complex thinning could be used to determine the risk of vision-related quality of life in patients with glaucoma.

Faster and sectoral central location thinning in the ganglion cell complex (GCC) could be used as a determinant for the risk of vision-related quality of life (QOL) in patients with glaucoma, according to study findings published in JAMA Ophthalmology.

The retrospective, longitudinal cohort study used all patients who had primary open angle glaucoma (POAG) enrolled in the Diagnostic Innovations in Glaucoma Study and African Descent and Glaucoma Evaluation Study. The data analysis took place in November 2021.

Participants were included if they were 18 years and older, had open angles on gonioscopy, had a best-corrected visual acuity of 20/40 or better, and had refraction plus or minus 5.0 diopters sphere and plus or minus 3.0 diopters cylinder. Participants were excluded if they had a history of trauma or intraocular surgery, coexisting retinal disease, other systemic or ocular disease known to the affect visual field (VF), significant cognitive impairment, or an axial length of 27 mm or more. Participants with unreliable VFs and poor-quality optical coherence tomography (OCT) were excluded.

Thickness measurements were obtained through the spectralis spectral domain-OCT macula horizontal posterior pole scans from September 2014 to March 2020. Vision-related QOL was evaluated using a 25-item survey from the National Eye Institute Visual Function Questionnaire (NEI VFQ).

There were 236 eyes from 118 participants that were included in this study. There were 72 participants who had bilateral POAG and 46 participants with suspected POAG/glaucoma. The mean (SD) age of the study participants was 73.2 (8.7) years.

The multivariable model found that a faster rate of GCC thinning in the bettery eye was associated with a higher disability score in the NEI VFQ (–15.0; 95% CI, –28.4 to –1.7 per 1-mcm faster rate of change per year).

An association between a fast annual rate of inferior GCC thinning and higher disability was found in the composite NEI VFQ score (–28.4; 95% CI, –49.5 to –7.4) although superior GCC thinning was not (–7.1; 95% CI, –16.1 to 1.9).

The 5.6º and 6.8º areas, when stratified by degrees from the fovea, were associated with the composite NEI VFQ score of –14.5 (95% CI, –27.0 to –2.0) and –23.5 (95% CI, –45.5 to –1.9) per 1 mcm faster, respectively, and –8.0 (95% CI, –16.8 to 0.8) per 1 mcm faster for the 3.4º area after adjustment for confounding factors.

There were some limitations to this study. The study was evaluated subjectively, which may not provide the most accurate representation of QOL, and information on ocular surface diseases that may affect QOL was not collected. There also may be some confounding factors due to the complicated nature of QOL analysis.

The researchers concluded that a faster rate and central location of GCC thinning was weakly associated with a lower vision-related QOL in patients with glaucoma.

“Understanding how structural changes influence [vision-related QOL] is vital for understanding which patients may need more frequent observation and additional treatment to prevent visual disability and reduced QOL,” the authors wrote.


Nishida T, Moghimi S, Mohammadzadeh V, et al. Association between ganglion cell complex thinning and vision-related quality of life in glaucoma. JAMA Opthalmol. Published online June 30, 2022. doi:10.1001/jamaophthalmol.2022.2140