Differential Associations of Cognitive Function, Frailty, and Comorbidity Burden with Visual Field Sensitivity and Reliability in Glaucoma.

Background/

Objectives

Cognitive impairment, frailty, and systemic comorbidity burden are common in elderly patients with glaucoma and may influence both visual field (VF) performance and glaucoma severity. This study investigated the associations of comprehensive geriatric assessment (CGA) parameters, including Mini-Cog, G8, and Age-Adjusted Charlson Comorbidity Index (ACCI), with VF sensitivity and VF reliability indices in glaucoma patients.

Methods

This retrospective cross-sectional study included 1125 eyes of 622 glaucoma patients who underwent Humphrey VF testing and CGA at a tertiary referral center. Associations between CGA parameters and VF indices, including mean deviation (MD), pattern standard deviation (PSD), foveal sensitivity, fixation loss rate (FL), false-negative rate (FN), and false-positive rate (FP), were evaluated. Generalized linear mixed models were used to assess independent associations after adjustment for demographic, systemic, and ocular covariates.

Results

In univariate analyses, lower Mini-Cog and G8 scores and higher ACCI scores were associated with several VF sensitivity and reliability indices. After multivariable adjustment, ACCI remained independently associated with lower MD (estimate = -0.52, p = 0.004), higher PSD (estimate = 0.27, p = 0.04), and lower foveal sensitivity (estimate = -0.36, p = 0.01). Lower G8 scores and higher ACCI scores were independently associated with increased FN rates, whereas higher G8 scores were associated with increased FP rates.

Conclusions

Systemic comorbidity burden, assessed using ACCI, was independently associated with both glaucomatous functional impairment and selected VF reliability indices. Frailty, assessed using G8, was associated with VF reliability but not VF sensitivity. Although cognitive function measured by Mini-Cog was associated with VF parameters in univariate analyses, these associations were not retained after multivariable adjustment. Consideration of systemic health status and geriatric vulnerability may improve interpretation of VF results in patients with glaucoma.