Location of visual field defects and their impact on vision-related quality of life in glaucoma: A systematic review.

BACKGROUND

Regional patterns of visual field (VF) loss may affect vision-related quality of life (QoL) differently in people with glaucoma; yet evidence across studies remains inconsistent.

OBJECTIVES

To identify and evaluate studies comparing vision-related QoL, measured by the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25), with specific regions of VF loss in glaucoma.

DATA SOURCES: MEDLINE, EMBASE, CINAHL, PsycINFO, and AMED were systematically searched from inception to April 2025.

STUDY ELIGIBILITY CRITERIA: Eligible studies included adults with glaucoma that examined regional VF loss (e.g., central vs. peripheral, hemifield, or cluster analyses) and reported NEI-VFQ-25 outcomes. Studies using only global VF indices were excluded.

STUDY APPRAISAL AND SYNTHESIS

METHODS

Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Joanna Briggs Institute tools. Due to heterogeneity in VF metrics and NEI-VFQ-25 scoring approaches, the findings were synthesized narratively.

RESULTS

Nine studies (n = 2626 participants) met the inclusion criteria. Most cohorts were relatively young (mean age mid-60s) with mild-moderate glaucoma; only two included participants with advanced loss. Despite methodological variation, a consistent pattern emerged: central and inferior VF loss were most strongly associated with poorer QoL, whereas superior and peripheral loss showed weaker or domain-specific effects. Associations were generally stronger when using better-eye or integrated VF measures.

LIMITATIONS: The evidence base is limited by few studies, small sample sizes, predominance of mild disease, and variability in both VF and NEI-VFQ-25 methodologies.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Central and inferior VF loss appear most closely linked to reduced QoL; however, conclusions are constrained by the limited number and methodological heterogeneity of available studies. Larger, standardized investigations across disease stages are needed to clarify these relationships and guide patient-centered care.

TRIAL REGISTRATION: PROSPERO CRD420251169334.