THE IMPACT OF ADVANCED GLAUCOMA: QUALITY OF LIFE AND MENTAL HEALTH

Abstract

Advanced glaucoma imposes the greatest burden of visual disability, severely affecting daily activities, emotional health, and social participation. This systematic review synthesized evidence from 31 studies published between 2015 and 2025 that evaluated vision-related quality of life and mental health in patients with advanced glaucoma. The findings consistently demonstrate marked impairment in quality of life, particularly in tasks requiring peripheral vision, dark adaptation, driving, and near work. Integrated binocular visual fields and inferior hemifield loss correlated more strongly with functional disability than global indices such as mean deviation. Mental health outcomes were also substantially compromised, with high rates of anxiety, depression, and fear of falling, often worsening with disease progression. Randomized trials, including the Treatment of Advanced Glaucoma Study (TAGS), confirmed that while pressure-lowering strategies effectively slow disease progression, they do not consistently improve quality of life, underscoring the need for supportive measures. Vision-specific instruments, such as NEI VFQ-25, GQL-15, VFQ-UI, and GlauCAT, proved more sensitive than generic tools like EQ-5D-5L or HUI-3. Overall, advanced glaucoma has a profound impact that extends beyond visual function, reinforcing the importance of patient-centered care strategies that integrate psychosocial support, fall prevention, visual rehabilitation, and preservative-free therapies alongside traditional intraocular pressure control.