Distinguishing Glaucoma, Cataract, and Glaucoma Suspect Based on Visual Symptoms

Abstract

Précis: Cataract, glaucoma, and glaucoma suspect patients report differing visual symptoms. Asking patients about their visual symptoms may provide useful diagnostic information and inform decision-making in patients with comorbid conditions. Purpose: To compare visual symptoms in glaucoma, glaucoma suspect (controls), and cataract patients. Methods: Glaucoma, cataract, and glaucoma suspect patients at Wilmer Eye Institute responded to a questionnaire rating the frequency and severity of 28 symptoms. Univariate and multivariable logistic regression determined the symptoms that best differentiate each disease pair. Results: In all, 257 patients (mean age: 67.4 ± 13.4 y; 57.2% female; 41.2% employed), including 79 glaucoma, 84 cataract, and 94 glaucoma suspect patients, participated. Compared with glaucoma suspects, glaucoma patients were more likely to report poor peripheral vision (OR 11.29, 95% CI: 3.73–34.16), better vision in 1 eye (OR 5.48, 95% CI: 1.33–22.64), and light sensitivity (OR 4.85, 95% CI: 1.78–13.24), explaining 40% of the variance in diagnosis (ie, glaucoma vs. glaucoma suspect). Compared with controls, cataract patients were more likely to report light sensitivity (OR 3.33, 95% CI: 1.56–7.10) and worsening vision (OR 12.20, 95% CI: 5.33–27.89), explaining 26% of the variance in diagnosis (ie, cataract vs. glaucoma suspect). Compared with cataract patients, glaucoma patients were more likely to report poor peripheral vision (OR 7.24, 95% CI: 2.53–20.72) and missing patches (OR 4.91, 95% CI: 1.52–15.84), but less likely to report worsening vision (OR 0.08, 95% CI 0.03–0.22), explaining 33% of the variance in diagnosis (ie, glaucoma vs. cataract). Conclusions: Visual symptoms distinguish disease state to a moderate degree in glaucoma, cataract, and glaucoma suspect patients. Asking about visual symptoms may serve as a useful diagnostic adjunct and inform decision-making, for example, in glaucoma patients considering cataract surgery.