Glaucomatous Retinal Nerve Fiber Layer Thickness Loss Is Associated With Slower Reaction Times Under a Divided Attention Task

• Published in: American journal of ophthalmology 2014-11, Vol.158 (5), p.1008-1017.e2
• Main Authors: Tatham, Andrew J, Boer, Erwin R, Rosen, Peter N, Della Penna, Mauro, Meira-Freitas, Daniel, Weinreb, Robert N, Zangwill, Linda M, Medeiros, Felipe A
• Format: Article
• Language: English
• Subjects: Age; Assessment centers; Attention - physiology; Automation; Cross-Sectional Studies; Family medical history; Female; Glaucoma; Glaucoma - diagnosis; Glaucoma - physiopathology; Health Insurance Portability & Accountability Act 1996-US; Human subjects; Humans; Intraocular Pressure - physiology; Male; Medical imaging; Middle Aged; Nerve Fibers - pathology; Ophthalmology; Photic Stimulation; Prognosis; Reaction Time - physiology; Regression analysis; Retinal Ganglion Cells - pathology; Studies; Tomography, Optical Coherence - methods; Visual Field Tests; Visual Fields; Visual impairment
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2014.07.028

Purpose To examine the relationship between glaucomatous structural damage and ability to divide attention during simulated driving. Design Cross-sectional observational study. Methods setting : Hamilton Glaucoma Center, University of California San Diego. patient population : Total of 158 subjects from the Diagnostic Innovations in Glaucoma Study, including 82 with glaucoma and 76 similarly aged controls. observation procedure : Ability to divide attention was investigated by measuring reaction times to peripheral stimuli (at low, medium, or high contrast) while concomitantly performing a central driving task (car following or curve negotiation). All subjects had standard automated perimetry (SAP) and optical coherence tomography was used to measure retinal nerve fiber layer (RNFL) thickness. Cognitive ability was assessed using the Montreal Cognitive Assessment and subjects completed a driving history questionnaire. main outcome measures : Reaction times to the driving simulator divided attention task. Results The mean reaction times to the low-contrast stimulus were 1.05 s and 0.64 s in glaucoma and controls, respectively, during curve negotiation ( P < .001), and 1.19 s and 0.77 s ( P  = .025), respectively, during car following. There was a nonlinear relationship between reaction times and RNFL thickness in the better eye. RNFL thickness remained significantly associated with reaction times even after adjusting for age, SAP mean deviation in the better eye, cognitive ability, and central driving task performance. Conclusions Although worse SAP sensitivity was associated with worse ability to divide attention, RNFL thickness measurements provided additional information. Information from structural tests may improve our ability to determine which patients are likely to have problems performing daily activities, such as driving.