= 증례보고 = 녹내장환자에서양안이스터만시야검사결과와삶의질과의연관성 대한안과학회지 2013 년제 54 권제 10 호 J Korean Ophthalmol Soc 2013;54(10):1567-1572 pissn: 0378-6471 eissn: 2092-9374 http://dx.doi.org/10.3341/jkos.2013.54.10.1567 이주연 조현경 기창원 성균관대학교삼성서울병원안과학교실 목적 : 양안 Esterman 시야검사를이용하여녹내장환자에서시야결손의정도및위치와환자의주관적삶의질과연관성을알아보고자하였다. 대상과방법 : 개방각녹내장을진단받은환자중양안모두시야결손이있으면서적어도한눈은중기이상의녹내장성시야결손을보이는 60 명을대상으로단안 Humphrey 시야검사및양안이스터만시야검사와한국판시기능설문지 (25-item National Eye Institute Visual function Questionnaire) 를시행하였다. 양안 Esterman 시야검사는상, 하측중심시야 10 도이내, 상, 하측중심시야 30 도이내, 상, 하측주변부시야결손으로분류하여각점수와설문지의세부항목과연관성을비교하였다 (spearman correlation). 또한단안 Humphrey 시야검사의 mean deviation 값을각각조사하여양안 Esterman 시야검사와의연관성을분석하였다. 결과 : 양안 Esterman 시야검사의전체점수와설문지의전체점수는연관성을보였다 (p=0.03). 하측주변부시야결손은설문지 12 개세부항목중가장많은 8 개항목에서연관성을보였다 (p<0.05). 특히세부항목중 전반적인시력 항목과연관성을보인곳은하측 10 도이내시야결손이었고 (p=0.011), 운전 항목과연관성을보인곳은상측주변부시야결손이었다 (p=0.038). Humphrey 시야검사에서측정한나쁜눈의 MD 수치는설문지전체점수와유의한연관성을보였다 (p=0.008). 결론 : 녹내장환자의삶의질과시기능을평가하는데양안 Esterman 시야검사가간편하고유용하게사용될수있다. < 대한안과학회지 2013;54(10):1567-1572> 최근녹내장을진단하고치료하는것뿐아니라, 녹내장으로인한시야결손의위치와정도가녹내장환자의삶의질에얼마나영향을주는지알아보고자하는연구가다양하게진행되어왔다. 이것은임상소견이환자가실제로느끼는불편감을얼마나객관적으로반영하는지분석하여환자의치료에도움을주려는것으로, 녹내장환자의시야결손은환자의삶의질과일상생활능력을평가하는가장특징적이고주요한인자로간주되어왔다. 1,2 이전연구결과에따르면주변시야결손보다중심시야결손이환자의시력및시기능에더큰영향을미친다고하였는데, 3 녹내장환자에서중심시야 5도이내시야결손이있는경우시력상실의위험성이더크며, 4 두사분면에서중심시야 3도이내시야결손이있는경우읽기능력이현저히저하된다고보고 Received: 2013. 5. 10. Revised: 2013. 6. 20. Accepted: 2013. 8. 24. Address reprint requests to Changwon Kee, MD, PhD Department of Ophthalmology, Samsung Medical Center, #81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea Tel: 82-2-3410-3569, Fax: 82-2-3410-0029 E-mail: ckee@skku.edu * This study was presented as a narration at the 109th Annual Meeting of the Korean Ophthalmology Society 2013. 하였다. 5 이와더불어상방의시야결손보다하방의시야결손이녹내장환자의시기능에더큰영향을미친다고하였는데, 6 이전연구에서특히상대적으로좋은눈의중심시야 5도이내하방시야결손은환자의시력과역할제한, 사회적기능을포함한일상속시기능장애와가장밀접하게연관되어있다고기술하였다. 3 앞선대부분의연구에서는녹내장환자의시야를평가하는데있어일반적으로 Humphrey 시야검사 (Humphrey field analyzer, HFA) 를사용하였다. Humphrey 시야검사는단안의시야결손을정확한수치로나타내어질병의진단과진행을평가하는데도움을주지만, 양안시야의결손을측정하기에는적합하지않다고알려졌다. 7 Kulkarni et al 7 은여러가지 visual field staging system의효용성에대해보고하였고, 이연구에서는좋은눈의 mean deviation 수치와 integrated visual field (IVF) 검사결과가녹내장환자의삶의질과가장연관성이있으며단안시야검사보다양안시야검사가더연관있다고기술하였다. 일상생활에서환자는양안을사용하므로환자가주관적으로느끼는불편함과삶의질을평가하는데에는양안시야검사를이용하는것이더정확할것이다. 그러나현재우리나라에서는이러한양안시야검사에대한연구가많이 www.ophthalmology.org 1567
- 대한안과학회지 2013 년제 54 권제 10 호 - 이루어져있지않다. 본연구에서는양안시야검사방법중하나인양안 Esterman 시야검사를통하여녹내장환자의시야결손의위치및정도와환자가직접적으로느끼는삶의질과의관련성을알아보고자하였다. 대상과방법 개방각녹내장을진단받은환자중 2012년 11월부터 2013년 3월까지본원에내원한환자중양안모두시야결손이있으면서적어도한눈은중기이상의녹내장성시야결손 (mean deviation, MD < -6 db) 을보이는환자를대상으로 Humphrey 시야계 (HFA) 를이용한단안시야검사및양안 Esterman 시야검사를이용한양안시의시야검사를하였고, 한국판시기능설문지 (25-item National Eye Institute Visual function Questionnaire, VFQ, Korean version) 를시행하였다. 8 검사당시 Goldman 압평안압계로측정한안압, 양안교정시력및굴절률을함께측정하였다. 녹내장환자의진단기준은시신경유두의국소결손및증가된시신경유두함몰등기존의알려진전형적인녹내장형시신경유두모양을가지고, 두번의연속적인시야검사에서 1) Pattern deviation plot에서활모양영역에있는 3개이상의점의역치가정상의 5% 미만에서나타나고그중한점이 1% 미만일때이거나, 2) Glaucoma Hemifield test (GHT) 에서 outside normal limits 가나타날때, 또는 3) Pattern standard deviation (PSD) 에서정상의 5% 이하로편위된경우로정의하였다. 9 20/200 미만의시력을가진환자는제외하였고, 녹내장이외의시력이나시야에영향을끼칠수있는안과질환 ( 예. 당뇨망막병증및시신경과망막의기타안질환 ) 및신경과질환 ( 예. 두개강내병변, 뇌하수체질환, 탈수초성질환 ) 을이미진단받은경우는제외하였다. 또한시야검사결과에영향을줄수있는각막의병변이나중등도이상의백내장을가진환자는제외하였다. 양안 Esterman 시야검사는 10 db의강도를가지는 120개의주시점으로이루어져있으며, 이주시점은중심부및하방시야에더중점을두고배치되어있다 (Fig. 1A). 10 본연구에서는전체주시점의개수에대해환자가실제로본주시점개수의퍼센트를산출하여 efficiency score로명명하였다. 양안 Esterman 시야검사는 1) 상측중심시야 10도이내, 2) 상측중심시야 30도이내, 3) 상측중심시야 30도외주변부, 4) 하측중심시야 10도이내, 5) 하측중심시야 30도이내, 6) 하측중심시야 30도외주변부시야결손으로분류하여총 6부분각각의점수와시기능설문지의세부항목과연관성을비교하였다 (spearman correlation) (Fig. 1B). 한국판시기능설문지는전체점수와건강상태, 전반적인시력, 통증, 근거리시력, 원거리시력, 사회적기능제한, 정신건강, 역할제한, 의존성, 운전, 색각, 주변부사물인지의세부 12가지항목으로분류되어있다. 8 또한시야결 A B Figure 1. (A) Binocular Esterman visual field. Sixty patients who had bilateral visual field defect underwent binocular Esterman visual field test. The Esterman VF which uses fixed stimulus intensity of 10dB is a grid of 120 test points to examine more than 130 of visual field. It gives more weight to central and inferior parts of visual field. (B) This figure shows the 6 clusters we divided the binocular visual field into - upper and lower central 10, upper and lower central 30, upper and lower periphery. 1568 www.ophthalmology.org
- 이주연외 : Esterman 시야와녹내장환자의삶의질 - 손의정도를기준으로좋은눈과나쁜눈으로나눈후 HFA 의 mean deviation (MD) 수치를각각조사하여양안 Esterman 시야검사의각부분및시기능설문지와의연관성을함께분석하였다. 통계는 SPSS 12.0 (SPSS Inc., Chicago, IL) 프로그램을사용하였으며, spearman correlation을사용하여시야검사와설문지각항목간의연관성을분석하였다. p<0.05 인경우통계적으로유의하다고판단하였다. HFA검사에서거짓양성반응 (false positive response) 이나거짓음성반응 (false negative response) 이 33% 를넘거나주시실패 (fixation loss) 가 20% 이상이거나환자의검사협조도가심하게저하된경우에는검사의신뢰도가낮다고판단하여해당된모든시야검사를분석에서제외하였다. 결 본연구의대상이된환자는총 60명으로남자가 36명, 여자가 24명, 검사시점의평균나이는 57.7 ± 16.1세 ( 범위 : 18-75 세 ) 였다. 연구에포함된총 60명의환자중 28명 과 Table 1. Demographics of the study subjects Variable Number of subject n = 60 Age (years) 57.7 ± 16.1 (range: 18-75) Male/Female ratio 1.5 Family history of glaucoma (%) 5 (8) Taking glaucoma medications (%) 60 (100) Previous intraocular surgery (%) 20 (33.3) Glaucoma surgery (%) 10 (16.7) Cataract surgery (%) 17 (28.3) Vitrectomy (%) 2 (3.3) Primary open angle glaucoma (%) 28 (46.6) Normal tension glaucoma (%) 24 (4) Juvenile open angle glaucoma (%) 6 (10) Steroid induced glaucoma (%) 2 (3.4) Intraocular pressure (mm Hg) Better eye 16.4 ± 3.97 Worse eye 15.6 ± 2.66 Mean deviation (db) Better eye -13.1 ± 7.77 Worse eye -21.08 ± 5.78 Pattern standard deviation (db) Better eye 13.45 ± 2.79 Worse eye 10.11 ± 4.08 Spherical equivalent (diopter) Better eye -2.57 ± 3.17 Worse eye -2.06 ± 2.64 Best corrected visual acuity (log MAR) Better eye 0.12 ± 0.29 Worse eye 0.19 ± 0.36 Values are presented as mean ± SD. 은일차성개방각녹내장, 24명은정상안압녹내장, 6명은유소년개방각녹내장, 2명은스테로이드에의한이차성녹내장을진단받았다. 좋은눈의평균안압은 16.4 ± 3.97 mmhg였으며, 나쁜눈의평균안압은 15.6 ± 2.66 mmhg 로두군간의유의한차이는보이지않았다. 또한좋은눈의교정시력은 0.12 ± 0.29 logmar 로, 나쁜눈의교정시력은 0.19 ± 0.36 logmar 로측정되었다. 좋은눈의평균기저 MD 값은 -12.71 ± 7.61 db였으며 ( 범위 : -32.66< X<-1.06 db), 나쁜눈의평균기저 MD 값은 -20.85 ± 6.31 db ( 범위 : -34.35<X<-8.91 db) 였다. 대상환자군모두안압강하점안약을사용하고있었으며 20명 (33.3%) 에서적어도한눈은안내수술 ( 백내장수술, 섬유주절제술, 유리체절제술 ) 과거력이있었다 (Table 1). 양안 Esterman 시야검사의시행완료시간의평균은 4.78 ± 0.49분이었고총점수의평균은 97.51 ± 25.99점이었으며, 총 efficiency score의평균은 81.25 ± 21.66점이었다. 위치별로분류한여섯부분의점수평균은아래 Fig. 2에명시되어있다. 시기능설문지의총점수평균은 71.15 ± 16.28점 ( 범위 : 34.13<X<92.50) 이었으며세부항목의평균점수중색각항목의평균이 86.4점으로가장높았으며, 건강상태항목의평균이 38.16점으로가장낮았다 (Fig. 3). 양안 Esterman 시야검사의총점수와시기능설문지의총점수는유의하게강한연관성을보였으며 (p=0.005, spearman correlation 0.4), 양안 Esterman 시야검사의각부분중에서상측 30도외부분과하측 30도외주변부, 하측중심 10도이내부분에서시기능설문지의총점수와유의한상관성을보였다. 또한하측 30도외주변부는시기능설문지의전체 12개세부항목중가장많은 8개 (66.67%) 항목 ( 전반적인시력, 근거리시력, 원거리시력, 사회적기능제한, 역할제한, 의존성, 색각, 주변부시력 ) 에서유의한연관성을보였 Figure 2. The average efficient score of each cluster in binocular Esterman visual field Esterman efficient score (%) = (number of point which patients can see) / (total number of point in each cluster) 100. www.ophthalmology.org 1569
- 대한안과학회지 2013 년제 54 권제 10 호 - Peripheral vision Color vision Driving Dependency Role difficulties Mental health Social function Far activities Near activities Ocular pain General vision General health Composition score Figure 3. The average score of each subscale in Visual Function Questionnaire (VFQ). We assessed patients visionspecific quality of life by using the Korean version of the 25-item National Eye institute Visual Function Questionnaire (NEI VFQ-25). The VFQ is compsed of 12 subscales and a composite score. The figure showes the average score of each subscale and composition score. Table 2. The results of correlation coefficients between all clusters of binocular Esterman visual field test and the NEI VFQ-25 (25-item National Eye institute Visual Function Questionnaire) Correlation coefficients (n = 60) Esterman total score Upper 10 Upper 30 Upper periphery Lower 10 Lower 30 Lower periphery Composition score 0.40 * 0.08 0.23 0.44 * 0.28 * 0.22 0.40 * General health 0.40 * 0.23 0.13 0.05 0.05 0.12 0.01 General vision 0.43 0.05 0.11 0.30 * 0.42 * 0.33 * 0.35 * Ocular Pain 0.01 0.02 0.60 0.09 0.08 0.03 0.04 Near activities 0.35 * 0.19 0.29 * 0.34 * 0.27 0.19 0.33 * Distance activities 0.37 * 0.11 0.24 0.40 * 0.28 * 0.21 0.38 * Social function 0.29 * 0.10 0.18 0.32 0.32 * 0.25 0.29 * Mental health 0.23 0.11 0.18 0.31 0.28 * 0.13 0.23 Role difficulties 0.27 0.02 0.14 0.42 * 0.12 0.11 0.34 * Dependency 0.28 * 0.13 0.25 0.41 * 0.18 0.16 0.34 * Driving 0.19 0.21 0.28 0.34 * 0.15 0.07 0.12 Color vision 0.29 * 0.13 0.28 0.40 * 0.20 0.23 0.36 * Peripheral vision 0.32 * 0.05 0.21 0.34 * 0.20 0.23 0.34 * * p < 0.05 by Spearman correlation. Table 3. The results of correlation coefficients between mean deviation of Humphrey Visual Field Analyzer and the NEI VFQ-25 (25-item National Eye institute Visual Function Questionnaire) Correlation coefficients (n = 60) MD (db) in the better eye MD (db) in the worse eye Composition score 0.22 0.32 * General health 0.02 0.05 General vision 0.14 0.27 * Ocular Pain 0.06 0.26 Near activities 0.17 0.33 * Distance activities 0.32 0.44 * Social function 0.25 0.40 * Mental health 0.23 0.14 Role difficulties 0.07 0.23 Dependency 0.22 0.13 Driving 0.09 0.17 Color vision 0.18 0.40 * Peripheral vision 0.14 0.32 * MD = mean deviation. * p < 0.05 by Spearman correlation. 다 (Table 3). 하측중심 10도이내부분은시기능설문지의전반적인시력항목및원거리시력항목과강한유의성을보였고, 상측 30도외주변부는시기능설문지의운전항목과강한유의성을보였다 (Table 2). 좋은눈의 MD 값은시기능설문지의총점수와유의한연관성을보이지않았으나 (p>0.05, spearman correlation), 나쁜눈의 MD 값은시기능설문지의총점수와유의한연관성을보였고 (p=0.008), 12개세부항목중총 6개 (50%) 항목 ( 전반적인시력, 근거리시력, 원거리시력, 사회적기능제한, 색각, 주변부시력 ) 에서유의성을나타내었다 (Table 3). 고찰 본연구는양안 Esterman 시야검사의결과가환자가주관적으로느끼는삶의질을얼마나잘반영하고있는지알아보고자하였고, 특히시야결손을세부적으로 6개로분류 1570 www.ophthalmology.org
- 이주연외 : Esterman 시야와녹내장환자의삶의질 - 하여어떤시야결손의위치가환자가느끼는시기능이상과가장연관성이높은지알아보고자하였다. 본연구결과는주변부시야결손과하측중심부시야결손이환자의시기능에미치는영향이크다는것을보여주었다. 본연구결과에따르면전체적으로중심부시야결손보다주변부시야결손이환자가주관적으로느끼는삶의질과높은연관성을보였고, 중심부시야결손중에서상측시야결손보다하측시야결손이전반적으로높은연관성을보였다. 중심부시야결손은주로환자가느끼는전반적인시력에영향을준반면, 주변부시야결손은시력외에도운전및사회적기능저하, 의존도증가등일상활동과심리적인부분까지유의한상관관계를보였다. 이는비록주변부시야가중심부에비해민감도가떨어지고검사중주시의어려움으로인해정확한측정이어려우나주변부시야또한기능적으로일상생활에중요하다는것을시사한다. 시야검사와시기능설문지와의연관성을분석한몇몇연구들이있었는데 Sawada et al 3 에따르면, 좋은눈의하측중심외시야결손과아래주변부시야결손이환자가느끼는시기능의장애와높은연관성을가진다고보고하였다. 상기논문에서는 30-2 단안 Humphrey 시야검사를총 10 구획으로나눈후양안의시야결손을각각검사하여환자의시기능설문지와비교하였는데, 하측중심외시야결손이원거리와근거리시기능에큰영향을미치며, 특히주변부시야결손과상측시야결손이운전기능에중요하다고하였다. 3 덧붙여또다른연구에서는주변에서접근하는자동차를인지하거나운전시자동차사고를방지하기위해서주변시야가중요하다고언급하였다. 5 좋은눈의기능이나쁜눈보다환자의시기능과더관련성이높다는이전연구와달리, 5,7 본연구결과에따르면좋은눈의 MD 값은환자의삶의질과직접적인상관관계가없었고, 나쁜눈의 MD 값은시기능설문지의총점수및환자가느끼는전반적인시력과원거리, 근거리작업과유의한상관관계를보였다. 이는상대적으로이전연구에서조명되지않았던나쁜눈의기능도일상생활속시기능에실제로영향을미친다는것을보여준다. 이전에시행되었던연구중에서나쁜눈의시야결손은장애물이있는곳을속도내어걷기어렵게하고, 11 자동차사고를일으키는위험성을증가시킨다는일부연구결과는이러한본연구를뒷받침한다. 12 그러나일부연구에서양안 Esterman 시야검사가녹내장환자의시야결손을평가하는데있어민감도가떨어진다는결과가발표된바있다. 양안 Esterman 시야검사의유용성을평가하기위해진행된한연구에서는 Esterman 검사의민감도가떨어져환자의시야결손을정확하게파악하지못한다고언급하였다. 13 Nelson-Quigg et al 14 은 Humphrey 시야검사를각각시행한후하나로통합하여합친결과 (integrated visual field) 가양안 Esterman 시야검사보다녹내장환자의시기능결손과높은연관성을보인다고보고하였다. 그러나 Humphrey 시야검사는중심시야 30도이내의시야결손만반영하며, 양안시야를보기위하여단안검사를각각시행한후다시두개의시야검사결과를조합해야하는불편감이있다. 반면양안 Esterman 시야검사는 130도이상의넓은시야를한번의검사로간편하게평가할수있다는점에서 Humphrey 시야검사보다장점을가진다. 또한양안 Esterman 시야검사는이론적으로녹내장의진행정도를정밀하게평가하기어렵지만, 기존의다른시야검사에비해서넓은시야를반영하기때문에주변부시야를포함하여실제일상생활속의시야를평가하는데더유용하다. 실제로운전면허시험시, 시야결손이있는진행된녹내장환자의운전능력을평가하기위해시행한시야검사결과를비교해보았을때, 양안 Esterman 시야검사가대상자의운전능력과연관된중심시야의시기능을평가하는데단안 Humphrey 시야검사보다유용하다고보고되어있다. 15 이논문의제한점으로는대상환자군의수가충분하지않았다는점과환자의시기능을판별하는데있어주관적인설문지에의존했기때문에시기능의이상을객관적으로평가하지않았다는점이다. 또한양안 Esterman 시야검사시환자가주시점을제대로보고있는지평가할수있는장치가없어결과에어떤영향을미쳤는지도평가하기가어렵다. 그러나결론적으로본연구에서는양안 Esterman 시야검사가 Humphrey 시야검사보다더넓은시야를간편하게검사할수있으며, 환자가주관적으로느끼는시기능을반영할수있음을알수있었다. 추후양안 Esterman 시야검사의효용성과관련하여다각도로추가적인대규모의연구가필요할것으로생각한다. REFERENCES 1) Gutierrez P, Wilson MR, Johnson C, et al. Influence of glaucomatous visual field loss on health-related quality of life. Arch Ophthalmol 1997;115:777-84. 2) Luini LP, Mastroberardino S, Marucci FS. Investigating spatial behaviour: an application of space analysis to criminal investigations. Cogn Process 2009;10 Suppl 2:S247-9. 3) Sawada H, Yoshino T, Fukuchi T, Abe H. Assessment of the vision-specific quality of life using clustered visual field in glaucoma patients. J Glaucoma 2012 Jul 23. [Epub ahead of print] 4) Kolker AE. Visual prognosis in advanced glaucoma: a comparison of medical and surgical therapy for retention of vision in 101 eyes with advanced glaucoma. Trans Am Ophthalmol Soc 1977;75: 539-55. www.ophthalmology.org 1571
- 대한안과학회지 2013 년제 54 권제 10 호 - 5) Fujita K, Yasuda N, Oda K, Yuzawa M. [Reading performance in patients with central visual field disturbance due to glaucoma]. Nihon Ganka Gakkai Zasshi 2006;110:914-8. 6) Jampel HD, Friedman DS, Quigley H, Miller R. Correlation of the binocular visual field with patient assessment of vision. Invest Ophthalmol Vis Sci 2002;43:1059-67. 7) Kulkarni KM, Mayer JR, Lorenzana LL, et al. Visual field staging systems in glaucoma and the activities of daily living. Am J Ophthalmol 2012;154:445-51.e3. 8) Ryan B, Court H, Margrain TH. Measuring low vision service outcomes: Rasch analysis of the seven-item national eye institute visual function questionnaire. Optom Vis Sci 2008;85:112-21. 9) Anderson MD. Douglas R. Basis of quantitative perimetry. In: Kimberly kist eds. Automated static perimetry, 2nd ed. St. Louis: Mosby, 1997; chap. 2. 10) Esterman B. Functional scoring of the binocular field. Ophthalmology 1982;89:1226-34. 11) Turano KA, Rubin GS, Quigley HA. Mobility performance in glaucoma. Invest Ophthalmol Vis Sci 1999;40:2803-9. 12) Owsley C, Stalvey BT, Wells J, et al. Visual risk factors for crash involvement in older drivers with cataract. Arch Ophthalmol 2001;119:881-7. 13) Mills RP, Drance SM. Esterman disability rating in severe glaucoma. Ophthalmology 1986;93:371-8. 14) Nelson-Quigg JM, Cello K, Johnson CA. Predicting binocular visual field sensitivity from monocular visual field results. Invest Ophthalmol Vis Sci 2000;41:2212-21. 15) Ayala M. Comparison of the monocular Humphrey Visual Field and the binocular Humphrey Esterman Visual Field test for driver licensing in glaucoma subjects in Sweden. BMC Ophthalmol 2012;12:35. =ABSTRACT= Assessment of the Vision-Specific Quality of Life Using Binocular Esterman Visual Field in Glaucoma Patients Ju Yeon Lee, MD, Hyun Kyung Cho, MD, Changwon Kee, MD, PhD Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Purpose: To investigate the correlation of binocular visual field (VF) with vision-specific quality of life in glaucoma patients. Methods: Sixty patients who were diagnosed as open-angle glaucoma were recruited for the present study. The patients had at least moderate VF defect in 1 eye. VF testing was performed using the unilateral Humphrey Field Analyzer (HFA) and binocular Esterman VF test which was divided into 6 clusters: upper and lower center 10, upper and lower center 30, and upper and lower periphery. The 25-item National Eye Institute Visual Function Questionnaire (VFQ) was used to evaluate patients vision-specific quality of life. We analyzed the correlation between the efficiency score of each cluster from binocular Esterman VF test, mean deviation of HFA, and the scores of VFQ (Spearman correlation). Results: The correlation between the composition score of VFQ and total score of binocular Esterman visual field test was significant. The highest correlation was observed in the lower periphery cluster (all p < 0.05). For general vision, the lower center 10 visual field was strongly correlated (p = 0.011), and for driving, the upper peripheral visual field was the strongest correlated (p = 0.038). The level of mean deviation in the worse eye showed significant correlation with composition score of questionnaire (p = 0.008), otherwise the level of mean deviation in the better eye did not show any significant correlation (p > 0.05). Conclusions: Binocular Esterman VF test is an easy and effective way to evaluate the vision-specific quality of life in glaucoma patients. J Korean Ophthalmol Soc 2013;54(10):1567-1572 Key Words: Binocular visual field, Esterman visual field test, Quality of life, Visual function Address reprint requests to Changwon Kee, MD, PhD Department of Ophthalmology, Samsung Medical Center #81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea Tel: 82-2-3410-3569, Fax: 82-2-3410-0029, E-mail: ckee@skku.edu 1572 www.ophthalmology.org