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.