Importance: It is reasonable to hypothesize that for 2 patients with similar degrees of integrated binocular visual field (BVF) loss, the patient with a history of faster disease progression will report worse vision-related quality of life (VRQOL) than the patient with slowly progressing damage. However, to our knowledge, this hypothesis has not been investigated in the literature. Objective: To evaluate the association between binocular rates of visual field change and VRQOL in patients with glaucoma. Design: Observational cohort study. Setting: Patients were recruited from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Participants: The study included 796 eyes of 398 patients with diagnosed or suspected glaucoma followed up from October 1, 1998, until January 31, 2012, for a mean (SD) of 7.3(2.0) years. Main Outcome Measures: The VRQOL was evaluated using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) at the last follow-up visit. The NEI VFQ-25 was completed for all patients during the period extending from December 1, 2009, through January 31, 2012. Integrated BVFs were calculated from the monocular fields of each patient. Linear regression of mean deviation values was used to evaluate rates of BVF change during the follow-up period. Logistic regression models were used to investigate the association between abnormal VRQOL and rates of BVF change, while adjusting for potentially confounding socioeconomic and demographic variables. Results: Thirty-two patients (8.0%) had abnormal VRQOL as determined by the results of the NEI VFQ- 25. Patients with abnormalVRQOLhad significantly faster rates of BVF change than those with normal VRQOL (>0.18 vs <0.06 dB/y; P<.001). Rates of BVF change were significantly associated with abnormality in VRQOL (odds ratio=1.31 per 0.1 dB/y faster; P=.04), after adjustment for confounding variables. Conclusions and Relevance: Patients with faster rates of BVF change were at higher risk of reporting abnormal VRQOL. Assessment of rates of BVF change may provide useful information in determining risk of functional impairment in glaucoma. Copyright © 2013 American Medical Association. All rights reserved.