Full Text Available Introduction. The term glaucoma is used to cover a wide range of diseases, whose main feature is optic neuropathy. According to the level of intraocular pressure (IOP, the open angle glaucoma is arbitrarily divided into high tension glaucoma (HTG and normal tension glaucoma (NTG. Objective. The aim of this study was to investigate the differences of optic disc cup appearance between patients with NTG and HTG. Methods. Prospective study included 30 patients (60 eyes with NTG and 30 patients (60 eyes with HTG. IOP was measured by Goldmann applanation tonometry. Examination of optic disc head was performed by indirect ophthalmoscopy with Volk 90 D superfield lens through a dilated pupil to observe qualitative and quantitative parameters. Visual fields were examined in all patients with the Octopus program G1, full threshold strategy (Octopus 500 EZ, Interzeag, Switzerland. Results. Vertical form of optic disc cup was present in 11 eyes with NTG (18.3% and three eyes with HTG (5% (p<0.05. A disc with localized tissue loss (polar notching on the inferior pole was observed in eight eyes with NTG (13.3% and in one eye with HTG (1.7% (p<0.01. Uniformly enlarged, round cup was more frequent in patients with HTG than NTG: 93.3% and 68.3% respectively (p<0.05. Conclusion. The perceived differences indicate a complex multifactorial nature of glaucoma disease and a possible existence of two pathophysiological ways of optic disc changes within the same basic disease.
Stojčić, Milan; Hentova-Senćanić, Paraskeva; Stojčić, Biljana; Senćanić, Ivan
According to the level of intraocular pressure (IOP), open angle glaucoma is divided into high tension glaucoma (HTG) and normal tension glaucoma (NTG). To determine if there are differences in the distribution of patients by age and sex between NTG and HTG. Our prospective study included 30 patients with NTG and 30 with HTG. A complete eye examination was performed. The examination included measuring of intraocular pressure by Goldmann applanation tonometry, examination of optic disc head by indirect ophthalmoscopy with Volk 90 D lens and visual field examination using the Octopus program. The average damage of visual field in the group of patients with NTG was 8.14 +/- 4.43 dB, while in the group with HTG it was 7.40 +/- 2.84 dB (p > 0.05). The average age of the group of patients with NTG was 66 +/- 11.58 years, while among those with HTG the average age was 59.7 +/- 11.63 years (p HTG there were more men than women, but without statistically significant difference between the tested groups (chi2 = 1.851; p > 0.05). Open angle glaucoma is a disease of elderly population. According to our results, risk factors for this disease can be age and sex. NTG is more frequently present than HTG among elderly population and females.
Hlupheka L. Sithole
Full Text Available Normal tension glaucoma (NTG is a disease associated with normal intraocular pressure (10 mmHg – 21 mmHg that may lead to irreversible blindness if misdiagnosed or left untreated over a period of time. The author observed a patient with NTG over a period of 5 years (from 2013 to 2017. The initial visual field analysis results (2014 showed mild visual field defects because of NTG at the start of the 5-year period. Although the patient was also diagnosed with hydrocephalus, a condition associated with optic nerve head damage, following years of noncompliance to treatment of NTG and follow-up eye examination schedules, the patient’s visual field defects were found to have progressed by the year 2017. It is therefore important for optometrists to apply due diligence when examining patients with NTG in order to expedite intervention and prevention of visual impairment and blindness.
Pajic, Bojan; Pajic-Eggspuchler, Brigitte; Haefliger, Ivan
Intraocular pressure (IOP) remains the only treatable risk factor of progressive glaucoma. Recently a device became available to continuously record IOP fluctuation in contrast to classical, discreet IOP measurements. To perform 24-h IOP fluctuation monitoring using a CE-marked silicone lens-embedded strain gauge sensor (SENSIMED Triggerfish) in five normal tension glaucoma patients in the presence and absence of anti-glaucomatous treatment and to show the clinical importance of this diagnostic tool. 24-h continuous IOP fluctuation monitoring was performed on two occasions separated by at least 6 weeks in each patient. In the control session patients were untreated or previous IOP-lowering medication was washed-out for at least 6 weeks. In the treatment session patients received IOP-lowering medication for at least 6 weeks. The continuous recordings were analyzed for differences between daytime and nighttime data and for repeatability over time. Furthermore, profiles recorded in each patient in treated and non-treated conditions were compared. Highly individual and repeatable profiles were obtained. Data recorded during daytime portions of the recordings showed higher coefficients of variation than nighttime data. Positive and significant linear slopes for the transition period from wake time to sleep time were detected in all patients in the absence of anti-glaucomatous treatment, while in three patients of five no significant slopes were detected under treated conditions. Our data suggest that the continuous IOP fluctuation monitoring device is sensitive to individual IOP rhythms and to differences in such rhythms due to anti-glaucomatous drug therapy.
Park, Myoung Hee; Moon, Jungil
Purpose Oxidative stress plays a critical role in the pathogenesis of glaucoma. Glutathione is a major antioxidant molecule present in intracellular or extracellular space. Herein, we aimed to examine circulating glutathione level in normal tension glaucoma (NTG), which comprises the largest proportion of glaucoma disease in the Korean population. Methods Nineteen NTG patients (NTG group) and 30 age- and gender-matched normal control subjects (control group) were included. Antecubital venous ...
Adlina, Abdul Rahim; Shatriah, Ismail; Liza Sharmini, Ahmad Tajudin; Ahmad, Mt Saad
There are limited data in the literature on the optic disc topography in normal tension glaucoma (NTG) patients in Asian countries, especially in Southeast Asia. This study is aimed at comparing optic disc topography in NTG patients and a control group in Malaysia, and we discuss the literature on NTG studies in other Asian populations. A comparative cross-sectional study was conducted in two hospitals with glaucoma services in Malaysia from November 2010 to February 2012. A total of 109 eyes of 109 Malay patients were included in this study: 32 NTG patients and 77 subjects in the control group. All participants underwent a thorough ocular examination, including visual acuity, subjective refraction, anterior segment and fundus examinations, Humphrey visual field 24-2, intraocular pressure measurement, gonioscopy examination and fundus photography. Optic disc topography was assessed using the Heidelberg Retinal Tomograph III by an identified masked investigator in each hospital. NTG patients had a notably larger disc area (2.65 (0.41) vs 2.19 (0.43) mm(2), respectively), larger cupping (1.54 (0.43) vs 0.63 (0.40) mm(2), respectively), smaller retinal rim areas (1.12 (0.41) vs 1.56 (0.33) mm(2), respectively), higher cup volume (0.47 (0.28) vs 0.11 (0.19) mm(3), respectively), reduced rim volume (0.23 (0.13) vs 0.41 (0.16) mm(3), respectively), higher cup to disc area ratio (0.58 (0.14) vs 0.27 (0.15), respectively), higher linear cup to disc ratio (0.76 (0.09) vs 0.49 (0.17) mm(2), respectively), higher mean cup depth (0.37 (0.09) vs 0.22 (0.09) mm, respectively), higher maximum cup depth (0.77 (0.16) vs 0.59 (0.20) mm, respectively), higher mean of cup shape measure (-0.04 (0.06) vs -0.16 (0.07), respectively), and thinner mean retinal nerve fibre layer thickness (0.15 (0.15) vs 0.24 (0.07) mm, respectively) compared to the control group (pMalaysia. Our findings are comparable to those reported in NTG studies in other Asian countries.
Bach-Holm, Daniella; Kessing, Svend Vedel; Mogensen, Ulla
PURPOSE: To investigate whether normal tension glaucoma (NTG) is associated with increased risk of developing dementia/Alzheimer disease (AD). METHODS: A total of 69 patients with NTG were identified in the case note files in the Glaucoma Clinic, University Hospital of Copenhagen (Rigshospitalet...
Park, Ji-Hye; Yoo, Chungkwon; Park, Jinhwan; Kim, Yong Yeon
To investigate the clinical features of young Korean patients with open-angle glaucoma (OAG), and to compare visual field (VF) defects between patients with normal-tension glaucoma (NTG) and those with high-tension glaucoma (HTG). Patients with OAG younger than 40 years of age were divided into NTG and HTG groups based on untreated intraocular pressure (IOP) level. The patients were matched according to the mean deviation of standard automated perimetry. VFs were divided into 2 pairs of corresponding areas across the horizontal meridian, and the depths of VF defects were compared. Tilt ratio and torsion degree of their optic discs were also compared between the 2 groups. Thirty-four pairs of NTG and HTG eyes were matched. Although untreated IOP showed intergroup differences, there was no difference in age, refractive error, tilt ratio, torsion degree, and depth of VF defects between the 2 groups. However, NTG eyes showed deeper VF defects in the superior paracentral area than in the inferior paracentral area (-8.29±9.33 vs. -4.45±6.03 dB, P=0.038), whereas the HTG eyes showed symmetric VF defects. Moreover, the superior paracentral area showed deeper VF defects compared with the superior arcuate area in the NTG group (P=0.002). Young patients with NTG showed asymmetric VF defects in the paracentral area, whereas those with HTG did not show such asymmetric defects. This suggests that the level of IOP may affect the pattern of VF defects in young patients with OAG. However, these findings may not be generalizable to other populations.
Inoue, Kenji; Iwasa, Mayumi; Wakakura, Masato; Tomita, Goji
The purpose of this study was to evaluate the effects of benzalkonium (BAK)-free travoprost monotherapy administered for 3 years on intraocular pressure and visual field performance. The intraocular pressure of 76 patients with normal tension glaucoma was monitored every 1-3 months. A Humphrey visual field test was performed every 6 months after treatment and compared with the results before treatment. Visual field performance was also evaluated by trend and event analysis. Thirty cases discontinued within 3 years. Mean intraocular pressure after 3 years of travoprost treatment (14.1 ± 2.4 mmHg) was significantly lower than that before treatment (16.8 ± 2.6 mmHg, P trend analysis and five patients (13.9%) by event analysis. Treatment was discontinued in six cases (7.9%) due to the appearance of adverse reactions. BAK-free travoprost monotherapy was effective in reducing intraocular pressure for at least 3 years; however, visual field performance worsened in 2.8%-13.9% of patients with normal tension glaucoma.
Li, Bai-Bing; Cai, Yu; Pan, Ying-Zi; Li, Mei; Qiao, Rong-Hua; Fang, Yuan; Tian, Tian
High intraocular pressure (IOP) and low central corneal thickness (CCT) are important validated risk factors for glaucoma, and some studies also have suggested that eyes with more deformable corneas may be in higher risk of the development and worsening of glaucoma. In the present study, we aimed to evaluate the association between corneal biomechanical parameters and asymmetric visual field (VF) damage using a Corvis-ST device in patients with untreated normal tension glaucoma (NTG). In this observational, cross-sectional study, 44 newly diagnosed NTG patients were enrolled. Of these, 31 had asymmetric VF damage, which was defined as a 5-point difference between the eyes according to the Advanced Glaucoma Intervention Study scoring system. Corneal biomechanical parameters were obtained using a Corvis-ST device, such as time from start until the first and second applanation is reached (time A1 and time A2, respectively), cord length of the first and second applanation (length A1 and length A2, respectively), corneal speed during the first and second applanation (velocity A1 and velocity A2, respectively), time from start until highest concavity is reached (time HC), maximum amplitude at the apex of highest concavity (def ampl HC), distance between the two peaks at highest concavity (peak dist HC), and central concave curvature at its highest concavity (radius HC). Time A1 (7.19 ± 0.28 vs. 7.37 ± 0.41 ms, P = 0.010), length A1 (1.73 [1.70-1.76] vs. 1.78 [1.76-1.79] mm, P = 0.007), length A2 (1.58 [1.46-1.70] vs. 1.84 [1.76-1.92] mm, Pcorneal response parameters but not IOP or CCT between the paired eyes of NTG patients with asymmetric VF damage. We suggest that the shape of the cornea is more easily altered in the worse eyes of asymmetric NTG patients.
Mohammed K El Mallah
Full Text Available Mohammed K El Mallah1, Molly M Walsh2, Sandra S Stinnett2, Sanjay G Asrani21Ocala Eye, Ocala, Florida, USA; 2Duke University Eye Center, Durham, North Carolina, USAPurpose: To evaluate the effect of selective laser trabeculoplasty (SLT in normal tension glaucoma (NTG patients.Patients and methods: A retrospective review was performed of NTG patients who had undergone SLT at the Duke University Eye Center between 12/2002 and 7/2005. For each eye of each patient at pre-laser and post-laser time points, the IOP measurements were summarized by mean, standard deviation, and range. Then for each of these descriptive statistics, the differences between pre-laser and post-laser values were obtained. Statistical analysis was performed using a random effects model. Main outcome measures: difference in mean IOP, standard deviation of IOP, and range of IOP.Results: Thirty-one eyes of 18 patients were included for analysis. The average of the mean pre-operative IOP measurements was 14.3 ± 2.6 mmHg compared to 12.2 ± 1.7 mmHg (P < 0.001 post-operatively. The mean pre-operative standard deviation was 1.9 ± 0.9 mmHg compared to 1.0 ± 0.6 mmHg (P = 0.002 post-operatively while the mean IOP range prior to treatment was 4.5 ± 2.5 mmHg compared to 2.5 ± 1.9 mmHg (P = 0.017 after treatment.Conclusion: In this pilot study, SLT was found to lower mean IOP and intervisit IOP variation in NTG patients. Given the importance of IOP variation and its association with glaucoma progression, measurement of IOP variation following treatment with SLT may be considered.Keywords: SLT, NTG, laser, glaucoma
Shin, Jonghoon; Lee, Ji-Woong; Kim, Eun-Ah; Caprioli, Joseph
To evaluate the effects of corneal biomechanical properties on intraocular pressure (IOP) measured with the ICare, and to compare IOP readings obtained with ICare, Ocular Response Analyzer (ORA), and Goldmann applanation tonometry (GAT) in normal-tension glaucoma (NTG) and normal subjects. Prospective, cross-sectional, comparative study. IOP was measured with ICare, ORA, and GAT. All subjects had corneal hysteresis (CH) and corneal resistance factor (CRF), which were measured with ORA; and central corneal thickness (CCT), axial length, spherical equivalent, and keratometry. This study enrolled 97 eyes of 97 NTG patients and 89 eyes of 89 normal subjects. CCT, CH, and CRF in NTG patients were significantly lower than those in normal subjects (P = .033, P = .006, and P = .003). The difference in IOP between techniques was highly significant in NTG patients (P biomechanical characteristics in NTG can cause ICare to underestimate IOP. Copyright © 2015 Elsevier Inc. All rights reserved.
Full Text Available Kenji Inoue,1 Ayumi Tanaka,1 Goji Tomita2 1Inouye Eye Hospital, 22nd Department of Ophthalmology, Toho University School of Medicine, Tokyo, Japan Purpose: To evaluate the effects of tafluprost treatment for 3 years on intraocular pressure (IOP and visual field performance. Methods: The IOP of 55 patients with normal-tension glaucoma was monitored every 1–3 months for 3 years. The Humphrey visual field test was performed every 6 months after treatment and results compared with before-treatment results. Visual field performance was also evaluated by trend and event analysis. Results: After 3 years’ tafluprost single-use vials treatment, the IOP (12.8 ± 2.8 mmHg [mean ± standard deviation] was significantly lower than before treatment (15.7 ± 2.2 mmHg; P < 0.0001. When comparing before-treatment Humphrey visual field test findings with those after 3 years of treatment, no change was found in the mean deviation and pattern standard deviation. Visual field performance had worsened in four patients and three patients according to trend analysis and event analysis, respectively. Adverse reactions appeared in ten cases and one patient (1.8% discontinued treatment due to an adverse reaction. Conclusion: Tafluprost single-use vials treatment was effective in reducing IOP over the 3 years of this study, but visual field performance worsened by 10.3%–13.8% in patients with normal-tension glaucoma. Safety was satisfactory. Keywords: intraocular pressure, visual field, trend analysis, event analysis
Full Text Available Kenji Inoue,1 Mayumi Iwasa,1 Masato Wakakura,1 Goji Tomita21Inouye Eye Hospital, 2Toho University Ohashi Medical Center, Tokyo, JapanBackground: The purpose of this study was to evaluate the effects of benzalkonium (BAK-free travoprost monotherapy administered for 3 years on intraocular pressure and visual field performance.Methods: The intraocular pressure of 76 patients with normal tension glaucoma was monitored every 1–3 months. A Humphrey visual field test was performed every 6 months after treatment and compared with the results before treatment. Visual field performance was also evaluated by trend and event analysis.Results: Thirty cases discontinued within 3 years. Mean intraocular pressure after 3 years of travoprost treatment (14.1 ± 2.4 mmHg was significantly lower than that before treatment (16.8 ± 2.6 mmHg, P ‹ 0.0001. There was no change in the mean deviation and pattern standard deviation as measured by Humphrey visual field test after 3 years of treatment compared with before treatment. Visual field performance was worse in one patient (2.8% by trend analysis and five patients (13.9% by event analysis. Treatment was discontinued in six cases (7.9% due to the appearance of adverse reactions.Conclusion: BAK-free travoprost monotherapy was effective in reducing intraocular pressure for at least 3 years; however, visual field performance worsened in 2.8%–13.9% of patients with normal tension glaucoma.Keywords: BAK-free travoprost, intraocular pressure, visual field, trend analysis, event analysis
Park, Myoung Hee
Purpose Oxidative stress plays a critical role in the pathogenesis of glaucoma. Glutathione is a major antioxidant molecule present in intracellular or extracellular space. Herein, we aimed to examine circulating glutathione level in normal tension glaucoma (NTG), which comprises the largest proportion of glaucoma disease in the Korean population. Methods Nineteen NTG patients (NTG group) and 30 age- and gender-matched normal control subjects (control group) were included. Antecubital venous puncture was performed between 8 and 10 o'clock in the morning to obtain a 4 mL venous blood sample. Total glutathione level was measured by the spectrophotometric method at 412 nm. Correlation of total glutathione level with mean deviation and pattern standard deviation from the Humphrey visual field test was analyzed in the NTG group. Results Total glutathione level in circulating blood was 524.02 ± 231.09 nmol and 586.06 ± 156.08 nmol in the NTG group and the control group, respectively. The difference between these values was not statistically significant (p = 0.121, F = 2.212). Age had no significant effect on circulating total glutathione level in either the NTG group (p = 0.171, r = -0.328) or the control group (p = 0.380, r = -0.166). In the NTG group, circulating total glutathione level had no significant relationship with mean deviation (p = 0.226, F = 1.636) and pattern standard deviation (p = 0.200, F = 1.766) after correcting for age and gender. Conclusions In NTG patients, circulating total glutathione levels were not different compared to those of normal subjects. PMID:22511833
Park, Jong Hyuk; Jun, Roo Min; Choi, Kyu-Ryong
To investigate the clinical significance of corneal biomechanical properties assessed using an ocular response analyser in patients with progressing normal-tension glaucoma (NTG). In this retrospective study, we included 82 eyes of 82 NTG patients who had been receiving topical anti-glaucoma medications. Patients were allocated to two groups based on the mean value of corneal hysteresis (CH) and the status of progression. The assessment of progression was based on the trend analysis using mean deviation slope. Uni- and multivariable logistic analyses were constructed to identify factors associated with increased odds of progression, including CH, central corneal thickness (CCT), and retinal nerve fibre layer (RNFL) thickness. Forty-six eyes (56.1%) reached the progression criteria. Eyes with progression had lower CCT (530.2±38.6 vs 549.4±38.3 μm, p=0.03), thinner average RNFL thickness (70.6±16.1 vs 82.8±17.4 μm, pcorneal resistance factor (9.3±1.3 vs 10.4±1.8 mm Hg, pCorneal biomechanical properties are correlated and associated with the progression of visual field damage in NTG patients. These findings suggest that CH can be used as one of the prognostic factors for progression, independent of corneal thickness or intraocular pressure. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Full Text Available Normal tension glaucoma (NTG is labelled when typical glaucomatous disc changes, visual field defects and open anterior chamber angles are associated with intraocular pressure (IOP constantly below 21 mmHg. Chronic low vascular perfusion, Raynaud's phenomenon, migraine, nocturnal systemic hypotension and over-treated systemic hypertension are the main causes of normal tension glaucoma. Goldmann applanation tonometry, gonioscopy, slit lamp biomicroscopy, optical coherence tomography and visual field analysis are the main tools of investigation for the diagnosis of NTG. Management follows the same principles of treatment for other chronic glaucomas: To reduce IOP by a substantial amount, sufficient to prevent disabling visual loss. Treatment is generally aimed to lower IOP by 30% from pre-existing levels to 12-14 mmHg. Betaxolol, brimonidine, prostaglandin analogues, trabeculectomy (in refractory cases, systemic calcium channel blockers (such as nifedipine and 24-hour monitoring of blood pressure are considered in the management of NTG. The present review summarises risk factors, causes, pathogenesis, diagnosis and management of NTG.
Hong, Ying; Shoji, Nobuyuki; Morita, Tetsuya; Hirasawa, Kazunori; Matsumura, Kazuhiro; Kasahara, Masayuki; Shimizu, Kimiya
To compare the corneal biomechanical properties difference by ocular response analyzer (ORA) in normal tension glaucoma (NTG) patients with different visual field (VF) progression speed. NTG patients with well-controlled Goldmann applanation tonometer (GAT) who routinely consulted Kitasato University Hospital Glaucoma Department between January 2010 and February 2014 were enrolled. GAT and ORA parameters including corneal compensated intraocular pressure (IOPcc), Goldmann estimated intraocular pressure (IOPg), corneal hysteresis (CH), corneal resistance factor (CRF) were recorded. VF was tested by Swedish interactive threshold algorithm (SITA)-standard 30-2 fields. All patients underwent VF measurement regularly and GAT did not exceed 15 mm Hg at any time during the 3y follow up. Patients were divided into four groups according to VF change over 3y, and ORA findings were compared between the upper 25(th) percentile group (slow progression group) and the lower 25(th) percentile group (rapid progression group). Eighty-two eyes of 56 patients were studied. There were 21 eyes (21 patients) each in rapid and slow progression groups respectively. GAT, IOPcc, IOPg, CH, CRF were 12.1±1.4 mm Hg, 15.8±1.8 mm Hg, 12.8±2.0 mm Hg, 8.4±1.1 mm Hg, 7.9±1.3 mm Hg respectively in rapid progression group and 11.5±1.3 mm Hg, 13.5±2.1 mm Hg, 11.2±1.6 mm Hg, 9.3±1.1 mm Hg, 8.2±0.9 mm Hg respectively in slow progression group (P=0.214, <0.001, 0.007, 0.017, 0.413, respectively). In bivariate correlation analysis, IOPcc, IOPcc-GAT and CH were significant correlated with mΔMD (r=-0.292, -0.312, 0.228 respectively, P=0.008, 0.004, 0.039 respectively). Relatively rapid VF progression occurred in NTG patients whose IOPcc are rather high, CH are rather low and the difference between IOPcc and GAT are relatively large. Higher IOPcc and lower CH are associated with VF progression in NTG patients. This study suggests that GAT measures might underestimate the IOP in such patients.
Lawlor, Mitchell; Quartilho, Ana; Bunce, Catey; Nathwani, Neil; Dowse, Emily; Kamal, Debbie; Gazzard, Gus
We determined whether there is relative sparing of pupil function in glaucoma patients with normal pressures compared to those with high pressures. A cross-sectional study was done of 68 patients with primary open angle glaucoma (POAG): 38 had normal IOPs on all-day phasing before treatment (never >21 mm Hg), with confirmed progression of glaucomatous optic neuropathy (NTG) and 30 had glaucomatous optic neuropathy associated with elevated intraocular pressures (>25 mm Hg; HP-POAG). The relative afferent pupillary defect (RAPD) was quantified with the RAPDx device, and mean deviation of visual field loss was obtained from reliable Humphrey visual fields. Outcomes measures evaluated were difference in slope between NTG and HP-POAG when plotting: (1) RAPD score against difference in mean deviation (MD) between eyes, and (2) RAPD score against difference in RNFL thickness between eyes. The slopes for magnitude of RAPD versus difference in MD were -0.06 (95% confidence interval [CI], -0.076, -0.044) for patients with NTG and -0.08 (95% CI, -0.109, -0.067) for those with HP-POAG. Fitting the interaction term showed a statistically significant difference between the slopes (0.023; 95% CI [0.0017, 0.0541]; P value = 0.037; HP-POAG reference group). Thus, for difference in MD, the slope for patients with NTG was flatter than the slope for those with HP-POAG. Glaucoma patients with NTG have a lesser RAPD for a given level of intereye difference of HVF MD, compared to patients with high IOPs. This suggests that damage to intrinsically photosensitive retinal ganglion cells (ipRGCs) differs between the normal and high-pressure forms of open-angle glaucoma (OAG), and supports the theory that mitochondrial optic neuropathies may have a role in the group of diagnoses currently termed normal tension glaucoma.
Agnifili, Luca; Mastropasqua, Rodolfo; Frezzotti, Paolo; Fasanella, Vincenzo; Motolese, Ilaria; Pedrotti, Emilio; Di Iorio, Angelo; Mattei, Peter A; Motolese, Eduardo; Mastropasqua, Leonardo
To examine the circadian intraocular pressure (IOP) patterns in healthy subjects, in primary open angle and normal tension glaucoma (POAG; NTG) using a contact lens sensor (CLS; Sensimed Triggerfish, Lausanne, Switzerland). This was an observational, nonrandomized study. Ten healthy subjects (Group 1, 10 eyes) and 20 glaucomatous patients [20 eyes, 10 with POAG (Group 2) and 10 with NTG (Group 3)] were enrolled. All patients were controlled with prostaglandin analogues. The 24-hr IOP pattern was the main outcome. The morning (6AM-11AM), afternoon/evening (noon-11PM) and night (midnight-5AM) subperiod patterns, peaks and prolonged peaks (>1 hr) were secondary outcomes. Mean 24-hr IOP pattern showed a nocturnal acrophase in all groups. Patterns were significantly different among groups (p = 0.02), with highest nocturnal IOP values in POAG. Prolonged peaks were more common in patients with glaucoma (70%) than in healthy subjects (33.3%) (p < 0.001). Significant differences were found for Groups 2 and 3 in the morning versus afternoon/evening (p = 0.019 and p = 0.035, Bonferroni correction), morning versus night (p = 0.005 and p < 0.0001) and afternoon/evening versus night periods comparisons (p < 0.0001 for both groups). In Group 1, patterns significantly differed in the morning versus night and afternoon/evening versus night period comparisons (p < 0.0001). Continuous 24-hr IOP monitoring with the CLS revealed a nocturnal acrophase in healthy subjects and, more markedly, in glaucoma. Because the diurnal IOP profile seems not to predict the nocturnal rhythm, the circadian IOP pattern should be evaluated in clinical practice. These findings may be worthwhile for the management of glaucoma. © 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Murakami, Kaori; Ota, Masao; Shiota, Tomoko; Nomura, Naoko; Kashiwagi, Kenji; Mabuchi, Fumihiko; Iijima, Hiroyuki; Kawase, Kazuhide; Yamamoto, Tetsuya; Nakamura, Makoto; Negi, Akira; Sagara, Takeshi; Nishida, Teruo; Inatani, Masaru; Tanihara, Hidenobu; Aihara, Makoto; Araie, Makoto; Fukuchi, Takeo; Abe, Haruki; Higashide, Tomomi; Sugiyama, Kazuhisa; Kanamoto, Takashi; Kiuchi, Yoshiaki; Iwase, Aiko; Ohno, Shigeaki; Inoko, Hidetoshi; Mizuki, Nobuhisa
Purpose To investigate whether the GLC1F locus is associated with normal tension glaucoma (NTG) in Japanese patients. Methods We recruited 242 unrelated Japanese subjects, including, 141 NTG patients and 101 healthy controls. The patients exhibiting a comparatively early onset were selected as they suggest that genetic factors may show stronger involvement. Genotyping and assessment of allelic diversity was performed on 11 highly polymorphic microsatellite markers in and around the GLC1F locus. Results Individuals carrying the 163 allele of D7S1277i had a statistically significant increased risk of NTG (p=0.0013, pc=0.016, OR=2.47, 95%CI=1.42–4.30). None of the other markers identified significant loci (pc>0.05) after Bonferroni’s correction. Conclusions These findings suggested that the genes in the GLC1F locus may be associated with the pathogenesis of NTG. PMID:20309402
Full Text Available Kenji Inoue,1 Minako Shiokawa,1 Takayuki Fujimoto,1 Goji Tomita21Inouye Eye Hospital, Tokyo, Japan; 22nd Department of Ophthalmology, Toho University School of Medicine, Tokyo, JapanPurpose: To evaluate the effects of bimatoprost 0.03% single treatment for 3 years on intraocular pressure (IOP and visual field performance.Methods: We monitored the IOP of 62 patients with normal-tension glaucoma every 1–3 months. The Humphrey visual field test was performed every 6 months after treatment and the results obtained were compared to those before treatment. In addition, visual field performance was evaluated using trend and event analysis.Results: The mean ± standard deviation (SD of IOP after treatment with bimatoprost for 3 years (13.6±3.1 mmHg was significantly lower than that before treatment (16.8±2.4 mmHg, P<0.0001. No change was observed in the mean deviation and pattern SD values of the Humphrey visual field before and 3 years after treatment. Worsening of visual field performance was observed in one patient (3.0% by using trend analysis and in four patients (12.1% by using event analysis. Treatment was discontinued in 17 patients (27.4% because of adverse reactions.Conclusion: Bimatoprost 0.03% single treatment was effective in reducing the IOP at least during the 3 years of treatment, but visual field performance worsened by 3.0%–12.1% in patients with normal-tension glaucoma.Keywords: IOP, visual field, trend analysis, event analysis
Tojo, Naoki; Abe, Shinya; Ishida, Masaaki; Yagou, Takaaki; Hayashi, Atsushi
We compared the fluctuation of intraocular pressure (IOP) in normal-tension glaucoma (NTG) patients and individuals with nonglaucoma eyes. We obtained continuous IOP values using a SENSIMED Triggerfish contact lens sensor. The eyes of 12 nonglaucoma subjects and 14 NTG patients were examined. In all 26 subjects, the IOP fluctuation was measured continuously for 24 hours with a contact lens sensor. We evaluated the range of IOP fluctuations over the 24-hour period separately for diurnal IOP and nocturnal IOP and identified each subject's maximum value. The range of IOP fluctuation were analyzed, cutoff level of IOP fluctuation was calculated using receiver operating characteristic curve analyses. The mean IOP in the NTG eyes was 11.5±2.4 mm Hg and that in the nonglaucoma eyes was 12.7±2.0 mm Hg, a nonsignificantly difference (P=0.175). The 24-hour range of IOP fluctuations in the NTG group was significantly larger than that of the nonglaucoma group (P=0.007). The percentage of NTG patients who had the peak time of IOP fluctuation during nocturnal sleep was 57.1%, whereas the corresponding rate for the nonglaucoma eyes was 91.7%. The cutoff level of IOP fluctuation for glaucoma was 442 mVeq (sensitivity=1.00; specificity=0.571). The range of IOP fluctuation was larger in the eyes with NTG than in the nonglaucoma eyes. This larger fluctuation might be one of the reasons underlying the aggravation of the visual field by NTG. Measurements of 24-hour continuous IOP might be one of the useful methods to distinguish NTG from nonglaucoma eyes.
Full Text Available Normal tension glaucoma (NTG also known as low tension glaucoma, presents with optic nerve head and visual field damage in the absence of high intraocular pressure (<21 mmHg. There are several patients of NTG seen in our clinics who have repeatable visual field defects, which may or may not correlate with the disc appearance, but are labeled as glaucoma. Ruling out ischemic, nutritional, and other causes of one-time damage are important before diagnosing an NTG. We report 3 such cases that were misdiagnosed and referred as NTG. All three cases were not glaucomatous and had typical features of nutritional optic neuropathy. The typical clinical features, visual field and imaging abnormalities seen in these two conditions and their management is highlighted in this article. Misdiagnosis leads to inappropriate investigations and treatment, but more importantly would lead to worsening of undiagnosed underlying disease.
Luksch, A; Rainer, G; Koyuncu, D; Ehrlich, P; Maca, T; Gschwandtner, M E; Vass, C; Schmetterer, L
Aim: To investigate the effects of oral nimodipine on ocular haemodynamic parameters and colour contrast sensitivity in patients with normal tension glaucoma (NTG). Design: The study was performed in a randomised, placebo controlled, double masked, crossover design. Participants: Nimodipine (60 mg) or placebo was administered to 14 consecutive NTG patients. Methods: The effects or oral nimodipine or placebo on ocular and systemic haemodynamic parameters and colour contrast sensitivity along the tritan axis were studied two hours after administration. Optic nerve head blood flow (ONHBF) and choroidal blood flow (CHBF) were assessed with laser Doppler flowmetry. Ocular fundus pulsation amplitude (FPA) was measured with laser interferometry. Colour contrast sensitivity (CCS) was determined along the tritan colour axis. Main outcome measures: ONHBF, CHBF, FPA, intraocular pressure and CCS were assessed in patients with NTG. Results: Mean ocular FPA increased by 14% (SD 14%) (p = 0.0008), ONHBF by 18% (SD 16%) (p = 0.0031), and CHBF by 12% (SD 14%) (pnimodipine. Nimodipine also decreased the threshold of colour contrast sensitivity along the tritan colour axis (−14% (SD 12%); p = 0.048). However, individual changes in FPA, ONHBF, or CHBF were not correlated with changes in threshold of CCS along the tritan colour axis. Conclusions: The results indicate that nimodipine increases ONH and choroidal blood flow in NTG patients and improves CCS. The latter effect does not, however, seem to be a direct consequence of the blood flow improvement. PMID:15615740
Shin, In Ha; Kang, Sung Yong; Hong, Samin; Kim, Seung Kab; Seong, Gong Je; Tak, Ma Kyung; Kim, Chan Yun
To evaluate the relationship between optic disc and retinal nerve fiber layer (RNFL) measurements obtained with the optical coherence tomography (OCT) and the Heidelberg retina topography (HRT) in normal, normal tension glaucoma (NTG), and high tension glaucoma (HTG). Normal, NTG and HTG subjects who met inclusion and exclusion criteria were evaluated retrospectively. One hundred seventy eyes of 170 patients (30 normal, 40 NTG, and 100 HTG) were enrolled. Complete ophthalmologic examination, HRT, OCT, and automated perimetry were evaluated. Disc area, cup area and cup/disc area ratio measured with HRT were significantly different between NTG and HTG (all p HTG (84.97+/-24.20 micrometer vs. 73.53+/-27.17 micrometer, p = 0.037). Four quadrant RNFL thickness measurements were not significantly different between NTG and HTG (all p > 0.05). Mean deviation and corrected pattern standard deviation measured by automated perimetry was significantly correlated with mean and inferior RNFL thickness in both NTG and HTG (Pearson's r, p HTG than NTG (35.21+/-18.92 vs. 31.30+/-10.91, p = 0.004). These findings suggest that optic disc and RNFL damage pattern in NTG may be different from those of HTG.
Tojo, Naoki; Oka, Miyako; Miyakoshi, Akio; Ozaki, Hironori; Hayashi, Atsushi
The aim of this study was to examine the effects of selective laser trabeculoplasty (SLT) treatment on habitual intraocular pressure (IOP) fluctuations in patients with normal-tension glaucoma (NTG) using a SENSIMED Triggerfish contact lens sensor (CLS). Ten patients diagnosed with NTG were enrolled in this study. All patients underwent SLT treatment. Habitual 24-hour IOP fluctuations were recorded before and after SLT. The IOP fluctuations were divided into diurnal periods and nocturnal periods and compared before and after SLT. Changes in corneal thickness and curvature were measured before and after the CLS use with anterior segment optical coherence tomography. The mean IOP was 13.5±2.5 mm Hg before SLT. The mean IOP at 1, 2, and 3 months after SLT was significantly decreased to 10.1±2.3 mm Hg (P=0.002), 11.2±2.7 mm Hg (P=0.0059), and 11.3±2.4 mm Hg (P=0.018), respectively. The range of IOP fluctuations over 24 hours was not significantly changed between before and after SLT treatment (P=0.77). Although the range of IOP fluctuations during the diurnal periods was not significantly changed between before and after SLT treatment (P=0.92), the range of IOP fluctuations during the nocturnal periods significantly decreased from 290±86 mVEq before SLT to 199±31 mVEq after SLT treatment (P=0.014). With respect to corneal changes, the steeper meridian decreased significantly after the CLS use (P=0.016), although other parameters showed no significant difference between before and after the CLS use. SLT treatment was shown to significantly lower IOP and decrease IOP fluctuations during the nocturnal periods in NTG patients. These effects might be important to prevent the progression of NTG.
Guo, Xinxing; Kong, Xiangbin; Huang, Rui; Jin, Ling; Ding, Xiaohu; He, Mingguang; Liu, Xing; Patel, Mehul Chimanlal; Congdon, Nathan G
We evaluated the effect of ginkgo biloba extract on visual field defect and contrast sensitivity in a Chinese cohort with normal tension glaucoma. In this prospective, randomized, placebo-controlled crossover study, patients newly diagnosed with normal tension glaucoma, either in a tertiary glaucoma clinic (n = 5) or in a cohort undergoing routine general physical examinations in a primary care clinic (n = 30), underwent two 4-week phases of treatment, separated by a washout period of 8 weeks. Randomization determined whether ginkgo biloba extract (40 mg, 3 times per day) or placebo (identical-appearing tablets) was received first. Primary outcomes were change in contrast sensitivity and mean deviation on 24-2 SITA standard visual field testing, while secondary outcomes included IOP and self-reported adverse events. A total of 35 patients with mean age 63.7 (6.5) years were randomized to the ginkgo biloba extract-placebo (n = 18) or the placebo-ginkgo biloba extract (n = 17) sequence. A total of 28 patients (80.0%, 14 in each group) who completed testing did not differ at baseline in age, sex, visual field mean deviation, contrast sensitivity, IOP, or blood pressure. Changes in visual field and contrast sensitivity did not differ by treatment received or sequence (P > 0.2 for all). Power to have detected a difference in mean defect as large as previously reported was 80%. In contrast to some previous reports, ginkgo biloba extract treatment had no effect on mean defect or contrast sensitivity in this group of normal tension glaucoma patients. (http://www.chictr.org number, ChiCTR-TRC-08000724).
Natalia I Kurysheva
Full Text Available Purpose: to study the eye’s venous blood flow and the correlation between clinical data and ocular blood flow in normal tension and high tension open angle glaucoma (POAG. Methods: Color Doppler imaging of arterial and venous blood flow was performed on 78 patients with normal tension glaucoma (NTG, 80 patients with high-pressure glaucoma (HPG and 60 control subjects. The statistical analysis included the calculation of the correlation between clinical data and ocular blood flow parameters, as well as Pearson’s correlation coefficient. The threshold P value for statistical significance was 0.05. Results: Ocular blood flow (both arterial and venous was significantly reduced in NTG and HTG, compared to the control group. While the arterial blood flow reduction was more significant in HTG than in NTG, a decrease in venous blood flow had a higher incidence in NTG. In contrast to the control group, POAG patients showed a correlation between clinical data and venous blood flow. The correlation was higher in NTG patients. Conclusions: The results obtained indicate the potential importance of venous blood flow in glaucoma pathogenesis, especially in NTG.
Conclusions: There were differences in dynamic corneal response parameters but not IOP or CCT between the paired eyes of NTG patients with asymmetric VF damage. We suggest that the shape of the cornea is more easily altered in the worse eyes of asymmetric NTG patients.
Souto, Fernanda Maria Silveira; de Vasconcellos, José Paulo Cabral; de Melo, Mônica Barbosa; Sartorato, Edi Lúcia; Moura, Frederico Castelo
Glaucoma is a neurodegenerative disorder characterized by thinning of neuroretinal rim, enlarged cup-to-disc ratio (CDR) and visual field damage. Although raised intraocular pressure is main risk factor for development of glaucoma, it can occur with consistently normal measurements in the intraocular pressure as normal tension glaucoma (NTG). Enlargement of CDR is a classical sign of glaucoma, but it can also result from non-glaucomatous optic neuropathies such as Leber hereditary optic neuropathy (LHON). We describe a case of LHON with increased CDR, discuss its differential diagnosis with NTG and highlight the reasons for misdiagnoses between these two entities.
Full Text Available The efficacy and safety of add-on 0.1% brimonidine tartrate preserved with sodium chlorite in on-treatment Japanese normal-tension glaucoma patients [Corrigendum] Tsumura T, Yoshikawa K, Kimura T, et al. Clin Ophthalmol. 2014;8:1681–1687. The authors wish to advise of the following errors: on page 1684, right column, line 18, “10.72” should be replaced with “–10.72”; on page 1685, right column, line 2, “<–6D” should be replaced with “<–6dB”. Read the original article Previous corrigendum has been published
Flow dynamics of cerebrospinal fluid between the intracranial cavity and the subarachnoid space of the optic nerve measured with a diffusion magnetic resonance imaging sequence in patients with normal tension glaucoma.
Boye, Dirk; Montali, Margherita; Miller, Neil R; Pircher, Achmed; Gruber, Philipp; Killer, Hanspeter E; Remonda, Luca; Berberat, Jatta
This study offers a new approach for the quantification of CSF dynamics. Non-invasive method to quantify the CSF dynamics in the subarachnoid space of the optic nerve is highly desirable. The aim of the study was to measure slow-flow CSF velocities in healthy controls and normal tension glaucoma patients between the intracranial cavity and the subarachnoid space of the optic nerve. Prospective observational study. Eleven age-matched healthy volunteers and 15 normal tension glaucoma patients. Using phase contrast images, the phase shift in MRI diffusion images can be used to determine the flow velocity. Flow-range ratio between the intracranial cavity and the subarachnoid space of the optic nerve was calculated. Flow-range ratio between the intracranial cavity and the subarachnoid space of the optic nerve was calculated. First, phantom measurements were provided to validate the slow-flow velocity calculations. Second, flow-range ratio was validated for the healthy controls (0.63 ± 0.05), with the range being similar for the right and left optic nerve (P = 0.1). Statistically significant results were obtained (P flow-range ratio in the optic nerve of healthy controls (n = 22 eyes, 0.63 ± 0.05) with the flow-range ratio in pathological optic nerves (n = 23, 0.55 ± 0.08) of normal tension glaucoma patients. MANOVA revealed no dependency between flow-range ratio and patient dependent variables. Diffusion-weighted imaging provides a method to evaluate CSF flow within the subarachnoid space of the optic nerve in a non-invasive manner. Compared to healthy controls, patients with normal tension glaucoma measure a significantly lower flow-range ratio. This finding suggests a possible role of impaired CSF dynamics in the pathophysiology in normal tension glaucoma. © 2017 Royal Australian and New Zealand College of Ophthalmologists.
Kim, Joon Mo; Kim, Tae-Woo; Kim, Chan Yun; Kim, Hwang Ki; Park, Ki Ho
To compare the therapeutic efficacy and safety of brimonidine/timolol fixed-combination (BTFC) and 0.5% timolol ophthalmic solution in normal-tension glaucoma (NTG) patients. This was a multi-institution, randomized, active-controlled, open-label, parallel-group study. After a full ophthalmic and glaucoma examination, a total of 110 NTG patients--55 undergoing therapy with BTFC and 55 0.5%, with timolol--participated in this study. Among them, 1 failed to meet the inclusion/exclusion criteria, 10 revoked their consent to participate in the study, 3 had adverse reactions, and 1 had a drug adherence rate of less than 70%. Ultimately, a total of 95 patients--48 in the BTFC group and 47 in the 0.5% timolol group--completed the study. The study visits took place at baseline and at 4 and 12 weeks. Diurnal IOP was measured at 9 a.m., 11 a.m., and 5 p.m. during the baseline visit and the visit at 12 weeks after eye-drop instillation. At each follow-up visit, compliance was assessed. Throughout the study, all adverse events were recorded and monitored by the investigators. The average difference in IOP change measured at 11 a.m. 12 weeks after administration between the two groups was 2.10 ± 2.59 mmHg. The BTFC group had a better IOP-lowering effect at all time points than did the 0.5% timolol group. The ratio of patients whose average IOP had decreased by >20% after 4 and 12 weeks was 50 and 56% in the BTFC group, respectively, whereas it was 29.41 and 23.53% in the 0.5% timolol group, respectively (p = 0.034, <0.001). BTFC has a superior IOP-lowering effect than 0.5% timolol in NTG patients.
Tsumura, Toyoaki; Yoshikawa, Keiji; Kimura, Tairo; Suzumura, Hirotaka; Kawashima, Miwako; Nanno, Mami; Ishijima, Kiyotaka; Takeda, Ryuji
To evaluate the efficacy and safety of newly formulated brimonidine (0.1% brimonidine tartrate preserved with sodium chlorite: brimonidine) as add-on therapy in on-treatment Japanese normal-tension glaucoma (NTG) patients. Brimonidine was added to on-treatment NTG patients with intraocular pressures (IOP) of between 13 mmHg and 16 mmHg after three consecutive IOP measurements. The time courses of IOP, conjunctival hyperemia, superficial punctate keratitis, and adverse events were examined at 4, 8, and 12 weeks after brimonidine instillation. Though 75 of 83 patients (31 males and 52 females; mean age: 63.4±11.6 years) completed the study, six patients discontinued because of side effects and two patients withdrew. The mean IOP after brimonidine addition at week 4 (12.6±1.8 mmHg, Psuperficial punctate keratitis or conjunctival hyperemia scores were observed throughout the study. Dizziness, sleepiness, eye pain, and itching (mild to moderate) were noted in five, four, three, and three patients, respectively. The addition of newly formulated brimonidine to on-treatment Japanese NTG patients with IOP of 13-16 mmHg further reduced the levels of IOP with minimal side effects and adverse events.
Full Text Available Toyoaki Tsumura,1 Keiji Yoshikawa,2 Tairo Kimura,3 Hirotaka Suzumura,4 Miwako Kawashima,5 Mami Nanno,6 Kiyotaka Ishijima,7 Ryuji Takeda8 1Fussa Hospital, Tokyo, Japan; 2Yoshikawa Eye Clinic, Tokyo, Japan; 3Ueno Eye Clinic, Tokyo, Japan; 4Suzumura Eye Clinic, Tokyo, Japan; 5Nakano General Hospital, Tokyo, Japan; 6Kagurazaka Minamino Eye Clinic, Tokyo, Japan; 7Irumagawa Hospital, Saitama, Japan; 8Department of Biological Chemistry, Faculty of Agriculture, Kinki University, Nara, Japan Background: To evaluate the efficacy and safety of newly formulated brimonidine (0.1% brimonidine tartrate preserved with sodium chlorite: brimonidine as add-on therapy in on-treatment Japanese normal-tension glaucoma (NTG patients.Methods: Brimonidine was added to on-treatment NTG patients with intraocular pressures (IOP of between 13 mmHg and 16 mmHg after three consecutive IOP measurements. The time courses of IOP, conjunctival hyperemia, superficial punctate keratitis, and adverse events were examined at 4, 8, and 12 weeks after brimonidine instillation.Results: Though 75 of 83 patients (31 males and 52 females; mean age: 63.4±11.6 years completed the study, six patients discontinued because of side effects and two patients withdrew. The mean IOP after brimonidine addition at week 4 (12.6±1.8 mmHg, P<0.001, week 8 (12.4±1.7 mmHg, P<0.001, and week 12 (12.6±1.8 mmHg, P<0.001 was significantly decreased compared with that before the addition of brimonidine (13.9±1.2 mmHg. No significant changes in superficial punctate keratitis or conjunctival hyperemia scores were observed throughout the study. Dizziness, sleepiness, eye pain, and itching (mild to moderate were noted in five, four, three, and three patients, respectively.Conclusions: The addition of newly formulated brimonidine to on-treatment Japanese NTG patients with IOP of 13–16 mmHg further reduced the levels of IOP with minimal side effects and adverse events. Keywords: normal-tension glaucoma, 0
Full Text Available Introduction. Extreme dippers are patients with a nocturnal fall of blood pressure (BP of more than 20%, dippers have normal diurnal rhythm and decrease of BP of 10-15%, while patients with a nocturnal BP fall of less than 10% are considered to be non-dippers. Objective. The aim of this study was to compare 24-hour ambulatory BP monitoring results of normaltension glaucoma (NTG patients with NTG suspects, as well as to determine whether NTG patients are more prone to daytime/nighttime systemic arterial BP and heart rate oscillations in comparison to NTG suspects. Methods. This was a prospective, cross-sectional and observational study of 57 hypertensive patients (39 female and 18 male, all examined at the Eye and the Cardiology Clinic, Clinical Center of Serbia in Belgrade, between November 2011 and March 2012. Before 24-hour ambulatory BP monitoring, complete ophthalmological examination was performed (intraocular pressure was measured with both Goldmann applanation and dynamic contour tonometer, as well as with computerized perimetry and Heidelberg retinal tomography. Results. There was no statistically significant difference between NTG patients and NTG suspects both in systolic daytime (131.86-141.81 mmHg, SD=±14.92 vs. 129.67-141.83 mmHg, SD=±13; p=0.53 and nighttime measurements (117.1-129.7 mmHg, SD=±18.96 vs. 112.11-127.59 mmHg, SD=±16.53; p=0.53 as well as diastolic daytime (74.55-80.37 mmHg, SD=±8.72 vs. 75.19-82.41 mmHg, SD=±7.72; p=0.58 and nighttime measurements (65.66-71.48 mmHg, SD=±8.73 vs. 67.12-73.78 mmHg, SD=±7.11; p=0.34. There was no statistically significant difference between NTG patients and NTG suspects in heart rate during the day (72.73-76.36 beats per minute [bpm], SD=±5.44 vs. 72.15-76.45 bpm, SD=±4.59; p=0.43 nor during the night (64.4-71.9 bpm, SD=±6.74 vs. 68.02-72.48 bpm, SD=±4.76; p=0.11. Conclusion. No statistically significant difference was found between NTG patients and NTG suspects in regard to
Full Text Available Hazem Helmy,1 Mahmoud Leila,2 Ahmed Atef Zaki3 1Department of Glaucoma and Optic Nerve Diseases, 2Retina Department, 3Corneal Diseases Department, Research Institute of Ophthalmology, Cairo, Egypt Purpose: We aimed to assess corneal biomechanics using the ocular response analyzer in patients with normal-tension glaucoma (NTG, and to evaluate the relationship between corneal biomechanics and visual field loss. Methods: This was a prospective observational case series including patients with bilateral asymmetric NTG. For all patients, corneal hysteresis (CH, corneal resistance factor (CRF, CH - CRF difference, and central corneal thickness values were matched against the mean deviation (MD of the visual field and the cup/disc ratio. For paired-eye comparison in each patient, both eyes were categorized into a better-eyes group and a worse-eyes group according to lower and higher corneal-compensated intraocular pressure readings, respectively. Statistical analysis was carried out with the independent-samples Student’s t-test, and the level of statistical significance was set at 0.05. Correlation was assessed using Pearson’s correlation coefficient. Results: The study included 240 eyes of 120 patients. CH was inversely proportional to the MD in the visual field (P=0.01. CRF in both eyes was inversely proportional to the MD of the visual field (P=0.01. CH - CRF difference was directly proportional to the MD of the visual field (P=0.01. For paired-eye comparison, lower corneal-compensated intraocular pressure was associated with higher CH, higher CRF, smaller cup/disc ratio, and less deterioration of MD of visual field. Conclusion: CH, CRF, and CH - CRF are more powerful predictors of NTG progression than central corneal thickness. Keywords: corneal-compensated intraocular pressure, corneal hysteresis, corneal resistance factor
Igarashi, Ryoko; Togano, Tetsuya; Sakaue, Yuta; Yoshino, Takaiko; Ueda, Jun; Fukuchi, Takeo
Purpose. To evaluate the effect on intraocular pressure (IOP) of switching from latanoprost and travoprost monotherapy to timolol fixed combinations in Japanese patients with normal-tension glaucoma (NTG). Methods. 27 NTG patients (54 eyes) were compared IOP, superficial punctuate keratitis (SPK) scores, and conjunctival injection scores in eyes treated with prostaglandin (PG) or PG analog/beta-blocker (PG/b) fixed-combination 6 months after the change in therapy. Results. The mean baseline intraocular pressure was 17.4 ± 1.59 mmHg in eyes receiving PG therapy only and 17.4 ± 1.69 mmHg in eyes switched to PG/b. Switching to fixed combination therapy from PG monotherapy, the mean IOP was 13.1 ± 1.79 mmHg (P < 0.001) (-24.71% reduction from baseline) at 6 months. The mean conjunctival injection score was 0.69 for eyes on PG monotherapy and 0.56 for eyes on fixed combination therapy (P = 0.028). The mean SPK scores were 0.46 and 0.53. This difference was not statistically significant (P = 0.463). Conclusions. Switching from PG monotherapy to PG/b fixed combination therapy for NTG resulted in a greater intraocular pressure reduction than PG alone without increasing the number of instillations.
Full Text Available Purpose. To evaluate the effect on intraocular pressure (IOP of switching from latanoprost and travoprost monotherapy to timolol fixed combinations in Japanese patients with normal-tension glaucoma (NTG. Methods. 27 NTG patients (54 eyes were compared IOP, superficial punctuate keratitis (SPK scores, and conjunctival injection scores in eyes treated with prostaglandin (PG or PG analog/beta-blocker (PG/b fixed-combination 6 months after the change in therapy. Results. The mean baseline intraocular pressure was 17.4±1.59 mmHg in eyes receiving PG therapy only and 17.4±1.69 mmHg in eyes switched to PG/b. Switching to fixed combination therapy from PG monotherapy, the mean IOP was 13.1±1.79 mmHg (P<0.001 (-24.71% reduction from baseline at 6 months. The mean conjunctival injection score was 0.69 for eyes on PG monotherapy and 0.56 for eyes on fixed combination therapy (P=0.028. The mean SPK scores were 0.46 and 0.53. This difference was not statistically significant (P=0.463. Conclusions. Switching from PG monotherapy to PG/b fixed combination therapy for NTG resulted in a greater intraocular pressure reduction than PG alone without increasing the number of instillations.
Ang, Ghee Soon; Bochmann, Frank; Townend, John; Azuara-Blanco, Augusto
To determine and compare the corneal biomechanical properties between eyes with primary open angle glaucoma (POAG) and eyes with normal tension glaucoma (NTG). Prospective cross-sectional study. Consecutive eligible POAG and NTG patients attending the Glaucoma Clinic had assessment of their corneal biomechanical properties-corneal hysteresis (CH) and corneal resistance factor (CRF)-using the Ocular Response Analyzer by an observer masked to the diagnosis. Exclusion criteria included previous intraocular surgery, corneal pathology, inflammatory connective tissue disease, and refraction of 5-dimensional or over. If both eyes were eligible, then the right eye was used for analysis. The main outcome measures were corneal hysteresis and CRF measurements. Data analysis was performed using the t test and general linear model. Eighty-one patients (80 whites) were analyzed. Forty had NTG, whereas 41 had POAG. Thirty-five were females. There was a statistically significant difference in mean CH (NTG 9.6+/-1.3 mm Hg; POAG 9.0+/-1.4 mm Hg; P=0.01), but not in mean CRF (NTG 9.9+/-1.4; POAG 10.8+/-1.7; P=0.06). The highest recorded Goldmann applanation intraocular pressure (IOP) was statistically significantly associated with lower CH (P=0.01) and higher CRF (P=0.02). There was a small but statistically significant difference in the mean CH between POAG and NTG (CH was higher in NTG). The highest recorded Goldmann applanation IOP was also statistically significantly correlated with lower CH and higher CRF, suggesting that alterations to the corneal biomechanical properties may occur as a result of chronic raised IOP in POAG.
Levine, Russell M; Yang, Alina; Brahma, Venkatesh; Martone, James F
Ocular perfusion pressure (OPP) is defined as the difference between BP and intraocular pressure (IOP). With low BP comes low OPP and resultant ischemic damage to the optic nerve, leading to glaucoma progression. The purpose of this article is to review the literature on BP as it relates to glaucoma and to create a forum of discussion between ophthalmologists and internal medicine specialists. Both high and low BP has been linked glaucoma. Low BP is particularly associated with glaucoma progression in normal-tension glaucoma (NTG) patients. Patients who have low nighttime BP readings are at highest risk of progression of their glaucoma. Internal medicine specialists and ophthalmologists should consider the relationship between BP and glaucoma when treating patients with concomitant disease. Too-low nighttime BP should be avoided. Ambulatory blood pressure monitoring is a useful tool to identify patients at greatest risk for progression.
Sood, Vaneeta; Ramanathan, Uthaya S
To determine the value and accuracy of 24-hour intraocular pressure (IOP) phasing using Icare ONE rebound tonometry (RTONE), in subjects with normal tension glaucoma (NTG). Eighteen consecutive patients with treated NTG were studied, all subjects had undergone 24-hour IOP phasing during a 1-year period. Each patient had daytime (08:00 to 16:00) IOP phasing with Goldmann applanation tonometer at 2-hourly intervals; at these same time points an IOP reading was also obtained by the patient using RTONE. Self-measured IOPs were then recorded at home using RTONE between 18:00 and 06:00 (at 2-hourly intervals). The frequency with which the phasing results altered clinical management was evaluated. The mean peak IOP was significantly higher during nighttime phasing (15.78±4.8 mm Hg) compared with daytime phasing (12.83±2.7 mm Hg, P=0.0018) and clinic IOP measurements (11.8±1.6 mm Hg, PIOP phasing a change in management occurred in 10 of 18 patients (56%). In the majority of these patients, a peak IOP was identified during nighttime phasing compared with daytime phasing, this difference was significant (P=0.0090). There were strong correlations between the IOP measurements obtained with Goldmann applanation tonometer and RTONE (Spearman r values >0.60, PIOP measurements, 24-hour phasing can reveal higher IOP spikes than those identified during typical office hours. RTONE is a safe, easy to use, and accurate device for self-monitoring of IOP.
Takemoto, Daisuke; Higashide, Tomomi; Saito, Yoshiaki; Ohkubo, Shinji; Udagawa, Sachiko; Takeda, Hisashi; Sugiyama, Kazuhisa
We conducted a prospective study in patients with normal-tension glaucoma (NTG) who received either isopropyl unoprostone or latanoprost. We compared the drugs in terms of their effects on intraocular pressure (IOP) and visual field loss progression over a 3-year period. Prospective, randomized controlled study. We enrolled 48 patients with newly diagnosed NTG at Kanazawa University Hospital. Eligible patients were randomly allocated (1:1) to receive either unoprostone or latanoprost ophthalmic solutions. The primary outcomes were IOP changes and visual field deterioration within 36 months. Visual field changes were analyzed: the cumulative survival rates were calculated in terms of mean deviation, pattern standard deviation, and total deviation of the upper or lower hemi-visual field, each visual field sector, and guided progression analysis. In addition, we evaluated the progression of glaucomatous optic disc changes using fundus photography and confocal scanning laser ophthalmoscopy. The mean pretreatment IOP was 15.0±2.4 mmHg in the Unoprostone group and 15.2±1.9 mmHg in the Latanoprost group. The mean IOP during the treatment period was 13.7±2.3 mmHg in the Unoprostone group and 13.0±1.8 mmHg in the Latanoprost group. In both groups, the IOP decreased significantly (pvisual field loss progression, there were no significant differences between groups in any parameters of the visual field or guided progression analysis. There were no significant differences between groups in disc changes. No significant differences were found between groups with regard to the visual field and structural progression in patients with NTG, although unoprostone was less effective than latanoprost in lowering the IOP.
Li, Lüe; Bian, Ailing; Cheng, Gangwei; Zhou, Qi
To compare the in vivo lamina cribrosa position in patients with normal-tension glaucoma (NTG) and high-tension glaucoma (HTG). The comparative cross-sectional study included three age- and sex-matched groups: 26 eyes of 26 NTG patients, 26 eyes of 26 HTG patients and 25 eyes of 25 healthy controls. Serial horizontal B-scan images of the optic nerve head were obtained from each eye using enhanced depth imaging optical coherence tomography. Mean and maximum lamina cribrosa depths were measured in 11 equally spaced horizontal B-scans. Statistical analysis was conducted to compare lamina cribrosa depth among the three groups and to correlate lamina cribrosa depth with age, retinal nerve fibre layer (RNFL) thickness and visual field (VF) mean deviation (MD). The area under the receiver operating characteristic curve (AUC) for lamina cribrosa depth was calculated. Mean and maximum lamina cribrosa depths were significantly greater in HTG than in NTG eyes, and in NTG than in normal eyes in all 11 scans (all p HTG eyes (0.977 and 0.988, respectively) were significantly greater than those in NTG eyes (0.735 and 0.765, respectively; both p HTG eyes; however, the same association was not found in NTG or controls. Neither RNFL thickness nor VF MD was significantly correlated with lamina cribrosa depth in each group. The lamina cribrosa is more posteriorly located in HTG than in NTG eyes, as well as in NTG eyes compared with healthy controls. The lamina cribrosa depth can help differentiate HTG from normal eyes, but it does not reach a good level of diagnostic accuracy for detecting NTG. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Full Text Available The aim of the research is to analyse the influence of polymorphisms of endothelin-1 gene and endothelin-1 receptor type A gene on the clinical condition of patients with primary open angle glaucoma. Methods. 285 Polish patients took part in the research (160 normal-tension glaucoma and 125 high-tension glaucoma. DNA was isolated by standard methods and genotype distributions of four polymorphisms in genes encoding endothelin-1 (K198N and endothelin-1 receptor type A polymorphisms (C1222T, C70G, and G231A were determined. Genotype distributions were compared between NTG and HTG groups. The clinical condition of participants was examined for association with polymorphisms. Results. A similar frequency of occurrence of the polymorphic varieties of the studied genes was observed in patients with NTG and HTG. There is no relation between NTG risk factors and examined polymorphisms. NTG patients with TT genotype of K198N polymorphism presented with the lowest intraocular pressure in comparison to GG + GT genotype (p=0.03. In NTG patients with CC genotype of C1222T polymorphism (p=0.028 and GG of C70G polymorphism (p=0.03 the lowest values of mean blood pressure were observed. Conclusions. The studied polymorphic varieties (K198N, C1222T do have an influence on intraocular pressure as well as arterial blood pressure in NTG patients.
Zhong, Yisheng; Min, Yingjun; Jiang, Ying; Cheng, Yu; Qin, Jiao; Shen, Xi
To compare the differences in color Doppler imaging (CDI) and pattern visual evoked potential (P-VEP) examinations between normal tension glaucoma (NTG) and hypertension primary open angle glaucoma (HTG) patients, and investigate the relation between flow velocities measured by CDI and P-VEP examination in NTG and HTG patients. Sixty NTG patients, 66 HTG patients and 44 control subjects underwent CDI evaluation of the ophthalmic artery (OA), short posterior ciliary artery (SPCA) and central retinal arteries (CRA). The peak systolic velocities (PSV) and end-diastolic velocities (EDV) and resistive index (RI) of all retrobulbar vessels were measured. The latency and amplitude of P100 in P-VEP were recorded from the three groups. The differences of CDI and P-VEP parameters among NTG group, HTG group and control group were compared by one-way analysis of variance. The correlations between CDI parameters and visual field indices, P-VEP and visual field indices, P-VEP and CDI parameters in NTG and HTG patients were evaluated by Pearson's correlation analysis. NTG and HTG patients had the lower EDV and higher RI in the OA, CRA and SPCA comparing with that of control subjects. NTG and HTG patients also had lower PSV in OA and CRA comparing with that of control subjects. There was no significant difference in the blood flow velocities and RI of all retrobulbar vessels between NTG and HTG patients. The latency of P100 in VEP delayed and the amplitude of P100 decreased in the NTG and HTG patients comparing with that of the control group. There was no significant difference in the latency and amplitude of P100 between the NTG and HTG patients. The RI of OA and SPCA were negatively correlated with the mean deviation (MD) values in the NTG and HTG patients. The RI of OA was positively correlated with the PSD value in the NTG and HTG patients. The MD values in the NTG and HTG patients were negatively correlated with the latency time of P100. The RI of OA was positively correlated
Helmy, Hazem; Leila, Mahmoud; Zaki, Ahmed Atef
Purpose We aimed to assess corneal biomechanics using the ocular response analyzer in patients with normal-tension glaucoma (NTG), and to evaluate the relationship between corneal biomechanics and visual field loss. Methods This was a prospective observational case series including patients with bilateral asymmetric NTG. For all patients, corneal hysteresis (CH), corneal resistance factor (CRF), CH − CRF difference, and central corneal thickness values were matched against the mean deviation (MD) of the visual field and the cup/disc ratio. For paired-eye comparison in each patient, both eyes were categorized into a better-eyes group and a worse-eyes group according to lower and higher corneal-compensated intraocular pressure readings, respectively. Statistical analysis was carried out with the independent-samples Student’s t-test, and the level of statistical significance was set at 0.05. Correlation was assessed using Pearson’s correlation coefficient. Results The study included 240 eyes of 120 patients. CH was inversely proportional to the MD in the visual field (P=0.01). CRF in both eyes was inversely proportional to the MD of the visual field (P=0.01). CH − CRF difference was directly proportional to the MD of the visual field (P=0.01). For paired-eye comparison, lower corneal-compensated intraocular pressure was associated with higher CH, higher CRF, smaller cup/disc ratio, and less deterioration of MD of visual field. Conclusion CH, CRF, and CH − CRF are more powerful predictors of NTG progression than central corneal thickness. PMID:27051272
CONDITION AND TARGET POPULATION There are two main types of glaucoma, primary open angle (POAG) and angle closure glaucoma, of which POAG is the more common type. POAG is diagnosed by assessing degenerative changes in the optic disc and loss of visual field (VF). Risk factors for glaucoma include an increase in intraocular pressure (IOP), a family history of glaucoma, older age and being of African descent. The prevalence of POAG ranges from 1.1% to 3.0% in Western populations and from 4.2% to 8.8% in populations of African descent. Usually the IOP associated with POAG is elevated above the normal distribution (10-20 mmHg), but when IOP is not elevated it is often referred to as normal-tension glaucoma (NTG). In population based studies, approximately one-third to half of the patients with glaucomatous VF loss have normal IOP on initial examination. People with elevated IOP (>21 mmHg), but with no evidence of optic disc or VF damage have ocular hypertension. It has been estimated that 3 to 6 million people in the United States including 4% to 7% of those older than 40 years have elevated IOP without detectable glaucomatous damage on standard clinical tests. An Italian study found the overall prevalence of ocular hypertension, POAG, and NTG in 4,297 people over 40 years of age to be 2.1%, 1.4% and 0.6% respectively. DIURNAL CURVE: In normal individuals, IOP fluctuates 2 to 6 mmHg over a 24 hour period. IOP is influenced by body position with higher readings found in the supine relative to the upright position. As most individuals sleep in the supine position and are upright during the day, IOP is higher on average in people, both with and without glaucoma, in the nocturnal period. IOP is generally higher in the morning compared to the afternoon. Multiple IOP measurements over the course of a day can be used to generate a diurnal curve and may have clinical importance in terms of diagnosis and management of patients with IOP related conditions since a solitary
Häntzschel, Janek; Terai, Naim; Sorgenfrei, Friederike; Haustein, Michael; Pillunat, Karin; Pillunat, Lutz E
To compare visual field (VF) and nerve fibre loss in patients with normal-tension (NTG) and high-tension glaucoma (HTG) at an equal level of glaucomatous structural damage of the optic nerve head (ONH). In a retrospective, pair-matched, comparative study, 126 eyes with NTG and 126 eyes with HTG were matched according to the same glaucomatous ONH damage based on rim volume, rim area and disc size measured by the Heidelberg Retina Tomograph (HRT III). Visual field by Humphrey perimetry and nerve fibre layer thickness measured by scanning laser polarimetry (GdxVCC) were compared between both groups. Based on the HRT, NTG and HTG displayed comparable structural damage of the ONH without a statistically significant difference between both groups (mean, NTG/HTG: disc area 2.32/2.32 mm², p =0.342; rim area 1.03/1.00 mm², p = 0.279; rim volume 0.2/0.19 mm³; p = 0.274). Eyes with NTG had significantly less VF damage than eyes with HTG (mean, NTG/HTG: mean deviation (MD) -3.69/-9.77 dB, p = 0.0001; pattern standard deviation (PSD) 4.80/7.17 dB, p = 0.0001). The nerve fibre layer of NTG patients was thicker than that of HTG patients (mean, NTG/HTG: GDx total: 46.9/44.0 μm, p = 0.073; GDx superior: 57.2/49.9 μm, p = 0.0001; GDx inferior: 54.9/49.7 μm, p = 0.001). At an equal level of glaucomatous structural damage of the ONH indicated by cupping, rim area and rim volume, NTG patients seem to have a less affected visual field and a better preserved nerve fibre layer than HTG patients. © 2013 The Authors. Acta Ophthalmologica © 2013 Acta Ophthalmologica Scandinavica Foundation. Published by Blackwell Publishing Ltd.
Full Text Available Purpose: To report the case of an eye with normal tension glaucoma and a choroidal excavation. Methods: This is an observational case report. Results: A 59-year-old woman with normal tension glaucoma had a choroidal excavation in the left eye. Her best-corrected visual acuity and intraocular pressure were within normal limits and had been stable for 5 years. Fundus examination showed a small white lesion inferior to the macula and a nerve fiber layer defect at the inferior edge of the optic disc. Humphrey Field Analyzer (HFA showed visual field defects corresponding to the nerve fiber layer defect with C30-2, and a central scotoma superior to the macula with C10-2. Optical coherence tomography (OCT showed a 150-µm deep choroidal excavation. Disruptions of the IS/OS line were detected only in the area inferior to the choroidal excavation. During the 5 months of follow-up, her best-corrected visual acuity remained at 1.0 and the IOP ranged from 12 to 14 mm Hg in the left eye. The fundus and OCT images did not deteriorate and the choroidal excavation did not enlarge. Conclusions: The disruption of the inner/outer segment (IS/OS line was detected only at the area surrounding the choroidal excavation. OCT examinations are useful in assessing the area of the residual IS/OS line, and HFA can be used to estimate the residual central visual field.
Asao, Kazunobu; Morimoto, Takeshi; Nakada, Atsuko; Kawasaki, Yoshimi
To report the case of an eye with normal tension glaucoma and a choroidal excavation. This is an observational case report. A 59-year-old woman with normal tension glaucoma had a choroidal excavation in the left eye. Her best-corrected visual acuity and intraocular pressure were within normal limits and had been stable for 5 years. Fundus examination showed a small white lesion inferior to the macula and a nerve fiber layer defect at the inferior edge of the optic disc. Humphrey Field Analyzer (HFA) showed visual field defects corresponding to the nerve fiber layer defect with C30-2, and a central scotoma superior to the macula with C10-2. Optical coherence tomography (OCT) showed a 150-µm deep choroidal excavation. Disruptions of the IS/OS line were detected only in the area inferior to the choroidal excavation. During the 5 months of follow-up, her best-corrected visual acuity remained at 1.0 and the IOP ranged from 12 to 14 mm Hg in the left eye. The fundus and OCT images did not deteriorate and the choroidal excavation did not enlarge. The disruption of the inner/outer segment (IS/OS) line was detected only at the area surrounding the choroidal excavation. OCT examinations are useful in assessing the area of the residual IS/OS line, and HFA can be used to estimate the residual central visual field.
Chen, Yuhong; Hughes, Guy; Chen, Xueli; Qian, Shaohong; Cao, Wenjun; Wang, Li; Wang, Min; Sun, Xinghuai
We investigated the association of genetic factors with primary open angle glaucoma (POAG), including high tension glaucoma (HTG) and normal tension glaucoma (NTG), in a Han Chinese population. We recruited 1157 POAG cases, including 860 HTG and 297 NTG, and 934 normal controls. A total of 13 previously reported single nucleotide polymorphisms (SNPs) located at four gene regions (TMCO1, CDKN2B-AS1, ATOH7, and SIX1/SIX6) was genotyped. Distributions of allele frequencies were compared between cases and controls as well as in the HTG and NTG subgroups. The IOP, vertical cup-to-disc ratio (VCDR), central corneal thickness (CCT), axial length (AL), and age at diagnosis also were investigated as quantitative phenotypes with genotypes of these SNPs. The SNPs rs4656461 and rs7555523 at TMCO1, rs523096 and rs2157719 at CDKN2B-AS1, as well as rs33912345 and rs10483727 at SIX1/SIX6 showed statistically significant association with POAG. The SNPs at ATOH7 did not show statistically significant association with POAG in our dataset. In the subgroup analysis of HTG and NTG, multiple variants at CDKN2B-AS1 and SIX1/SIX6 showed stronger association with NTG than HTG. The SNPs rs523096 and rs2157719 at CDKN2B-AS1 as well as rs33912345 and rs10483727 at SIX1/SIX6 were found to be associated with IOP where the minor alleles were associated with an increase in IOP. In contrast, SNPs at TMCO1 showed significant association with HTG only. Genetic variants in CDKN2B-AS1, SIX1/SIX6, and TMCO1 were associated with POAG in a Han Chinese population. Genes CDKN2B-AS1 and SIX1/SIX6 seem to harbor a tendency toward POAG with lower IOP, while carriers of risk alleles at TMCO1 seem to be predisposed to developing POAG with higher IOP.
Full Text Available Although intraocular pressure (IOP is the most definitive cause of glaucoma, a subtype of open angle glaucoma (OAG termed normal tension glaucoma (NTG, which occurs in spite of normal IOP, accounts for a large part of glaucoma cases, especially in Japan. To find common genetic variants contributing to NTG in Japanese patients, we conducted a genome-wide association study (GWAS. We performed the first screening for 531,009 autosomal SNPs with a discovery cohort of 286 cases and 557 controls, and then a second screening for the top 30 suggestive loci in an independent cohort of 183 cases and 514 controls. Our findings identified a significantly associated SNP; rs523096 [combined p-value = 7.40× 10(-8, odds ratio (OR= 2.00 with 95% confidence interval (CI 1.55-2.58] located 10 kbp upstream of CDKN2B on chromosome 9p21. Moreover, analysis of another independent case-control set successfully replicated the results of the screening studies (combined values of all 3 stages p = 4.96 × 10(-11, OR= 2.13 with 95% CI 1.69-2.68. The SNPs near rs523096 were recently reported to be associated with OAG associated with elevated IOP in primary open-angle glaucoma (POAG, the predominant subtype of glaucoma in Caucasian populations. Our results revealed that the 9p21 locus is also associated with NTG in Japanese. In addition, we identified SNPs more strongly associated with NTG.
Kung, Jennifer S.; Choi, Daniel Y.; Cheema, Anjum S.; Singh, Kuldev
To summarize the role of cataract surgery in the glaucoma patient, in terms of the effect on intraocular pressure (IOP) as well as diagnostic and therapeutic considerations for those with both conditions. Recent evidence suggests that cataract extraction may produce a significant and sustained IOP reduction in individuals with open-angle glaucoma, ocular hypertension, and angle-closure glaucoma. Cataract removal may improve the practitioner's ability to interpret perimetric testing, and re-establishing perimetric and optic nerve imaging baselines is recommended after cataract surgery. The sequence of cataract surgery relative to glaucoma surgery impacts the likelihood of complications and surgical success. There are multiple benefits to perform cataract surgery prior to glaucoma surgery while cataract surgery after trabeculectomy increases the risk of subsequent filtration failure. As “minimally invasive glaucoma surgeries” continue to improve in terms of efficacy, there is an evolving role for combined cataract and glaucoma surgery in patients with early to moderate stages of glaucoma. PMID:25624668
Iester, Michele; De Feo, Fabio; Douglas, Gordon R
Purpose. To determine whether the patterns of visual field damage between high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) are equivalent. Methods. In this retrospective cross-sectional study, fifty-one NTG and 57 HTG patients were recruited. For each recruited patient only the left eye was chosen. Glaucomatous patients had abnormal visual fields and/or glaucomatous changes at the optic nerve head. They were classified as HTG or NTG on the basis of intraocular pressure (IOP) measurements. Patients' visual fields were analyzed by using Humphrey Field Analyzer (HFA), program 30-2, full threshold. The visual field sensitivity values and the pattern deviation map values of the 72 tested points were considered. Then a pointwise analysis and an area analysis, based on the Glaucoma Hemifield test criteria, were performed, and a comparison between the two subgroups was made by Student's t test. Results. Between NTG and HTG, no significant difference was found pointwise for almost all the visual field points, except for two locations. One was under the blind spot, and the other was in the inferior hemifield around the twenty-degree position. When area analysis was considered, three areas showed a significantly different sensitivity between HTG and NTG. Conclusions. These data suggested that there was no relevant difference in the pointwise analysis between NTG and HTG; however, when visual field areas were compared, no difference in paracentral areas was found between NTG and HTG, but superior nasal step and inferior and superior scotomata showed to be deeper in HTG than in NTG.
Morita, Tetsuya; Shoji, Nobuyuki; Kamiya, Kazutaka; Fujimura, Fusako; Shimizu, Kimiya
To investigate the intraocular pressure (IOP) and corneal biomechanical properties of normal and normal-tension glaucoma (NTG) eyes. This study included 83 normal and 83 NTG eyes. We measured corneal-compensated IOP (IOPcc), Goldmann-correlated IOP (IOPg), corneal resistance factor (CRF), corneal hysteresis (CH) and central corneal thickness (CCT) three times each for normal and NTG eyes using an Ocular Response Analyzer (ORA). No significant difference in CCT was seen between normal eyes (541.4 ± 26.8 μm) and NTG eyes (535.4 ± 24.9 μm; p = 0.16). IOPcc was significantly higher in NTG eyes (16.1 ± 2.6 mmHg) than in normal eyes (15.1 ± 2.9 mmHg; p = 0.01), while IOPg was significantly lower in NTG eyes (14.1 ± 2.7 mmHg) than in normal eyes (15.1 ± 3.0 mmHg; p = 0.04). CRF and CH were significantly lower in NTG eyes (CRF, 8.9 ± 1.5 mmHg; CH, 9.2 ± 1.3 mmHg) than in normal eyes (CRF, 10.6 ± 1.4 mmHg; CH, 10.8 ± 1.3 mmHg; p < 0.0001 each). IOPcc was significantly higher in NTG eyes than in normal eyes. The ORA may be useful for distinguishing between the IOPcc of NTG eyes with normal IOP and that of normal eyes. In addition, the ORA enables CRF and CH to be measured in vivo, and weakness of the lamina cribrosa may be clinically inferred from the fact that CRF and CH were reduced in NTG eyes in our study. Low CRF and CH may be clues to the pathology of NTG. © 2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation.
Lee, Jacky W. Y.; Fu, Lin; Chan, Jonathan C.H.; Lai, Jimmy S. M.
Abstract To investigate intraocular pressure (IOP) related patterns before and after selective laser trabeculoplasty (SLT) for normal tension glaucoma (NTG). In this prospective cohort study, 18 NTG patients underwent SLT. Success was defined as IOP reduction ≥20% by Goldmann applanation tonometry. 24-hour IOP-related pattern recording with a contact lens sensor (CLS) (SENSIMED Triggerfish®, Sensimed, Switzerland) was done before (baseline) and 1 month after SLT. A cosine function was fitted ...
Kung, Jennifer S.; Daniel Y Choi; Cheema, Anjum S.; Kuldev Singh
To summarize the role of cataract surgery in the glaucoma patient, in terms of the effect on intraocular pressure (IOP) as well as diagnostic and therapeutic considerations for those with both conditions. Recent evidence suggests that cataract extraction may produce a significant and sustained IOP reduction in individuals with open-angle glaucoma, ocular hypertension, and angle-closure glaucoma. Cataract removal may improve the practitioner's ability to interpret perimetric testing, and re-es...
There have been relationships between inflammatory cell count and glaucoma. Eosinophils have inverse relationship with steroids which is used to induce ocular hypertension. Here we compare hematological parameters for a group of 68 chronic open-angle glaucoma (OAG) patients and a non-glaucomatous group of 71.
Häntzschel, Janek; Terai, Naim; Furashova, Olga; Pillunat, Karin; Pillunat, Lutz E
The aim of this study was to investigate differences in the nerve fiber layer and glaucoma-induced structural optic nerve head (ONH) damage in patients with normal- (NTG) and high-tension (HTG) glaucoma. In this retrospective pair-matched comparative study, 22 NTG and 22 HTG eyes were matched according to the same glaucomatous damage based on rim volume, rim area and disk size, as measured by Heidelberg retinal tomography (HRT III). Visual fields (VF) were assessed by Humphrey perimetry, and nerve fiber layer thickness was determined both by scanning laser polarimetry (GDxVCC) and spectral-domain optical coherence tomography (SD-OCT). Comparisons of all measured parameters were made between NTG and HTG groups. Based on HRT results, both NTG and HTG eyes displayed comparable structural damage to the ONH (NTG/HTG, mean: disk area, 2.30/2.31 mm(2), p = 0.942; rim area, 1.02/0.86 mm(2), p = 0.082; rim volume, 0.19/0.17 mm(3), p = 0.398). NTG eyes had significantly less VF damage than HTG eyes (NTG/HTG, mean deviation: -4.23/-12.12 dB, p = 0.002; pattern standard deviation: 5.39/8.23 dB, p = 0.022). The inferior nerve fiber layer of NTG patients was significantly thicker than that of HTG patients (NTG/HTG, mean: GDx inferior: 53.5/46.3 µm, p = 0.046). SD-OCT revealed a significantly thicker nerve fiber in NTG compared with HTG patients in all quadrants (NTG/HTG, total mean: 72.72/58.45 µm, p = 0.002). At comparable glaucomatous stages, nerve fiber loss was more advanced in HTG patients compared with NTG patients.
lowering intraocular pressure have been shown to be unable to prevent progressive vision loss in some glaucoma. 7,8,9,10 patients . Most patients with elevated IOP never develop glaucoma, many patients who do not have statistically elevated pressure (low tension glaucoma) as well as many patients with controlled IOP ...
Lee, Jacky Wy; Ho, Wing Lau; Chan, Jonathan Ch; Lai, Jimmy Sm
Normal tension glaucoma (NTG) is commonly treated with anti-glaucoma medications. Recently, selective laser trabeculoplasty (SLT) has been demonstrated to lower the intraocular pressure (IOP) and medication use in NTG. The purpose of this study was to investigate the efficacy of a single session of SLT for NTG at 1 year. This prospective cohort study recruited NTG patients taking anti-glaucoma medication. Potential subjects were excluded if they had had previous glaucoma surgery or laser and also if intraocular surgery or additional SLT procedures were performed after the first treatment. All subjects underwent a 1-month washout. A 30% IOP reduction was set as the target IOP. A single session of SLT was performed to 360 degrees of the trabecular meshwork. At 1-month after SLT, medication was resumed to achieve the target IOP. The IOP was measured every 3 months, and the number of medications was recorded at 3, 6, and 12 months. Only the right eye was used for statistical analysis. In 41 right eyes, the mean pre-study IOP was 14.3 ± 3.4 mmHg while on 1.5 ± 0.8 eye drops. The post-washout IOP was 16.2 ± 2.2 mmHg. A mean of 191.1 ± 26.3 SLT shots at 1.0 ± 0.07 mJ were applied. There was significant IOP reduction at all time intervals following SLT when compared to the post-washout IOP (P 1). The number of medications was significantly reduced at all time intervals following SLT when compared to the pre-study level (P 1). At 12 months, the mean IOP was 12.2 ± 2.2 mmHg while on 1.1 ± 0.9 eye drops. A single session of SLT for NTG achieved an additional 15% IOP reduction while using 27% less medication at 1 year compared to pre-study levels. The Clinical Trials Register of the University of Hong Kong HKCTR1847 The European Clinical Trials Database 2014-003305-15 (August 11, 2014) ( https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-003305-15 ).
Harju, Mika; Suominen, Sakari; Allinen, Pasi; Vesti, Eija
To study the long-term outcome of deep sclerectomy with and without mitomycin-C (MMC) in patients with normal-tension glaucoma (NTG). We prospectively analysed consecutive patients randomized to surgery performed either with (MMC group) or without (non-MMC) MMC. Surgery was considered totally successful if, after surgery, the preoperative intra-ocular pressure (IOP) level was reduced by 25% without medication, and a qualified success if medication was required to achieve the same limits. A total of 37 patients were enrolled, 15 in the MMC and 22 in the non-MMC group. The median (range) follow-up was 7.9 (1.0-9.0) years, with a drop-out of three (8%) patients. The preoperative IOP was 15 (11-21) mmHg in the MMC and 15 (10-19) mmHg in the non-MMC group. At the last 6- to 9-year follow-up, IOP was significantly reduced to 9 (2-13) mmHg (p = 0.002) and 10 (5-13) mmHg (p MMC and non-MMC groups (p = 0.14). Needling with MMC injection was performed 0 (0-1) times in the MMC group and 0.5 (0-4) times in the non-MMC group (p = 0.056). We encountered no cases of hyphema, shallow anterior chamber, hypotony maculopathy, choroidal effusion, late bleb leakage, blebitis, endophthalmitis or malignant glaucoma. In NTG, long-term significant IOP reduction can be achieved with deep sclerectomy with a low incidence of sight-threatening complications. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Sripriya, S; Nirmaladevi, J; George, R; Hemamalini, A; Baskaran, M; Prema, R; Ve Ramesh, S; Karthiyayini, T; Amali, J; Job, S; Vijaya, L; Kumaramanickavel, G
Optineurin gene (OPTN) mutations are reported in primary open angle glaucoma patients (POAG) from different populations. The coding and noncoding regions of OPTN were screened for mutations in 100 Indian high tension glaucoma patients (HTG). The frequency of the OPTN M98K mutation in an additional 120 patients (70 HTG and 50 normal tension glaucoma [NTG]) was analyzed by restriction enzyme digestion. The HTG patients (about 40 years of age) were characterized by open angles on gonioscopy, with raised intraocular pressure (IOP) more than 21 mmHg (A polymorphism was attempted with AliBaba software (version 2.1). Six sequence alterations were observed in the 100 POAG patients by direct sequencing. The M98K substitution was observed in a total of 10 patients (7/170 HTG and 3/50 NTG) contributing to 4.1% in HTG and 6% in the NTG group and not in the controls. The IVS7+24G>A nucleotide change showed a significant difference in the HTG group (7/100) when compared to the control group (0/100) and found to be associated with increased IOP at diagnosis (p=0.03). The IVS7+24G>A polymorphism resulted in the creation of binding sites for transcription factors NF-1 and CPE that were not present in the wild type. The current study suggests a possible role of SNPs rather than mutations in OPTN in POAG pathology in the Indian population.
Lin, Michelle P; Ekşioğlu, Ümit; Mudumbai, Raghu C; Slabaugh, Mark A; Chen, Philip P
To examine the development and management of glaucoma in patients with ocular chemical burns. Retrospective, observational case series. setting: University of Washington Eye Clinics. patient population: Twenty-nine eyes (18 patients) with ocular chemical burns seen between 1997 and 2010 with a minimum of 3 months of follow-up. observation procedure: Eyes were graded using the Roper-Hall scale. main outcome measures: Long-term use of glaucoma medications (3 months or more) and need for glaucoma surgery. The mean age was 45 ± 17 years, with a mean follow-up of 75 ± 47 months (median, 66 months). Roper-Hall grade III or IV eyes (n = 20) had significantly higher intraocular pressure at presentation (35.9 vs 16.4 mm Hg; P = .001) and over follow-up were more likely to require long-term glaucoma medications (P = .003) or to undergo glaucoma surgery (P = .016) than Roper-Hall grade I or II eyes. Thirteen eyes (12 Roper-Hall grade III or IV) underwent glaucoma surgery. Eight eyes underwent glaucoma tube implant surgery; 4 required at least 1 revision. Seven eyes underwent diode laser cyclophotocoagulation; 4 required repeat treatment. Most (89%) eyes had controlled intraocular pressure at the last follow-up. However, 76% of eyes with visual acuity of 20/200 or worse at initial evaluation did not have improved vision at the last follow-up. Eyes with Roper-Hall grade III or IV ocular chemical burns were more likely to have glaucoma and to require surgery for it. Outcomes of glaucoma management generally were good, although tube implant surgeries often had complications requiring revision. Copyright © 2012 Elsevier Inc. All rights reserved.
Hu, Cindy X.; Zangalli, Camila; Hsieh, Michael; Gupta, Lalita; Williams, Alice L.; Richman, Jesse
Abstract: Background: Vision loss from glaucoma has traditionally been described as loss of “peripheral vision.” In this prospective study, we aimed to improve our clinical understanding of the visual symptoms caused by glaucoma by asking patients specific detailed questions about how they see. Methods: Patients who were clinically diagnosed with various types and stages of glaucoma were included. All had a comprehensive ocular examination, including Octopus visual field testing. Patients were excluded if they had other ocular conditions that affected their vision, including cornea, lens or retina pathologies. Patients responded to an oral questionnaire about their visual symptoms. We investigated the visual symptoms described by patients with glaucoma and correlated the severity of visual field loss with visual symptoms reported. Results: Ninety-nine patients completed the questionnaire. Most patients (76%) were diagnosed with primary open-angle glaucoma. The most common symptoms reported by all patients, including patients with early or moderate glaucoma, were needing more light and blurry vision. Patients with a greater amount of field loss (Octopus mean defect >+9.4 dB) were more likely to report difficulty seeing objects to one or both sides, as if looking through dirty glasses and trouble differentiating boundaries and colors. Conclusions: Vision loss in patients with glaucoma is not as simple as the traditional view of loss of peripheral vision. Needing more light and blurry vision were the most common symptoms reported by patients with glaucoma. PMID:24992392
Karanjit S Kooner
Full Text Available Karanjit S Kooner1, Mohannad AlBdoor1, Byung J Cho3, Beverley Adams-Huet21Department of Ophthalmology, 2Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA; 3Konkuk University Hospital, Seoul, KoreaAims: To determine which risk factors for blindness were most critical in patients diagnosed with high tension primary open angle glaucoma (POAG in a large ethnically diverse population managed with a uniform treatment strategy.Methods: A longitudinal observational study was designed to follow 487 patients (974 eyes with POAG for an average of 5.5 ± 3.6 years. Detailed ocular and systemic information was collected on each patient and updated every six months. For this study, blindness was defined as visual acuity of 20/200 or worse and/or visual field less than 20° in either eye. Known risk factors were compared between patients with blindness in at least one eye versus nonblind patients.Results: The patients with blindness had on average: higher intraocular pressure (IOP, mmHg: (24.2 ± 11.2 vs. 22.1 ± 7.7, p = 0.03, wide variation of IOP in the follow-up period (5.9 vs. 4.1 mmHg, p = 0.031, late detection (p = 0.006, poor control of IOP (p < 0.0001, and noncompliance (p < 0.0003. Other known risk factors such as race, age, myopia, family history of glaucoma, history of ocular trauma, hypertension, diabetes, vascular disease, smoking, alcohol abuse, dysthyoidism, and steroid use were not significant.Conclusions: The most critical factors associated with the development of blindness among our patients were: elevated initial IOP, wide variations and poor control of IOP, late detection of glaucoma, and noncompliance with therapy.Keywords: primary open angle glaucoma, blindness, intraocular pressure, risk factors, and noncompliance
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Full Text Available OBJECTIVE: The aim of this study was to determine the prevalence of open angle glaucoma in first-degree relatives accompanying POAG patients during routine examination in a reference hospital. METHOD: First-degree relatives of primary open angle glaucoma patients who accompanied their relatives to the glaucoma service of a reference hospital were screened for glaucoma. RESULTS: One-hundred and one first-degree relatives were examined, of which 56.4% had never had their intraocular pressure measured. 10.9% had previously been diagnosed with glaucoma, and 5.9% were newly diagnosed during this study. CONCLUSIONS: The eye examination of first-degree relatives identified a significant percentage of individuals with glaucoma. Despite being first-degree relatives of glaucoma patients, 56.4% of the companions had never had their eye pressure measured, demonstrating a lack of awareness about this disease.
Nuyen, Brenda; Mansouri, Kaweh
Lowering intraocular pressure (IOP) remains the guiding principle of glaucoma management. Although IOP is the only treatable risk factor, its 24-hour behavior is poorly understood. Current glaucoma management usually relies on single IOP measurements during clinic hours, even though IOP is a dynamic parameter with rhythms dependent on individual patients. It has further been shown that most glaucoma patients have their highest IOP measurements outside clinic hours. The fact that these IOP peaks go largely undetected may explain why certain patients progress in their disease despite treatment. Nevertheless, single IOP measurements have determined all major clinical guidelines regarding glaucoma treatment. Other potentially informative parameters, such as fluctuations in IOP and peak IOP, have been neglected, and effects of IOP-lowering interventions on such measures are largely unknown. Continuous 24-hour IOP monitoring has been an interest for more than 50 years, but only recent technological advances have provided clinicians with a device for such an endeavor. This review discusses current uses and shortcomings of current measurement techniques, and provides an overview on current and future methods for 24-hour IOP assessment. It may be possible to incorporate continuous IOP monitoring into clinical practice, potentially to reduce glaucoma-related vision loss.
Kim, Sewon; Kim, Kyunglan; Heo, Dong Won; Kim, Jong-Sung; Park, Chan Kee; Kim, Chang-sik; Kang, Changwon
The human CAV1-CAV2 locus has been associated with susceptibility to primary open-angle glaucoma in four studies of Caucasian, Chinese, and Pakistani populations, although not in several other studies of non-Korean populations. In this study with Korean participants, the CAV1-CAV2 locus was investigated for associations with susceptibility to primary open-angle glaucoma accompanied by elevated intraocular pressure (IOP), namely, high-tension glaucoma (HTG), as well as with IOP elevation, which is a strong risk factor for glaucoma. Two single nucleotide polymorphisms (SNPs) were genotyped in 1,161 Korean participants including 229 patients with HTG and 932 healthy controls and statistically examined for association with HTG susceptibility and IOP. One SNP was rs4236601 G>A, which had been reported in the original study, and the other SNP was rs17588172 T>G, which was perfectly correlated (r2=1) with another reported SNP rs1052990. Expression quantitative trait loci (eQTL) analysis was performed using GENe Expression VARiation (Genevar) data. Both SNPs were associated with HTG susceptibility, but the rs4236601 association disappeared when adjusted for the rs17588172 genotype and not vice versa. The minor allele G of rs17588172 was associated significantly with 1.5-fold increased susceptibility to HTG (p=0.0069) and marginally with IOP elevation (p=0.043) versus the major allele T. This minor allele was also associated with decreased CAV1 and CAV2 mRNA in skin and adipose according to the Genevar eQTL analysis. The minor allele G of rs17588172 in the CAV1-CAV2 locus is associated with decreased expression of CAV1 and CAV2 in some tissues, marginally with IOP elevation, and consequently with increased susceptibility to HTG.
Full Text Available Purpose. Vascular risk factors are important factors in the pathogenesis of glaucoma. The purpose of this research was to investigate retrobulbar hemodynamics and visual field progression in patients with normal tension glaucoma (NTG. Patients and Methods. 31 eyes of 16 patients with NTG were included in a retrospective long-term follow-up study. Colour Doppler imaging was performed at baseline to determine various CDI parameters in the different retrobulbar vessels. The rate of visual field progression was determined using the Visual Field Index (VFI progression rate per year (in %. To be included in the analysis, patients had at least 4 visual field examinations with a follow-up of at least 2 years. Results. Mean follow-up was 7.6 ± 4.1 years with an average of 10 ± 5 visual field tests. The mean MD (mean defect at baseline was −7.61 ± 7.49 dB. The overall VFI progression was −1.14 ± 1.40% per year. A statistical significant correlation between VFI progression and the RI of the NPCA and PSV of the CRA was found. Conclusion. Long-term visual field progression may be linked to impaired retrobulbar hemodynamics in patients with NTG only to a limited degree. Interpretation of the data for an individual patient seems to be limited due to the variability of parameters.
Full Text Available Purpose: To evaluate the correlation of Humphrey visual field (VF parameters (MD and PSD with Heidelberg Retina Tomograph (HRT 3 and Stratus optical coherence tomography (OCT parameters in patients with primary open-angle glaucoma (POAG, normal-tension glaucoma (NTG and ocular hypertension (OHT. Material and Method: Fifty-five eyes of 29 POAG patients, 32 eyes of 16 OHT patients and 26 eyes of 13 NTG patients were enrolled in the study prospectively. Humphrey visual field test as well as optic nerve head and retinal nerve fiber layer (RNFL thickness analysis with HRT 3 and Stratus OCT were performed in all patients; the measurements were repeated every 6 months. Results: The mean age of the patients was 66.4±10.0 years and the mean follow-up time was 22±2.2 months. In POAG and NTG groups, MD and PSD correlated with all analyzed parameters in HRT, except for the height variation contour (HVC. In POAG group, MD and PSD values correlated with all analyzed parameters in OCT, except for the rim area (RA. In NTG group, correlation was found between MD values and all parameters in OCT. In NTG group, PSD correlated with all parameters in OCT, except for the RNFL thickness. In OHT group, no correlation was found between MD, PSD values and HRT parameters. In OHT group, only RA values in OCT correlated with MD and PSD. In all groups, there was no statistically significant difference between the first and last examinations for MD and PSD values and for the mean RNFL thickness measured with OCT and HRT. Discussion: In our study, it was found that in POAG and NTG patients, there was a general correlation of Humphrey VF parameters with HRT 3 and Stratus OCT parameters. (Turk J Ophthalmol 2011; 41: 143-50
Shrivastava, Anurag; Madu, Assumpta; Schultz, Jeffrey
Patients considering corneal refractive surgery undergo extensive preoperative testing, but current protocols may not address the management of glaucoma appropriately. This review outlines the current body of literature on the diagnostic and management challenges that exist in the treatment of glaucoma patients undergoing laser ablative surgery, and makes recommendations to improve current perioperative protocols. As permanent structural alterations to the cornea after laser-assisted in-situ keratomileusis surgery make Goldmann applanation tonometry inaccurate, the advent of new diagnostic modalities and recommendations to accurately measure postoperative intraocular pressure (IOP) and subtle damage to the optic nerve have been further analyzed and tested. As IOP is the only modifiable risk factor in the treatment of glaucoma to date, traditional diagnostic and treatment algorithms may not be appropriate for refractive surgery patients. Glaucoma remains a relative contraindication to refractive procedures, but as new diagnostic modalities emerge, our ability to diagnose and manage these patients may improve. More uniform recommendations need to be implemented to improve our long-term management of these patients.
Grise-Dulac, Alice; Saad, Alain; Abitbol, Olivia; Febbraro, Jean-Luc; Azan, Elodie; Moulin-Tyrode, Christine; Gatinel, Damien
To assess the biomechanical properties of corneas in patients with normal tension glaucoma (NTG) and to compare them with those of patients with primary open-angle glaucoma (POAG), ocular hypertension (OHT), and normal controls (N). Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann intraocular pressure (IOPg), and corneal compensated IOP (IOPcc) were obtained using an ocular response analyzer for 28 eyes in 14 patients with NTG, 75 eyes in 38 patients with chronic POAG, 53 eyes of 27 patients with OHT, and 44 eyes of 22 N controls. IOP using Goldmann applanation tonometry (IOPGA) and ultrasonic central corneal thickness (CCT) were also measured for each eye. Analysis of variance test was used for statistical analysis. CH was significantly lower in the NTG group (9.88±2.02 mm Hg) compared with the N group (11.05±1.53 mm Hg; P<0.01). CRF was significantly lower in the NTG group (9.5±1.89 mm Hg) compared with the POAG group (11.15±2.35 mm Hg; P<0.01) and to the N group (11.00±1.75 mm Hg; P<0.01). CCT was not considered significantly different between the 4 groups. However, IOPcc was found to be significantly lower in NTG group compared with the POAG group and OHT group (P<0.001). NTG was associated with significantly lower CRF than chronic POAG and N patients. CH and CRF could be a useful tool in early diagnosis of NTG.
Bae, Hyoung Won; Ji, Yongwoo; Lee, Hye Sun; Lee, Naeun; Hong, Samin; Seong, Gong Je; Sung, Kyung Rim; Kim, Chan Yun
Normal-tension glaucoma (NTG) is a heterogenous disease, and there is still controversy about subclassifications of this disorder. On the basis of spectral-domain optical coherence tomography (SD-OCT), we subdivided NTG with hierarchical cluster analysis using optic nerve head (ONH) parameters and retinal nerve fiber layer (RNFL) thicknesses. A total of 200 eyes of 200 NTG patients between March 2011 and June 2012 underwent SD-OCT scans to measure ONH parameters and RNFL thicknesses. We classified NTG into homogenous subgroups based on these variables using a hierarchical cluster analysis, and compared clusters to evaluate diverse NTG characteristics. Three clusters were found after hierarchical cluster analysis. Cluster 1 (62 eyes) had the thickest RNFL and widest rim area, and showed early glaucoma features. Cluster 2 (60 eyes) was characterized by the largest cup/disc ratio and cup volume, and showed advanced glaucomatous damage. Cluster 3 (78 eyes) had small disc areas in SD-OCT and were comprised of patients with significantly younger age, longer axial length, and greater myopia than the other 2 groups. A hierarchical cluster analysis of SD-OCT scans divided NTG patients into 3 groups based upon ONH parameters and RNFL thicknesses. It is anticipated that the small disc area group comprised of younger and more myopic patients may show unique features unlike the other 2 groups.
Full Text Available Shiro Mizoue,1 Tadashi Nakano,2 Nobuo Fuse,3 Aiko Iwase,4 Shun Matsumoto,5 Keiji Yoshikawa6 On behalf of the IOP CHANGE Study Group7 1Department of Ophthalmology, Ehime University Graduate School of Medicine, Ehime, Japan; 2Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan; 3Department of Integrative Genomics, Tohoku Medical Megabank Organization, Miyagi, Japan; 4Tajimi Iwase Eye Clinic, Gifu, Japan; 5Department of Ophthalmology, Tokyo Teishin Hospital, 6Yoshikawa Eye Clinic, Tokyo, Japan; 7IOP CHecked and Assessed in Normal tension Glaucoma by Exceptional Glaucomatologists Study Group, Japan Background: This study aimed to evaluate the effect of travoprost with sofZia® preservative system for lowering the intraocular pressure (IOP of Japanese normal tension glaucoma (NTG patients. Methods: In this prospective, multicenter, open-label study, Japanese NTG patients with baseline IOPs <20 mmHg were enrolled after three consecutive time measurements taken at screening and baseline visits. Travoprost with sofZia® was instilled once daily. Lowering effect on IOP, conjunctival hyperemia, superficial punctate keratopathy, and adverse events were examined at week 4, 8, and 12 after drug instillation. Results: One-hundred and three of the 107 enrolled patients (baseline IOP =15.2±2.0 mmHg [mean ± standard deviation] completed the study. The mean IOP value as well as percent reduction was significantly reduced at each visit after travoprost with sofZia® initiation (P<0.0001. The conjunctival hyperemia score was 1 or less throughout the study, though it increased significantly over time. No significant change was observed in superficial punctate keratopathy. The cumulative incidence of side effects such as eyelash changes, eyelid pigmentation, and deepening of the upper lid was 47.6%, 27.2%, and 16.5%, respectively. Conclusion: Travoprost preserved with sofZia® effectively lowered the IOP of Japanese NTG patients. It was
Glaucoma awareness among ophthalmic patients at Menelik. II Hospital, Addis Ababa, Ethiopia. Hiwot Degineh1, Abeba T. Giorgis1. Abstract. Background: Glaucoma is one of the main causes of blindness worldwide that has been considered as a major public health issue. Raising awareness about glaucoma among the ...
Dilraj S Grewal
Full Text Available To identify the risk factors for development of peripapillary retinal splitting (schisis in patients with glaucoma or suspicion of glaucoma.Glaucoma Clinic, Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL.In this institutional cross-sectional study, 495 patients (990 eyes who had undergone spectral-domain optical coherence tomography (OCT Spectralis HRA-OCT, Heidelberg Engineering optic nerve head (ONH imaging and did not have identifiable optic nerve pits, pseudopits or coloboma were included. OCT scans were reviewed by two observers.Presence of peripapillary retinal splitting identified on OCT raster scans.Eleven of 990 glaucoma and glaucoma suspect eyes (1.1% of 7 patients (2 females, 5 males, mean age 64.5 ± 9.2 years had peripapillary retinal splitting. Two of these 11 eyes had extension of the splitting into the macula but none to the fovea. Of these 11 patients, 2 (28.6% were glaucoma suspects, 3 (42.9% had primary open-angle glaucoma, 1 (14.3% had chronic angle-closure glaucoma and 1 (14.3% had pigmentary glaucoma. 7/11 (63.6% eyes had vitreous traction to the disc visualized on OCT and 6/11 eyes (54.5% had beta-zone peripapillary atrophy.We observed peripapillary retinal splitting in 1.1% of a series of 990 glaucoma and glaucoma-suspect eyes. Evidence of adherent vitreous with traction and peripapillary atrophy was found in a majority of the involved eyes. A comparison to an age and axial length matched cohort is required to determine if this is a condition that is associated with glaucoma.
Grewal, Dilraj S; Merlau, Daniel J; Giri, Pushpanjali; Munk, Marion R; Fawzi, Amani A; Jampol, Lee M; Tanna, Angelo P
To identify the risk factors for development of peripapillary retinal splitting (schisis) in patients with glaucoma or suspicion of glaucoma. Glaucoma Clinic, Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL. In this institutional cross-sectional study, 495 patients (990 eyes) who had undergone spectral-domain optical coherence tomography (OCT Spectralis HRA-OCT, Heidelberg Engineering) optic nerve head (ONH) imaging and did not have identifiable optic nerve pits, pseudopits or coloboma were included. OCT scans were reviewed by two observers. Presence of peripapillary retinal splitting identified on OCT raster scans. Eleven of 990 glaucoma and glaucoma suspect eyes (1.1%) of 7 patients (2 females, 5 males, mean age 64.5 ± 9.2 years) had peripapillary retinal splitting. Two of these 11 eyes had extension of the splitting into the macula but none to the fovea. Of these 11 patients, 2 (28.6%) were glaucoma suspects, 3 (42.9%) had primary open-angle glaucoma, 1 (14.3%) had chronic angle-closure glaucoma and 1 (14.3%) had pigmentary glaucoma. 7/11 (63.6%) eyes had vitreous traction to the disc visualized on OCT and 6/11 eyes (54.5%) had beta-zone peripapillary atrophy. We observed peripapillary retinal splitting in 1.1% of a series of 990 glaucoma and glaucoma-suspect eyes. Evidence of adherent vitreous with traction and peripapillary atrophy was found in a majority of the involved eyes. A comparison to an age and axial length matched cohort is required to determine if this is a condition that is associated with glaucoma.
Glaucoma is a group of diseases that can damage the eye's optic nerve. It is a leading ... no symptoms at first. Without treatment, people with glaucoma will slowly lose their peripheral, or side vision. ...
Full Text Available Purpose. To compare optical coherence tomography angiography (OCT-A and laser speckle flowgraphy (LSFG for the diagnosis of normal-tension glaucoma (NTG. Methods. Twenty-eight eyes of 28 patients with NTG and 25 eyes of 25 normal subjects matched for age, refractive errors, systemic blood pressure, and central corneal thickness were evaluated. OCT-A was used to measure whole image vessel density, inside disc vessel density, and peripapillary vessel density; using LSFG, mean blur rate (MBR inside the whole optic nerve head (ONH area (MBRA, and MBR of the vessel area (MBRV and tissue area (MBRT inside the ONH, were determined. Receiver operating characteristic (ROC curves and areas under the ROC (AUROC were used to assess the diagnostic ability of each variable. Results. The AUROC for OCT-A whole image vessel density (0.950 was significantly greater than that for OCT-A peripapillary vessel density (0.830 and for all LSFG parameters (MBRA = 0.793, MBRV = 0.601, and MBRT = 0.61 (P<0.001. The AUROC for OCT-A inside disc vessel density (0.931 was significantly greater than that for all LSFG parameters (P<0.005. Conclusions. OCT-A vessel density had a higher glaucoma diagnostic ability compared to all LSFG parameters in patients with NTG.
Wostyn, Peter; De Groot, Veva; Van Dam, Debby; Audenaert, Kurt; De Deyn, Peter Paul
To evaluate the evidence supporting a role for senescent changes in cerebrospinal fluid (CSF) circulatory physiology in the pathogenesis of normal-tension glaucoma (NTG). Literature review and personal perspective of the authors. Analysis of selected articles in the peer-reviewed literature with interpretation and perspective. Recent studies have reported that intracranial pressure is lower in patients with NTG when compared with patients with primary open-angle glaucoma and nonglaucomatous control subjects. It has been suggested that a low intracranial pressure in patients with normal intraocular pressure could lead to glaucomatous damage. This low intracranial pressure, leading to an abnormally high trans-lamina cribrosa pressure difference, could result in barotraumatically induced optic nerve damage at the lamina cribrosa. However, several experimental studies do not support the speculation that low intracranial pressure and the resulting pressure-dependent effects cause bowing back of the lamina cribrosa and optic disc cupping. On the other hand, CSF production and turnover have been shown to be decreased in aging and in pathologic conditions, such as Alzheimer disease and normal pressure hydrocephalus. Interestingly, recent studies have revealed that both Alzheimer disease patients and patients with normal pressure hydrocephalus may have a higher risk of developing glaucoma. Therefore, we believe that CSF circulatory failure, ultimately resulting in reduced neurotoxin clearance along the optic nerves, could be an alternative explanation as to why glaucoma develops in patients with low intracranial pressure. On the basis of the evidence available from the peer-reviewed literature, our tentative conclusion is that age-related changes in CSF circulatory physiology and the subsequent decrease in CSF turnover, with diminished clearance of toxic substances, can account for, at least in part, the pathogenesis of NTG. It should be stressed that for the moment at
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Mathews, Priya M.; Ramulu, Pradeep Y.; Friedman, David S.; Utine, Canan A.; Akpek, Esen K.
Purpose To evaluate the subjective and objective measures of ocular surface disease in patients with glaucoma. Design Cross-sectional study. Participants Sixty-four glaucoma subjects with bilateral visual field (VF) loss and 59 glaucoma suspects with normal VFs. Methods Consecutive patients were recruited prospectively from the Wilmer Eye Institute Glaucoma Clinic. Main Outcome Measures Tear film breakup time (TBUT), corneal staining score (0–15), and Schirmer’s test results were included as objective metrics, whereas the Ocular Surface Disease Index (OSDI) questionnaire was administered to assess symptoms. Total OSDI score, vision-related subscore (derived from questions about vision and task performance), and discomfort-related subscore (derived from questions about ocular surface discomfort) were calculated for each subject. Results Seventy-five percent (48/64) of glaucoma subjects and 41% (24/59) of glaucoma suspects were receiving topical medications. The corneal staining grade was greater in glaucoma subjects than in glaucoma suspects (6.4 vs. 4.1; P0.20 for both). Multivariate regression models showed that topical glaucoma therapy burden was associated with a significantly higher total corneal staining grade (β, +0.9 for each additional glaucoma drop; 95% confidence interval [CI], 0.5–1.3; P0.20 for both). Glaucoma subjects had significantly higher total OSDI scores than glaucoma suspects (16.7 vs. 7.9; Pglaucoma group (11.1 vs. 3.3; Pglaucoma therapy burden was not associated with higher total OSDI score or vision- or discomfort-related subscore (P>0.20 for all). Conclusions Glaucoma is associated with significant ocular surface disease, and topical glaucoma therapy burden seems predictive of corneal staining severity. However, OSDI is a poor metric for capturing ocular surface disease in glaucoma because symptoms seem to be related largely to VF loss. PMID:23714318
Wostyn, Peter; De Groot, Veva; Van Dam, Debby; Audenaert, Kurt; De Deyn, Peter Paul
PURPOSE: To evaluate the evidence supporting a role for senescent changes in cerebrospinal fluid (CSF) circulatory physiology in the pathogenesis of normal-tension glaucoma (NTG). DESIGN: Literature review and personal perspective of the authors. METHODS: Analysis of selected articles in the
Full Text Available The present study was conducted to study the topical steroid response in glaucoma suspects and family members of established glaucoma patients and its hereditary pattern The cases understudy were divided into three groups, namely normal (25 cases, suspected open angle glaucoma cases (20 and family members of established open angle glaucoma cases (33. After preliminary examination each patient was advised to put dexamethasone drop 1 % in one eye and a placebo in other eye. The IOP was noted after three weeks It was found that 80% of all eyes under study showed a rise in IOP after use of topical dexamethasone. The highest mean IOP was found in primary open angle glaucoma suspects, and the highest mean post-corticosteroid rise in IOP of 8.91 mm Hg was found among family members of established open angle glaucoma patients. The lOP response to topical corticosteroids was found to be of three phenotypical types viz., poor responders (nn, moderate responders (ng and high responders (gg. Normal subjects were generally poor responders. Suspected open angle glaucoma cases were generally high responders. However, family members of established open angle glaucoma cases showed the highest percentage of presence of responder gene.
Murphy, Melissa L; Pokrovskaya, Olya; Galligan, Marie; O'Brien, Colm
To compare corneal hysteresis (CH) measurements between patients with glaucoma, ocular hypertension (OHT) and glaucoma-like optic discs (GLD)- defined as a cup to disc ratio greater than or equal to 0.6 with normal intraocular pressure (IOP) and visual fields. The secondary aim was to investigate whether corneal resistance factor (CRF) and central corneal thickness (CCT) differ between patient groups. In this cross sectional study a total of 123 patients (one eye each) were recruited from a glaucoma outpatient department to undergo ocular response analyser (ORA) testing and ultrasound pachymetry as well as clinical examination. A One-way Analysis of Covariance (ANCOVA) was conducted to evaluate the mean difference in CH between the three diagnostic groups (glaucoma, OHT and GLD) correcting for potential confounding factors, IOP and age. Analysis was repeated for CRF and CCT. There was a significant difference in mean CH across the three diagnosis groups; F(2, 115) = 96.95; p glaucoma (mean difference 1.83, p glaucoma (mean difference 2.35, p glaucoma suggests increased viscoelasticity of ocular tissues may have a protective role against glaucoma.
Soroka, Mort; Krumholz, David M; Wende, Joseph
Glaucoma is one of the leading causes of impaired vision and blindness in the United States. An understanding of the disease process and its risk factors by patients is essential if its consequences are to be mitigated. Among the known risk factors, family history is one that can help promote awareness for early recognition and treatment among potential patients. This study reports on the responses to a questionnaire by glaucoma patients on their use of vision care, their understanding of their disease, and whether they shared their medical history with other family members. A survey was mailed to members of a national vision care benefits plan who received an eye examination with a diagnosis of glaucoma. Patients were identified by diagnosis through the managed care organization's management information system. A survey instrument was designed to determine family history, use of vision care, medications used, and basic knowledge of glaucoma. One hundred forty-eight surveys were returned; two thirds were from glaucoma patients and one third from glaucoma suspects. The frequency of eye examinations and the reason for their most recent examination differed between the 2 groups. Most glaucoma patients informed relatives of their condition. As expected, glaucoma patients were better educated than the glaucoma suspect group; however, knowledge of the disease process and its consequences was lacking even among those who were taking glaucoma medication. Some glaucoma patients appear to be unaware as to how glaucoma affects their vision. Understanding one's disease can enhance patient compliance and ensure that the patient returns for continued treatment and management. Patients with poor health literacy (especially with a disease with an asymptomatic beginning stage) are at a higher risk for noncompliance. Copyright © 2010 American Optometric Association. Published by Elsevier Inc. All rights reserved.
Eun Ji Lee
Full Text Available To compare the deep optic nerve head (ONH structure between normal-tension glaucoma (NTG and nonarteritic anterior ischemic optic neuropathy (NAION and also in healthy subjects as a control using enhanced depth imaging (EDI spectral-domain optical coherence tomography (SD-OCT.This prospective cross-sectional study included 21 NAION patients who had been diagnosed as NAION at least 6 months prior to study entry, and 42 NTG patients and 42 healthy controls who were matched with NAION patients in terms of age, intraocular pressure (IOP, and optic disc area. The retinal nerve fiber layer (RNFL thickness in the affected sector was also matched between NAION and NTG patients. The ONH was imaged using SD-OCT with the EDI technique. The anterior lamina cribrosa surface depth (LCD and average prelaminar tissue (PT thickness were measured in a sector of interest in each eye and compared among the three groups.In the sector-matched comparison, LCD was largest in NTG patients, followed by NAION patients, while PT was thinner in NTG patients than in NAION patients (all P < 0.001. NAION patients had a comparable LCD and a thinner PT relative to normal controls (P = 0.170 and < 0.001, respectively.The deep ONH configuration is strikingly different between NTG and NAION. The differing features provide comparative insight into the pathophysiology of the two diseases, and may be useful for differential diagnosis.
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Tsumura, Toyoaki; Yoshikawa, Keiji; Suzumura, Hirotaka; Kimura, Tairo; Sasaki, Satoshi; Kimura, Itaru; Takeda, Ryuji
The aim of this study was to evaluate the efficacy and safety of bimatoprost ophthalmic solution 0.03% (bimatoprost) in Japanese normal-tension glaucoma (NTG) patients with an intraocular pressure (IOP) of 18 mmHg or less. Bimatoprost was instilled into the unilateral conjunctival sac of Japanese NTG patients with a baseline IOP of 18 mmHg or less. The time courses of IOP, conjunctival hyperemia, superficial punctate keratitis, and adverse events were examined at 2, 4, 8, and 12 weeks post bimatoprost instillation. Thirty-two of the 38 enrolled NTG patients (mean age, 64.1 ± 12.6 years; 19 males and 19 females) completed the study, with six patients unable to complete the study (two patients discontinued because of side effects and four patients withdrew). The levels of IOP in the treated eyes were significantly reduced (P superficial punctate keratitis scores were noted between the baseline and each point examined. Eyelash disorder, eyelid pigmentation, and deepening of the upper eyelid sulcus were observed in 28, six, and three eyes, respectively. Bimatoprost effectively lowered the IOP. It was well tolerated in Japanese NTG patients, with few patients having to discontinue because of adverse events.
Cybulska-Heinrich, A.K.; Mozaffarieh, M.
Gingko biloba has been used for hundreds of years to treat various disorders such as asthma, vertigo, fatigue and, tinnitus or circulatory problems. Two of the main extracts are EGb761 and LI 1370. Most pharmacological, toxicological and clinical studies have focused on the neuroprotective value of these two main extracts. Neuroprotection is a rapidly expanding area of research. This area is of particular interest due to the fact that it represents a new avenue of therapy for a frustrating disease that may progress despite optimal treatment. One such disease is glaucoma. Glaucoma leads to the loss of retinal ganglion cells and their axons but also to tissue remodelling which involves both the optic nerve head and the retina. In the retina the astrocytes get activated. In addition, the optic nerve gets thinner and the cells of the lateral geniculate ganglion disappear partially. On average, ocular blood flow (OBF) is reduced in glaucoma patients in various tissues of the eye. Increased intraocular pressure (IOP) is a major risk factor for glaucomatous damage. Nevertheless, there is little doubt that other risk factors besides IOP are involved. One such risk factor is a primary vascular dysregulation (PVD) occurring in patients with a disturbed autoregulation, another risk factor is oxidative stress. PMID:22355250
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Omodaka, Kazuko; Kikawa, Tsutomu; Shiga, Yukihiro; Tsuda, Satoru; Yokoyama, Yu; Sato, Haruka; Ohuchi, Junko; Matsumoto, Akiko; Takahashi, Hidetoshi; Akiba, Masahiro; Nakazawa, Toru
To identify sectors of the optical coherence tomography (OCT) macular map that could be used to effectively assess structural progression in patients with normal-tension glaucoma (NTG). This study examined 117 eyes of 117 NTG patients to establish axonal tract-dependent macular sectors, and also examined a separate group of 122 eyes of 81 NTG patients to evaluate the ability of these sectors to reveal glaucoma progression. Longitudinal data, including macular maps from at least 5 OCT examinations performed over at least 2 years, was available for all patients in this group. Circumpapillary retinal nerve fiber layer thickness (cpRNFLT), temporal clockwise sector scans (from 7 to 11 o'clock), macular retinal nerve fiber layer thickness (mRNFLT), and macular ganglion cell layer plus inner plexiform layer thickness (mGCIPLT) were measured with spectral-domain OCT (3D OCT-2000, TOPCON). The axonal tract-dependent macular sectors were identified by calculating Spearman's rank correlation coefficient for each point on a grid overlaid on the macular map and cpRNFLT in each clockwise scan sector. Trend and event analyses for the slope of progression in each sector and macular map were performed. Visual field progression in the macula was defined by the presence of more than 2 progressive test points in the 16 central test points of the Humphrey field analyzer SITA standard 24-2 program, evaluated with Progressor software. The slope of progression in the entire macular area was -0.22 ± 0.58 μm/year for mRNFLT and -0.35 ± 0.52 μm/year for mGCIPLT. The fastest-progressing mRNFLT sector (-1.00 ± 0.84 μm/year, p OCT macular sectors could effectively reveal structural change in patients with NTG. Furthermore, mRNFLT slope was consistent with visual field progression. This method promises to open new avenues for the OCT-based evaluation of glaucoma progression.
Mohindroo, Chirayu; Ichhpujani, Parul; Kumar, Suresh
Poor knowledge, attitude and self-care practices (KAP) as regards medication compliance is a major concern in the management of glaucoma. This study aims to evaluate the knowledge, attitude regarding eyedrop instillation and self-care practices pertaining to eyedrops in diagnosed glaucoma patients. In this cross-sectional, open-ended questionnaire-based study, 101 consecutive glaucoma patients on medication were recruited from an urban tertiary care hospital of North India. A self-designed 10-point KAP questionnaire that addressed patient-, medication-, environment- and physicians related factors was used. For each desirable answer, the participant gives a score of 1 was given and for each undesirable answer a score of '0' was given for each question. The total scores for each domain were calculated separately along with the total score. The association between the individual domain scores, the total score and various sociodemographic parameters were compared using unpaired t-test. Analysis of variance (ANOVA) test was used to compare the means, where the exposure variable had more than two categories. Out of 101 participants, 98% knew the reason why they were instilling the medicine. Only 61.4% subjects knew that the eyedrops should be stored in cool and dry place. Nearly 30% participants believed that two eyedrops could be instilled back to back. Half of the participants (55.4%) did not consider missing a dose of medicine to be significant. Majority (89.1%) of the participants asked the doctor about the drug dosage and timings and 71.3% of them did not use the eyedrops beyond 40 days after opening the vial. 37.6% participants believed that the medicine could be discontinued without asking the doctor, once the symptoms are relieved. Eighty percent patients checked the vial for correct drug name and expiry date before buying. 57.4% of the participants washed their hands before instilling the eyedrops. Only 23.8% patients asked their doctor for alternate medication
Foo, Valencia Hui Xian; Tan, Sarah En Mei; Chen, David Ziyou; Perera, Shamira A; Sabayanagam, Charumathi; Fenwick, Eva Katie; Wong, Tina T; Lamoureux, Ecosse L
The aim of this study was to evaluate patients' dissatisfaction with overall and specific aspects of a tertiary glaucoma service and to determine their independent factors, including intraocular pressure (IOP) and visual acuity (VA). Patients, aged ≥21 years, from a specialist glaucoma service in a tertiary eye hospital in Singapore for at least 6 months, were recruited for this cross-sectional study between March and June 2014. All consenting patients completed a 7-area glaucoma-specific satisfaction questionnaire and one item related to satisfaction with overall glaucoma care. We determined the top three areas of dissatisfaction and overall dissatisfaction with the glaucoma service. We also explored the independent factors associated with overall and specific areas of patients' dissatisfaction with their glaucoma care, including VA and IOP by using logistic regression models. Of the 518 patients recruited, 438 (84.6%) patients completed the study. Patients' dissatisfaction with the overall glaucoma service was 7.5%. The three areas of glaucoma service with the highest dissatisfaction rates were as follows: 1) explanation of test results (24.8%); 2) explanation of glaucoma complications (23.7%); and 3) advice on managing glaucoma (23.5%). Patients who were dissatisfied with the overall service had a worse mean VA compared with satisfied patients (logarithm of the minimum angle of resolution =0.41±0.43 vs 0.27±0.49, p=0.005), whereas mean IOP remained well-controlled in both the groups (13.55±2.46 mmHg vs 14.82±2.86 mmHg, p=0.014). In adjusted models, factors associated with overall dissatisfaction with glaucoma care included a pre-university education and above (odds ratio [OR] =8.06, 95% CI =1.57-41.27) and lower IOP (OR =0.83, 95% CI =0.71-0.98). Although less than one tenth of glaucoma patients were dissatisfied with the overall glaucoma service, one in four patients were dissatisfied with three specific aspects of care. A lower IOP, ironically, and
Full Text Available Samsul Islam, Ahmad Salha, Saeed Azizi Faculty of Medicine, St George’s Hospital Medical School, London, UKWe read the article by Foo et al1 with great interest. We were intrigued by the factors influencing satisfaction rates among glaucoma patients. It made us question what changes could be made in the future attempting to improve patient satisfaction.\tSimilar to Foo et al,1 we were also surprised to find a lower end-point intraocular pressure was linked with increased patient dissatisfaction. As stated by Foo et al,1 other studies exploring clinical outcomes and patient satisfaction found that a positive clinical state was linked to higher patient satisfaction. Prakash2 proposes a three-way association between patient satisfaction, increased compliance, and better clinical outcomes. Hence, in attempting to investigate patient satisfaction, it would be appropriate to assess patient compliance and clinical outcomes.View the original paper by Foo and colleagues.
Choi, Yun Jeong; Kim, Martha; Park, Ki Ho; Kim, Dong Myung; Kim, Seok Hwan
To investigate the risk and risk factors for newly developed visual impairment in treated patients with normal-tension glaucoma (NTG) followed up on for 10 years. Patients with NTG, who did not have visual impairment at the initial diagnosis and had undergone intraocular pressure (IOP)-lowering treatment for more than 7 years, were included on the basis of a retrospective chart review. Visual impairment was defined as either low vision (0.05 [20/400] ≤ visual acuity (VA) visual field (VF) visual impairment, Kaplan-Meier survival analysis and generalized linear mixed effects models were utilized. During the 10.8 years mean follow-up period, 20 eyes of 16 patients were diagnosed as visual impairment (12 eyes as low vision, 8 as blindness) among 623 eyes of 411 patients. The cumulative risk of visual impairment in at least one eye was 2.8% at 10 years and 8.7% at 15 years. The risk factors for visual impairment from treated NTG were worse VF mean deviation (MD) at diagnosis and longer follow-up period. The risk of newly developed visual impairment in the treated patients with NTG was relatively low. Worse VF MD at diagnosis and longer follow-up period were associated with development of visual impairment. © 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Purpose: To compare the clinical features of glaucoma patients who present at a rural hospital in North Eastern Ghana and an urban hospital in the capital city of Accra. Methods: This is a multi-center retrospective case series involving records of newly diagnosed glaucoma patients with emphasis on primary open angle ...
Mizoue, Shiro; Nakano, Tadashi; Fuse, Nobuo; Iwase, Aiko; Matsumoto, Shun; Yoshikawa, Keiji
This study aimed to evaluate the effect of travoprost with sofZia® preservative system for lowering the intraocular pressure (IOP) of Japanese normal tension glaucoma (NTG) patients. In this prospective, multicenter, open-label study, Japanese NTG patients with baseline IOPs superficial punctate keratopathy, and adverse events were examined at week 4, 8, and 12 after drug instillation. One-hundred and three of the 107 enrolled patients (baseline IOP =15.2±2.0 mmHg [mean ± standard deviation]) completed the study. The mean IOP value as well as percent reduction was significantly reduced at each visit after travoprost with sofZia® initiation (Psuperficial punctate keratopathy. The cumulative incidence of side effects such as eyelash changes, eyelid pigmentation, and deepening of the upper lid was 47.6%, 27.2%, and 16.5%, respectively. Travoprost preserved with sofZia® effectively lowered the IOP of Japanese NTG patients. It was well tolerated with few discontinuations due to adverse events.
Cate, Heidi; Bhattacharya, Debi; Clark, Allan; Fordham, Richard; Holland, Richard; David C Broadway
Background Improving adherence to ocular hypertension (OH)/glaucoma therapy is highly likely to prevent or reduce progression of optic nerve damage. The present study used a behaviour change counselling intervention to determine whether education and support was beneficial and cost-effective in improving adherence with glaucoma therapy. Methods A randomised controlled trial with a 13-month recruitment and 8-month follow-up period was conducted. Patients with OH/glaucoma attending a glaucoma c...
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Iyigun, Emine; Tastan, Sevinc; Ayhan, Hatice; Coskun, Halise; Kose, Gulsah; Mumcuoglu, Tarkan
Studies that describe the experiences of patients with glaucoma from different cultures may help health professionals gain a broader perspective on this issue. Currently, few qualitative studies describe how patients with glaucoma in Turkey cope with daily life. The aim of this study was to explore the experiences of patients with glaucoma. This descriptive phenomenological study used purposive sampling to enroll 20 patients with glaucoma. A qualitative, in-depth, face-to-face interview technique was used to collect data during January and February 2014. The data were analyzed using to the Van Kaam method. Seven themes were identified, including confirming the diagnosis by acute symptoms or unrelated symptoms, grateful to God for having a non-life-threatening disease, feeling happy after receiving more accurate information, coping with the disease by using eye drops and attending follow-up examinations regularly, managing daily life to avoid further damage to eyesight, emotional reactions related to going blind, and urging family members or friends to attend regular glaucoma checkups. Patients with glaucoma experience physiological and psychological problems throughout the course of their disease. Being informed and cultural practices such as "praising God" and "resignation" helped patients cope with the disease. Furthermore, because of the cultural characteristic of social collectivism, participants acted to protect the health of others by informing them about glaucoma. Understanding the experiences of patients with glaucoma is important for nursing practice. Nurses should be encouraged to take a greater role in the care of patients with glaucoma by becoming the primary source of glaucoma disease, treatment, and care-related information.
Fingert, John H; Robin, Alan L; Scheetz, Todd E; Kwon, Young H; Liebmann, Jeffrey M; Ritch, Robert; Alward, Wallace L M
To investigate the role of TANK-binding kinase 1 ( TBK1 ) gene copy-number variations (ie, gene duplications and triplications) in the pathophysiology of various open-angle glaucomas. In previous studies, we discovered that copy-number variations in the TBK1 gene are associated with normal-tension glaucoma. Here, we investigated the prevalence of copy-number variations in cohorts of patients with other open-angle glaucomas-juvenile-onset open-angle glaucoma (n=30), pigmentary glaucoma (n=209), exfoliation glaucoma (n=225), and steroid-induced glaucoma (n=79)-using a quantitative polymerase chain reaction assay. No TBK1 gene copy-number variations were detected in patients with juvenile-onset open-angle glaucoma, pigmentary glaucoma, or steroid-induced glaucoma. A TBK1 gene duplication was detected in one (0.44%) of the 225 exfoliation glaucoma patients. TBK1 gene copy-number variations (gene duplications and triplications) have been previously associated with normal-tension glaucoma. An exploration of other open-angle glaucomas detected a TBK1 copy-number variation in a patient with exfoliation glaucoma, which is the first example of a TBK1 mutation in a glaucoma patient with a diagnosis other than normal-tension glaucoma. A broader phenotypic range may be associated with TBK1 copy-number variations, although mutations in this gene are most often detected in patients with normal-tension glaucoma.
Background: Glaucoma is one of the main causes of blindness worldwide that has been considered as a major public health issue. Raising awareness about glaucoma among the general public, ophthalmic patients and health professionals would be key instrument for early case identification and prevention of blindness.
Cesareo, Massimo; Ciuffoletti, Elena; Ricci, Federico; Missiroli, Filippo; Giuliano, Mario Alberto; Mancino, Raffaele; Nucci, Carlo
Glaucoma is an optic neuropathy that can result in progressive and irreversible vision loss, thereby affecting quality of life (QoL) of patients. Several studies have shown a strong correlation between visual field damage and visual disability in patients with glaucoma, even in the early stages of the disease. Visual impairment due to glaucoma affects normal daily activities required for independent living, such as driving, walking, and reading. There is no generally accepted instrument for assessing quality of life in glaucoma patients; different factors involved in visual disability from the disease are difficult to quantify and not easily standardized. This chapter summarizes recent works from clinical and epidemiological studies, which describe how glaucoma affects the performance of important vision-related activities and QoL. © 2015 Elsevier B.V. All rights reserved.
Full Text Available The purpose of this study was to evaluate the influence of polymorphisms of the eNOS gene on the clinical status of patients with normal and high tension glaucoma.266 Polish Caucasian patients with primary open angle glaucoma were studied. Of the 266, 156 had normal tension glaucoma (NTG and 110 high tension glaucoma (HTG. DNA material was isolated from peripheral venous blood using commercial kits. Real-time PCR reaction was used to amplify the promoter site of the endothelial nitric oxide synthase (eNOS gene, including the single nucleotide polymorphism (SNP site T-786C and part of the 7th exon of eNOS, including G894T SNP. Genotypes were determined with TaqMan SNP Genotyping Assays.There were no significant differences in frequencies of the allelic variants of both polymorphisms. In G894T SNP, however, the wild GG form was more common in the HTG group. The SNP of the eNOS gene did not significantly influence the progression rate in either of the groups studied. There were no differences in variants of the eNOS gene regarding the necessity for and success of surgery and the progression of the disease. In the NTG group, no statistical correlation was observed between G894T, T786C polymorphism variants, and risk factors such as optic disc haemorrhages, optic disc notches, and peripapillary atrophy. Mean diastolic and systolic pressure during the day and night were lowest in NTG patients with the CC variant of the T786C polymorphism. No statistical correlation was observed between the G894T and T786C polymorphisms and capillaroscopic examination results.Genotype frequencies are similar for both the eNOS G894T and T-786C polymorphisms in NTG and HTG patients. These polymorphisms do not correlate with risk factors and do not influence the state of the capillary system in NTG patients. Systolic blood pressure is lower in NTG patients with mutated alleles of both polymorphisms.
Kosior-Jarecka, Ewa; Łukasik, Urszula; Wróbel-Dudzińska, Dominika; Kocki, Janusz; Bartosińska, Joanna; Witczak, Agnieszka; Chodorowska, Grażyna; Mosiewicz, Jerzy; Żarnowski, Tomasz
Aim The purpose of this study was to evaluate the influence of polymorphisms of the eNOS gene on the clinical status of patients with normal and high tension glaucoma. Methods 266 Polish Caucasian patients with primary open angle glaucoma were studied. Of the 266, 156 had normal tension glaucoma (NTG) and 110 high tension glaucoma (HTG). DNA material was isolated from peripheral venous blood using commercial kits. Real-time PCR reaction was used to amplify the promoter site of the endothelial nitric oxide synthase (eNOS) gene, including the single nucleotide polymorphism (SNP) site T-786C and part of the 7th exon of eNOS, including G894T SNP. Genotypes were determined with TaqMan SNP Genotyping Assays. Results There were no significant differences in frequencies of the allelic variants of both polymorphisms. In G894T SNP, however, the wild GG form was more common in the HTG group. The SNP of the eNOS gene did not significantly influence the progression rate in either of the groups studied. There were no differences in variants of the eNOS gene regarding the necessity for and success of surgery and the progression of the disease. In the NTG group, no statistical correlation was observed between G894T, T786C polymorphism variants, and risk factors such as optic disc haemorrhages, optic disc notches, and peripapillary atrophy. Mean diastolic and systolic pressure during the day and night were lowest in NTG patients with the CC variant of the T786C polymorphism. No statistical correlation was observed between the G894T and T786C polymorphisms and capillaroscopic examination results. Conclusions Genotype frequencies are similar for both the eNOS G894T and T-786C polymorphisms in NTG and HTG patients. These polymorphisms do not correlate with risk factors and do not influence the state of the capillary system in NTG patients. Systolic blood pressure is lower in NTG patients with mutated alleles of both polymorphisms. PMID:26807726
Slota, Catherine; Davis, Scott A; Blalock, Susan J; Carpenter, Delesha M; Muir, Kelly W; Robin, Alan L; Sleath, Betsy
This article is the first to investigate the nature of medication cost discussions between ophthalmologists and glaucoma patients. Only 87 of the 275 office visits analyzed had a discussion of medication cost. Providers should consider discussing medication cost with patients to identify potential cost-related barriers to medication use. Glaucoma is an incurable chronic eye disease affecting a growing portion of the aging population. Some of the most commonly utilized treatments require lifelong use, requiring high patient adherence to ensure effectiveness. There are numerous barriers to glaucoma treatment adherence in the literature, including cost. The aim of this secondary analysis was to describe the frequency and nature of patient-physician communication regarding medication cost during glaucoma office visits. This was a mixed-methods secondary analysis of video-recorded participant office visits (n = 275) from a larger observational study of glaucoma communication. We analyzed medical information, demographic characteristics, and interviewer-administrated questionnaires, as well as verbatim transcripts of interviews. Only 87 participants discussed medication cost during their glaucoma office visit. The majority of the subjects who discussed cost had mild disease severity (51%), took one glaucoma medication (63%), and had Medicare (49%) as well as a form of prescription insurance (78%). The majority of glaucoma office visits did not discuss medication cost, and providers often did not ask about cost problems. Of the few conversations related to cost, most focused on providers offering potential solutions (n = 50), medical and prescription service coverage (n = 41), and brand or generic medication choices (n = 41). Our findings are similar to previous studies showing few patients have conversations with providers about the cost of glaucoma medications. Providers should consider bringing up medication cost during glaucoma office visits to prompt a discussion of
PATIENTS AT THE EYE CLINIC OF A TEACHING HOSPITAL .... ready significant visual loss. The aim of this study ... factors associated with glaucoma awareness among eye patients ..... Health Attitudes in Switzerland: A survey of the general ...
Full Text Available Purpose. We evaluated the association between optic nerve head (ONH microcirculation and macular ganglion cell complex (mGCC thickness in patients with untreated normal tension glaucoma (NTG and a hemifield defect. Methods. The medical records of 47 patients with untreated NTG were retrospectively reviewed. Laser speckle flowgraphy was used to obtain mean blur rate (MBR, a relative measure of blood flow. Average total deviation (TD, mGCC, and the circumpapillary retinal nerve fiber layer (cpRNFL thickness were also analyzed. Results. All parameters corresponding to the defective hemifield were significantly lower than those corresponding to the normal hemifield. In the defective hemifield, MBR was correlated with TD, mGCC, and cpRNFL thickness. In the normal hemifield, MBR was only correlated with mGCC thickness, and multiple regression analysis showed that mGCC thickness was a significant contributing factor of the MBR. Conclusion. MBR was well correlated with mGCC thickness in eyes with untreated NTG and a hemifield defect. In the normal hemifield, mGCC thickness was a contributing factor of the MBR indicating that ONH circulatory dysfunction may be associated with retinal structural changes in the early stages of glaucoma. A reduction in ONH microcirculation may be an early indicator of the presence and progression of glaucoma.
Holtzer-Goor, Kim M.; van Vliet, Ellen J.; van Sprundel, Esther; Plochg, Thomas; Koopmanschap, Marc A.; Klazinga, Niek S.; Lemij, Hans G.
Comparing the quality of care provided by a hospital-based shared care glaucoma follow-up unit with care as usual. This randomized controlled trial included stable glaucoma patients and patients at risk for developing glaucoma. Patients in the Usual Care group (n=410) were seen by glaucoma
Full Text Available ExPress glaucoma filtration device (GFD has recently become available in India as a surgical option for glaucoma patients. We retrospectively evaluated the outcome of ExPress GFD in 12 eyes with advanced glaucoma with intraocular pressures (IOPs not controlled on maximal tolerable medical therapy. The mean preoperative IOP of 29.58 ± 7.13 mmHg decreased to 17.0 ± 2.67 and 17.40 ± 0.89 mmHg at 6 and 12 months after surgery. Absolute success (IOP ≤ 18 mmHg, with no additional glaucoma medications was achieved in eight cases (66.7% and qualified success (IOP ≤ 18 mmHg, with additional glaucoma medications in two cases (16.7% at 1-year after surgery. Early intervention was needed in 4 patients; two underwent anterior chamber reformation while the other two required needling. Two patients required resurgery. There was no significant change in the best corrected visual acuity postoperatively (P = 0.37. ExPress GFD does not seem to offer a benefit over standard trabeculectomy in patients with advanced glaucomatous disease in terms of IOP control or complication rate. However, due to the small sample size with a heterogeneous mixture of primary and secondary glaucoma′s, we await further studies with a larger sample size and long-term follow-up, to see how the device performs.
Kurtz, Shimon; Soiberman, Uri; Shemesh, Gabi
Normal tension glaucoma (NTG) is a chronic progressive optic neuropathy, characterized by relatively normal intraocular pressure (IOP) measurements. This study utilized three modalities in the measurement of lOP: dynamic contour tonometry (Pascal-DCT), Goldmann applanation tonometry (GAT) and Tonopen XL. To compare the lOP measurements of the three devices in eyes with NTG. This retrospective study of thirty-three NTG patients (66 eyes) who underwent lOP measurements using the three devices was approved by a local ethics committee. The lOP measurements were stratified according to central corneal thickness (CCT) and corneal curvature (CC). The mean DCT IOP was higher (16.22 +/- 3.04 mmHg) than the mean GAT IOP (13.14 +/- 2.83 mmHg, P IOP (12.76 +/- 3.11 mmHg, P measurements were significantly infLuenced by corneal curvature (P = 0.004 and P measured by GAT or Tonopen XL were consistently lower than by DCT. CC significantly influenced GAT and DCT results.
Schwab, Christoph; Glatz, Wilfried; Schmidt, Bernd; Lindner, Ewald; Oettl, Karl; Riedl, Regina; Wedrich, Andreas; Ivastinovic, Domagoj; Velikay-Parel, Michaela; Mossboeck, Georg
To evaluate the impact of oxidative stress - present in glaucoma - on the vitreous. We therefore compare the presence of early and late stages of posterior vitreous detachment (PVD) between patients with glaucoma and controls. The vitreous state was evaluated by the combination of optical coherence tomography and ultrasound. The main outcome was the vitreous state classified into 'no PVD', 'initial PVD' and 'advanced PVD'. We evaluated the vitreous state in 48 patients with glaucoma (age: mean 66.5 ± 11.9 years; visual field deviation: mean 10.4 ± 6.8 dB) and compared the results with 101 previously investigated controls (age: mean 73.6 ± 9.3 years). After one-to-one matching on age and sex, ordinal logistic regression revealed that patients with glaucoma were significantly more likely to exhibit advanced PVD stages compared to non-glaucoma patients (OR 2.60, 95% confidence interval: 1.06-6.36, p = 0.037). Our results suggest that the presence or absence of PVD might be a valuable hint for diagnosing glaucoma - however, further research is needed to determine whether PVD can be used to supplement current glaucoma screening guidelines. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Verbraak, F. D.; vd Berg, W.; Delleman, J. W.; Greve, E. L.
Results of a pilot study to evaluate goniodysgenesis as a cause of familial open-angle glaucoma are reported. Patients with a familial high tension open-angle glaucoma and a goniodysgenetic chamber angle (n = 11), a number of their relatives with glaucoma (n = 12), and their relatives without
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Oct 12, 2007 ... Glaucoma, a major cause of worldwide irreversible blindness, is a progressive optic neuropathy that is characterised by specific structural changes to the optic nerve head and associated functional. (visual field) changes. This particular neuropathy involves apoptosis of the retinal ganglion cells whose ...
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Background: Pseudoexfoliation syndrome (PXS) has variable prevalence rates in the glaucoma population depending on geographic location and racial composition of the population studied. There is no data available on this subject in Ethiopia. Objective: To determine the prevalence of PXS among Ethiopian glaucoma ...
Zhang, Hai-Tao; Yang, Yu-Xin; Xu, Ying-Ying; Yang, Rui-Min; Wang, Bao-Jun; Hu, Jun-Xi
To explore the efficacy of preoperative intravitreal bevacizumab (IVB) injection combined with Ahmed glaucoma valve (AGV) implantation in the treatment of neovascular glaucoma (NVG). This retrospective study included 35 eyes from 35 patients who underwent preoperative IVB and AGV implantation for treatment of NVG. Findings such as intraocular pressure (IOP) number of anti-glaucoma medications, visual acuity (VA), surgical success rates, and complications were recorded. After AGV implantation, IOP was 18.2±4.0 mm Hg, 15.5±3.3 mm Hg and 9.8±2.6 mm Hg at 6, 12 and 36mo, significantly decreased compared with pre-IOP (PAGV implantation should be one of treatments for NVG because of its safety and effectiveness.
Kiyota, Naoki; Kunikata, Hiroshi; Takahashi, Seri; Shiga, Yukihiro; Omodaka, Kazuko; Nakazawa, Toru
To investigate factors associated with choroidal microcirculation in the peripapillary chorioretinal atrophy (PPA) zone in eyes with normal-tension glaucoma (NTG) and myopic disc. In 100 eyes of 100 NTG patients with myopic disc and 20 eyes of 20 age-matched myopic controls, 4.5 × 4.5 mm scans were made of the optic nerve head with optical coherence tomography angiography (OCTA). Peripapillary chorioretinal atrophy (PPA) area and PPA superficial choroidal image intensity (PPA-CI) were calculated with image j software. Clinical characteristics, laser speckle flowgraphy-measured mean blur rate in the temporal tissue area (temporal MT), the central thresholds (the averaged standard automated perimetry-measured visual field thresholds in the four paracentral points) and 3D-OCT-measured ganglion cell complex thickness in the papillomacular bundle (PMB-GCCT) were recorded. The NTG patients had significantly lower intraocular pressure, PMB-GCCT and central threshold values, and a larger PPA area, than the controls. The area under the receiver operating characteristics curve to differentiate NTG with parafoveal scotoma (PFS) from controls was 0.76 for temporal MT, 0.85 for PPA-CI and 0.87 for PMB-GCCT. Univariate and multivariate analyses revealed that PPA-CI was negatively correlated with age, pulse rate, best-corrected visual acuity, axial length and PPA area, and positively correlated with temporal MT, PMB-GCCT and the central thresholds. Peripapillary chorioretinal atrophy (PPA)-CI was associated with temporal MT, ageing, bradycardia, axial length elongation and changes in central retinal structure and visual function in patients with NTG and myopic disc. Thus, microcirculation deep within the PPA zone might be a clinically useful biomarker of PFS in NTG. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Full Text Available Introduction. According to the level of intraocular pressure (IOP, open angle glaucoma is divided into high tension glaucoma (HTG and normal tension glaucoma (NTG. Objective. To determine if there are differences in the distribution of patients by age and sex between NTG and HTG. Methods. Our prospective study included 30 patients with NTG and 30 with HTG. A complete eye examination was performed. The examination included measuring of intraocular pressure by Goldmann applanation tonometry, examination of optic disc head by indirect ophthalmoscopy with Volk 90 D lens and visual field examination using the Octopus program. Results. The average damage of visual field in the group of patients with NTG was 8.14±4.43 dB, while in the group with HTG it was 7.40±2.84 dB (p>0.05. The average age of the group of patients with NTG was 66±11.58 years, while among those with HTG the average age was 59.7±11.63 years (p<0.01. Among the patients with NTG there were three times more women than men (χ2=9.124; p<0.01, while in the group of patients with HTG there were more men than women, but without statistically significant difference between the tested groups (χ2=1.851; p>0.05. Conclusion. Open angle glaucoma is a disease of elderly population. According to our results, risk factors for this disease can be age and sex. NTG is more frequently present than HTG among elderly population and females.
Song, Brian J; Aiello, Lloyd Paul; Pasquale, Louis R
Diabetes mellitus represents a growing international public health issue with a near quadrupling in its worldwide prevalence since 1980. Though it has many known microvascular complications, vision loss from diabetic retinopathy is one of the most devastating for affected individuals. In addition, there is increasing evidence to suggest that diabetic patients have a greater risk for glaucoma as well. Though the pathophysiology of glaucoma is not completely understood, both diabetes and glaucoma appear to share some common risk factors and pathophysiologic similarities with studies also reporting that the presence of diabetes and elevated fasting glucose levels are associated with elevated intraocular pressure-the primary risk factor for glaucomatous optic neuropathy. While no study has completely addressed the possibility of detection bias, most recent epidemiologic evidence suggests that diabetic populations are likely enriched with glaucoma patients. As the association between diabetes and glaucoma becomes better defined, routine evaluation for glaucoma in diabetic patients, particularly in the telemedicine setting, may become a reasonable consideration to reduce the risk of vision loss in these patients.
Ross, Andrew; Blake, Robert C; Ayyala, Ramesh S
To measure and compare the surface tension of aqueous humor in patients with and without glaucoma. The surface tension of aqueous humor was measured using a commercially available instrument and software that were validated by using a known fluid (deionized water and methanol). Analysis of aqueous and vitreous samples obtained from 20 rabbit eyes showed that the system could be used successfully for small amounts of ocular fluid. The effect of glaucoma drugs on the surface tension of aqueous humor was then studied in a rabbit model. Comparison of aqueous humor from 66 patients with glaucoma and 53 patients with cataracts but no glaucoma was carried out. The surface tension of rabbit aqueous humor was 65.9 ± 1.2; vitreous, 60.6 ± 2.6; and balanced salt solution, 70.7 ± 0.9. Timolol and latanoprost did not alter the surface tension of the aqueous humor in the rabbit model. The average surface tension of human aqueous humor was 63.33 ± 4.0 (glaucomatous eyes) and 66.19 ± 2.64 (nonglaucomatous eyes with cataracts) (P=0.0001). A technique of measuring the surface tension from small quantities of aqueous humor is validated. Surface tension of the aqueous humor in glaucoma patients was less than that of cataract patients.
Keane, P A
PURPOSE: To investigate whether new classes of glaucoma medication have influenced glaucoma filtration surgery over a 20-year period in the southeast region of Ireland. METHODS: All patients undergoing glaucoma filtration surgery between January 1986 and December 2005 in Waterford Regional Hospital were identified. The following data were recorded for each patient: age; sex; and type of filtration procedure. RESULTS: Over the 20-year study period two consultant ophthalmic surgeons performed a total of 760 glaucoma filtration procedures on patients aged over 20 years. The annual average number of glaucoma surgeries declined steadily, defined by availability of different topical anti-glaucoma medications, from an average of 23.75 surgeries per surgeon per year in the subperiod 1986-1995, to 21 in 1996, 20 in 1997, and 12.69 surgeries per surgeon per year in 1998-2005, these differences being statistically significant (general linear model, P<0.001). The age profile of patients did not change significantly over the course of the study period. CONCLUSIONS: The volume of patients requiring glaucoma filtration surgery under the care of two consultant ophthalmic surgeons decreased over the 20-year study period, an era in which three classes of anti-glaucoma medications were made available. However, an increase in the age profile of patients undergoing glaucoma filtration surgery during the same period was not observed. Further study is required to resolve whether introduction of the new topical anti-glaucoma medications has led to a real reduction in the demand for glaucoma filtration surgery, or has just led to the deferral of such a demand.
Naito, Tomoko; Okuma, Shinichi; Nagayama, Mikio; Mizoue, Shiro; Ozaki, Mineo; Namiguchi, Koji; Miyamoto, Kazuhisa; Tanito, Masaki; Yoshikawa, Keiji
We examined the sustainability of the intraocular pressure (IOP)-lowering efficacy of travoprost (0.004%) ophthalmic solution in subjects with normal tension glaucoma (NTG). Travoprost ophthalmic solution was given once daily at 9 PM to subjects with newly diagnosed NTG or with NTG who had not received any ocular hypotensives within the previous 30 days. IOP was measured at three time points (9 AM, 1 PM, and 5 PM) at baseline and week 12 visits, and at one time point (9 AM) at week 4 and week 8 visits. Conjunctival hyperemia, superficial punctate keratopathy, and other adverse events were evaluated during the observation period. Thirty subjects (12 males and 18 females; mean age 65.6 years) from 32 subjects enrolled were included in the efficacy analysis. The mean IOPs (±standard deviation) of 16.6 ± 1.4, 15.7 ± 1.8, and 15.7 ± 2.2 mmHg at 9 AM, 1 PM, and 5 PM, respectively, at baseline reduced significantly to the mean IOPs of 13.0 ± 1.8, 12.7 ± 1.8, and 12.8 ± 1.6 mmHg, respectively, at week 12 (P < 0.0001 for every time point). Together with the mean IOPs of 13.4 ± 1.9 mmHg at week 4 and 13.2 ± 1.9 mmHg at week 8, the pooled IOP during the observation period for up to 12 weeks showed a statistically and clinically significant reduction of IOP at 9 AM. (3.4 mmHg or 20.3% reduction from baseline, P < 0.0001). There were no adverse events leading to treatment discontinuation. This multi-center collaborative study suggests that IOP-lowering efficacy of travoprost ophthalmic solution persists during the day at the clinically relevant level in subjects with NTG. Alcon Japan Ltd. University Hospital Medical Information Network, UMIN ID: 000011621.
Full Text Available Toyoaki Tsumura,1 Keiji Yoshikawa,2 Hirotaka Suzumura,3 Tairo Kimura,4 Satoshi Sasaki,5 Itaru Kimura,6 Ryuji Takeda71Department of Ophthalmology, Fussa Hospital, Fussa, Tokyo, Japan; 2Yoshikawa Eye Clinic, Machida, Tokyo, Japan; 3Department of Ophthalmology, Nakano General Hospital, Nakano, Tokyo, Japan; 4Ueno Eye Clinic, Ueno, Tokyo, Japan; 5Sasaki Eye Clinic, Ueno, Tokyo, Japan; 6Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan; 7Department of Biological Chemistry, Faculty of Agriculture, Kinki University, Nara, Nara, JapanPurpose: The aim of this study was to evaluate the efficacy and safety of bimatoprost ophthalmic solution 0.03% (bimatoprost in Japanese normal-tension glaucoma (NTG patients with an intraocular pressure (IOP of 18 mmHg or less.Methods: Bimatoprost was instilled into the unilateral conjunctival sac of Japanese NTG patients with a baseline IOP of 18 mmHg or less. The time courses of IOP, conjunctival hyperemia, superficial punctate keratitis, and adverse events were examined at 2, 4, 8, and 12 weeks post bimatoprost instillation.Results: Thirty-two of the 38 enrolled NTG patients (mean age, 64.1 ± 12.6 years; 19 males and 19 females completed the study, with six patients unable to complete the study (two patients discontinued because of side effects and four patients withdrew. The levels of IOP in the treated eyes were significantly reduced (P < 0.0001 from the baseline IOP levels. No significant change in IOP was observed in the fellow eyes. There were significant increases in conjunctival hyperemia. No significant superficial punctate keratitis scores were noted between the baseline and each point examined. Eyelash disorder, eyelid pigmentation, and deepening of the upper eyelid sulcus were observed in 28, six, and three eyes, respectively.Conclusion: Bimatoprost effectively lowered the IOP. It was well tolerated in Japanese NTG patients, with few patients having to discontinue
Türkcü, Fatih Mehmet; Köz, Ozlem Gürbüz; Yarangümeli, Alper; Oner, Veysi; Kural, Gülcan
...), pseudoexfoliation syndrome (PEXS), PEXS plus normotensive glaucoma (NTG). In total, 24 patients with PEXG, 35 patients with PEXS, 18 patients with PEXS plus NTG, and 35 control subjects were enrolled into study...
Full Text Available Hans G Lemij,1 Juliette GMM Hoevenaars,2 Cees van der Windt,3 Christophe Baudouin4 On behalf of the GOAL Study Investigators 1Glaucoma Service, Rotterdam Eye Hospital, Rotterdam, 2VieCuri Medisch Centrum, Venlo, 3Ziekenhuis Rivierenland, Tiel, the Netherlands; 4Quinze-Vingts National Hospital and Vision Institute, Paris, France Abstract: While safe and effective treatments for glaucoma exist, their effectiveness is compromised by poor compliance. Patients who have problems with their topical glaucoma medication are acknowledged to be at higher risk for poor compliance, frequent medication switching, and surgery. Patient satisfaction with therapy and its associated benefits have until recently taken second place to efficacy. The present study is a transverse cross-sectional epidemiological survey among glaucoma patients receiving therapy with prostaglandin analogs. The primary objective was to determine and characterize patient satisfaction with glaucoma therapy, and the secondary objective was to identify factors that may contribute to poor patient satisfaction. Ophthalmologists in the Netherlands included 199 patients and 164 were analyzed. Patients were predominantly elderly with early, primary, open angle glaucoma. Eighty-nine percent of them stated they were satisfied or very satisfied with their treatment. However, signs of ocular surface disorder on ophthalmological examination were evident in 44% of patients, corneal fluorescein staining was positive in 28% of patients, and 38% of patients were using tear substitutes. The prevalence of blepharitis/meibomian gland dysfunction and dry eye was more than twice as high after the commencement of therapy compared with before therapy. Univariate analysis revealed that patient dissatisfaction with their glaucoma therapy was statistically significantly (P<0.001 associated with the presence of ocular surface disease, hyperemia, ocular signs, symptoms upon and between instillation, and the use of
Bae, Hyoung Won; Rho, Seungsoo; Lee, Hye Sun; Lee, Naeun; Hong, Samin; Seong, Gong Je; Sung, Kyung Rim; Kim, Chan Yun
To classify medically treated open-angle glaucoma (OAG) by the pattern of progression using hierarchical cluster analysis, and to determine OAG progression characteristics by comparing clusters. Ninety-five eyes of 95 OAG patients who received medical treatment, and who had undergone visual field (VF) testing at least once per year for 5 or more years. OAG was classified into subgroups using hierarchical cluster analysis based on the following five variables: baseline mean deviation (MD), baseline visual field index (VFI), MD slope, VFI slope, and Glaucoma Progression Analysis (GPA) printout. After that, other parameters were compared between clusters. Two clusters were made after a hierarchical cluster analysis. Cluster 1 showed -4.06 ± 2.43 dB baseline MD, 92.58% ± 6.27% baseline VFI, -0.28 ± 0.38 dB per year MD slope, -0.52% ± 0.81% per year VFI slope, and all "no progression" cases in GPA printout, whereas cluster 2 showed -8.68 ± 3.81 baseline MD, 77.54 ± 12.98 baseline VFI, -0.72 ± 0.55 MD slope, -2.22 ± 1.89 VFI slope, and seven "possible" and four "likely" progression cases in GPA printout. There were no significant differences in age, sex, mean IOP, central corneal thickness, and axial length between clusters. However, cluster 2 included more high-tension glaucoma patients and used a greater number of antiglaucoma eye drops significantly compared with cluster 1. Hierarchical cluster analysis of progression patterns divided OAG into slow and fast progression groups, evidenced by assessing the parameters of glaucomatous progression in VF testing. In the fast progression group, the prevalence of high-tension glaucoma was greater and the number of antiglaucoma medications administered was increased versus the slow progression group. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.
Lee, Jacky W Y; Fu, Lin; Chan, Jonathan C H; Lai, Jimmy S M
To investigate intraocular pressure (IOP) related patterns before and after selective laser trabeculoplasty (SLT) for normal tension glaucoma (NTG).In this prospective cohort study, 18 NTG patients underwent SLT. Success was defined as IOP reduction ≥ 20% by Goldmann applanation tonometry. 24-hour IOP-related pattern recording with a contact lens sensor (CLS) (SENSIMED Triggerfish, Sensimed, Switzerland) was done before (baseline) and 1 month after SLT. A cosine function was fitted to the mean CLS patterns for each individual in the SLT success and non-success groups and the amplitude before and after SLT was calculated. Diurnal, nocturnal, and 24-hour CLS pattern local variability was determined for pre- and post-SLT sessions. Cosine amplitude and variability were compared before and after SLT by group using paired t-tests, with α = 0.05. Patients (11 women, 7 men) had a mean age of 65.1 ± 13.7 years. Mean IOP was 15.3 ± 2.2 mm Hg at baseline and was reduced by 17.0% to 12.7 ± 1.8 mm Hg 1 month after SLT (P = 0.001). SLT was successful in 8 patients (44%). The amplitude of the fitted cosine was reduced by 24.6% in the success group, but displayed an amplitude increase of 19.2% post-SLT in the non-success group. Higher diurnal local variability of the CLS pattern was observed after SLT in non-success subjects (P = 0.002), while nocturnal variability showed no significant change. The increase in diurnal variability in the non-success group led to an increase in 24-hour variability in this group (P = 0.001). No change in local variability (diurnal, nocturnal, and 24-hour) was seen in the success group. The IOP-related pattern cosinor amplitude was reduced in NTG patients with a successful SLT treatment whereas the non-success group exhibited an increase of cosine amplitude. Higher diurnal and 24-hour CLS pattern variability was observed in non-success patients 1 month post-SLT.
SUMMARY. Background: Primary open angle glaucoma (POAG) is an irreversible blinding disease that often presents late because it is symptomless in the early stages. Prognosis depends on early diagnosis and treatment and patient understanding of their condition. Many patients present late because of poor awareness ...
Background: Primary open angle glaucoma (POAG) is an irreversible blinding disease that often presents late because it is symptomless in the early stages. Prognosis depends on early diagnosis and treatment and patient understanding of their condition. Many patients present late because of poor awareness and ...
Gramer, Gwendolyn; Gramer, Eugen; Weisschuh, Nicole
Prospective evaluation of family history (FH) of glaucoma and FH of optic disc drusen (ODD) in patients with sonographically confirmed ODD. A total of 87 patients with ODD interviewed all their first-degree and second-degree relatives using a detailed questionnaire on whether an ophthalmologist had diagnosed or excluded glaucoma or ocular hypertension (OH). Using a second questionnaire, 62 of these patients also provided information about ODD in their FH. Control groups for FH of glaucoma consisted of 2170 patients with glaucoma or OH evaluated with the same methods and identical questions for FH of glaucoma in a previous study, and of 176 healthy individuals without glaucoma or ODD who were interviewed on family history of glaucoma. Glaucoma in FH was significantly more frequent in patients with ODD with an incidence of 20.7% compared with healthy controls with an incidence of 2.8%, and half as frequent as in glaucoma patients with an incidence of 40%. ODD in FH were found in 9.7% of patients with ODD. As there is a high frequency of family history of glaucoma in patients with ODD, evaluation of FH of ODD and FH of glaucoma is essential in patients with ODD. Glaucoma in FH of ODD patients requires intraocular pressure monitoring and whenever deemed beneficial timely initiation of intraocular pressure-lowering therapy.
Jamal, Karim N; Gürses-Ozden, RabIa; Liebmann, Jeffrey M; Ritch, Robert
To evaluate the effect of attempted eyelid closure on intraocular pressure (IOP) measurements in normal-tension (NTG) and high-tension (HTG) open-angle glaucoma patients. Prospective clinical trial. Forty randomly selected eyes of 40 patients underwent corneal pachymetry and IOP measurements using both Goldmann applanation tonometry and Tono-pen XL (Mentor, Inc., Norwell, Massachusetts, USA). Intraocular pressure was measured by the same examiner holding the eyelids open, both with and without the subject simultaneously attempting forced eyelid closure. Subjects were seated during all measurements and waited 5 minutes between measurements with each instrument; the order of measurement was randomized. Twenty NTG and 20 HTG eyes were enrolled. The mean age was 63.0 +/- 13.0 years (range, 31-80 years). The average corneal thickness was 540 +/- 32 microm (range, 480-608 microm) in NTG patients and 552 +/- 40 microm (range, 449-610 microm) in HTG patients (P =.07, analysis of variance [ANOVA]). Using Goldmann applanation tonometry, IOP measurement in eyes with NTG increased by 3.9 +/- 2.0 mm Hg with attempted eyelid closure (P pen XL, IOP measurements increased 4.2 +/- 2.7 mm Hg (P pen XL, measurements increased 4.5 +/- 2.0 mm Hg (P tonometry is a significant and common source of error in eyes with glaucoma and may influence the clinical management and decision-making in the treatment of NTG and HTG.
closure glaucoma depends on their ethnic background. In order to examine the presenting features and effects of primary angle-closure glaucoma in people of mixed ethnicity, we reviewed all 'coloured' patients who presented to Groote Schuur ...
Ahmad, Meleha; Chocron, Isaac; Shrivastava, Anurag
Given the popularity of keratorefractive surgery, and an aging populous of patients who have undergone these procedures, there is an increasing need for updated management protocols. This is particularly relevant for patients with chronic progressive diseases such as glaucoma, due to the variety of related diagnostic and management challenges inherent to these diseases. Here, we will review the current literature to provide an update on the management of patients with glaucoma who are undergoing, or have had laser ablative refractive surgery. Preoperative testing and eligibility considerations, intraoperative factors, and postoperative observation and follow-up will be discussed. Intraoperative intraocular pressure (IOP) rise during flap creation is associated with low risk of acute complications, and furthermore do not appear to have significant long term effects. Modern technologies have improved our ability to determine accurate IOP after refractive surgery despite postoperative changes in corneal architecture. Furthermore, advances in structural imaging allow for earlier detection of even subtle glaucomatous nerve damage. Although glaucoma remains a relative contraindication to refractive surgery, it is a safe procedure for many patients with appropriate perioperative management and follow-up. Advancements in diagnostic modalities have allowed for earlier detection of glaucomatous disease, and subsequent earlier intervention when appropriate. Standardized diagnostic algorithms and rigorous perioperative assessment are critical to safe management of glaucoma patients undergoing refractive corneal surgery.
Full Text Available AIM:To study the reliability of visual electrophysiological examination(pattern visual evoked potentials, P-VEP, fundus photography, visual field and optical coherence tomography(OCTto evaluating chronic angle-closure glaucoma. METHODS:Visual electrophysiological examination, fundus photography, visual field and OCT were used to evaluate the chronic angle-closure glaucoma in 96 cases(109 eyes. The correlations were analyzed according to the results of P-VEP, fundus photography, visual field and OCT. RESULTS:In 96 cases(109 eyes, P-VEP was positive in 72 eyes(66.1%. The P-VEP was no obvious abnormal in 37 eyes(33.9%. Visual field inspection successfully acquired positive cases images in 84 eyes(77.1%, no obvious abnormal in 25 eyes(22.9%. Fundus photography captured positive cases in 87 eyes(79.8%, no obvious abnormal in 22 eyes(20.2%. OCT image captured positive cases in 94 eyes(86.2%, no obvious abnormal in 15 eyes(13.8%. The positive rate of OCT was higher than that of visual field examination, fundus photography, P-VEP examination(PP>0.05. CONCLUSION:Visual electrophysiological examination, visual field, fundus photography and OCT can evaluate the visual function in patients with chronic angle-closure glaucoma for comprehensive assessment.
Full Text Available AIM:To evaluate the efficacy and safety of Ahmed glaucoma valve(AGVimplantation surgery using different methods. METHODS:This was a retrospective study of patients with refractory glaucoma in whom AGV implantation was performed between June 2011 and September 2014. According to the method of tube insertion into the anterior chamber, the sample was divided into two groups, needle-generated scleral tunnel and scleral flap. The surgical success rate, intraocular pressure(IOP, number of antiglaucoma medications used, best correct visual acuity, postoperative complications, and operation duration were analyzed between the two groups. RESULTS:Compared with preoperative data, the two groups showed statistically significant decrease on IOP and the number of antiglaucoma medication used at all follow-up points(PP=0.932; however, statistically significant differences were detected when flat anterior chamber complications between the needle-generated scleral tunnel group(6%and the scleral flap group(24%were compared(P=0.032. CONCLUSION:AGV implantation may be an effective method in managing refractory glaucoma, since the two methods have similar efficacy. However, the needle-generated scleral tunnel technique application could greatly decrease the incidence of flat anterior chamber complications and decrease the duration of the operation.
Full Text Available Sarwat Salim, Haiming Du, Sumalee Boonyaleephan, Jim WanUniversity of Tennessee Health Science Center, Memphis, TN, USAPurpose: To compare the surgical outcomes of the Ex-PRESS glaucoma filtration device in African American and white glaucoma patients.Design: Retrospective comparative case series.Methods: This was a comparative case series of 36 eyes of 36 African Americans and 43 eyes of 43 whites that underwent placement of the Ex-PRESS glaucoma filtration device under a partial-thickness scleral flap for uncontrolled glaucoma. All eyes received intraoperative mitomycin C. The primary outcome measures were intraocular pressure (IOP, number of postoperative glaucoma medications, and surgical success. Surgical success was defined as IOP between 5 and 18 mm Hg, with or without glaucoma medications, without further glaucoma surgery, or loss of light perception vision. Results: Average follow-up was 31.9 ± 9.8 (range, 14.6–47 months for African Americans and 30.7 ± 8.6 (range, 14.3–47 months for whites. At 33 months, surgical success was 80.0% in the African American group and 83.3% in the white group (P = 1.00. Reasons for surgical failure included increased IOP (3 eyes, 3.8%, persistent hypotony with maculopathy (1 eye, 1.3%, and further surgery (4 eyes, 5.06%. Compared with preoperative values, the mean postoperative IOP and number of glaucoma medications were significantly reduced in both groups, and no statistical difference was observed between the two groups at 33 months. Postoperative complications were similar in the two groups.Conclusions: Similar surgical outcomes were observed in African American and white glaucoma patients after implantation of the Ex-PRESS glaucoma filtration device. This latest modification of glaucoma filtration surgery may be a better surgical option for African Americans given its potential advantages of no tissue removal, predictable outcomes related to consistent lumen size and controlled flow, fewer
Full Text Available Abstract Background With the increasing number of people participating in physical aerobic exercise, jogging in particular, we considered that it would be worth knowing if there are should be limits to the exercise with regard to the intraocular pressure (IOP of the eyes. The purpose of this study is to check IOP in healthy and primary glaucoma patients after aerobic exercise. Methods 145 individuals were subdivided into seven groups: normotensives who exercised regularly (Group A; normotensives in whose right eye (RE timolol maleate 0.5% (Group B, latanoprost 0.005% (Group C, or brimonidine tartrate 0.2% (Group D was instilled; and primary glaucoma patients under monotherapy with β-blockers (Group E, prostaglandin analogues (Group F or combined antiglaucoma treatment (Group G instilled in both eyes. The IOP of both eyes was measured before and after exercise. Results A statistically significant decrease was found in IOP during jogging. The aerobic exercise reduces the IOP in those eyes where a b-blocker, a prostaglandin analogue or an α-agonist was previously instilled. The IOP is also decreased in glaucoma patients who are already under antiglaucoma treatment. Conclusion There is no ocular restriction for simple glaucoma patients in performing aerobic physical activity.
Full Text Available PURPOSE: To determine the prevalence and types of glaucoma in rural patients posted for cataract surgery under eye camps at a tertiary care hospital . BACKGROUND: Glaucoma is the second leading cause of blindness in the adult pop ulation in India. The global prevalence of glaucoma for population aged 40 to 80 years is estimated to be 3.54% and the projected number of people with glaucoma worldwide will increase to 111.8 million in 2040. This creates a need for early diagnosis and p rompt management of glaucomas especially in the underprivileged rural areas that lack awareness and facilities. METHODOLOGY: A cross - sectional study was conducted at a regional ophthalmic center for all the patients posted for cataract surgery under eye ca mps. Study was carried out for duration of one year and included 1400 patients. The patients underwent detailed workup to detect the presence of glaucomas and were treated accordingly if the disease was detected. RESULTS: The overall prevalence of glaucoma in our study population was 2.14%. Amongst them, 0.78% had primary open angle glaucoma, 0.14% had primary angle closure glaucoma and 1.21% of them had pseudoexfoliative glaucoma. The prevalence of glaucomas increased with increasing age. CONCLUSION: With increasing life expectancy the number of glaucoma patients is constantly growing large in our country. Early case detection rate is of utmost importance to reduce the disease burden in the rural population where awareness in terms of routine eye screening is very low
... Involved News About Us Donate In This Section Glaucoma In Asian Populations email Send this article to ... lower than in their Asian counterparts. Normal Tension Glaucoma affects Japanese Japanese populations, however, have a substantially ...
Jampel, Henry D; Frick, Kevin D; Janz, Nancy K; Wren, Patricia A; Musch, David C; Rimal, Rajiv; Lichter, Paul R
To assess depression and mood indicators in subjects newly diagnosed with chronic open-angle glaucoma. Cross-sectional study of data from a randomized clinical trial. Newly-diagnosed glaucoma patients enrolled in the Collaborative Initial Glaucoma Treatment Study (CIGTS) responded at baseline to quality-of-life (QOL) telephone interviews. We studied responses to the 33-item Visual Activities Questionnaire (VAQ), six items from a disease-specific Health Perceptions Index (HPI), and eight questions from the Center for Epidemiological Studies Depression Scale (CES-D). We correlated the responses to the HPI and the CES-D with visual acuity (VA) and CIGTS visual field (VF) as well as to the responses to the VAQ. VAQ score was correlated (P perception of their vision (total VAQ score) and each item on the HPI and CES-D. None of the clinical vision measures were associated with any of the CES-D items. The strongest correlation between a clinical measure and an item from the HPI was between worse VF and worry about the possibility of blindness (P = -0.114, P = .005). The odds ratio of reporting mood indicators and symptoms of depression increased with patients' perceptions of worsening visual function but not worsening VA or VF. In these newly diagnosed glaucoma patients, symptoms of depression and altered mood were related to worse self-reported visual function as assessed by the VAQ, but not to monocular clinical measures of visual function.
Sung, Kyung Rim; Chun, Yeoun Sook; Park, Chan Kee; Kim, Hwang Ki; Yoo, Chungkwon; Kim, Yong Yeon; Park, Ki Ho; Kim, Chan Yun; Choi, Kyu-Ryong; Lee, Kyoo Won; Han, Seungbong; Kim, Chang-Sik
The purpose of the study was to evaluate vision-related quality of life in Korean glaucoma patients and to explore the associated factors. A total of 907 glaucoma patients were recruited from the prospectively designed LIGHT (Life quality of the glaucoma patient who underwent treatment) study organized by the Korean Glaucoma Society. Basic questionnaire that included items related to socioeconomic status, comorbidity, and lifestyle, and the validated Korean version of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) were collected. The Rasch score, a logit-based interval scale estimate to summarizing the NEI VFQ-25 responses, was calculated. The univariate and multivariable regression models were used to evaluate associations between the Rasch score and variables. The mean patient age was 58.1±14.1 years, visual field mean deviation (VF MD) of the better and worse eyes was -4.92±6.14 and -9.77±8.31 dB, binocular-integrated VF (IVF) MD was -3.55±5.31 dB, respectively. The lower NEI VFQ-25 Rasch score showed a significant association with the presence of other ocular diseases (P=0.020), a high school level of education or less [vs. university (P=0.006), vs. graduate school or higher (P=0.019)], an anxious personality [vs. a moderate personality (Pvision-related quality of life of Korean glaucoma patients, notably for worse eye visual acuity and IVF MD. However, social factors, self-assessed personality, and treatment-related issues are also substantial predictors of overall life quality.
Bai, Yu-jing; Wang, Mei; Li, Yi-qing; Chai, Fang; Wei, Yan-tao; Zhang, Yi-chong; Yang, Xue-jiao; Ge, Jian; Zhuo, Ye-hong
To evaluate the efficacy and safety of FP-7 Ahmed glaucoma valves (AGV) implantation in neurovascular glaucoma (NVG) as the first choice of surgery. This retrospective, comparative case series study collected a total of 36 eyes of 36 patients with neurovascular glaucoma who underwent AGV implantation in Zhongshan Ophthalmic Center from January 2009 to June 2010. Change of intraocular pressure (IOP), the best corrected visual acuity, numbers of anti-glaucoma medication, success rate and postoperative complications were followed up at day 1, week 1, month 1, and every 3 months after surgery. Complete success of surgery was rated as reduction of IOP ≥ 30% without medication and those who failed to meet criteria was rated as partial success. Data were analyzed by paired Student t-test for IOP, rank sum test for paired non-parametric numbers of medication, and repeated measures analysis of variance for comparison of IOP between different time points using SPSS 13.0. Compared with pre-operation, IOP was significant (F = 9.26, P AGV implantation (39.5 ± 9.7) mm Hg (1 mm Hg = 0.133 kPa) vs (9.2 ± 8.9), (11.8 ± 3.8), (13.7 ± 4.8), (16.9 ± 5.3), (16.9 ± 6.8) mm Hg at day 1, week 1, month 1, month 3 and the last following-up of post-operation, respectively. The numbers of anti-glaucoma medication were significantly (Z = 6.764, P AGV implantation was 80.6%, and qualified success rate was 91.7%. The postoperative complications including occlusion of the drainage tube, exposure of the drainage tube, shallow anterior chamber and encapsulated cystic blebs around the plate were controlled with additional treatment. The clinical outcome indicated that the implantation of FP-7 AGV has a stable IOP lowering effect and fewer complications, which can be considered as one of the first choices for management of NVG.
Aref, Ahmad A
To summarize the findings of the recent reports on nighttime events that may lead to the development or progression of glaucomatous optic neuropathy. Peak intraocular pressure (IOP) likely occurs at night because of the head and body positions assumed during sleep. Sleeping in a 30° head-up position leads to IOP lowering during this time period. Laser trabeculoplasty and glaucoma-filtering surgery are efficacious in controlling IOP over a 24-h period, although most medical therapies may be inadequate. The Sensimed Triggerfish (Sensimed AG, Lausanne, Switzerland) device is capable of recording IOP fluctuations over a 24-h period. A nocturnal increase in IOP and decrease in blood pressure leads to lower ocular perfusion pressure (OPP), which may significantly increase the risk of glaucomatous visual field progression. Prospective case-control studies report a positive association between obstructive sleep apnea (OSA) and glaucoma; larger, retrospective cohort studies report no association. Several nighttime events including increased IOP, decreased OPP, and possibly OSA contribute to the development and progression of glaucomatous optic neuropathy. These events may explain the occurrence and progression of glaucomatous disease in the setting of seemingly controlled office-measured IOP.
Beatriz Fiuza Gomes
Full Text Available ABSTRACT Purpose: To study the technique of eye drop instillation in glaucoma patients and identify independent factors that may influence their performance. Methods: In this cross-sectional study, 71 consecutive patients with glaucoma or ocular hypertension, self-administering topical anti-glaucoma medications for ≥6 months were evaluated. All patients instilled a tear substitute into the eye with the worst eyesight using the technique normally used at home. The following parameters were evaluated: age, number of years receiving treatment with ocular hypotensive eye drops, time spent to instill the first drop, number of drops instilled, correct location of the eye drops, contact of the bottle with the eye, closing of the eyelids or occlusion of the tear punctum, and asepsis of the hands. Results: The mean age of the patients was 66 ± 10.8 years, and patients were on ocular hypotensive drugs for 11.3 ± 7.3 (range, 2-35 years. Only 28% of the patients were able to correctly instill the eye drops (squeeze out 1 drop and instill it into the conjunctival sac without bottle tip contact. Touching the tip of the bottle to the globe or periocular tissue occurred in 62% of the patients. In 49% of the patients, the eye drops fell on the eyelids or cheek. Two or more drops were squeezed by 27% of the patients. Conclusions: The majority of glaucoma patients were unable to correctly instill eye drops. Age was an independent factor associated with eye drop instillation performance.
Andréia Peltier Urbano
treatment were analyzed. RESULTS: There were 329 patients examined at the Glaucoma Service: 132 (40.1% were referred to the service as glaucoma suspects and 197 (59.9% as glaucoma patients. Ninety of the 132 glaucoma suspects had glaucoma (68.2% and 42 are still under investigation (31.8%. Among the 329 patients, 283 (86% had glaucoma, 42 (12.8% were glaucoma suspects, 2 (0.6% had ocular hypertension and 2 (0.6% did not have glaucoma. There were 530 eyes with glaucoma: 298 (56.2% with primary open angle glaucoma, 108 (20.4% with chronic angle closure glaucoma, 21 (4% with glaucoma following cataract surgery, 19 (3.6% congenital glaucoma and 16 (3% with low-tension glaucoma. All patients received initial clinical treatment with IOP-lowering medication. After a mean follow up of 10.5 months, 89 (16.8% underwent laser therapy: 72 (13.6% iridotomy, 7 (1.3% trabeculoplasty and 10 (1.9% panphotocoagulation. A hundred and seventy nine (33% eyes required surgical treatment. CONCLUSION: The most frequent types of glaucoma were primary open angle and angle closure glaucoma. Low tension glaucoma and glaucoma associated with exfoliation syndrome were uncommon in this population.
Full Text Available We report the case of a 16-year-old woman with microspherophakia and secondary open angle glaucoma. The patient presented with a membrane dividing the anterior chamber into two segments without edema or Descemet′s membrane detachment. Slit lamp biomicroscopy, Pentacam, and specular microscopy images were obtained. Double anterior chamber is primarily found in patients with anterior chamber anomalies when there is no history of surgery or trauma.
Lemaitre, S; Blumen-Ohana, E; Akesbi, J; Laplace, O; Nordmann, J-P
Preoperative anxiety is often expressed by patients requiring filtration surgery for their glaucoma. So far, there has been no scale for screening this group of patients for preoperative anxiety. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a self-evaluation questionnaire which has been used in specialties other than ophthalmology and which makes it possible to identify the adult patients with a high level of preoperative anxiety over an upcoming surgical procedure. The purpose of this study is to estimate the preoperative anxiety in glaucoma patients requiring filtration surgery. We performed a prospective study of 36 adult patients with chronic glaucoma not responding to medical treatment and who were about to undergo filtration surgery (trabeculectomy or deep sclerectomy). The APAIS questionnaire was given to the patients after discussing the indication for surgery. A global anxiety score (ranging from 4 to 20) above 10 defined patients with a high level of preoperative anxiety. We attempted to identify among these patients the factors related to filtration surgery which caused them anxiety (lack of control of intraocular pressure, risk of blindness, presence of the filtering bleb). In our sample of patients, we found that glaucoma was a source of anxiety. That was also true for the surgical procedure, though most patients believe that once the decision had been made, their psychological status was not modified by the upcoming procedure. The patient-clinician relationship is important in any chronic disease, all the more so in glaucoma, since this disease remains asymptomatic for a long time. When filtration surgery is necessary, the patients are going to express less preoperative anxiety if they trust their physician and if individualized information has been given to them The French version of the APAIS is a quick scale, easily completed, that can be recommended for evaluating anxiety and patients' need for information prior to filtering
Feasibility, Patient Acceptability, and Preliminary Efficacy of a Culturally Informed, Health Promotion Program to Improve Glaucoma Medication Adherence Among African Americans: "Glaucoma Management Optimism for African Americans Living with Glaucoma" (GOAL).
Dreer, Laura E; Owsley, Cynthia; Campbell, Lisa; Gao, Liyan; Wood, Andy; Girkin, Christopher A
To examine the feasibility, patient acceptability, and preliminary effectiveness of a culturally informed, health promotion program designed to improve glaucoma medication adherence among African American's (AA's) with glaucoma. A sample of 11 AA glaucoma patients (mean age 61 years; 73% women and 27% men) completed a culturally informed and individually tailored, health promotion program developed for AAs titled, "Glaucoma Management Optimism for African Americans Living with Glaucoma" (GOAL)©. The aim of the brief 4-week program is to enhance glaucoma medication adherence through a combination of education, motivational interviewing (MI), and problem-solving training (PST). Feasibility was assessed on the basis of patient satisfaction with the program, number of sessions completed, and length of sessions. Preliminary efficacy was evaluated using a pre-post design to determine whether the program improved objective glaucoma medication adherence via an electronic Travalert dosing aid as well as satisfaction with aspects of glaucoma treatment, health beliefs about medications, glaucoma symptoms, emotional well-being, and intraocular pressure. Overall patient satisfaction and acceptability was high for the program, interactions with the health educator, program materials, and the length of sessions. Feasibility was also supported given the need for the program, success in recruitment/retention, and ease of implementing the program with AA glaucoma patients in clinic and/or over the telephone. In terms of preliminary efficacy, patients showed significant pre-post improvements in objective medication adherence rates by 15% (p = 0.03), self-efficacy for glaucoma management (p = 0.02), ease of use in administering eye drops (p = 0.03), glaucoma treatment satisfaction (p = 0.05), beliefs about the necessity of taking glaucoma medications (p = 0.05), and functional visual ocular symptoms (p = 0.03). (GOAL)© holds great promise toward improving
Shin, Joong Won; Sung, Kyung Rim; Lee, Ji Yun; Kwon, Junki; Seong, Mincheol
To investigate peripapillary vessel density at various spatial locations and layers in healthy and normal tension glaucoma eyes using optical coherence tomography angiography (OCTA). A commercial OCTA device (AngioPlex; Carl Zeiss Meditec) was used to image microvasculature in a 6 × 6-mm optic disc region. Vessel densities of superficial and deep retinal layers were calculated using an automatic thresholding algorithm. Vessel density maps were plotted by averaging individual angiogram images. The spatial characteristics of vessel densities were analyzed at clock-hour sectors and in five 0.7-mm-thick concentric circles from a diameter of 2.0 to 5.5 mm. Areas under the receiver operating characteristics curves (AUCs) assessed the glaucoma diagnostic ability. Vessel density maps of superficial and deep retinal layers were significantly reduced at the 7 and 11 o'clock positions in glaucomatous eyes. In superficial layer, vessel density significantly decreased as the distance from the optic disc margin increased, except in the innermost circle (2.0-2.7-mm). There were significant differences in AUCs of superficial vessel density between innermost circle and the other outer circles. In the deep layer, the innermost circle showed significantly higher vessel density than the outer circles. Vessel density at 7 o'clock showed the best diagnostic performance (AUCs, 0.898 and 0.789) both in the superficial and deep layers. The innermost circle showed eccentric feature compared to the outer circles in terms of spatial characteristics and diagnostic ability. Understanding of the spatial characteristics of peripapillary vasculature may be helpful in clinical practice and determining the optimal measurement area of vessel density.
Myrjam De Keyser
Full Text Available AIM: To compare quality of life and treatment satisfaction between patients who had selective laser trabeculoplasty (SLT and those on medication. METHODS: A prospective clinical trial on 143 glaucoma patients that received SLT and a control group that continued using anti glaucoma medication was conducted. Tear break-up time (BUT, punctuate keratitis, need for help, use of artificial tears and the treatment satisfaction survey of intraocular pressure (IOP were measured at baseline, 6 and 12mo. RESULTS: SLT was able to reduce the mean number of medications needed from 1.56±0.81 to 0.42±0.66 at six months and to 0.33±0.69 at one year. Punctuate keratitis was observed significantly less often (12.24% after SLT than before (35.94%; P=0.03. Use of artificial tears and BUT did not change significantly after SLT (P>0.05. At baseline, patients in the SLT group were significantly less convinced of medication effectiveness (P=0.006 and complained more about side effects (P=0.003. After SLT, these patients had significantly more confidence in their therapy (P<0.001, showed less side effects (P=0.006, complained less about changes in appearance of the eyes (P=0.003 and were less inconvenienced by the use of eye drops (P<0.001. CONCLUSION: SLT is able to improve treatment-related quality of life in glaucoma patients.
Full Text Available AIM:To determine whether red blood cell (RBC membrane and plasma lipids, particularly long-chain polyunsaturated fatty acids such as eicosapentaenoic acid (EPA, docosahexaenoic acid (DHA, arachidonic acid (AA are significantly correlated with severity of normal tension glaucoma (NTG.METHODS:This study included 35 patients with NTG and 12 healthy normal control subjects, matched for age and sex with the study group. The stage of glaucoma was determined according to the Hodapp-Parrish-Anderson classification. Lipids were extracted from RBC membranes and plasma, and fatty acid methyl esters prepared and analyzed by gas chromatography-mass spectrometry (GC-MS.RESULTS:When RBC lipids were analyzed, the levels of EPA, the levels of DHA and the ratio of n3 to n6 were positively associated with the Humphrey Perimetry mean deviation (MD score (r=0.617, P<0.001; r=0.727, P<0.001 and r=0.720, P<0.001, respectively, while the level of AA was negatively associated with the MD score (r=-0.427, P=0.001. When plasma lipids were analyzed, there was a significant positive relationship between the levels of EPA and the MD score (r=0.648, P<0.001, and the levels of AA were inversely correlated with the MD score (r=-0.638, P<0.001.CONCLUSION:The levels of n3 and n6 polyunsaturated fatty acids in RBC membrane and plasma lipids were associated with severity of NTG.
Full Text Available Jennifer H Court,1 Michael W Austin1,21Department of Ophthalmology, Singleton Hospital, Swansea, Wales, UK; 2Department of Ophthalmology, Neath Port Talbot Hospital, Swansea, Wales, UKPurpose: Virtual glaucoma clinics allow rapid, reliable patient assessment but the service should be acceptable to patients and concordance with treatment needs to be maintained with adequate patient education. This study compares experiences and understanding of patients reviewed via the virtual clinic versus the standard clinic by way of an extended patient satisfaction questionnaire (PSQ.Patients and methods: One hundred PSQs were given to consecutive patients attending glaucoma clinics in October 2013. All 135 patients reviewed via the virtual clinic from April 2013 until August 2013 were sent postal PSQs in September 2013. Data were obtained for demographics, understanding of glaucoma, their condition, satisfaction with their experience, and quality of information. Responses were analyzed in conjunction with the clinical records.Results: Eighty-five percent of clinic patients and 63% of virtual clinic patients responded to the PSQ. The mean satisfaction score was over 4.3/5 in all areas surveyed. Virtual clinic patients’ understanding of their condition was very good, with 95% correctly identifying their diagnosis as glaucoma, 83% as ocular hypertension and 78% as suspects. There was no evidence to support inferior knowledge or self-perceived understanding compared to standard clinic patients. Follow-up patients knew more about glaucoma than new patients. Over 95% of patients found our information leaflet useful. Forty percent of patients sought additional information but less than 20% used the internet for this.Conclusion: A substantial proportion of glaucoma pathway patients may be seen by non-medical staff supervised by glaucoma specialists via virtual clinics. Patients are accepting of this format, reporting high levels of satisfaction and non
Nkum, G; Lartey, S; Frimpong, C; Micah, F; Nkum, B
Primary open angle glaucoma (POAG) is an irreversible blinding disease that often presents late because it is symptomless in the early stages. Prognosis depends on early diagnosis and treatment and patient understanding of their condition. Many patients present late because of poor awareness and knowledge. This study was conducted to assess patient's awareness and knowledge of glaucoma in a referral Teaching Hospital. Descriptive cross-sectional study conducted among glaucoma patients aged 40 years and above attending the Komfo Anokye Teaching Hospital (KATH). Patients were selected by simple random sampling. They were recruited after informed consent had been given. A questionnaire on demographics, socio-economics and awareness of glaucoma was administered. There were a total of 117 participants, 61 males and 56 females. The median and modal age group was 50 and 59 years. Amongst the participants, 74% were aware of glaucoma. There were no significant statistical difference in the various age groups, sex, ethnic group or religion and their awareness of glaucoma (P > 0.05).There were statistically significant differences between those who had higher education and their awareness of glaucoma (P < 0.001). Yet only 27% of these had accurate knowledge of glaucoma. Glaucoma awareness in patients attending Komfo Anokye Teaching Hospital is high. Higher education was associated with higher awareness yet this was not translated into accurate knowledge as there were significant misconceptions. There is the need to review the contents of health education with the aim of reducing dangerous misconception of glaucoma and targeting the lower socioeconomic population.
Belyea, David A; Alhabshan, Rashed; Del Rio-Gonzalez, Ana Maria; Chadha, Nisha; Lamba, Tania; Golshani, Cyrus; Merchant, Kunal; Passi, Neena; Dan, Jacob A
Previous research has shown several limitations associated with the use of marijuana as a treatment for glaucoma. However, little is known regarding patients' perceptions toward using marijuana for glaucoma and their intentions to use this therapeutic alternative. To identify factors among patients with glaucoma that could lead to intentions to use marijuana for treatment. This cross-sectional survey study of 204 patients with glaucoma or suspected to have glaucoma was conducted at an academic-based glaucoma clinic in Washington, DC, between February 1 and July 31, 2013. Patients completed a self-administered survey assessing demographics, perceived severity of glaucoma, prior knowledge about marijuana use in glaucoma, past marijuana use, perceptions toward marijuana use (legality, systemic adverse effects, safety and effectiveness, and false beliefs), satisfaction with current glaucoma management, relevance of treatment costs, and intentions to use marijuana for glaucoma. Medical records were reviewed for disease severity. Data analysis was conducted from September 1, 2013, to September 30, 2015. The main outcome was patients' intentions to use marijuana for glaucoma. Multiple linear regression analysis was conducted to identify factors associated with patients' intentions to use marijuana for glaucoma. Of the 334 patients who were invited to participate in the study, 204 (61.1%) completed the survey. About half the participants were women (104 [51.0]%), and 82 (40.2%) were white. Regression analysis of 204 respondents indicated that perceptions of legality of marijuana use (β, 0.378; 95% CI, 0.205 to 0.444; P marijuana (β, 0.323; 95% CI, 0.236 to 0.504; P marijuana and glaucoma treatment costs (β, 0.127; 95% CI, 0.008 to 0.210; P = .04) were significantly associated with intentions to use marijuana for glaucoma treatment after controlling for demographic variables, disease severity, and previous marijuana use. This study's findings suggest a need for more
Overall 15.1% (13) had family history of glaucoma and only 18.1% had heard of glaucoma before their diagnosis was made.93.9% believed that glaucoma is a serious condition which can damage vision and 7.1% believed that they can recover from the illness after treatment. We conclude that glaucoma awareness among ...
Mabuchi, Fumihiko; Yoshimura, Kimio; Kashiwagi, Kenji; Yamagata, Zentaro; Kanba, Shigenobu; Iijima, Hiroyuki; Tsukahara, Shigeo
To assess the risk factors for anxiety and depression in patients with glaucoma. Anxiety and depression in 408 patients with glaucoma were evaluated using the hospital anxiety and depression scale (HADS) questionnaire, which consists of two subscales, representing HADS-anxiety (HADS-A) and HADS-depression (HADS-D). To identify the risk factors for anxiety and depression, the stepwise and multiple linear regression analyses were carried out with the HADS-A and HADS-D subscores as dependent variables and demographic and clinical features as independent variables. A stepwise linear regression analysis revealed the significantly related factors to be age for HADS-A (β=-0.046, p=0.0007) and HADS-D (β=0.035, p=0.011) and the mean deviation of the Humphrey Visual Field Analyzer 30-2 (HFA30-2) in the better eye for HADS-D (β=-0.095, p=0.0026). Based on multiple linear regression analyses, significant relationships were confirmed between age and the HADS-A subscore (β=-0.046, p=0.0008). Significant relationships were also confirmed between age (β=0.037, p=0.0077) or the mean deviation of HFA30-2 in the better eye (β=-0.094, p=0.0036) and the HADS-D subscore. A younger age was thus found to be a risk factor for anxiety, while an older age and increasing glaucoma severity were risk factors for depression in patients with glaucoma.
Cohen, Elisabeth J
To test the hypothesis that keratoconus and pellucid patients who have glaucoma or are suspected of having glaucoma have lower corneal hysteresis (CH) and/or corneal resistance factor (CRF) measurements compared to controls. A prospective study at a tertiary eye center of keratoconus and pellucid patients with glaucoma or suspected of having glaucoma, and age-matched keratoconus and pellucid controls, was performed. After informed consent was obtained, corneal topography, ocular response analyzer measurements, pachymetry, intraocular pressure, A-scan measurements, Humphrey visual fields (VFs), and disc photos were done. Analyses compared cases to controls on primary (CH and CRF) and secondary variables. Disc photos and VFs were rated in a masked fashion. The mean CH (8.2, SD=1.6, vs 8.3, SD=1.5) and CRF (7.3, SD=2.0, vs 6.9, SD=2.1) were low and did not differ significantly between 20 study patients (29 eyes) and 40 control patients (61 eyes), respectively. CH had a negative, significant correlation with maximum corneal curvature by topography (P corneal thickness (P < .003). The mean cup-disc ratio was larger among cases than controls (0.54, SD=0.20, vs 0.38, SD=0.20; P = .003). VFs were suggestive of glaucoma more often among the study eyes than controls (11 of 29, 37.9%, vs 8 of 60, 13.3%; P =.019). CH was low in study and control patients and was correlated with severity of keratoconus/pellucid, but not with glaucoma/suspected glaucoma or control status. Evidence of glaucoma was more common in study eyes than controls, but was present in both.
Full Text Available Aim: We sought to identify differences in the following measures of the ocular response analyser (ORA between primary open angle glaucoma (POAG and exfoliative glaucoma (EXG patients: Corneal hysteresis (CH, corneal resistance factor (CRF, corneal-compensated intraocular pressure (IOPcc and Goldmann-correlated intraocular pressure (IOPg. We also sought to relate these ORA measures with central corneal thickness (CCT. Materials and Methods: This cross-sectional study was conducted on a total of 162 individuals (46 EXG patients, 66 POAG patients and 50 healthy subjects without any ocular and systemic disease. ORA measurements were performed, and a minimum of three readings were obtained from each test subject. Groups were compared according to their ORA parameters. Results: The mean CH levels of the EXG, POAG and healthy subjects were 7.6 ± 2.1, 9.1 ± 1.9 and 9.6 ± 1.7 mmHg, respectively. CH was significantly lower in the EXG patients compared to the other groups (P < 0.001.The mean CRF levels of the EXG, POAG and healthy subjects were 9.0 ± 2.0, 10.1 ± 1.7 and 9.8 ± 1.8mmHg, respectively. CRF levels in the eyes of the EXG patients were significantly lower compared to those of either the POAG patients (P = 0.005 or the healthy subjects (P = 0.03, but there was no significant difference in CRF levels between the POAG patients and the healthy subjects (P = 0.59. There was a significant positive correlation between CH and CCT in the EXG patients and healthy subjects (P < 0.001, but this correlation was not present in the POAG patients (P = 0.70. Conclusions: In this study, CH and CRF were found to be significantly reduced in the eyes of EXG patients compared to both the POAG patients and healthy subjects. Reduced CH in EXG patients might result in decreased support of peripapillary scleral structure and increased damage to the optic nerve during IOP increase.
Cohen, Elisabeth J; Myers, Jonathan S
To test the hypothesis that patients with keratoconus and pellucid who have glaucoma or are glaucoma suspects have lower corneal hysteresis (CH) and/or corneal resistance factor (CRF) measurements compared with controls. A prospective study at a tertiary eye center of patients with keratoconus and pellucid, with glaucoma or suspect glaucoma and age-matched keratoconus and pellucid controls, was performed. After informed consent was obtained, corneal topography, ocular response analyzer (ORA; Reicher, Buffalo, NY), pachymetry, intraocular pressure, A scan measurements, Humphrey visual fields (VFs), and disk photographs were done. Analyses compared cases with controls on primary (CH and CRF) and secondary variables. Disk photographs and VFs were rated in a masked fashion. The mean CH [8.2 (SD = 1.6) and 8.3 (SD = 1.5)] and CRF [7.3 (SD = 2.0) and 6.9 (SD = 2.1)] were low and did not differ significantly between 20 study (29 eyes) and 40 control patients (61 eyes), respectively. CH had a negative significant correlation with maximum corneal curvature by topography (P corneal thickness (P < 0.003). The mean cup to disk ratio was larger (0.54, SD = 0.20) among cases than in controls (0.38, SD = 0.20), P = 0.003. VFs were suspicious for glaucoma more often among the study eyes (11 of 29, 33.9%) than controls (8 of 60, 13.3%), P = 0.019. CH was low in study and control patients and was correlated with severity of keratoconus/pellucid but not with glaucoma/glaucoma suspect or control status. Evidence of glaucoma was more common in study eyes than in controls but was present in both.
Kamppeter, B; Degenring, R F; Jonas, J B
A photo-stress test was conducted at the subjective contrast threshold to evaluate whether psychophysical differences could be detected between chronic open-angle glaucoma patients and normal subjects. The prospective, comparative, clinical observational study included 20 patients (29 eyes) with chronic open-angle glaucoma and 20 control subjects (29 eyes). The study groups did not vary significantly in age and refractive error, but visual acuity showed a difference of 0.16. All participants underwent photo-stress using the Kontrastometer BA4. In the glaucoma group compared with the control group, the mean contrast threshold was significantly higher and the readaptation time significantly longer. The latter correlated significantly with the papillo-morphological glaucoma stage. In patients with chronic open-angle glaucoma, the foveal recovery time after a photo-stress test is significantly prolonged compared with normal subjects. It may suggest involvement of the fovea in glaucoma even if the visual acuity is 20/20.
Hasanreisoglu, Murat; Priel, Ethan; Naveh, Lili; Lusky, Moshe; Weinberger, Dov; Benjamini, Yoav; Gaton, Dan D
One of the leading methods for optic nerve head assessment in glaucoma remains stereoscopic photography. This study compared conventional film and digital stereoscopy in the quantitative and qualitative assessment of the optic nerve head in glaucoma and glaucoma suspect patients. Fifty patients with glaucoma or suspected glaucoma underwent stereoscopic photography of the optic nerve head with a 35-mm color slide film and a digital camera. Photographs/images were presented in random order to 3 glaucoma specialists for independent analysis using a standardized assessment form. Findings for the following parameters were compared among assessors and between techniques: cup/disc (C/D) ratio, state of the optic rim, presence of peripapillary atrophy and appearance of the retinal nerve fiber layer, blood vessels, and lamina cribrosa. The film-based and image-based diagnoses (glaucoma yes/no) were compared as well. Despite high level of agreement across graders using the same method for the horizontal and vertical C/D ratio, (intraclass correlations 0.80 to 0.83), the agreement across graders was much lower for the other parameters using the same method. Similarly the agreement between the findings of the same grader using either method was high for horizontal and vertical C/D ratio, but low for the other parameters. The latter differences were reflected in the disagreement regarding the final diagnosis: The diagnoses differed by technique for each grader in 18% to 46% of eyes, resulting in 38.5% of eyes diagnosed with glaucoma by film photography that "lost" their diagnosis on the digital images, whereas 18.7% of eyes diagnosed as nonglaucomatous by film photography were considered to have glaucoma on the digital images. Although there is consistency between 35-mm film stereoscopy and digital stereoscopy in determining the cup/disc (C/D) ratio, in all other parameters large differences exist, leading to differences in diagnosis. Differences in capturing images between
Full Text Available To investigate the success rate of eye drop instillation in glaucoma patients with visual field defect as well as non-glaucoma volunteers. Factors that may affect the success rate of eye drop instillation were also evaluated.A prospective, observational study.Seventy-eight glaucoma patients and 85 non-glaucoma volunteers were recruited in this study.Open angle glaucoma patients with visual field defect as well as non-glaucoma volunteers were asked to video record their procedures of eye drop instillation using a 5-mL plastic bottle of artificial tear solution. Success of eye drop instillation was judged on video based on the first one drop of solution successfully applied on the cornea, by two investigators.Success rate of eye drop instillation in glaucoma patients and non-glaucoma volunteers. Factors related to success rate of eye drop instillation, such as visual field defect and clinical characteristics, were also analyzed using multivariable logistic regression.No significant deference in mean age was observed between two groups (glaucoma: 64.5 ± 14.4 years, non-glaucoma: 60.9 ± 14.1 years, P = 0.1156. Success rate of eye drop instillation was significantly lower (P = 0.0215 in glaucoma patients (30/78; 38.5% than in non-glaucoma volunteers (48/85; 56.5%. The most frequent reason of instillation failure in glaucoma patients was touching the bulbar conjunctiva, cornea, eyelid or eyelashes with the tip of the bottle (29.5%. Multivariable logistic regression analysis identified lower corrected visual acuity (VA (≤ 1.0; odds ratio [OR] = 0.20, 95% confidence interval [CI] 0.04-0.93, P = 0.0411, lower mean deviation (MD (< -12 dB; OR = 0.20, 95% CI 0.05-0.86, P = 0.0307 and visual field defect (VFD in the inferior hemifield (OR = 0.11, 95% CI 0.02-0.34, P < 0.001 to be significantly related to instillation failure in glaucoma patients.Success rate of eye drop instillation was significantly lower in glaucoma patients than in non-glaucoma
Mohindroo, Chirayu; Kumar, Suresh
ABSTRACT Background: Poor knowledge, attitude and self-care practices (KAP) as regards medication compliance is a major concern in the management of glaucoma. This study aims to evaluate the knowledge, attitude regarding eyedrop instillation and self-care practices pertaining to eyedrops in diagnosed glaucoma patients. Methods: In this cross-sectional, open-ended questionnaire-based study, 101 consecutive glaucoma patients on medication were recruited from an urban tertiary care hospital of North India. A self-designed 10-point KAP questionnaire that addressed patient-, medication-, environment- and physicians related factors was used. For each desirable answer, the participant gives a score of 1 was given and for each undesirable answer a score of ‘0’ was given for each question. The total scores for each domain were calculated separately along with the total score. The association between the individual domain scores, the total score and various sociodemographic parameters were compared using unpaired t-test. Analysis of variance (ANOVA) test was used to compare the means, where the exposure variable had more than two categories. Results: Out of 101 participants, 98% knew the reason why they were instilling the medicine. Only 61.4% subjects knew that the eyedrops should be stored in cool and dry place. Nearly 30% participants believed that two eyedrops could be instilled back to back. Half of the participants (55.4%) did not consider missing a dose of medicine to be significant. Majority (89.1%) of the participants asked the doctor about the drug dosage and timings and 71.3% of them did not use the eyedrops beyond 40 days after opening the vial. 37.6% participants believed that the medicine could be discontinued without asking the doctor, once the symptoms are relieved. Eighty percent patients checked the vial for correct drug name and expiry date before buying. 57.4% of the participants washed their hands before instilling the eyedrops. Only 23.8% patients
Kosior-Jarecka, Ewa; Wróbel-Dudzińska, Dominika; Łukasik, Urszula; Aung, Tin; Khor, Chiea Chuen; Kocki, Janusz; Żarnowski, Tomasz
The purpose of this study was to determine whether four single nucleotide polymorphisms (SNPs) of endothelin and endothelin receptor type A genes can constitute a risk factor for normal tension glaucoma (NTG) and high tension glaucoma (HTG). The study included 160 patients with NTG, 124 patients with HTG, and 165 healthy controls. To analyze the frequency of polymorphic variants of the endothelin EDN gene (K198N) and the endothelin receptor type A gene EDN RA (C1222T, C70G, G231A), DNA was isolated from peripheral blood, and SNP genotyping was performed using the real-time PCR (RT-PCR) method. Plasma endothelin (ET) concentrations were detected using an enzyme immunoassay. Endothelin levels were compared with genotype and allele distributions, patients' clinical status, and various risk factors for NTG. There was a significant difference between the patients with NTG and HTG and the controls (p = 0.035, p = 0.008) regarding the genotype of the C1222T and C70G polymorphism. Plasma concentrations of ET did not differ between the NTG and HTG groups, and no significant correlation with intraocular pressure (IOP), best-corrected visual acuity (BCVA), and the cup to disc ratio (c/d ratio) was seen in patients with NTG. Plasma endothelin levels showed a noticeably positive correlation with age in the NTG group (R = 0.249, p = 0.042). Higher endothelin levels corresponded to more advanced visual field damage. No statistical difference was observed between variant genotypes of K198N and the ET-1 plasma concentration in patients with NTG, whereas a slightly higher ET level was observed in the patients with HTG with the GT genotype in comparison to those with the GG genotype (p = 0.001). The C1222T polymorphism significantly affected the plasma ET level in patients with NTG. The TT genotype carriers had the highest ET level, and the CC genotype carriers the lowest (p = 0.034). The AA variant genotype of the G231A polymorphism exhibited the highest ET level, while the GG
Kashiwagi, Kenji; Tsukahara, Shigeo
Glaucoma is one of the leading causes of blindness. Reduction of intraocular pressure is the only proven way to prevent progression of glaucomatous optic neuropathy. The majority of glaucoma patients need to use antiglaucoma ophthalmic solutions over the course of their life. Thus, good adherence and persistency of glaucoma treatment are important factors for better glaucoma care. The purpose of this study was to investigate the impact of an Internet-based glaucoma care support system on glaucoma medication use. Patients were randomly divided into two groups. The non-Internet access (NIA) group consisted of patients who had access to the Internet-based glaucoma care support system during the 4-year period only when they were examined by ophthalmologists. The Internet access (IA) group consisted of patients who had the same Internet-based glaucoma care support system access as the NIA group for the first 2 years following enrollment but who were also given free access to the glaucoma care support system for the remaining 2 years. Changes in glaucoma medication use were investigated. In total, 81 patients in the IA group and 90 patients in the NIA group satisfied the study protocol. The number of antiglaucoma ophthalmic solutions used during the study period significantly increased in the NIA group (PInternet access significantly shifted from an increasing intraocular pressure trend to a decreasing trend in the IA group (P=.002) among the patients who did not have any medication changes. Allowing patients to browse their medical data may reduce the use and improve the effectiveness of glaucoma medication. UMIN-CTR Clinical Trial Number: UMIN000006982; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000008238&language=E (Archived by WebCite at http://www.webcitation.org/6MRPQeEAv).
Supplementary data: TBK1 duplication is found in normal tension and not in high tension glaucoma patients of Indian origin. Lalit Kaurani, Mansi Vishal, Jharna Ray, Abhijit Sen, Kunal Ray and Arijit Mukhopadhyay. J. Genet. 95, 459–461. Table 1. Intraocular pressure of NTG and HTG patients. Total. Mean IOP. Mean IOP ...
Shtein, Roni M; Newman-Casey, Paula A; Herndon, Leon; Coleman, Anne L; Lee, Paul P
To investigate the role of the family/friends support system for patients with glaucoma and their perspective on barriers to effective glaucoma management. Six focus groups were conducted in 3 geographically and ethnically diverse areas of the United States (Los Angeles, CA; Rochester, MN; Durham, NC) that included 31 participants; 68% (21/31) were family members and friends of glaucoma patients with poor vision and 32% (10/31) were support system individuals of patients with good vision. Content analysis was used to identify important themes. Semiquantitative analysis was used to measure the frequency of each theme. A total of 134 relevant comments were made in the 6 focus groups and 72% of relevant comments were made by individuals providing support for patients with poor vision. Family members and friends mentioned the following areas of concern regarding patients' glaucoma care: patient education (19.4%), doctor-patient relationship (17.9%), their own lack of involvement in the patient's medical care (17.2%), frustration with glaucoma and with the patient (14.9%), patient dependency on caregivers (14.9%), patient frustration with the disease (10.4%), and sex differences in coping mechanisms (5.2%). Support system individuals tend to be minimally involved in the patient's glaucoma status and care. This is especially true for support system members of patients with glaucoma who maintain good vision and those who do not have any other personal experiences with difficulties from glaucoma. Many of these family members express an interest in acquiring more education about glaucoma and becoming more involved in the patient's glaucoma care.
The result probably suggests, that decrease in magnesium aggravates glaucoma while decrease in membrane potential could cause poor energy transmission and hence affect ocular blood flow. Hence, decreased magnesium and membrane potential levels contributes greatly to glaucoma.
Pronin, Savva; Brown, Lyndsay; Megaw, Roly; Tatham, Andrew J
The ability of patients to measure their own intraocular pressure (IOP) would allow more frequent measurements and better appreciation of peak IOP and IOP fluctuation. To examine whether patients with glaucoma can perform self-tonometry using a rebound tonometer and examine patient acceptability. An observational study in which IOP was assessed using Goldmann applanation tonometry and a rebound tonometer. Consecutive patients were provided with a patient information sheet and those consenting to take part in the study received standardized self-tonometry training and were then instructed to measure their own IOP under observation. This study was conducted at a glaucoma clinic at a university hospital from March 1, 2016, to December 30, 2016, and included both eyes of 100 patients with glaucoma or ocular hypertension. The percentage of patients who could successfully perform self-tonometry. Complete success was defined by a good technique and an IOP reading within 5 mm Hg of that obtained by a clinician using the same device. A 3-item questionnaire was used to examine perceptions of self-tonometry among patients. Among the 100 patients, the mean (SD) age was 67.5 (10.9) years (53% female). A total 73 of 100 patients (73%) met the complete success criteria. An additional 6 patients could use the device but had IOP readings greater than 5 mm Hg different from those obtained by the clinician. On average, IOP by the rebound tonometer was 2.66 mm Hg lower than Goldmann applanation tonometry (95% limits of agreement, -3.48 to 8.80 mm Hg). The IOPs with the rebound tonometer were similar whether obtained by self-tonometry or investigator, with excellent reproducibility with an intraclass correlation coefficient of 0.903 (95% CI, 0.867-0.928). A total of 56 of 79 successful or partially successful patients (71%) felt self-tonometry was easy, with 73 of 79 (92%) reporting self-tonometry to be comfortable, and a similar number happy to perform self-tonometry in the future
de Kaspar, Herminia Miño; Kreidl, Ken O; Singh, Kuldev; Ta, Christopher N
To assess differences in conjunctival bacterial flora between patients undergoing glaucoma and cataract surgery. A prospective study comparing conjunctival bacterial cultures obtained from 339 patients undergoing either cataract (n = 258) or glaucoma (n = 81) surgery. All cultures were acquired during the preoperative visit, approximately three to seven days prior to surgery. The culture samples were inoculated onto blood and chocolate agar, as well as blood culture broth media. All bacterial isolates were identified and statistical analyses were performed to determine if there were differences in flora between the eyes undergoing cataract versus glaucoma surgery. Two hundred fifteen of 258 eyes (83%) undergoing cataract surgery were found to have positive bacterial growth, compared with 62 of 81 eyes (77%) of those undergoing glaucoma surgery (P = 0.2246). Coagulase-negative Staphylococci, the most common bacterial isolate, was cultured from 167 eyes (65%) in the cataract group and 42 (52%) in the glaucoma group (P = 0.0514). Among all bacterial isolates, only Corynebacterium species was found to be statistically different between the two patient groups with 92 (36%) and 11 (14%) eyes testing positive in the cataract and glaucoma groups, respectively (P = 0.0003). There was no statistically significant difference in the proportion of conjunctival culture samples testing positive for bacterial growth in eyes undergoing glaucoma surgery compared with those undergoing cataract surgery. Glaucoma medications, or their preservatives, do not appear to significantly alter conjunctival flora. Techniques used for endophthalmitis prophylaxis prior to cataract surgery are likely appropriate for glaucoma surgery as well.
Full Text Available Fabio N Kanadani,1 Paulo AA Mello,1 Syril K Dorairaj,2 Tereza CM Kanadani31Federal University of Sao Paulo, Sao Paulo, Brazil; 2Mayo Clinic, Department of Ophthalmology, Jacksonville, Florida, USA; 3Sao Jose University Hospital, Belo Horizonte, BrazilIntroduction: The gold standard in functional glaucoma evaluation is standard automated perimetry (SAP. However, SAP depends on the reliability of the patients’ responses and other external factors; therefore, other technologies have been developed for earlier detection of visual field changes in glaucoma patients. The frequency-doubling perimetry (FDT is believed to detect glaucoma earlier than SAP. The multifocal visual evoked potential (mfVEP is an objective test for functional evaluation.Objective: To evaluate the sensitivity and specificity of FDT and mfVEP tests in normal, suspect, and glaucomatous eyes and compare the monocular and interocuar mf VEP.Methods: Ninety-five eyes from 95 individuals (23 controls, 33 glaucoma suspects, 39 glaucomatous were enrolled. All participants underwent a full ophthalmic examination, followed by SAP, FDT, and mfVEP tests. Results: The area under the curve for mean deviation and pattern standard deviation were 0.756 and 0.761, respectively, for FDT, 0.564 and 0.512 for signal and alpha for interocular mfVEP, and 0.568 and 0.538 for signal and alpha for monocular mfVEP. This difference between monocular and interocular mfVEP was not significant. Conclusion: The FDT matrix was superior to mfVEP in glaucoma detection. The difference between monocular and interocular mfVEP in the diagnosis of glaucoma was not significant. Keywords: standard automated perimetry, electrophysiology, glaucomatous eyes
Otori, Yasumasa; Takahashi, Genichiro; Urashima, Mitsuyoshi; Kuwayama, Yasuaki
To evaluate anxiety felt by glaucoma patients. In total, 472 glaucoma patients responded to a questionnaire on anxiety, subjective symptoms, and vision-related quality of life (VR-QOL) associated with glaucoma. Anxiety was evaluated using the State-Trait Anxiety Inventory (STAI), state anxiety (STAI-State) subscale along with our novel questionnaire, assessing visual function and subjective symptoms, specialized for glaucoma. VR-QOL was evaluated using 5 subitems from the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25). Adherence to ophthalmic antiglaucoma agents was confirmed. As indexes of visual function, corrected visual acuity (measured by eye chart), mean deviation (MD) score (measured with static perimetry), and 4 thresholds at the center of vision were determined. Stages were classified according to the Aulhorn Classification. From the STAI-State scores, the prevalence of anxiety in glaucoma patients was evaluated. We analyzed the correlation between the STAI-State and VFQ-25, anxiety, subjective symptoms, adherence, and visual function indexes. In total, 78% of glaucoma patients experienced at least an intermediate level of anxiety. The STAI-State correlated significantly with anxiety and subjective symptoms as measured by our novel questionnaire, particularly for questions "current anxiety about loss of vision" and "current anxiety in life" (r=0.468 and 0.500; both Panxiety. The STAI-State is correlated with the VR-QOL and anxiety in glaucoma patients, making it useful for understanding the anxiety present in glaucoma patients.
Salopek-Rabatić, Jasminka; Pavan, Josip; Kastelan, Snjezana; Rabatić, Leon
As the number of glaucoma patients rasing up by aging population, importante is, to point out facts about glaucoma patients as contact lens carriers. Diagnostic and therapy options as well as quality of life are discussed and recommended. Glaucoma as chronic desease needs adequate specific diagnostic procedure as a visual field depending on the right/best visual correction, daily therapy, specific eye drop medication, but also needs daily quality of life for those patients. Advantages of both, quality of therapy and quality of life, is explaned and discussed in connection together. It is possible to treat glaucoma patients with the mixture of different active eye drops because of the new glaucoma strategy recently presented, investigated and prescribed as the best therapy approach. The prostaglandines, or the combination of two in one different drugs (combi) bottle is reality. That means, active medication applied once a day, new preservatives strategy from different manufacturers are discussed and recommended.
When patients with glaucoma meet doctors and their assistants in a doctor's office or a hospital all hope that this contact will be trouble-free, helpful, perhaps even happy and conducted in a constructive spirit. But this is not always the case. Words and gestures may accidently hurt or reject the patient. Often the communication results in harm instead of help and healing. For this reason, it is worthwhile to have a glimpse behind the curtain of the difficult interactions between people. The rules of communication in the medical context will help to facilitate the contact between doctors and patients. Verbal and non-verbal communication play an important role, for example in how to address the individual patient, as well as the timing and wording. Expertise in communication is a key qualification for medical professionals! Georg Thieme Verlag KG Stuttgart · New York.
Chakraborty, Subhadip; Vishal, Mansi; Banerjee, Deblina; Sen, Abhijit; Ray, Kunal
Purpose Glaucoma is a heterogeneous group of optic neuropathies with a complex genetic basis. To date, only the following four genes have been identified: viz. myocilin (MYOC), optineurin (OPTN), WD repeat domain 36 (WDR36), and neurotrophin 4 (NTF4). However, there are conflicting reports regarding the involvement of WDR36 in the pathogenesis of primary open-angle glaucoma (POAG). In the Asian population, mutations in WDR36 appear to play a minor role in POAG pathogenesis but polymorphic variants have been found to be associated with POAG, especially in patients with high tension glaucoma (HTG). The purpose of this study is to determine the role of WDR36 in East Indian POAG patients. To date, no other studies have yet examined this role. Methods Ten single nucleotide polymorphisms (SNPs; rs1971050, rs1993465, rs13153937, rs10038177, rs11241095, rs10043631, rs10038058, rs10491424, rs17553936, and rs13186912) spanning almost the entire WDR36 gene were selected and their association with eastern Indian POAG patients was evaluated. Our study pool consisted of 323 POAG patients. Of these 116 were patients who had HTG with intraocular perssure (IOP) >21mmHg and 207 were found to be non-HTG patients (presenting IOPT) was found to be strongly associated with the HTG cases (OR=2.186; 95% CI=1.458–3.277; p=1.4×10−4). To increase the significance of the study, the SNP was genotyped in an additional 184 of the participants in the control group and it was observed that the SNP retained the association (OR=1.216; 95% CI=1.064–2.306; p=0.002). However, no haplotype was found to have any sustainable association with POAG. Based on the LD pattern and location of rs10038177, exon 5 of WDR36 was sequenced but no suspected disease-causing variant was detected. Conclusions Our study suggests a possible association between WDR36 SNP in a cohort of eastern Indian POAG patients who also have high intraocular pressure (IOP). This study needs to be further validated in a larger
Honjo, Megumi; Igarashi, Nozomi; Kurano, Makoto; Yatomi, Yutaka; Igarashi, Koji; Kano, Kuniyuki; Aoki, Junken; Weinreb, Robert N; Aihara, Makoto
To compare the levels of autotaxin (ATX), lysophosphatidic acid (LPA), and lysophosphatidylcholine (LPC) in the aqueous humor (AH) of healthy control subjects with those of patients with different subtypes of glaucoma, and also to investigate the relationship of the ATX-LPA pathway with IOP and subtype of glaucoma. This study included 164 eyes of 164 consecutive cases of cataract and glaucoma surgery (37 healthy, 31 normal tension glaucoma, 49 primary open angle glaucoma, 28 secondary open angle glaucoma, and 19 exfoliation glaucoma). Aqueous levels of LPA, LPC, and ATX were quantified using liquid chromatography-tandem mass spectrometry and a two-site immunoenzymetric assay. The association between aqueous levels of ATX/LPA/LPC and IOP elevation in different glaucoma subtypes was investigated. The diagnostic values of indices of the ATX-LPA pathway were compared using receiver operating characteristic curve analysis. Notable increases in ATX/LPA/LPC levels in glaucoma patients were observed. The ATX-LPA pathway was significantly related to IOP elevation and the subtype of glaucoma, especially in SOAG and XFG patients, and the area under the curve was significant for discriminating glaucoma eyes from healthy eyes. Bioactive ATX/LPA/LPC concentrations were present in aqueous humor, and higher ATX and LPA concentrations were significantly correlated with IOP in all study subjects. Furthermore, the ATX-LPA pathway was significantly related to glaucoma subtype. These results reveal the potentially important role of the ATX-LPA pathway for IOP regulation in healthy subjects and glaucoma patients.
Francisco J. Muñoz-Negrete
Full Text Available Purpose. To determine the diagnostic accuracy for glaucoma of a set of criteria with nonmydriatic monoscopic fundus photography (NMFP in diabetics. Methods. Diabetics recruited from a screening program for diabetic retinopathy and diabetic glaucoma patients recruited from our glaucoma unit were included. Any patient with evidence of diabetic retinopathy was excluded. Diabetic patients had to have no visual field defects to be included as controls. Glaucoma patients had to have a glaucomatous field defect in at least one eye to be included. One NMFP was taken per eye for all subjects. These photographs were evaluated by two masked glaucoma specialists for the presence of the following: bilateral cup to disc (C/D ratio ≥0.6, notching or thinning of the neuroretinal rim, disc hemorrhages, and asymmetry in the C/D ratio between both eyes ≥0.2. This evaluation led to a dichotomous classification: if any of the above criteria was present, the patient was classified as glaucoma. If none were present, the patient was classified as normal. Results. 72 control subjects and 72 glaucoma patients were included. Evaluation of NMFP had a sensitivity of 79.17% and a specificity of 80.56% for specialist 1 and a sensitivity of 72.22% and a specificity of 88.88% for specialist 2 for the detection of glaucoma. The overall accuracy was 79.83% and 80.55%, respectively. Discussion. NMFP evaluation by a glaucoma specialist may be useful for the detection of glaucoma in diabetics.
Jansonius, Nomdo M.; Heeg, Govert P.
We aimed to determine prospectively the incidence of abnormal test results on frequency doubling perimetry (FDT), the nerve fibre analyser (GDx) and standard automated perimetry (SAP) in a cohort of glaucoma suspect patients with normal findings for all these tests at baseline. Seventy glaucoma
Skalicky, Simon E; D'Mellow, Guy; House, Philip; Fenwick, Eva
Targeted education may impact glaucoma patients' clinical experience. The aim of this study was to measure the impact of patient-centred glaucoma-related education on knowledge, anxiety and treatment satisfaction. This was a multicentre Australia-wide randomized clinical trial. One hundred one newly diagnosed glaucoma patients were randomized 1:1 to intervention or control groups. Those randomized to the Glaucoma Australia educational intervention received telephone-based counselling about glaucoma followed by mail-out information, in addition to usual care and information from their treating ophthalmologist. The control group received only usual care and information from their treating ophthalmologist. Surveys were administered at baseline and 4 weeks following intervention. The Auckland Glaucoma Knowledge Questionnaire measured glaucoma-related knowledge. The Hospital Anxiety and Depression Scale and Eye-Drop Satisfaction Questionnaire measured anxiety and patient treatment satisfaction, respectively. Mean age was 64.7 ± 11.1 years, and 52 (51.5%) were male. There was no noticeable increase in knowledge levels in the control group (mean difference: 0.04 logits, P = 0.7), compared with a 0.49-logit (P = 0.02) increase in knowledge levels in the intervention group. Between-group comparison showed a non-significant increase in knowledge (0.45 logits, P = 0.07) comparing intervention participants with controls. Intervention participants experienced a statistically significant decrease in anxiety compared to controls (-0.60 logits, P = 0.02). No between-group difference was found in Eye-Drop Satisfaction Questionnaire scores. Patient-centred glaucoma-related education and support services may improve knowledge and can reduce anxiety for newly diagnosed glaucoma patients. All glaucoma patients should be adequately counselled about the nature of the disease and its management. © 2017 Royal Australian and New Zealand College of Ophthalmologists.
Akil, Handan; Chopra, Vikas; Huang, Alex; Loewen, Nils; Noguchi, Jonathan; Francis, Brian A
To evaluate outcomes of Trabectome on pigmentary glaucoma (PG) patients compared to matched controls with primary open angle glaucoma (POAG). Prospective comparison study PARTICIPANTS: A total of 101 POAG cases were matched with 101 PG cases. Data of the patients diagnosed with PG or POAG was obtained from Trabectome Study Group Database. A one-to-one exact matching was performed between POAG and pigmentary cases based on type of surgery, baseline IOP and baseline number of glaucoma medications. IOP and number of glaucoma medications were compared between groups by Wilcoxon test. Success was defined as IOP ≤ 21 mmHg, at least 20% IOP reduction from baseline for two consecutive visits after 3 months and no secondary surgery. Success rate after Trabectome surgery in PG patients. Baseline IOP for PG is 24.4 ± 7.7 mmHg and 24.2 ± 7.5 mmHg for POAG (P = 1.0), while baseline number of glaucoma medications was 2.8 ± 1.2 mmHg for PG and 2.8 ± 1.2 mmHg for POAG (P = 1.0). Postoperative IOP values at 12 months were 17.1 ± 5.0 for PG cases and 15.9 ± 4.2 mmHg for POAG cases. Postoperative number of glaucoma medications at 12 month was 2.1 ± 1.4 in PG cases and 2.4 ± 1.3 in POAG cases. There was no statistically significant difference between groups in IOP or number of medications at any time point. Survival rate at 12 months was 92% and 86% in PG and POAG, respectively (P = 0.47). Six PG cases and nine POAG cases required secondary surgery. Trabectome provides similar outcomes to PG patients and POAG patients. © 2016 Royal Australian and New Zealand College of Ophthalmologists.
Sleath, Betsy; Sayner, Robyn; Vitko, Michelle; Carpenter, Delesha M; Blalock, Susan J; Muir, Kelly W; Giangiacomo, Annette L; Hartnett, Mary Elizabeth; Robin, Alan L
The purpose of this study was to: (a) describe the extent to which ophthalmologists and glaucoma patients discuss vision quality-of-life during office visits, and (b) examine the association between patient and ophthalmologist characteristics and provider-patient communication about vision quality-of-life. Patients with glaucoma who were newly prescribed or on glaucoma medications were recruited at six ophthalmology clinics. Patients' visits were video-tape recorded and quality-of-life communication variables were coded. Generalized estimating equations were used to analyze the data. Two hundred and seventy-nine patients participated. Specific glaucoma quality-of-life domains were discussed during only 13% of visits. Older patients were significantly more likely to discuss one or more vision quality-of-life domains than younger patients. African American patients were significantly less likely to make statements about their vision quality-of-life and providers were less likely to ask them one or more vision quality-of-life questions than non-African American patients. Eye care providers and patients infrequently discussed the patient's vision quality-of-life during glaucoma visits. African American patients were less likely to communicate about vision quality-of-life than non-African American patients. Eye care providers should make sure to discuss vision quality-of-life with glaucoma patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Park, Jong Hyuk; Choi, Kyu-Ryong; Kim, Chan Yun; Kim, Sung Soo
To evaluate the characteristics of the posterior segments of eyes with high myopia and normal-tension glaucoma (NTG) and identify which ocular factors are most associated with scleral thickness and posterior staphyloma height. The study included 45 patients with highly myopic NTG and 38 controls with highly myopic eyes (≤-6D or axial length ≥26.0 mm). The subfoveal retinal, choroidal, scleral thickness and the posterior staphyloma heights were examined from enhanced depth imaging spectral-domain optical coherence tomography and compared between two groups. Highly myopic NTG eyes had thinner subfoveal scleral thickness (473.03±43.75 vs 579.46±75.87 µm, pcorneal hysteresis and the posterior staphyloma height of the superior quadrant, the nasal quadrant and the arithmetic mean of four quadrants in highly myopic NTG eyes. Corneal hysteresis (β=2.694, p=0.015), corneal resistance factor (β=-2.916, p=0.010) and the posterior staphyloma height of the nasal quadrant (β=-0.463, p=0.017) were significantly associated with the subfoveal scleral thickness in highly myopic NTG eyes. Subfoveal scleral thinning and non-uniform posterior staphyloma were closely related in highly myopic NTG eyes. Corneal hysteresis, corneal resistance factor and the nasal posterior staphyloma height were associated with the scleral thickness. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Ngai, Philip; Kim, Grace; Chak, Garrick; Lin, Ken; Maeda, Masahiro; Mosaed, Sameh
To determine the efficacy and safety of Trabectome surgery on patients with steroid response, ranging from ocular hypertension refractory to maximal medical therapy to the development of steroid-induced glaucoma.A nonrandomized, nonblinded, retrospective study of 20 subjects with steroid response was conducted. All 20 eyes underwent Trabectome surgery alone. Nine subjects had steroid response with unremarkable visual field, 3 had mild steroid-induced glaucoma, and 8 had advanced steroid-induced glaucoma. Outcome measures included intraocular pressure (IOP), number of glaucoma medications, need for secondary glaucoma surgery, and steroid regimen. Mann-Whitney U test was used to compare postoperative IOP and number of medications to preoperative IOP and number of medications. Kaplan-Meier was used for survival analysis, and success was defined as: IOP reduced by 20% or more on any 2 consecutive visits after 3 months; IOP ≤21 mm Hg on any 2 consecutive visits after 3 months; and no secondary glaucoma surgery.The average preoperative IOP was 33.8 ± 6.9 mm Hg and average preoperative glaucoma medication usage was 3.85 ± 0.75 medications. At 12 months, the IOP was reduced to 15.00 ± 3.46 mm Hg (P = 0.03) and glaucoma medication was reduced to 2.3 ± 1.4 (P glaucoma surgery (glaucoma drainage device). No other complications were noted.The Trabectome procedure is safe and highly effective for steroid-response glaucoma, even in the context of continued steroid treatment.
Gramer, Eugen; Reiter, Constantin; Gramer, Gwendolyn
To evaluate the following in patients with aniridia: age at first examination at the University Eye Hospital and age at diagnosis of glaucoma; visual acuity; frequency of family history of aniridia; and frequency of ocular and general diseases associated with aniridia. This was a consecutive examination of 30 unrelated patients with aniridia and retrospective evaluation of ophthalmologic, pediatric, and internal findings. The relative frequency of age at glaucoma diagnosis within decades was evaluated for the 20 patients with aniridia and glaucoma. Statistical analysis was performed using the Mann-Whitney test. Relative frequency of the age of patients with aniridia at time of glaucoma diagnosis within the following decades was as follows: from birth to 9 years: 15%, 10-19: 15%, 20-29: 15%, 30-39: 15%, 40-49: 35%, and 50-59: 5%. Visual acuity in the better eye of 20/100 or less was found in 60%. Family history of aniridia was found in 33.3% of patients, with 1-4 relatives with aniridia. A total of 76.7% of patients had congenital cataract, and 66.7% had glaucoma. Mean maximum intraocular pressure of the 20 patients with glaucoma was 35.9 mmHg in the right and 32.6 mmHg in the left eye. A total of 53.3% had nystagmus, 26.6% corneal opacifications, 16.7% bilateral lens dislocation upwards, 6.7% optic nerve hypoplasia, 3.3% poor foveal development, and 3.3% Wilms tumor. Up to the age of 40 years, 15% of patients were diagnosed with glaucoma per age decade. Frequent bilateral glaucoma and similar bilateral height of intraocular pressure suggest a genetic glaucoma disposition with malformation at Schlemm canal, besides possible sequential anatomic changes in the chamber angle. Associated ocular abnormalities limit visual prognosis.
Seong Hee Shim
Full Text Available Purpose. To investigate the role of systemic arterial stiffness in glaucoma patients with diabetes mellitus (DM. Design. Retrospective, cross-sectional study. Participants. DM subjects who underwent brachial-ankle pulse wave velocity (baPWV were recruited. Methods. Glaucoma patients (n=75 and age-matched control subjects (n=92 were enrolled. Systemic examination including BaPWV and detailed eye examination were performed. The glaucoma group was divided into subgroups of normal tension glaucoma (NTG, n=55 and primary open-angle glaucoma (POAG based on an IOP of 21 mmHg. BaPWV was used to stratify the population into 4 groups based on the rate. Stepwise multiple logistic regression analysis by baPWV quartiles was used to compare the glaucoma group with the control group. Main Outcome Measures. BaPWV in glaucoma with DM patients. Results. Faster baPWV was positively associated with glaucoma (odds ratio: 3.74; 95% CI: 1.03–13.56, stepwise multiple logistic regression analysis in patients with DM. Increasing baPWV was also positively associated with glaucoma (p for trend = 0.036. The NTG subgroup showed similar results to those of the glaucoma group. Conclusions. In this study, increased arterial stiffness was shown to be associated with glaucoma and may contribute to the pathogenesis of glaucoma in DM patients.
Caglar, Çagatay; Gul, Adem; Batur, Muhammed; Yasar, Tekin
To compare the sensitivity and specificity of Moorfields regression analysis (MRA) and glaucoma probability score (GPS) between healthy and glaucomatous eyes with Heidelberg Retinal Tomograph 3 (HRT-3). The study included 120 eyes of 75 glaucoma patients and 138 eyes of 73 normal subjects, for a total of 258 eyes of 148 individuals. All measurements were performed with the HRT-3. Diagnostic test criteria (sensitivity, specificity, etc.) were used to evaluate how efficiently GPS and MRA algorithms in the HRT-3 discriminated between the glaucoma and control groups. The GPS showed 88 % sensitivity and 66 % specificity, whereas MRA had 71.5 % sensitivity and 82.5 % specificity. There was 71 % agreement between the final results of MRA and GPS in the glaucoma group. Excluding borderline patients from both analyses resulted in 91.6 % agreement. In the control group the level of agreement between MRA and GPS was 64 % including borderline patients and 84.1 % after excluding borderline patients. The accuracy rate is 92 % for MRA and 91 % for GPS in the glaucoma group excluding borderline patients. The difference was nor statistically different. In both cases, agreement was higher between MRA and GPS in the glaucoma group. We found that both sensitivity and specificity increased with disc size for MRA, while the sensitivity increased and specificity decreased with larger disc sizes for GPS. HRT is able to quantify and clearly reveal structural changes in the ONH and RNFL in glaucoma.
Din, Norshamsiah Md; Talat, Lazha; Isa, Hazlita; Tomkins-Netzer, Oren; Barton, Keith; Lightman, Sue
To determine whether the second eyes (SE) of patients with bilateral uveitic glaucoma undergoing filtration surgery have more glaucomatous progression in terms of visual acuity, visual field (VF) and optic nerve changes compared to the first eyes (FE). This retrospective study analysed data of 60 eyes from 30 patients with bilateral uveitic glaucoma who had undergone glaucoma surgery in both eyes on separate occasions. Humphrey VF progression was assessed using the Progressor software. The pre-operative IOP between the FE (43.1 ± 7.7 mmHg) and SE (40 ± 8.7 mmHg) was not statistically significant (p = 0.15). IOP reduction was greater in the FE (64 %) than SE (59.7 %) post-operatively, but the mean IOP at the final visit in the FE (12.3 ± 3.9 mmHg) and SE (14.5 ± 7 mmHg) was not statistically different (p = 0.2). There was no significant change in mean logMAR readings pre and post-operatively (0.45 ± 0.6 vs 0.37 ± 0.6, p = 0.4) or between the FE and SE. The number of SE with CDR > 0.7 increased by 23 % compared to the FE. From 23 available VFs, five SE (21.7 %) progressed at a median of five locations (range 1-11 points) with a mean local slope reduction of 1.74 ± 0.45 dB/year (range -2.39 to -1.26), whereas only one FE progressed. However, there was no significant difference between mean global rate of progression between the FE (-0.9 ± 1.6 dB/year) and SE (-0.76 ± 2.1 dB/year, p = 0.17) in the Humphrey VF. In eyes with bilateral uveitic glaucoma requiring glaucoma surgery, the SEs had more progressed points on VF and glaucomatous disc progression compared to FEs at the final visit.
Ernest, Paul J G; Busch, Michiel J W M; Webers, Carroll A B; Beckers, Henny J M; Hendrikse, Fred; Prins, Martin H; Schouten, Jan S A G
To assess the prevalence of end-of-life visual impairment in patients followed for glaucoma. Data of 122 patients followed for glaucoma who had died between July 2008 and July 2010 and who had visited the ophthalmology outpatient department of a large non-academic Dutch hospital were collected from the medical files. Sixty-one patients had open-angle glaucoma (OAG), and 61 patients were suspect for glaucoma or had ocular hypertension (OHT). Visual impairment was defined as a mean deviation value visual acuity visual impairment on the last patient visit before death and investigated its main explanations. Overall, the mean age at death was 81.8 years after a mean follow-up period of 9.2 years. Seventy-three per cent of all patients had their last visit in the year preceding death. In OAG, 16 patients (26%) had an end-of-life visual impairment. In nine patients (15%), this was caused by glaucoma. Eight of them had substantial visual loss at the initial visit. Six (10%) impaired OAG cases were mainly explained by ocular comorbidity, and there was an equal contribution of comorbidity and glaucoma in one case. Five glaucoma suspects or patients with OHT (8%) were visually impaired at death and these were all caused by ocular comorbidity. The prevalence of end-of-life visual impairment is considerable in patients with OAG. Substantial visual loss at baseline is an important contributing factor. In glaucoma suspects or patients with OHT, the prevalence is lower and can be attributed to ocular comorbidity. © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.
NRR width reduced to ≤0.1CDR (between 11 to 1 o'clock or 5 to 7 o'clock). 2 ... 24. TOTAL. 100. 855. 100. 1013. Table 2: POAG - primary open angle glaucoma, POAGS – primary open angle glaucoma suspect, NTG ..... Twenty-four-hour.
Chiam, Nathalie; Baskaran, Mani; Li, Zheng; Perera, Shamira; Goh, David; Husain, Rahat; Khor, Chiea Chuen; Cheng, Ching-Yu; Aung, Tin; Vithana, Eranga N
There is limited literature on lifestyle and health factors related to primary open-angle glaucoma amongst Asians. This study evaluated the association of primary open-angle glaucoma with smoking, health and ocular factors amongst Chinese Singaporeans. Case-control study. The study used 711 primary open-angle glaucoma patients from a Singapore hospital and 2788 population-based controls. Subjects underwent clinical examination and completed a questionnaire with details on family history of glaucoma, comorbidities, smoking and alcohol consumption. Glaucoma cases were subclassified as normal or high-tension glaucoma according to their untreated intraocular pressures. The association of various health and lifestyle factors, with normal-tension and high-tension glaucoma was evaluated. Using multiple logistic regression, primary open-angle glaucoma was associated with older age (odds ratio 1.12 per year older; 95% confidence interval 1.10-1.15; P angle glaucoma (P angle glaucoma amongst Chinese Singaporeans. © 2017 Royal Australian and New Zealand College of Ophthalmologists.
Natalia A Iutaka
Conclusion: VFI showed a strong correlation with MD and PSD but demonstrated a weak correlation with structural measures. It can possibly be used as a marker for functional impairment severity in patients with glaucoma.
Abreu-Reyes, J A; Álvarez-Luis, D; Arteaga-Hernández, V; Sánchez-Mendez, M; Abreu-González, R
To study the adherence to the Mediterranean diet in patients affected by primary open angle glaucoma (POAG). An observational study was conducted to assess the adherence to the Mediterranean diet in patients affected by POAG, and who attended the Ophthalmology Department of the Canary Islands University Hospital. The study included completing a 14-item questionnaire validated by the PREDIMED Study, in person or by telephone. A total of 100 questionnaires were completed successfully by 50 males and 50 females. The mean age was 69.58 years for the males and 67.42 years for women. The men had more comorbidities than women (tobacco 14 vs. 3%), arterial hypertension, and diabetes (30 vs. 28%, and 16 vs. 6%, respectively). Adherence to the Mediterranean diet in males, was low in 9 patients (18%), moderate in 37 (74%), and high in 4 (8%) cases. In women adherence was low in 14 patients (28%), moderate in 34 (68%), and high in 2 (6%) cases. The overall adhesion to the Mediterranean diet is low in 23%, moderate in 71% and high in 6% of the cases. Patients who are affected by POAG have moderate adherence to the Mediterranean diet. Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.
Schroeder, B; Hager, A; Kutschan, A; Wiegand, W
The ocular response analyzer (ORA) uses an air-pressure-triggered, dynamic, bi-directional corneal applanation method to measure biomechanical parameters of the cornea. Corneal hysteresis (CH) is defined as the difference in intraocular pressure recorded during inward and outward applanation. CH is therefore an indicator for the viscoelastic properties of the cornea. CH was recorded in non-glaucoma patients (80 eyes) as well as in patients with primary open angle glaucoma (POAG, 82 eyes). The correlation between CH and central corneal thickness (CCT) was analyzed. Mean CH was 10.6+/-2.2 mmHg in the non-glaucoma group and 9.3+/-2.2 mmHg in patients with POAG (pcorneal parameters with a significant decrease in corneal hysteresis. A positive correlation between CH and CCT, which was seen in the non-glaucoma group could not be detected in the POAG group.
Terelak-Borys, Barbara; Grabska-Liberek, Iwona; Piekarniak-Wozniak, Anita; Konieczka, Katarzyna
We present a long term follow-up of a young female patient with choroidal infarction, primary open angle glaucoma and Flammer syndrome. The patient had no classical risk factors for vascular occlusions, except for the presence of Flammer syndrome. The essential feature of this syndrome is primary vascular dysregulation, sometimes including vasospasm. The vessels of affected people respond more intensely to a number of stimuli, such as coldness or emotional stress. Any organ can be involved, including parts of the eye. The dense autonomic innervation of the choroidal vessels predisposes them particularly to vasospasms. The patient was originally referred to our centre because of a deep unilateral paracentral scotoma with the presumptive diagnosis of a normal tension glaucoma. The discrepancy between the visual field defect and the optic nerve head morphology, however, led us to a vascular evaluation by a simultaneous fluorescein/indocyanine green angiography. This revealed an antecedent choroidal infarction that explained the visual field scotoma and the retinal nerve fibre layer defect in the corresponding area. During the follow-up period of 11 years, the patient also developed bilateral glaucomatous optic neuropathy despite a well-controlled intraocular pressure. We hypothesise that in the patient presented here, the Flammer syndrome contributed to both the acute unilateral choroidal infarction and to the chronic development of bilateral glaucomatous optic neuropathy.
Full Text Available The author, a sufferer of tension-type headache (TTH, believes that the word "tension" in "tension-type headache" carries a social stigma and that patients do not accept a diagnosis of TTH readily. TTH is the most common primary headache disorder. The disability of TTH as a burden of society is greater than that of migraine. Absenteeism because of TTH is higher than that due to migraine. However, patients with TTH do not go for consultation. Even the prevalence of new daily persistent headache (NDPH is 12 times higher at the headache clinic than that of chronic TTH (CTTH. These points hint that TTH patients probably do not want to visit the clinic. The author believes that it could be because of the stigma attached to "tension." Herein, the author has noted the first responses given by 50 consecutive patients with TTH when they were told that they had been suffering from TTH. The first answer of 64% of patients with TTH was "I do not have any tension/stress ." This denial is similar to the denial declared by patients with depression. Depression and tension are similar in the sense that both are considered as a signs of personal weakness. Such a preconception in the society creates a stigma, and patients deny the diagnosis, conceal symptoms, and become reluctant to seek help and treatment.
Dmitry M. Shamaev
Full Text Available Assessment of ocular hemodynamics is an important element in diagnosis of all forms of glaucoma. Existing methods, unlike the transpalpebral rheoophthalmography (TP-ROG, evaluate only the posterior eye segment. This study evaluates the opportunities of new TP-ROG technology to assess the effectiveness of the glaucoma treatment. The proposed TP-ROG method is characterized by ease of use and the lack of direct contact between the surface of the eyeball and the electrodes; this method is highly informative and quite accurate, which allows us to objectively assess the state of ocular hemodynamics in patients with primary open-angle glaucoma.
Full Text Available Introduction: Glaucoma is one of the leading causes of blindness throughout the world. Some studies have suggested a relationship between glaucoma and sensorineural hearing loss, while others have found no evidence of an association. We performed a study to determine whether there is a significant difference in hearing of patients with glaucoma and a match control population. Methods: In this cross-sectional study, from February, 2005 till April, 2006, 44 patients with glaucoma were studied. The age range was between 15 to 60 years. After taking a complete medical history, those suffering from presbycusis, history of exposure to ototoxic drugs and substances and history of ear surgery were excluded from the study. All of the patients were cases of open-angle glaucoma, and were surveyed separately for normal-pressure glaucoma. Then complete audiometric tests (PTA, SDS, SRT, Impedance were conducted for all of them, and the results compared with a control group. Results: There was no statistically significant difference between the case group and control group in PTA, SDS, and SRT, except for Normal Tension Glaucoma (NTG. There wasn't any statistically significant difference between two groups with respect to age, gender, and history of diseases. In the NTG group, significant difference was seen only in high frequencies. Conclusion: As mentioned, there was a statistically significant difference between NTG group and control group. It is therefore recommended to conduct complete audiometric tests and histopathologic examinations in this group for early detection of hearing loss and application of rehabilitative measures.
Blumberg, Dana M; De Moraes, Carlos Gustavo; Liebmann, Jeffrey M; Garg, Reena; Chen, Cynthia; Theventhiran, Alex; Hood, Donald C
...), stereoscopic disc photographs, and automated perimetry as assessed by a group of glaucoma specialists in differentiating individuals with early glaucoma from suspects. Forty-six eyes (46 patients...
Kunimatsu-Sanuki, Shiho; Iwase, Aiko; Araie, Makoto; Aoki, Yuki; Hara, Takeshi; Fukuchi, Takeo; Udagawa, Sachiko; Ohkubo, Shinji; Sugiyama, Kazuhisa; Matsumoto, Chota; Nakazawa, Toru; Yamaguchi, Takuhiro; Ono, Hiroshi
To assess the role of specific visual subfields in collisions with oncoming cars during simulated driving in patients with advanced glaucoma. Normal subjects and patients with glaucoma with mean deviation glaucoma. And, 5 of the 100 patients with advanced glaucoma experienced simulator sickness during the main test and were thus excluded. In total, 95 patients with advanced glaucoma and 43 normal subjects completed the main test of DS. Advanced glaucoma patients had significantly more collisions than normal patients in one or both DS scenarios (pglaucoma who were involved in collisions were older (p=0.050) and had worse visual acuity in the better eye (pglaucoma. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Raber, Susan; Courtney, Rachel; Maeda-Chubachi, Tomoko
To evaluate short-term safety and steady-state systemic pharmacokinetics (PK) of latanoprost acid in pediatric subjects with glaucoma or ocular hypertension who received the adult latanoprost dose....
Wu, Peixia; Xi, Shuxin; Xia, Haiou; Lu, Huijuan; Guo, Wenyi
The aim of the study was to investigate the vision-related quality of life in glaucoma patients and identify the possible predictors for outcomes. A total sample of 167 subjects with glaucoma was recruited using a convenience sampling strategy. The National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and the Glaucoma Self-Management Questionnaire were used for assessing vision-related quality of life and self-management behavior, respectively. The demographic and disease-related data were also collected. Regarding the vision-related quality of life, the lowest scores were for general health (32.78±23.59), followed by general vision (46.35±19.52). The highest score was for the dimension of color vision (89.02±20.76). Multiple linear regression analysis demonstrated that self-management behavior, positive glaucoma family history, and binocular visual acuity were predictors of vision-related quality of life in this patient group. The current study indicates that vision-related quality of life in glaucoma patients is at a moderate level in China. Self-management behavior is an important predictor. Demographic data may not increase the explanatory effect. Future research should focus on how to integrate self-management skills into routine nursing practice for patients with glaucoma.
Full Text Available Prior studies suggested that glaucoma patients suffer worse dry eye and mood and sleep disorders than non-glaucoma subjects. Prostaglandin analogues are first-line therapy for glaucoma, inducing few instillation problems and sufficient pressure-reduction effects. This study compared dry eye, sleep quality, and mood status between glaucoma patients receiving prostaglandin monotherapy and non-glaucoma subjects.This cross-sectional study evaluated 1520 patients (579 males and 941 females for glaucoma status and dry eye-related symptoms (dryness, eye fatigue, photophobia, pain, blurring and signs (Schirmer test, tear break-up time, corneal staining scores. Of the total cohort, 93 patients were also evaluated by Pittsburgh sleep quality index (PSQI and hospital anxiety and depression score (HADS. Inclusion criteria were consecutive patients ≥ 51 years of age and best-corrected visual acuity ≥ 20/25. Glaucoma patients included those treated with prostaglandin or a fixed combination including prostaglandin. Exclusion criteria were history of ocular surgery within one month. Data were analyzed using the chi-square or Mann-Whitney U tests, at 5% significance.There were no significant differences in dry eye-related signs and symptoms between the control (n = 1431, mean age of 66.9 years and glaucoma groups (n = 89, 67.9 years. The psychiatric sub-analysis of the control (n = 61, 66.2 years and glaucoma groups (n = 32, 67.3 years revealed mean scores of 5.02 ± 3.10 and 5.16 ± 3.46 for PSQI (normal range ≤ 5, 9.47 ± 5.61 and 9.42 ± 7.36 for HADS (normal range ≤ 10, 4.84 ± 3.22 and 4.71 ± 3.45 for anxiety (normal range ≤ 5, and 4.63 ± 3.05 and 4.71 ± 4.40 for depression (normal range ≤ 5, respectively, without statistical significance.Our results were comparable between glaucoma patients on prostaglandin monotherapy and non-glaucoma subjects for dry eye-related clinical manifestations, sleep quality, and mood status.
Full Text Available The glaucomas are a group of progressive optic neuropathies associated with characteristic structural changes at the optic nerve head (cupping and corresponding visual field defects. The main modifiable risk factor for glaucomatous optic neuropathy is increased intraocular pressure (IOP. The aims of assessment are:accurate diagnosisidentification of the cause of increased IOP, if applicablequantification of the level of glaucoma damage and functional impairment.
Yazdani, Shahin; Miraftabi, Arezoo; Pakravan, Mohammad; Ghahari, Elham; Tousi, Betsabeh K; Sedigh, Massih; Yaseri, Mehdi; Elahi, Elahe
To explore the correlation between clinical manifestations of primary congenital glaucoma (PCG) and CYP1B1 mutations. A clinical and molecular genetic study was performed on a cohort of 17 patients with PCG and known CYP1B1 mutation profile including 10 subjects with and 7 cases without mutations. Ophthalmolgical records were reviewed and phenotype which was defined by age at onset, presenting intraocular pressure (IOP), corneal diameter, and vertical cup to disc ratio, and the number of procedures was correlated with the presence or absence of CYP1B1 mutations. Overall, 8 mutations were identified in 10 patients. The disease became manifest earlier than 1 month of age in 9 of 10 (90%) cases with, as compared with 2 of 7 (28.6%) patients without mutations (P=0.035). Baseline IOP was 29.3±6.5 mm Hg in the mutation-positive group versus 17.6±3.7 mm Hg in subjects without mutations (P<0.001). Patients with mutations also had significantly higher IOP throughout follow-up (P<0.002). The number of operations was significantly higher in subjects with mutations (3.3±1.8 vs. 1.8±1.5 procedures, P=0.025). Six patients (60%) with mutations were female as compared with 1 subject (14.3%) in the nonmutation group (P=0.134). There was no significant difference between the study groups in terms of corneal diameter (P=0.475) and vertical cup to disc ratio (P=0.794). PCG patients with CYP1B1 mutations seem to have earlier onset disease, display more severe manifestations, and require more operations as compared with subjects without such mutations. These findings may have implications in prognosticating the disease and genetic counseling.
Full Text Available The loss of vision following Boston Keratoprosthesis (BKPro surgery due to glaucoma occurs at a high frequency as diagnosis and management of glaucoma after this procedure pose challenges.To compare visual outcomes in patients undergoing Boston Keratoprosthesis surgery with and without prior or concurrent glaucoma surgery.This is a retrospective, observational cohort study of patients who underwent Boston Type I Keratoprosthesis surgery. 19 eyes of 18 patients who had undergone BKPro and met the inclusion criteria were identified. Twelve eyes received BKPro with prior or concurrent glaucoma surgery (Group 1, and seven eyes were identified undergoing BKPro surgery without prior or concurrent glaucoma surgery (Group 2.Main outcome included best corrected visual acuity at each follow up.In Group 1, mean best corrected visual acuity (BCVA within a year of BKPro surgery was 20/100 (range 20/40 to Count Fingers (CF; n = 12 and mean BCVA at 1 year from BKPro surgery was 20/115 (range 20/30 to CF; n = 12. 7 out of 12 patients retained or had improved BCVA at 1 year follow up after BKPro implantation, and 5 out of 12 patients had mild BCVA worsening. In Group 2, the mean BCVA within a year of BKPro surgery was 20/140 (ranging from 20/25 to hand motion vision (HM; n = 7 and mean BCVA at 1 year from BKPro surgery was Count Fingers (range 20/60 to Light Perception (LP; n = 6. 4 out of 6 patients lost significant vision at one year after BKPro.BKPro patients with early glaucoma surgical intervention retained vision significantly better compared to patients with late or no intervention. Our preliminary findings support the recommendation for concurrent or pre-emptive glaucoma surgical intervention in patients undergoing BKPro implantation.
Lin, Mark; Bhatt, Anand; Haider, Asghar; Kim, Grace; Farid, Marjan; Schmutz, Mason; Mosaed, Sameh
The loss of vision following Boston Keratoprosthesis (BKPro) surgery due to glaucoma occurs at a high frequency as diagnosis and management of glaucoma after this procedure pose challenges. To compare visual outcomes in patients undergoing Boston Keratoprosthesis surgery with and without prior or concurrent glaucoma surgery. This is a retrospective, observational cohort study of patients who underwent Boston Type I Keratoprosthesis surgery. 19 eyes of 18 patients who had undergone BKPro and met the inclusion criteria were identified. Twelve eyes received BKPro with prior or concurrent glaucoma surgery (Group 1), and seven eyes were identified undergoing BKPro surgery without prior or concurrent glaucoma surgery (Group 2). Main outcome included best corrected visual acuity at each follow up. In Group 1, mean best corrected visual acuity (BCVA) within a year of BKPro surgery was 20/100 (range 20/40 to Count Fingers (CF); n = 12) and mean BCVA at 1 year from BKPro surgery was 20/115 (range 20/30 to CF; n = 12). 7 out of 12 patients retained or had improved BCVA at 1 year follow up after BKPro implantation, and 5 out of 12 patients had mild BCVA worsening. In Group 2, the mean BCVA within a year of BKPro surgery was 20/140 (ranging from 20/25 to hand motion vision (HM); n = 7) and mean BCVA at 1 year from BKPro surgery was Count Fingers (range 20/60 to Light Perception (LP); n = 6). 4 out of 6 patients lost significant vision at one year after BKPro. BKPro patients with early glaucoma surgical intervention retained vision significantly better compared to patients with late or no intervention. Our preliminary findings support the recommendation for concurrent or pre-emptive glaucoma surgical intervention in patients undergoing BKPro implantation.
Khurrum, Huma; AlGhamdi, Khalid M; Osman, Essam
There is scarce literature connecting vitiligo and primary open angle glaucoma (POAG). Most literature reports that secondary complications are a direct consequence of corticosteroid treatment of vitiligo. In this study, we aimed to investigate the prevalence of ocular problems in patients with vitiligo and to determine its association with periorbital topical corticosteroid use. A cross-sectional study was carried out on 90 patients with vitiligo. The Vitiligo European Task Force questionnaire was completed for each patient. A control group comprising 90 healthy individuals who did not have vitiligo and who were matched on age and gender was used for comparison. A complete ophthalmologic examination was performed. A family history of glaucoma and the use of topical steroids were recorded. Two (2/90, 2.2%) of the patients with vitiligo had glaucoma compared with none of the individuals in the control group (P = .25). Nineteen of the 90 patients with vitiligo used periorbital steroids, and of these patients, 10.5% (2/19) developed glaucoma. The duration of periorbital corticosteroid use was 4.50 ± 2.1 years. Eighty-nine percent (17/19) of the vitiligo patients who applied the potent topical corticosteroid (class I) clobetasol propionate to the periorbital area did not develop glaucoma. In contrast, glaucoma was not observed in 79% (71/90) of the vitiligo patients who did not use steroids. Cataract, uveitis, or fundus problems were not observed in either group. The study suggests that patients who have vitiligo and use topical steroids periorbitally do not have an increased risk of glaucoma or cataracts. Future studies that have a larger sample size and use a detailed steroid use protocol are needed. © The Author(s) 2015.
Villarruel, Jenni Martinez; Li, Xiao Q.; Bach-Holm, Daniella
Purpose: To compare the anterior lamina cribrosa (LC) surface position in patients with idiopathic intracranial hypertension (IIH), primary open-angle glaucoma (high-tension glaucoma [HTG] and normal-tension glaucoma [NTG]), and healthy controls using enhanced depth imaging spectral-domain optical...... the Bruch membrane opening plane to the anterior LC surface, was manually measured on selected B-scans covering the central three-quarters of the optic nerve head in each eye. Results: Mean LC depth in patients with IIH (325.2 ± 92.1 μm) was significantly (p
Si Hyung Lee
Full Text Available To investigate the association between estimated trans-lamina cribrosa pressure difference (TLCPD and prevalence of normal tension glaucoma (NTG with low-teen and high-teen intraocular pressure (IOP using a population-based study design.A total of 12,743 adults (≥ 40 years of age who participated in the Korean National Health and Nutrition Examination Survey (KNHANES from 2009 to 2012 were included. Using a previously developed formula, cerebrospinal fluid pressure (CSFP in mmHg was estimated as 0.55 × body mass index (kg/m2 + 0.16 × diastolic blood pressure (mmHg-0.18 × age (years-1.91. TLCPD was calculated as IOP-CSFP. The NTG subjects were divided into two groups according to IOP level: low-teen NTG (IOP ≤ 15 mmHg and high-teen NTG (15 mmHg < IOP ≤ 21 mmHg groups. The association between TLCPD and the prevalence of NTG was assessed in the low- and high-teen IOP groups.In the normal population (n = 12,069, the weighted mean estimated CSFP was 11.69 ± 0.04 mmHg and the weighted mean TLCPD 2.31 ± 0.06 mmHg. Significantly higher TLCPD (p < 0.001; 6.48 ± 0.27 mmHg was found in the high-teen NTG compared with the normal group. On the other hand, there was no significant difference in TLCPD between normal and low-teen NTG subjects (p = 0.395; 2.31 ± 0.06 vs. 2.11 ± 0.24 mmHg. Multivariate logistic regression analysis revealed that TLCPD was significantly associated with the prevalence of NTG in the high-teen IOP group (p = 0.006; OR: 1.09; 95% CI: 1.02, 1.15, but not the low-teen IOP group (p = 0.636. Instead, the presence of hypertension was significantly associated with the prevalence of NTG in the low-teen IOP group (p < 0.001; OR: 1.65; 95% CI: 1.26, 2.16.TLCPD was significantly associated with the prevalence of NTG in high-teen IOP subjects, but not low-teen IOP subjects, in whom hypertension may be more closely associated. This study suggests that the underlying mechanisms may differ between low-teen and high-teen NTG patients.
Hengerer, Fritz H; Kohnen, Thomas; Mueller, Michael; Conrad-Hengerer, Ina
The purpose of this study is to evaluate IOP lowering effects and complication management of an ab interno gel implant for the treatment of patients refractory to antiglaucoma medication or glaucoma surgery. Retrospective analysis of the medical records of 242 consecutive eyes of 146 patients with uncontrolled intraocular pressure (IOP) despite maximum tolerated medical therapy or prior surgical intervention that underwent XEN45 implantation (as sole procedure or in combination with cataract surgery) between March 2014 and June 2015. Data included IOP, number of glaucoma medications, the need for additional surgery, needling, and complications. During the study period, mean IOP had decreased by 54.1% from 32.19 (±9.1) mm Hg to 14.24 (±4.0) mm Hg (P=0.00; Wilcoxon test). The number of antiglaucoma medications had decreased from a mean of 3.13±1.0 to 0.3±0.7 (P=0.00; Wilcoxon test). Needling was required between week 1 and months 3 in 27.7% of all eyes to enhance the outflow. Hypotony (IOPglaucoma patients with unregulated IOP despite IOP lowering medical therapy or prior surgical intervention. It offers an effective approach, both as sole procedure and in combination with cataract surgery.
Sleath, B.; Carpenter, D. M.; Blalock, S. J.; Sayner, R.; Muir, K. W.; Slota, C.; Giangiacomo, A. L.; Hartnett, M. E.; Tudor, G.; Robin, A. L.
Little is known about how ophthalmologist-patient communication over time is associated with glaucoma patient long-term adherence. The purpose of our study was to examine the association between provider use of components of the resources and supports in self-management model when communicating with patients and adherence to glaucoma medications…
Movahedinejad, Tayebeh; Adib-Hajbaghery, Mohsen
Lack of adherence to medical treatments typically lead to burdensome consequences such as progressive visual impairment, blindness, and disabilities. This study aimed to determine the adherence to medication in patients with open-angle glaucoma and related factors in patients referred to the Matini Ophthalmology Hospital in Kashan, Iran. A cross-sectional study was conducted from 23 July 2015 to 20 January 2016 on all patients with open-angle glaucoma referred to the Matini Ophthalmology Hospital in Kashan, Iran. A questionnaire was used to gather data about patients' demographics and factors affecting adherence to medical treatments. The Morisky Medication Adherence Scale was used to evaluate the adherence to glaucoma medication. Results were analyzed using SPSS version 13. Descriptive statistics, chi-square, and logistic regression analysis were used. In total, 130 patients with a mean age of 55.36 ± 15.54 were studied. Only 34.6% of patients completely adhered to glaucoma medications. The chi-square test showed that age (p=0.007), education (p=0.01), life entourage (p=0.04), place of residence (p=0.06), average monthly income (p=0.005), the interval between medical visits (p=0.007), problem in scheduling the medical visits (plifelong using and side-effects of medications (pproblems (pproblems in traveling and scheduling medical visits, the large number and side effects of medications, impatience, forgetting, and lack of skill in using eye drops. About two-thirds of patients with open-angle glaucoma did not adhere to their own medications. Appropriate patient education and planning a patient follow-up strategy might positively affect the patients' adherence to glaucoma medications.
Sleath, Betsy; Blalock, Susan J; Carpenter, Delesha M; Sayner, Robyn; Muir, Kelly W; Slota, Catherine; Lawrence, Scott D; Giangiacomo, Annette L; Hartnett, Mary Elizabeth; Tudor, Gail; Goldsmith, Jason A; Robin, Alan L
To examine the associations of provider-patient communication, glaucoma medication adherence self-efficacy, and outcome expectations with glaucoma medication adherence. Prospective, observational cohort study. Two hundred seventy-nine patients with glaucoma who were newly prescribed or taking glaucoma medications were recruited at 6 ophthalmology clinics. Patients' visits were video recorded and communication variables were coded using a detailed coding tool developed by the authors. Adherence was measured using Medication Event Monitoring Systems for 60 days after their visits. The following adherence variables were measured for the 60-day period after their visits: whether the patient took 80% or more of the prescribed doses, percentage of the correct number of prescribed doses taken each day, and percentage of the prescribed doses taken on time. Higher glaucoma medication adherence self-efficacy was associated positively with better adherence with all 3 measures. Black race was associated negatively with percentage of the correct number of doses taken each day (β = -0.16; P medication adherence self-efficacy are associated positively with adherence. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
References. 1. Ramalho CM, Ribeiro LN, Olivieris, Silva JA, Vale. TC, Dugue W. Socio economic profile of people with glaucoma in the ophthalmology department of the university hospital of the federal university of. Juizde fora – Minas Gerais – Brazil. Arg Bras oftalmol 2007;70(5):809-813. Ethiop. J. Health Dev. 2013;27(3) ...
Ban, Norimitsu; Siegfried, Carla J; Lin, Jonathan B; Shui, Ying-Bo; Sein, Julia; Pita-Thomas, Wolfgang; Sene, Abdoulaye; Santeford, Andrea; Gordon, Mae; Lamb, Rachel; Dong, Zhenyu; Kelly, Shannon C; Cavalli, Valeria; Yoshino, Jun; Apte, Rajendra S
Glaucoma is the second leading cause of blindness worldwide. Physicians often use surrogate endpoints to monitor the progression of glaucomatous neurodegeneration. These approaches are limited in their ability to quantify disease severity and progression due to inherent subjectivity, unreliability, and limitations of normative databases. Therefore, there is a critical need to identify specific molecular markers that predict or measure glaucomatous neurodegeneration. Here, we demonstrate that growth differentiation factor 15 (GDF15) is associated with retinal ganglion cell death. Gdf15 expression in the retina is specifically increased after acute injury to retinal ganglion cell axons and in a murine chronic glaucoma model. We also demonstrate that the ganglion cell layer may be one of the sources of secreted GDF15 and that GDF15 diffuses to and can be detected in aqueous humor (AH). In validating these findings in human patients with glaucoma, we find not only that GDF15 is increased in AH of patients with primary open angle glaucoma (POAG), but also that elevated GDF15 levels are significantly associated with worse functional outcomes in glaucoma patients, as measured by visual field testing. Thus, GDF15 maybe a reliable metric of glaucomatous neurodegeneration, although further prospective validation studies will be necessary to determine if GDF15 can be used in clinical practice.
Behzad Fallahi Motlagh
Full Text Available ABSTRACT Purpose: To compare therapeutic outcomes between trabeculectomy and medical therapy in patients with open-angle glaucoma. Methods: In the present retrospective comparative study, the medical charts of 284 patients (eyes newly diagnosed with open-angle glaucoma who had received conventional medications (n=188 or undergone fornix-based trabeculectomy (n=96 at a teaching eye hospital were reviewed. Results: At a mean follow-up of 6.6 years, post-treatment changes in intraocular pressure (IOP, visual field (VF, best spectacle-corrected visual acuity (BSCVA, and number of required drugs were significantly more favorable in the surgical group (P<0.001 for all comparisons. However, the frequency of clinically desirable IOP (≤21 mmHg at the endpoint was comparable between the surgical and medical groups (87.2% vs. 82.3%; P=0.26. The rate of conversion to surgical therapy was 34% in the medical group. A greater baseline requirement for anti-glaucoma drugs (two or more was the only independent predictor of treatment failure in the present study. Conclusions: Although more severe cases naturally receive trabeculectomy, the surgical approach had greater efficacy than conventional medical therapy in patients with open-angle glaucoma. An initial requirement for two or more anti-glaucoma drugs may predict failure of medical therapy.
Dogan, Aysun Sanal; Kabatas, Naciye; Erden, Gonul; Celikay, Osman; Arzuhal, Abdullah Ercan; Gurdal, Canan
Insulin-like growth factor-1 (IGF-1) is altered in several neurodegenerative diseases, the association between serum IGF-1 levels and glaucoma has not been evaluated. This study was designed to evaluate whether serum IGF-1 levels are different in patients with Pseudoexfoliation (PEX) with or without glaucoma. The study was conducted with 110 participants aged 65 years or older who were divided into three groups: group 1, patients with PEX syndrome; group 2, patients with PEX glaucoma; and group 3, participants without PEX or glaucoma. All participants underwent full ophthalmological examination and a detailed medical history was recorded. Patients with known neurodegenerative diseases other than PEX glaucoma were excluded. Serum IGF-1 levels were measured by automated chemiluminescent assay. Groups 1, 2, and 3 included 35, 34, and 41 patients, respectively; there were no differences regarding age, gender, or systemic disease status. There were also no statistically significant differences between the groups in terms of IGF-1 levels, which were 91.7 ± 39.1, 101.1 ± 40.2, and 107.2 ± 43.8 ng/ml for groups 1, 2, and 3, respectively (p = 0.276). Serum IGF-1 levels were similar by gender, the presence of systemic disease, status of diabetes mellitus, and laterality of the PEX material. There was no correlation between the cup-to-disk ratios and IGF-1 levels (r = -0.214, p = 0.223). IGF-1 levels in the circulation did not differ in the presence of PEX syndrome with or without glaucoma. This may indicate that the neurodegenerative process is local rather than systemic.
Full Text Available AIM: To investigate the effectiveness of phacoemulsification with intraocular lens(IOLimplantation combined with trabeculectomy in patients with cataract and angle-closure glaucoma.METHODS: In 36 cases(46 eyesof angle-closure glaucoma with cataract, phacoemulsification with foldable IOL implantation combined with trabeculectomy was performed. Data of pre- and post-operation, including visual acuity, intraocular pressure, filtering bleb, anterior chamber depth, chamber angle, and funds were all recorded and analyzed in detail.RESULTS: During the follow-up of 3 months to 2 years,visual acuity of 43 eyes(93.5%got improved, and intraocular pressure in 44 eyes(95.7%were controlled in normal range(CONCLUSION: Phacoemulsification with IOL implantation combined with trabeculectomy is an effective and safe surgical technique for patients with angle-closure glaucoma and cataract, with satisfied control of intraocular pressure, deepening of anterior chamber, opening of anterior chamber angle, and improving visual function.
Full Text Available AIM: To compare the two methods for the measurement of glaucoma patients' intraocular pressure(IOPbetween Goldmann applanation tonometer(GATand non-contact tonometer(NCTand find the laws of the two methods.METHODS: The IOP of 108 glaucoma patients(206 eyeswere measured by GAT and NCT respectively. RESULTS: In 108 glaucoma patients, the average IOP of 206 eyes was 29.77±10.27mmHg by GAT and 24.59±8.58mmHg by NCT. There was significant difference between GAT and NCT(PCONCLUSION: The measurement results with NCT were lower than that of GAT. The higher of IOP, the difference between GAT and NCT was greater. It's better to measure IOP by GAT for the glaucoma patients, in order to avoid the misdiagnosis and mistreatment of glaucoma.
Coste, V; Schweitzer, C; Paya, C; Touboul, D; Korobelnik, J-F
To compare corneal biomechanical properties measured with Corvis Scheimpflug technology (Corvis ST) between a group of patients with chronic open-angle glaucoma and a group of control patients. Prospective observational case-control study. This study enrolled 56 right eyes of 56 patients (G1 [chronic open-angle glaucoma] n=37/G2 [control] n=19). Each patient underwent measurement of corneal biomechanical properties by dynamic Scheimpflug (Corvis ST) camera and the Ocular Response Analyser (ORA), then a measurement of intraocular pressure (IOP) by Goldmann applanation tonometry (GAT) and measurement of central corneal thickness (CCT) by optical coherence tomography during the same visit, by a single clinician. The parameters determined by Corvis ST are: Corvis IOP (IOP Corvis ST), the corneal deformation amplitude (CDA), corneal velocity, the time at highest concavity (TIME CONCAV), the lengths of applanation and their corresponding applanation time. Those studied by ORA are: compensated IOP (IOPcc), non-compensated IOL (IOPg), corneal hysteresis (CH) and corneal resistance factor (CRF). IOP measured on all patients by Corvis ST was positively correlated to GAT (Spearman r=0.569, Pcorneal biomechanical properties between glaucoma and control patients. The cornea of glaucoma patients appears less deformable. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
Anmar M. Abdul-Rahman
Full Text Available Purpose: To report a case of conjunctival microangiopathy secondary to diabetes presenting as a red eye 5 years after glaucoma implant surgery for neovascular glaucoma. Materials and Methods: A 52-year-old Tongan male with a past history of neovascular glaucoma secondary to proliferative diabetic retinopathy underwent slitlamp examination and color photography of the anterior and posterior segment, in addition to anterior segment fluorescein angiography. Results: The conjunctival venules perilimbally demonstrated tortuosity and dilation (saccular, fusiform and tricornuate. Capillaries were tortuous, with sparse microaneurysm formation, and arterioles were attenuated. Anterior segment fluorescein angiography showed generalized iris ischemia, extensive perilimbal microvascular degenerative changes and leakage of fluorescein into the anterior chamber. We are unaware of previous reports in the literature on conjunctival microangiopathy secondary to diabetes presenting as a red eye. Conclusions: We hypothesized that the clinical features in our case may have been modified by a combination of postoperative wound healing and degenerative vascular remodeling, in addition to microvascular alterations secondary to both diabetes and consequent ocular ischemia, which may have played a role.
Full Text Available AIM: To compare the efficacy of single-session 360-degree selective laser trabeculoplasty (SLT for reduction of intraocular pressure (IOP in patients with pseudoexfoliative glaucoma (PXFG and primary open angle glaucoma (POAG. METHODS: This is a single-center, prospective, nonrandomized comparative study. Patients older than 18 years of age with uncontrolled PXFG or POAG eyes requiring additional therapy while on maximally tolerated IOP-lowering medications were included. The primary outcome measure changed in IOP from baseline. Success was defined as IOP reduction ≥20% from baseline without any additional IOP-lowering medication. All patients were examined at 1d, 1wk, 1, 3, 6, 9, 12mo after SLT. RESULTS: Nineteen patients (20 eyes with PXFG and 27 patients (28 eyes with POAG were included in the study. In the visual fields mean deviation was -2.88 (±1.67 in the POAG and -3.1 (±1.69 in the PXFG groups (P=0.3. The mean (±SD IOP was 22.9 (±3.7 mm Hg in the POAG group and 25.7 (±4.4 mm Hg in the PXFG group at baseline and decreased to 18.4 (±3.2 and 18.0 (±3.9 mm Hg in the POAG group (P<0.001 and P=0.02, and to 17.9 (±4.0 and 21.0 (±6.6 mm Hg in the PXFG group (P<0.001 and P=0.47 at 6 and 12mo, respectively. The number of medications was 2.6 (±0.8 in the POAG group and 2.5 (±0.8 in the PXFG group at baseline, and did not change at all follow-up visits in both groups (P=0.16 in POAG and 0.57 in PXFG. Based on Kaplan-Meier survival analysis, the success rate was 75% in the POAG group compared to 94.1% in the PXFG group (P=0.08; log rank test at 6mo, and 29.1% and 25.0% at 12mo, respectively (P=0.9; log rank. CONCLUSION: The 360-degree SLT is an effective and well-tolerated therapeutic modality in patients with POAG and PXFG by reducing IOP without any change in number of medications. The response was more pronounced early in the postoperative period in patients with PXFG whereas there was no statistically significant difference at 12
Full Text Available Tube implants or glaucoma drainage devices have become an important method of intraocular pressure reduction when treating complex cases of traumatic glaucoma. However, it is not uncommon to have complications associated with tube implants. The optimal treatment of patients who have undergone glaucoma implant surgery complicated by vitreous incarceration is uncertain. If vitreous is present or is able to prolapse into anterior chamber, as in aphakic or pseudophakic patient without an intact posterior capsule, a concurrent anterior vitrectomy is usually performed. In such cases, pars plana vitrectomy has been found to be more effective in several studies. However, there are no set guidelines for management of such a case in a phakic eye and the management can be more challenging especially when there is no obvious deficiency in posterior capsule, zonular dialysis, or loose vitreous gel in the anterior chamber prior to or during tube implantation. We describe a case of 14-year-old phakic patient with traumatic glaucoma without vitreous gel in anterior chamber whose tube implant became occluded by vitreous resulting in increased intra ocular pressure. This is the first documented report of vitreous incarceration in a phakic patient and its successful management.
Esporcatte, Bruno L B; Teixeira, Luiz Fernando; Rolim-de-Moura, Christiane
Here we report a case of childhood glaucoma refractory to angle and trabeculectomy surgery. The patient was treated with an Ahmed™ drainage implant that was subsequently complicated by rapid-onset panophthalmitis and orbital cellulitis. Intravenous and intravitreal antibiotic therapy was initiated and the drainage tube was removed. The infectious process resolved within 3 weeks; however, phthisis bulbi developed subsequently.
Spiegel, Detlev; Wetzel, Wolfgang; Haffner, David S; Hill, Richard A
This study was undertaken to evaluate the efficiency of a trabecular micro-bypass stent designed to allow direct aqueous drainage from the anterior chamber into Schlemm's canal in patients with glaucoma. In this prospective case series of 6 patients with open-angle glaucoma, the microstent was inserted ab interno under local anesthesia in an ophthalmic operating room. Patients were seen postoperatively at 1 to 2 d, 1 wk, and 1, 2, 6, and 12 mo. All stents were successfully placed within Schlemm's canal. Mean intraocular pressure (IOP) at preoperative baseline was 20.2+/-6.3 mm Hg (range, 14-31 mm Hg). Mean IOP decreased during the immediate postoperative period to approximately 12 to 13 mm Hg and was stabilized at 14 to 15 mm Hg with reduction of medication throughout 1 y of follow-up. No major complications occurred. According to observations reported in this feasibility study, the microstent was effective in reducing IOP and in decreasing the number of glaucoma medications required to control IOP. Implantation procedures were safe, and stents remained in place throughout the follow-up period. None of the complications traditionally associated with filtering surgery were reported. Further research on this stent in a larger group of patients is needed to assess its role in glaucoma therapy.
Bruno L. B. Esporcatte
Full Text Available ABSTRACT Here we report a case of childhood glaucoma refractory to angle and trabeculectomy surgery. The patient was treated with an Ahmed™ drainage implant that was subsequently complicated by rapid-onset panophthalmitis and orbital cellulitis. Intravenous and intravitreal antibiotic therapy was initiated and the drainage tube was removed. The infectious process resolved within 3 weeks; however, phthisis bulbi developed subsequently.
Depression and quality of life in patients with glaucoma: a cross-sectional analysis using the Geriatric Depression Scale-15, assessment of function related to vision, and the Glaucoma Quality of Life-15.
Skalicky, Simon; Goldberg, Ivan
To determine the prevalence of depression and its association with visual field impairment, quality of life, objective assessment of visual function, and glaucoma severity in elderly patients with glaucoma. Cross-sectional study. One hundred sixty-five patients with mild (n=60), moderate (n=43), or severe (n=28) glaucoma and 34 controls with ocular hypertension were enrolled. Severity was stratified according to the Nelson Glaucoma Severity Scale (based on the degree of binocular visual field loss). Groups were substratified according to age. Demographic information was collected via interviews; the Geriatric Depression Scale-15 and Glaucoma Quality of Life-15 (GQL-15) questionnaires were administered. Visual function was assessed by clinical examination and visual field testing. A subset of patients (n=68) underwent objective assessment of function related to vision. Group differences were evaluated using analysis of variance; Kruskall-Wallis analysis of ranks was performed with significance set at Ppatients aged 70 to 79 years (Pquality of life with increasing glaucoma severity. Assessment of function related to vision scores indicated worsening visual function with increasing glaucoma severity. On multivariate regression analysis, depression status was correlated with age and GQL-15 summary score. Depression is more common in patients with increasing glaucoma severity (age, 70 to 79 y). In patients with glaucoma or ocular hypertension, age and GQL-15 summary score are independent risk factors for depression.
Geimer, Sabina Andersson
This thesis addresses several aspects of glaucoma diagnostics from both a clinical and a screening perspective. New instruments for diagnosing glaucoma have been developed over the past years, but little information is available regarding their performance as screening methods and their usefulness in ordinary clinical practice. PURPOSE OF THE RESEARCH UNDERLYING THIS THESIS: The objectives of this research were as follows: to compare the accuracy of results of analysis of the optic nerve head (ONH) achieved by computerized imaging using the Heidelberg Retina Tomograph (HRT) and by subjective assessment performed by physicians with different degrees of experience of glaucoma (paper III); to evaluate the effect of a continuous medical education (CME) lecture on subjective assessment of the ONH for diagnosis of glaucoma (paper II); to investigate subjective assessment of perimetric test results by physicians with varying knowledge of glaucoma with a trained artificial neural network (ANN) and to compare the certainty of the classifications (paper IV); and to compare the diagnostic performance of time-domain Stratus optical coherence tomography (OCT) with that of spectral-domain Cirrus OCT (paper I), frequency doubling technology (FDT) screening perimetry and scanning laser polarimetry with the GDx variable corneal compensator (VCC) in a random population-based sample and in patients with glaucoma of varying disease severity. In evaluation of the ONH, use of the HRT statistical tools, Moorfields regression analysis (MRA) and the Glaucoma Probability Score (GPS) was compared with subjective assessment performed by 45 physicians. Optic nerve head images and photographs from 138 healthy and 97 glaucoma subjects were included. The sensitivity of MRA was higher (87-94%) than that of the average physician (62-82%), considerably greater than that of ophthalmologists with subspecialties other than glaucoma (53-77%) and non-significantly better than that of glaucoma
N. I. Kurysheva
Full Text Available Purpose: To study the influence of venous blood flow on the ganglion cell complex (GCC in patients with preperimetric and perimetric open angle glaucoma.Methods: 74 patients were included in the research. 59 eyes and 62 eyes were diagnosed with preperimetric and perimetric open angle glaucoma respectively. The mean age was 56.5±10.5 years. 22 (12 female and 10 male healthy individuals constituted the control group. The ganglion cell complex and retinal nerve fibre layer were evaluated with the help of optical coherence tomography (RTVue-100 OCT, Optovue, Inc., Fremont, CA. Ocular blood flow was measured by Color Doppler Imaging (multifunctional VOLUSON 730 ProSystem. The statistical analysis included correlation between GCC and RNFL thickness in both glaucoma groups.Results: The results showed a statistically significant reduction of venous blood flow velocity in both glaucoma groups compared to the control group. No difference in venous blood flow parameters between two glaucoma groups was found, except resistance index, which was higher in perimetric group in comparison to preperimetric group. A correlation was also obtained between venous blood flow parameters and GCC and RNFL thickness in both glaucoma groups.Conclusion: Early GCC damage in glaucoma might occur due to venous blood flow reduction. This fact may be of great value in understanding glaucoma pathogenesis and search for novel treatment options.
Shazly, Tarek A; Aljajeh, Mouhab; Latina, Mark A
Glaucoma is one of the leading causes of blindness worldwide. The current view of glaucoma is that it is a multifactorial disease. Elevated IOP is a recognized etiologic factor which can trigger initial damage through biomechanical and ischemic injury to the retinal ganglion cells. However, elevated intraocular pressure cannot be entirely responsible for the development of glaucoma. Accumulating evidence suggests that abnormal immunity may be contributing to the glaucomatous optic neuropathy. Autoimmunity may be responsible for initiating or exacerbating glaucoma. This review provides an evaluation of the potential role of autoimmunity in some patients with glaucoma.
Todd E Scheetz
Full Text Available Glaucoma is the most common cause of irreversible blindness worldwide. One subset of glaucoma, normal tension glaucoma (NTG occurs in the absence of high intraocular pressure. Mutations in two genes, optineurin (OPTN and TANK binding kinase 1 (TBK1, cause familial NTG and have known roles in the catabolic cellular process autophagy. TKB1 encodes a kinase that phosphorylates OPTN, an autophagy receptor, which ultimately activates autophagy. The sequestosome (SQSTM1 gene also encodes an autophagy receptor and also is a target of TBK1 phosphorylation. Consequently, we hypothesized that mutations in SQSTM1 may also cause NTG. We tested this hypothesis by searching for glaucoma-causing mutations in a cohort of NTG patients (n = 308 and matched controls (n = 157 using Sanger sequencing. An additional 1098 population control samples were also analyzed using whole exome sequencing. A total of 17 non-synonymous mutations were detected which were not significantly skewed between cases and controls when analyzed separately, or as a group (p > 0.05. These data suggest that SQSTM1 mutations are not a common cause of NTG.
Gao, Yanlin; Wan, Bing; Li, Peiyu; Zhang, Yan; Tang, Xin
To evaluate the short-term reproducibility of diurnal intraocular pressure (IOP) and ocular perfusion pressure (OPP) measurements in normal volunteers, untreated normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG) patients. Fifty-four healthy volunteers (control group), 67 NTG patients and 54 POAG patients were recruited. The IOPs of both eyes were measured with a Goldmann applanation tonometer at 3-h intervals over 2 consecutive days. Blood pressure (BP) measurements were collected at the same times. The mean IOP/OPP, peak IOP/OPP, trough IOP/OPP and IOP/OPP fluctuations on each day were also calculated. The intraclass correlation coefficients (ICCs) were used to evaluate the reproducibilities. In the control group, the ICCs of mean IOP, peak IOP, trough IOP and IOP fluctuation were 0.921, 0.889, 0.888, and 0.661, respectively, and the ICCs of the mean OPP, peak OPP, trough OPP and OPP fluctuations were 0.962, 0.918, 0.953, and 0.680, respectively. In the NTG group, the ICCs of the mean IOP, peak IOP, trough IOP and IOP fluctuation were 0.862, 0.741, 0.798, and 0.290, respectively, and the ICCs of the mean OPP, peak OPP, trough OPP and OPP fluctuations were 0.947, 0.828, 0.927, and -0.008, respectively. In the POAG group, the ICCs of the mean IOP, peak IOP, trough IOP and IOP fluctuation were 0.857, 0.666, 0.808, and 0.546, respectively, and the ICCs of the mean OPP, peak OPP, trough OPP and OPP fluctuation were 0.934, 0.842, 0.910, and 0.093, respectively. The IOP measurements within a single day were not highly reproducible in the short-term. The normal volunteers exhibited better IOP and OPP reproducibilities than the glaucoma patients. The IOP and OPP fluctuations could not be accurately evaluated based on the IOP or OPP measurements within a single day.
Beirão, João M; Moreira, Luciana M; Oliveira, João C; Menéres, Maria J; Pessoa, Bernardete B; Matos, Maria E; Costa, Paulo P; Torres, Paulo A; Beirão, Idalina B
Glaucoma is the leading cause of irreversible blindness in familial amyloidotic polyneuropathy (FAP) patients. Erythropoietin (EPO) is a cytokine that has been shown to play a role in neuroprotection and is endogenously produced in the eye. EPO levels in the aqueous humor are increased in eyes with glaucoma. In this study, we evaluated the EPO concentration in the aqueous humor of FAP and non-FAP patients, with and without glaucoma. Undiluted aqueous humor samples were obtained from 42 eyes that underwent glaucoma surgery, phacoemulsification, or vitrectomy. EPO concentration in the aqueous humor and blood were measured using the Immulite 2000 Xpi using an automatic analyzer (Siemens Healthcare Diagnostics). The mean EPO concentration in the aqueous humor of non-FAP glaucoma eyes group 2 (75.73±13.25 mU/ml) was significantly higher than non-FAP cataract eyes (17.22±5.33 mU/ml; phumor EPO concentration and the ocular pressure (p = 0.95) and mean deviation (p = 0.41). There was no correlation between the EPO serum concentration and EPO aqueous humor concentration in our patients (p = 0.77). Unlike other glaucomatous patients, FAP patients with glaucoma do not show increased and potentially neuroprotective endocular EPO production in the aqueous humor and may need more aggressive glaucoma management.
Full Text Available Introduction. Ocular surface disease (OSD is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbances, tear film instability with potential damage to the ocular surface, accompanied by increased tear film osmolarity and inflammation of the ocular surface. It is a consequence of disrupted homeostasis of lacrimal functional unit. The main pathogenetic mechanism stems from tear hyperosmolarity and tear film instability. The etiological classification is hyposecretory (Sy-Sjögren and non-Sjögren and evaporative (extrinsic and intrinsic form. Delphi panel classification grades disease stages. Antiglaucoma topical therapy causes exacerbation or occurrence of symptoms of dry eye due to main ingredients or preservatives (benzalkonium chloride - BAK, which are dose- and time-dependent. BAK reduces the stability of the lipid layer of tears, the number of goblet cells, induces apoptosis and inflammatory infiltration. Objective. The aim of this study was the analysis of the OSD incidence in open-angle glaucoma patients caused by topical medicamentous therapy. Methods. Retrospective analysis of examined patients with open-angle glaucoma was used. Results. Increased incidence of moderate and advanced OSD Index degrees in the group of primary open-angle glaucoma (POAG and pseudoexfoliative glaucoma. According to the Delphi Panel Scale the most common grade is IIb (POAG and pseudoexfoliative glaucoma. Evaporative form of OSD prevailed in all treatment groups. High percentage of dry eye in patients with higher concentrations of preservatives applied was noticed. Conclusion. OSD should be timely diagnosed and treated. Dry eye has an impact on surgical outcome and postoperative visual acuity, and in order to improve patient compliance and quality of life, symptoms of dry eye should be addressed and medications with lower concentrations of preservatives should be applied.
Wilson, R P; Javitt, J C
Five patients with aphakia, glaucoma, and chronic inflammation were treated with ab interno sclerostomy by using the continuous wave Nd:YAG laser focused through a sapphire probe. After a follow-up period of 24 to 28 months, three of five patients had good intraocular pressure control. The sclerostomy failed in one patient when it was occluded by vitreous. The second failure was attributed to closure of the sclerostomy because of chronic intraocular inflammation.
Estudo do comportamento da PIO de 24 horas e frequência de glaucoma em pacientes com síndrome da apnéia obstrutiva do sono Study on 24 hours IOP study and glaucoma frequency in patients with obstructive sleep apnea syndrome
Maria Rosa Bet de Moraes Silva
: Eleven consecutive patients with OSAS, diagnosed by polysonography, were avaliated in a cross sectional study. Demographic data were analyzed: age, sex, race/color, weight, height and associated diseases. The patients were submitted to complete ophthalmologic examination, including the visual field, as well as to 24-hour intra-ocular pressure (IOP evaluation by an applanation tonometer at 9h, 12h, 15h, 18h, 24h and 6h in the lying and sitting positions. The diagnostic criterion for glaucoma was alteration of the visual field (VF compatible with glaucoma and one or more of the following alterations: cup-disc ratio ³ 0.7, hemorrhage, wedge-shaped defect, bayonet-shaped vessels, Hoyt's sign, asymmetry > than 0.2 between cup/disc ratio of the eyes. The angle should be opened without alterations. RESULTS: 9 (82% of 11 patients showed glaucoma or were suspected to have glaucoma, 9% of which exhibited normal tension glaucoma and 73% were suspected to have glaucoma for presenting alterations in the optic nerve or ocular hypertension. The mean for the IOP values of the 11 patients was observed to be the highest at 6 o'clock, when they were lying down. Variations of IOP ³ 5 mmHg occurred in 7 (64% of the patients, and variations of up to 14 mmHg and IOP peaks of up to 32 mmHg were observed. CONCLUSION: OSAS may be an important risk factor for the development of glaucoma, particularly that of normal tension glaucoma. Patients with OSAS must be referred to an ophthalmologist and those professionals must be attentive to the association of sleep disorders in patients with open-angle glaucoma.
Full Text Available Yang Liu, Weiming MaoDepartment of Cell Biology and Anatomy, North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TXAbstract: Glaucoma is a leading cause of visual loss worldwide. Current antiglaucoma therapy focuses on lowering intraocular pressure to a safe level. In recent years, prostaglandin analogs have become the first-line agents for treating open angle glaucoma. Tafluprost, which was first reported in 2003, is a novel prostaglandin analog, and has been shown to be a potent ocular hypotensive agent in a number of preclinical and clinical studies. Also, its unique preservative-free formulation helps to decrease preservative-associated ocular disorders and improve patient compliance. In this review, studies from 2003 to 2012 focusing on the structure, metabolism, efficacy, and safety of tafluprost are summarized. These studies suggested that application of tafluprost once daily is a safe and effective treatment for patients with open angle glaucoma.Keywords: tafluprost, prostaglandin analog, glaucoma, intraocular pressure, preservative-free formulation
Full Text Available Ulrich Welge-Lussen,1 Stefanie Weise,2 Alice L Yu3 1Department of Ophthalmology, Friedrich-Alexander University, Erlangen, Germany; 2Department of Ophthalmology, University of Cologne, Cologne, Germany; 3Department of Ophthalmology, Ludwig Maximilian University, Munich, Germany Purpose: The goal of this study was to determine the adherence of glaucoma patients to their topical glaucoma medication. Furthermore, the relationships between the adherence behavior and the patients’ demographic data, clinical characteristics, and their knowledge about glaucoma were evaluated. Methods: This was a prospective study of 123 patients with primary open-angle glaucoma who were given two standardized questionnaires. The first questionnaire at time point T1 comprised a knowledge assessment and the self-reported adherence measures Adherence to Refills and Medication Scale 2 (ARMS2, visual analogue scale for adherence (VAS-AD, and missed doses in the past 14 days. Two months later at time point T2, a second questionnaire reevaluated the adherence measures ARMS2, VAS-AD, and missed doses in the past 14 days. Results: There was a good correlation among all the three adherence measures at T1 and T2. The mean values of ARMS2 were in the lower range, with 3.38 at T1 and 2.8 at T2. The VAS-AD detected that 18.5% of patients always took their eye drops correctly, and 77.9% of patients reported not to have missed a single dose in the past 14 days. There was no significant correlation between the patients’ demographic data or knowledge about glaucoma and the adherence measures ARMS2 or VAS-AD. Among the clinical characteristics, only single-eye blindness showed a significant correlation with VAS-AD. Conclusion: In this study, no general relationships were found between medication adherence and the patients’ demographic data, clinical characteristics, or knowledge about glaucoma. It may be assumed that more individualized strategies are required to optimize
Pujol Carreras, O; Anton, A; Mora, C; Pastor, L; Gudiña, S; Maull, R; Vega, Z; Castilla, M
To assess the quality of life in glaucoma patients and normal subjects, and to assess its relationship with the severity of damage in each eye. A cross-sectional study was conducted with prospective selection of cases. The study included 464 subjects and were distributed into 4categories. Subjects included in group 1 had both eyes normal, that is with a normal intraocular pressure (IOP), optic disk and visual fields (VF), or mild glaucoma, defined as untreated IOP>21mmHg and abnormal VF with mean defect (MD) over -6dB. Group 2 consisted of patients with both eyes with mild or moderate glaucoma, defined as untreated IOP>21mmHg and abnormal VF with MD between -6 and -12dB. Group 3 included patients with moderate to severe glaucoma, that is, untreated IOP>21mmHg and abnormal VF with MD of less than -12dB in both eyes. Group 4 consisted of patients with asymmetric glaucoma damage, that is, they had one eye with severe glaucoma and the other eye normal or with mild glaucoma. All subjects completed 3 different questionnaires. Global quality of life was evaluated with EuroQol-5D (EQ-5D). Vision related quality of life was assessed with Visual Function Questionnaire (VFQ-25). Quality of life related to ocular surface disease was measured with Ocular Surface Disease Index (OSDI). VFQ-25 showed that group 3 had significantly lower scores than group 1 in mental health (P=.006), dependence (P=.006), colour vision (P=.002), and peripheral vision (P=.002). EQ-5D showed no significant differences between any group, but a trend was found to greater difficulty in group 3 than in groups 1 and 2, and in all dimensions. OSDI showed a higher score, or which was the same as a major disability, in groups 2 and 3 than group 1 (P=.021 and P=.014, respectively). VFQ-25 only found significant differences between group 1 and group 4. Dimensions with significant differences were found between group 1 and 3 (both eyes with advanced or moderate glaucoma). These were not found between group 1 and
Chang Kyu Lee
Full Text Available To evaluate the long-term efficacy of intraocular pressure (IOP reduction and complications of Ahmed Glaucoma Valve (AGV implantation in patients with refractory glaucoma.Retrospective study.The study involved 302 refractory glaucoma patients who underwent AGV implantation and had a minimum follow-up of 6 months between March 1995 and December 2013.An operation was defined as successful when (1 the postoperative IOP remained between 5 and 21 mmHg and was reduced 30% compared to the baseline IOP with or without medication, (2 there was no loss of light perception or vision-threatening severe complications, and (3 no additional filtering or aqueous drainage surgery was required. Clinical records were reviewed.IOP, anti-glaucoma medications, and complications.The mean follow-up period was 62.25 months (range, 6 to 190 months. The cumulative probability of success was 89% at 6 months, 81% at 1 year, 66% at 3 years, 44% at 10 years, and 26% at 15 years. IOP was reduced from a mean of 32.2 ± 10.5 mmHg to 18.6 ± 9.1 mmHg at 1 month, 15.2 ± 7.0 mmHg at 6 months, and 14.2 ± 3.5 mmHg at 15 years. Surgical failures were significantly increased when preoperative IOP was high, and when severe complications occurred after AGV implantation (P < 0.05.AGV implantation was successful for IOP control in patients with refractive glaucoma in the long term. However, the success rate of surgery decreased over time. Preoperative high IOP and severe complications related to the operation were significant risk factors for failure.
Heijl, Anders; Bengtsson, Boel; Hyman, Leslie; Leske, M Cristina
This article, based on the Early Manifest Glaucoma Trial (EMGT), provides prospective natural history data on progression of glaucomatous field defects in 3 of the most common glaucoma types. Cohort of EMGT patients randomized to the untreated control group and followed up to the time of progression, when treatment could be initiated. We evaluated 118 control patients: 46 with high-tension glaucoma (HTG), 57 with normal-tension glaucoma (NTG), and 15 with pseudoexfoliation glaucoma (PEXG). Visual fields were tested every 3 months with the Humphrey 30-2 Full Threshold test program. Linear regression analyses of the perimetric mean deviation (MD) values were performed, and the rate of progression was defined as the regression coefficient in decibels per year. Percentages of progressed eyes and time to progression were determined using EMGT event-based predetermined progression criteria derived from Glaucoma Change Probability Maps. The median and interquartile rates of visual function loss were -0.40 (1.05) dB/year overall and -0.46 (1.61) in HTG, -0.22 (0.65) in NTG, and -1.13 (6.13) in PEXG. Thus, interpatient variability was large. Mean rates were considerably higher than medians: -1.08 dB/year overall, -1.31 in HTG, -0.36 in NTG, and -3.13 in PEXG. Differences in median visual function progression rates among groups were statistically significant (NTG vs. HTG, P = 0.003; PEXG vs. non-PEXG, PHTG, 56% of those with NTG, and 93% of those with PEXG (P = 0.012). Median time to progression also differed considerably among groups: 19.5 months in PEXG, 44.8 months in HTG, and particularly 61.1 months in NTG (PHTG, and NTG progressing at the lowest rate.
Full Text Available Xinghuai Sun,1,2 Mingkai Lin,3 Xuanchu Duan,4 Chun Zhang,5 Jian Ming6 1Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, 2Key Laboratory of Myopia, Ministry of Health (Fudan University, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University, Shanghai, 3Zhongshan Ophthalmic Center, Guangzhou, 4The Second Xiangya Hospital of Central South University, Changsha, 5Peking University Third Hospital, Beijing, 6Allergan plc, Shanghai, People’s Republic of China Background: Poor adherence to treatment is a problem in glaucoma, and patient dissatisfaction with topical glaucoma medication is a barrier to adherence. The objective of this study was to evaluate glaucoma patients’ satisfaction with fixed-combination bimatoprost/timolol ophthalmic solution (BTFC. Methods: This observational, multicenter study was conducted in China in adults with glaucoma treated with BTFC for 1–3 months. Five hundred patients answered a questionnaire concerning their demographic characteristics, history of glaucoma and topical glaucoma treatment, and use of BTFC. The primary endpoint was patient satisfaction with BTFC assessed on a 10-point scale (1= very dissatisfied, 10= very satisfied.Results: Patients received BTFC alone (65% or with other treatments (35%, most commonly a carbonic anhydrase inhibitor. Most patients (87% used BTFC as a replacement for other medication, usually a β-blocker or prostaglandin analog; 13% received BTFC as add-on treatment. Key reasons for initiating BTFC therapy were poor efficacy of previous treatment (72% of patients and side effects of previous treatment (32% of patients. Most patients agreed or very much agreed that BTFC provided better control of intraocular pressure (85% of patients, had a simpler administration (87% of patients, and was associated with better tolerance and comfort (82% of patients compared with their previous treatment. Mean satisfaction scores were
Jiang, H; Zhao, L; Yang, L; Cai, H Y
Objective: To investigate the relationships among illness perception, medication beliefs and medication adherence in primary angle closure glaucoma patients. Methods: It was a cross-sectional study. Morisky 8-item Medication Adherence Questionnaire Chinese Revised, the Brief Illness Perceptions Questionnaire, the Specific Section of the Beliefs about Medicine Questionnaire Chinese Revised were administered to 156 primary angle closure glaucoma patients from Tianjin Eye Hospital. Chi-square test was used to analyze the types of glaucoma, gender, prescription complexity, medicine schedule, other disease and course of disease between the group of adherence and non-adherence. Pearson correlation method was used to analyze the correlations among the illness perception, necessity belief, concerns belief and medication adherence. Structural equation model was used to analyze the mediational role of medication belief between illness perception and medication adherence. Results: In the 156 primary angle closure glaucoma patients being investigated, 37 male and 119 female, the average age was (61.3±8.3) years old. The medication adherence of patients was 83 (53.2%) , the medication non-adherence of patients was 73 (46.8%) . It was showed that prescription complexity and medicine schedule were significantly correlated with medicine adherence (χ(2)=13.64, 11.31; Pmedication adherence (χ(2)=1.02, 1.73, 6.08; P>0.05). The scores of illness perception were positively correlated with the necessity belief of medication scores, the scores of concerns belief (r=0.18、0.45, Pmedication adherence (r=-0.22, Pmedication scores were negatively correlated with the medication adherence (r=-0.47, Pmedication adherence wholly (χ(2)/df=1.73, RMSEA=0.069, NNFI=0.98, CFI=0.98, IFI=0.98) . Conclusions: The types of medicines and the number of glaucoma medication used have a significant influence to the medication adherence in the patients with primary angle closure glaucoma. The patients
Diniz-Filho, Alberto; Boer, Erwin R; Gracitelli, Carolina P B; Abe, Ricardo Y; van Driel, Nienke; Yang, Zhiyong; Medeiros, Felipe A
To evaluate postural control using a dynamic virtual reality environment and the relationship between postural metrics and history of falls in patients with glaucoma. Cross-sectional study. The study involved 42 patients with glaucoma with repeatable visual field defects on standard automated perimetry (SAP) and 38 control healthy subjects. Patients underwent evaluation of postural stability by a force platform during presentation of static and dynamic visual stimuli on stereoscopic head-mounted goggles. The dynamic visual stimuli presented rotational and translational ecologically valid peripheral background perturbations. Postural stability was also tested in a completely dark field to assess somatosensory and vestibular contributions to postural control. History of falls was evaluated by a standard questionnaire. Torque moments around the center of foot pressure on the force platform were measured, and the standard deviations of the torque moments (STD) were calculated as a measurement of postural stability and reported in Newton meters (Nm). The association with history of falls was investigated using Poisson regression models. Age, gender, body mass index, severity of visual field defect, best-corrected visual acuity, and STD on dark field condition were included as confounding factors. Patients with glaucoma had larger overall STD than controls during both translational (5.12 ± 2.39 Nm vs. 3.85 ± 1.82 Nm, respectively; P = 0.005) and rotational stimuli (5.60 ± 3.82 Nm vs. 3.93 ± 2.07 Nm, respectively; P = 0.022). Postural metrics obtained during dynamic visual stimuli performed better in explaining history of falls compared with those obtained in static and dark field condition. In the multivariable model, STD values in the mediolateral direction during translational stimulus were significantly associated with a history of falls in patients with glaucoma (incidence rate ratio, 1.85; 95% confidence interval, 1.30-2.63; P = 0.001). The study presented and
Antón-López, A; Moreno-Montañés, J; Duch-Tuesta, S; Corsino Fernández-Vila, P; García-Feijoo, J; Millá-Griñó, E; Muñoz-Negrete, F J; Pablo-Júlvez, L; Rodríguez-Agirretxe, I; Urcelay-Segura, J L; Ussa-Herrera, F; Villegas-Pérez, M P
To establish evidence based guidelines to advise patients on the relationship between habits, diet, certain circumstances, diseases and glaucoma. Review of all published articles on glaucoma and sports or other activities. The papers were classified according to the level of scientific evidence based on the Oxford Centre for Evidence-based Medicine classification. The evidence on the relationship between diet or supplements and the incidence or progression of glaucoma is insufficient to make a general recommendation for glaucoma patients. Although some studies on normal tension glaucoma suggest that Gingko biloba could reduce glaucoma progression, the results do not allow a general recommendation for all these patients. Similarly, the evidence on the usefulness of vitamin supplements is not conclusive. The studies on smoking do not clearly demonstrate the relationship between this habit and incidence of glaucoma. Marihuana is not a useful treatment for glaucoma. Although the results on the relationship between sleep apnoea and glaucoma are heterogeneous, it is recommended that patients with moderate to intense apnoea are tested for glaucoma. Pregnancy does not influence the course of the disease, but several hypotensive drugs may be harmful for the foetus. Nocturnal systemic hypotension is a risk factor for glaucoma progression. Certain habits, circumstances, or diseases may have an influence on the onset or progression of glaucoma. It is important to have adequate information about the scientific evidence in the publications in order to properly advise patients. Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.
Shoshani, Yochai Z; Harris, Alon; Shoja, Mohammadali M; Rusia, Deepam; Siesky, Brent; Arieli, Yoel; Wirostko, Barbara
To review the role of endothelin in intraocular pressure control, its effect on the trabecular meshwork (TM) and the outflow facility, effect on ocular blood flow and vascular regulation and the potential role of endothelin-1 (ET-1) antagonism in the therapeutic paradigm of glaucoma. A thorough review of the medical literature and a meta-analysis on the level of ET-1 in OAG patients in an attempt to demonstrate the evolving importance of endothelin in glaucoma. ET-1 has been identified in the plasma in concentrations that are markedly increased in a number of systemic as well as ocular pathologies such as glaucoma where underlying vascular dysfunction and pathology play a role. It has been shown that ET-1 induces human TM cell contraction in culture and that it can affect the outflow facility. Evidence indicates that systemic ET-1 regulatory mechanisms and vascular responses to it are also altered in glaucoma. Recently, several endothelin antagonists have been shown to have a potential role in glaucoma therapy. In our meta-analysis, only patients with normal tension glaucoma (NTG) (as opposed to patients with high tension glaucoma (HTG)) had significantly higher plasma ET-1 levels compared to non-glaucomatous control. High tension glaucomaHTG patients had significant higher levels of ET-1 in the aqueous humor. The potential role of ET-1 antagonism in the therapeutic paradigm of glaucoma is an exciting possible new approach in the treatment of OAG patients. In NTG, ET-1 may have both a local and systemic component of vascular dysregulation, while whereas in HTG, the role of ET-1 may be dominantly localized to ocular tissue.
Bhargava, J S; Bhan-Bhargava, A; Foss, A J E; King, A J
To determine patients' preferences for provision of glaucoma follow-up services examining preferences for location, access and personnel for delivery of this care. 100 patient patients attending the glaucoma outpatient clinic for follow-up review underwent an interview-based assessment during which they completed the visual function questionnaire 25 and ranking of scenario options for provision of follow-up care for their glaucoma. Percentage preferences for aspects of care offered in the conjoint analysis scenario packages and generation of utility values for each of the factor levels included in the scenario design were calculated. Travel time and training of health professional were the most important factors for patients (accounting for over 60%) of their preference. Utility scores were generated for each factor, with shorter travel time and examination by a doctor being the most important features to the patients. Patients who lived furthest from the hospital and had severe visual disability considered the number of visits to complete an episode to be an important feature. Patients ideally would like to travel a short distance and be seen by a doctor when being followed up for their glaucoma.
Awoyesuku, E A; Ejimadu, C S
Glaucoma remains the second leading cause of blindness worldwide and the highes cause of irreversible blindness worldwide. In N Glaucoma accounts for 16% of blindness and primary open angle glaucoma is the most prevalent clinical type. The aim of this study is to assess the visual disability resulting from glaucoma in newly diagnosed POAG patients in University of Port Harcourt Teaching Hospital. This is a retrospective study of newly diagnosed glaucoma patients referred from the general ophthalmology clinic to the glaucoma clinic over a 12 month period (January-December 2010). All patients had a glaucoma workup includin Snellen distant visual acuity, slit lamp examination, Goldman applanation tonometry, gonioscopy, dilated fundoscopy with +78 diopter lens as well as perimetry. All examinations were carried out by both authors. Patients with other co-morbidities such as cataract and retinal/macular pathologies were excluded from the study. A total of 98 patients were reviewed. The were 34 males and 27 females, giving a male to female ratio of 1.3:1. The average age was 54.2 years and most patients (>80%) were in the 40-59 year age group. Of the 98 patients reviewed, 62.2% had POAG. 30 patients were-blind by distant visual acuity criteria while 45 patients were blind by central visual field criteria. POAG is the most prevalent clinical subtype of glaucoma in Nigeria and sub-Saharan Africa Paucity of symptoms in early stages of the disease at late presentation is a characteristic finding in our clinic environment. Our study showed that POAG in our environment is associated with marked visual disability at the time of presentation.
Brandt, F; Thvilum, M; Hegedüs, L
registers. 28,461 patients with GD and 17,283 with TNG were included. Each case was age and sex matched with four non-hyperthyroid controls and followed over a mean period of 8 years. Data on glaucoma was obtained by record linkage within the National Danish Patient Register and/or the Danish National.......2 vs. 5.7%, P = 0.003). Prior to the diagnosis of hyperthyroidism, the odds ratio (OR) for glaucoma was non-significant in GD (1.09, 95% CI: 1.00-1.18) but slightly increased in TNG (1.13, 95% CI: 1.02-1.24). However, in TNG the OR attenuated completely when only including patients without co...
Hannappel, E; Pankow, G; Grassl, F; Brand, K; Naumann, G O
21 amino acids have been determined in aqueous humor obtained during microsurgical intraocular procedures in 30 patients with senile cataract and 27 patients with primary open-angle glaucoma. All individual amino acids showed higher levels in the glaucomas than in the cataracts: this is valid at 2p less than 0.05 for threonine, serine, asparagine, glutamine, methionine, tyrosine, phenylalanine, histidine, tryptophan, and arginine.
Full Text Available BACKGROUND: Glaucoma is the leading cause of irreversible visual impairment in the world affecting 60.5 million people worldwide in 2010, which is expected to increase to approximately 79.6 million by 2020. Therefore, glaucoma screening is important to detect, diagnose, and treat patients at the earlier stages to prevent disease progression and vision loss. Teleglaucoma uses stereoscopic digital imaging to take ocular images, which are transmitted electronically to an ocular specialist. The purpose is to synthesize literature to evaluate teleglaucoma, its diagnostic accuracy, healthcare system benefits, and cost-effectiveness. METHODS: A systematic search was conducted to help locate published and unpublished studies. Studies which evaluate teleglaucoma as a screening device for glaucoma were included. A meta-analysis was conducted to provide estimates of diagnostic accuracy, diagnostic odds ratio, and the relative percentage of glaucoma cases detected. The improvements to healthcare service quality and cost data were assessed. RESULTS: Of 11237 studies reviewed, 45 were included. Our results indicated that, teleglaucoma is more specific and less sensitive than in-person examination. The pooled estimates of sensitivity was 0.832 [95% CI 0.770, 0.881] and specificity was 0.790 [95% CI 0.668, 0.876]. The relative odds of a positive screen test in glaucoma cases are 18.7 times more likely than a negative screen test in a non-glaucoma cases. Additionally, the mean cost for every case of glaucoma detected was $1098.67 US and of teleglaucoma per patient screened was $922.77 US. CONCLUSION: Teleglaucoma can accurately discriminate between screen test results with greater odds for positive cases. It detects more cases of glaucoma than in-person examination. Both patients and the healthcare systems benefit from early detection, reduction in wait and travel times, increased specialist referral rates, and cost savings. Teleglaucoma is an effective
Mahmut Oğuz Ulusoy
Full Text Available Objectives: The aim of this study is to evaluate the diagnostic accuracy of Moorfields regression analysis (MRA and glaucoma probability score (GPS and to measure the agreement between these two programs in classifying eyes as normal or abnormal. Materials and Methods: The study included 150 glaucoma patients followed in our glaucoma unit and 120 control subjects without glaucoma. All subjects underwent total ophthalmological examination, standard achromatic perimetry, and imaging of the optic nerve head with the Heidelberg Retina Tomograph II (HRT, using HRT III software, Version 3.0. The HRT parameters were compared between the two groups. The diagnostic accuracies of the two classifications were measured when the borderline was taken as either normal (highest specificity criteria or abnormal (highest sensitivity criteria. The agreement between them was calculated using the kappa (κ coefficient. Results: All HRT parameters except height variation contour in our study showed statistically differences between the control and glaucoma groups (p=0.000. The parameters with the highest area under curves were GPS global score (0.817, vertical cup/disc ratio (0.816, cup/disc area (0.808, and cup area (0.783. According to the highest specificity criteria, MRA had a sensitivity of 66% and specificity of 89.1% and GPS had a sensitivity of 62.7% and specificity of 81.6%. According to the highest sensitivity criteria, MRA had a sensitivity of 85.3% and specificity of 68.3% and GPS had a sensitivity of 90% and specificity of 60.8%. A moderate agreement of 65.9% (178 eyes with a κ coefficient of 0.47 was found between MRA and GPS. Conclusion: In conclusion, GPS and MRA had a similar sensitivity, but the specificity of MRA was found to be higher than that of GPS. A moderate agreement was found between these analysis programs. (Turk J Ophthalmol 2014; 44: 108-114
Mohammad Reza Razeghinejad
Full Text Available Background: A number of ocular biometric parameters, iris hiotologic and anatomic characters have been suggested as inciting factors for converting patients with narrow angle to angle-closure glaucoma. This study was conducted to determine if there was any goniscopic difference between patients with acute angle-closure glaucoma (AACG and chronic angle-closure glaucoma (CACG. Methods: The study is a retrospective analysis of the charts of 97 patients with asymmetric CACG and 15 patients with unilateral AACG. The age, sex, type of glaucoma, gonioscopic findings and optic nerve head cup/disc ratio were recorded for all patients. Dynamic gonioscopy and Spaeth’s convention were used to grade the drainage angle. The eyes with AACG or more optic nerve damage in CACG groups were considered as involved eye, and the contralateral eyes in the AACG and CACG groups were considered as noninvolved and less-involved, respectively. Results: There was no significant difference between patients with AACG and CACG in terms of age, gender, refraction, and laterality of the involved eyes. In intragroup analysis, no significant difference was observed for distribution of iris attachment, irido-corneal angle, iris configuration, or trabecular pigmentation. In intergroup analysis, the superior iris was attached more anterior in the involved eyes of AACG compared to that in CACG (P=0.007. Moreover, the iris root attachment was also more anterior in both the superior (P=0.001 and inferior (P=0.002 angles of the noninvolved eyes of AACG vs. than those in the less-involved eyes of CACG group. Conclusion: The findings of the study indicate that there is no significant difference between the eyes with AACG or CACG in terms of goniscopic findings. However, the superior iris attachment was located more anterior in eyes with AACG compared to that in eyes with CACG
Full Text Available AIM: To evaluate the neuroprotective effect of nerve growth factor(NGFon acute angle-closure glaucoma patients after trabeculetomy. METHODS: Patients with viral keratitis who underwent trabeculectomy in treatment of acute angle-closure glaucoma in Xiamen Eye Center of Xiamen University from December 2011 to October 2013 were selected and completed the treatment, 61 eyes of 45 cases were followed up. The treatment group of 23 cases(32 eyeswith acute angle-closure glaucoma patients were treated by NGF gel for 3mo after trabeculetomy, while in the control group 22 cases(29 eyeswere treated by normal saline replaced NGF. All patients were followed up for at least 12mo, visual acuity, perimetry, retinal nerve fiber layer(RNFLthickness and cup/disc ratio of the patients were followed up during the treatment. The safety of topical use of NGF gel was also evaluated. RESULTS:In all patients, the intraocular pressure(IOPwas successfully controlled under 21mmHg and the visual acuity was markedly increased in the affected eye after trabeculectomy. Compared with control group, the postoperative IOP and visual acuity had no significant differences in treatment group(P>0.05. The average light sensitivity of perimetry and mean defect were better than that in control group postoperative 6 and 12mo; The results of optical coherent tomography(OCTand Heiderburg Retina Tomography(HRT-Ⅲ showed that RNFL thickness was significantly greater than that in control group, while cup/disc ratio significantly less than that in control group postoperative 6 and 12mo. Ocular surface damage, corneal endothelium to reduce and other eye complication were no observed in treatment group. CONCLUSION:Acute angle-closure glaucoma treated by NGF gel after operation is effective and safe.
Wang, Dajiang; Yu, Jifeng; Tian, Lei; Wang, Liqiang; Huang, Yifei
To evaluate the efficacy and safety of diode laser transscleral cyclophotocoagulation (DLTSC) as an adjuvant therapy to treat refractory glaucoma diagnosed before or after Moscow Eye Microsurgery Complex (MICOF) keratoprosthesis surgery. Fifteen patients underwent unilateral DLTSC to treat refractory glaucoma diagnosed before or after undergoing MICOF keratoprosthesis surgery. The cause for keratoprosthesis was alkali burn in 8 patients (53.33%); thermal burn, sulfuric acid burn, and Steven-Johnson syndrome in 2 patients (13.33%) each; and ocular cicatricial pemphigoid in 1 patient (6.67%). Best-corrected visual acuity (BCVA), intraocular pressure (IOP), any medications, and adverse events were recorded before DLTSC and on postoperative day 7; months 1, 3, and 6; and every 6 months afterwards. The patients were followed up for an average of 13.15 ± 9.35 months. The IOP was significantly less at postoperative months 6, 12, 24, and 36. There were no changes in BCVA after DLTSC. No significant changes in medication to treat ocular hypertension were prescribed. Diode laser transscleral cyclophotocoagulation is an effective treatment option for refractory glaucoma and can be used as a therapy adjuvant to keratoprosthesis. Long-term effects require further clinical observation.
Purpose. To investigate the relationship between macular retinal thickness (MRT) and central visual field sensitivity (VFS) in patients with glaucoma. Methods. This retrospective study enrolled patients diagnosed with open-angle glaucoma. All study patients underwent Humphrey 10-2 visual field (VF) test and Spectralis spectral-domain optical coherence tomography (SD-OCT) exam for MRT measurement. Results. Sixty-eight eyes of 68 patients were examined. The correlation coefficients between VFS and MRT were 0.331 (P = 0.006) and 0.491 (P = 0.000) in the superior and inferior hemispheres, respectively. The average MRT in the eyes with abnormal 10-2 VF hemifields was significantly thinner than that in the eyes without abnormal hemifields in both hemispheres (P = 0.005 and 0.000 in the superior and inferior hemisphere, resp.). The average MRT values with an optimal sensitivity-specificity balance for discriminating the abnormal VF hemifield from the normal hemifield were 273.5 μm and 255.5 μm in the superior and inferior hemisphere, respectively. The area under the receiver operating characteristic curve was 0.701 in the superior hemisphere and 0.784 in the inferior hemisphere (both P MRT measured through SD-OCT was significantly correlated with central VFS. Lower MRT values might be a warning sign for central VF defects in glaucoma patients. PMID:28421139
Rocío Prado Vega
Full Text Available The objective of this study was to evaluate differences in driving performance, visual detection performance, and eye-scanning behavior between glaucoma patients and control participants without glaucoma. Glaucoma patients (n = 23 and control participants (n = 12 completed four 5-min driving sessions in a simulator. The participants were instructed to maintain the car in the right lane of a two-lane highway while their speed was automatically maintained at 100 km/h. Additional tasks per session were: Session 1: none, Session 2: verbalization of projected letters, Session 3: avoidance of static obstacles, and Session 4: combined letter verbalization and avoidance of static obstacles. Eye-scanning behavior was recorded with an eye-tracker. Results showed no statistically significant differences between patients and control participants for lane keeping, obstacle avoidance, and eye-scanning behavior. Steering activity, number of missed letters, and letter reaction time were significantly higher for glaucoma patients than for control participants. In conclusion, glaucoma patients were able to avoid objects and maintain a nominal lane keeping performance, but applied more steering input than control participants, and were more likely than control participants to miss peripherally projected stimuli. The eye-tracking results suggest that glaucoma patients did not use extra visual search to compensate for their visual field loss. Limitations of the study, such as small sample size, are discussed.
Bai, Yu-jing; Li, Yi-qing; Chai, Fang; Yang, Xue-jiao; Zhang, Yi-chong; Wei, Yan-tao; Huang, Jing-jing; Ge, Jian; Zhuo, Ye-hong
Ahmed glaucoma valves (AGV) has been used for decades, but there is no detailed report about the efficacy of AGV in Chinese glaucoma patients. This study aimed to compare the intraocular pressure (IOP) lowering efficacy and side effects of S-2 polypropylene and PF-7 silicone AGV implantation in Chinese refractory glaucoma patients. Patients were divided into S-2 model AGV group and FP-7 model AGV group. The complete and qualified surgical success rate, change of IOP, number of anti-glaucoma medications used and postoperative complications were recorded and analyzed. Average follow-up time was comparable between two groups. IOP was reduced from (37.9 ± 12.7) mmHg preoperatively to (17.3 ± 5.3) mmHg at the last follow-up in S-2 group and reduced from (39.9 ± 14.4) mmHg to (17.7 ± 4.9) mmHg in FP-7 group. Anti-glaucoma medications were reduced from 3.8 ± 0.2 to 1.5 ± 0.2 in S-2 group, and 3.5 ± 0.2 to 0.7 ± 0.2 in FP-7 groups. The cumulative success rates were comparable in two groups, which were 61.2% and 72.1% in S-2 group and FP-7 group respectively. When IOP reduction criteria was used, complete success rates were 30.6% and 51.2% for S-2 and FP-7 groups, and qualified success rates were 86.1% and 92.7% separately. In both groups, the major complication was hypotony, and the previous trabeculectomy of patients was the major risk factor for surgery failure. In this short-term retrospective study, S-2 AGV is showed at least as effective as FP-7 AGV in IOP reduction, but associated with higher rate of complications. Previous trabeculectomy is a principle risk factor for AGV implantation failure. These clinical outcomes are important for converting use of the FP-7 silicon AGV in Chinese refractory glaucoma patients.
... up You can help find a cure for glaucoma Give now Signs & Symptoms The most common types ... have completely different symptoms. Symptoms of Open-Angle Glaucoma Most people who develop open-angle glaucoma don’ ...
Ignat, Florica; Preda, Mirela; Olaru, C
The evaluation of the incidence of the open angle glaucoma to the patients with diabetes mellitus compared to the incidence in the general population and the frequency of the neovascular glaucoma. The work consists in a study of 1700 patients with diabetes mellitus who where examined during 13 years. From 1700 patients with diabetes mellitus, 240 (14.1%) have glaucoma (primary or secondary). Of those 240, 15 (6.2%) have diabetes mellitus type I and 225 (93.7%) have diabetes mellitus type II. Concerning the clinical form of glaucoma, 177 patients (10.4%) have primary glaucoma with open angle, 23 (1.3%) have primary glaucoma with narrow-angle and 40 (2.5%) have secondary glaucoma. The highly incidence of the primary glaucoma to the patients with diabetes mellitus comparative to the general population can be explained by the vegetative dysfunction in association with diabetes mellitus and the presence of some common immunitary anomalies. The small numbers of cases with neovascular glaucoma means an indicator of the efficiency of the antidiabetic treatment and of the ocular complications of the diabetes mellitus.
Kandarakis, Artemios; Soumplis, Vasileios; Karampelas, Michalis; Panos, Christos; Kyriakos, Nikolaos; Baxevanakis, Anastasios; Karagiannis, Dimitrios
To measure intraocular pressure (IOP) elevation 6 and 24 hours after phacoemulsification in patients with glaucoma and to investigate the efficacy of brimonidine tartrate 0.2% in preventing IOP rise on the first postoperative day following cataract surgery. In this prospective randomized single-masked study, 86 eyes of 78 patients with well-controlled open-angle glaucoma were scheduled for phacoemulsification surgery. Patients were randomly assigned into 2 groups. Group A received 1 drop of brimonidine tartrate 0.2% and group B, which served as a control group, received 1 drop of artificial tears. Intraocular pressure was measured at baseline, before surgery, and 6 and 24 hours postoperatively. Within each group, we found a statistically significant difference in IOP between baseline and 6 hours postoperatively (pbrimonidine group was 18.52±4.58 mmHg, compared with 20.86±3.79 mmHg in the control group. Treatment with brimonidine tartrate 0.2% significantly reduced postoperative IOP elevation 6 hours following cataract extraction (p=0.009). Patients with medically well-controlled glaucoma may experience a substantial increase in IOP shortly after phacoemulsification surgery. Instillation of brimonidine tartrate 0.2%, although it significantly reduced IOP elevation following cataract operation, did not completely prevent IOP spikes.
Ryu, Won Yeol; Kim, Jong Kuk; Jin, Sang Wook; Shim, Dong Hyun
To report a case of an angle-closure glaucoma in a patient with Miller Fisher syndrome (MFS) without pupillary dysfunction. We present a case report of a 75-year-old male presenting with total ophthalmoplegia, complete bilateral ptosis, and gait disturbance. He was diagnosed with MFS without pupillary dysfunction, which precipitated unilateral acute angle-closure glaucoma (AACG) due to complete lid ptosis. The initial ocular examination revealed hand motion in the right eye. Intraocular pressure, as assessed by Goldmann applanation tonometry, was 50 mm Hg, and gonioscopic findings revealed a closed angle on the right eye. After maximal tolerated medical therapy, laser peripheral iridotomy was performed. The unilateral AACG with MFS resolved without further incident. This is the first reported case of a patient with MFS without autonomic dysfunction and AACG. We believe that pupillary dysfunction or lid ptosis due to neurological disorders may increase the possibility of AACG.
Full Text Available AIM:To analyze ocular surface changes induced by topical intraocular-press(IOP-lowering medication in primary glaucoma patients after antiglaucoma surgery. METHODS:A case control study. Patients with primary glaucoma(primary angle-closure glaucoma and primary open angle glaucomawho were treated by a topical IOP-lowering medication containing benzalkonium chloride(BAKwere enrolled. According to either accepted antiglaucoma surgery or not, patients were divided into group with surgery and group without surgery, indicators of ocular surface disease(OSDwere compared between the two groups. Main indicators for outcomes included tear film break-up time(TFBUTand fluorescein staining of the cornea(punctate keratitis. RESULTS:This study collected 39 primary glaucoma cases(72 eyes, in which there were 9 cases(14 eyesin group with surgery and 30 cases(58 eyesin group without surgery. There were 78% of the cases in group with surgery suffering from the OSD and 67% in group without surgery. There was no statistically significant difference between the two groups. In group with surgery, TFBUT abnormal rate was 50% and 14% of the cases with punctate keratitis. In group without surgery, the rates were 54% and 5% respectively, and there were no statistical differences between the two groups on the two indicators. CONCLUSION:The probability of ocular surface damage in primary glaucoma patients with topical IOP-lowering medication to control IOP after antiglaucoma surgery is similar to that in primary glaucoma patients with topical IOP-lowering medication only.
Full Text Available AIM:To investigate the safety and efficacy of capsular tension ring(CTRinsertion combined with phacoemulsification and intraocular lens(IOLimplantation in patient with pseudoexfoliation syndrome after anti-glaucoma surgery.METHODS: A retrospective study was conducted of 10 eyes from 10 cataract patients with pseudoexfoliation syndrome following trabeculectomy surgery, and who underwent CTR insertion combined with phacoemulsification and IOL implantation between January, 2012 and June, 2013. All cases had nuclear cataracts(nuclear hardness Ⅱ 1 eye, nuclear hardness Ⅲ 4 eyes, nuclear hardness Ⅳ 5 eyes. One case with Ⅳ nuclear hardness cataract had iridodonesis and lens subluxation. Postoperative visual acuity, intra- and post-operative complications, anterior capsular opening, IOL position, and postoperative intraocular pressure(IOPwere assessed. Follow-ups ranged from 3 to 14mo. The t test was used to analyze the variables studied.RESULTS: All patients had a successful CTR insertion combined with phacoemulsification and IOL implantation. A modified CTR insertion was performed in one case, the others underwent a standard CTR insertion. The best corrected visual acuity(BCVAwas ≥0.5 in 3 eyes and 0.3-t=1.9955, P>0.05. The most common intrao- and post-operative complications were corneal edema, small pupil, residual cortex, spontaneous zonular dialysis.CONCLUSION: Suitable CTR insertion in appropriate occasion may be beneficial to patients with pseudoexfoliation syndrome after trabeculectomy during cataract surgery. It prevents the IOL decentration and decrease the surgical complication. Less complication occurs at the early stage.
Full Text Available OBJETIVO: Avaliar a prevalência de diabéticos em uma amostra de pacientes com glaucoma; verificar se existe associação entre diabetes mellitus e glaucoma na amostra estudada; verificar outros fatores de risco associados. MÉTODOS: Foram analisados de forma retrospectiva os prontuários de 50 pacientes com diagnóstico de glaucoma. Os dados registrados foram sexo, idade, raça, história familiar de glaucoma e história pessoal de diabetes mellitus tipo 2. RESULTADOS: Do total de pacientes avaliados, 5 (10% apresentavam diabetes mellitus tipo 2. Destes, 3 eram mulheres e 2 eram homens, com mediana de idade de 81 anos (71-88. A prevalência de diabetes nos pacientes com glaucoma não mostrou diferenças significativas (OR: 1,476; Intervalo de Confiança 95%: 0,4438 a 4,910; p= 0,5352 quando comparada à prevalência de diabetes mellitus tipo 2 na população geral brasileira (7,6%. CONCLUSÃO: Nesta amostra de pacientes com glaucoma, a prevalência de diabetes mellitus tipo 2 foi pouco mais elevada que a da população. Entretanto, nenhuma associação foi encontrada entre diabetes mellitus e glaucoma.PURPOSE: To evaluate prevalence of diabetes mellitus in a group of patients with glaucoma; to verify if there is association between diabetes mellitus and glaucoma; to verify other associated risk factors. METHODS: Fifty(50 glaucoma patients had their medical records analyzed in a retrospective way. Registered data included sex, age, ethnic group, family history of glaucoma and personal history of type 2 diabetes mellitus. RESULTS: Five (10% of all evaluated patients had type 2 diabetes mellitus. 3 of them were female and 2 were male, median age of 81 years old (71-88. Prevalence of diabetes in glaucoma patients did not show significant differences. (OR: 1.476; 95% Confidence Interval: 0.4438 to 4.910; p= 0.5352 when compared to the prevalence of type 2 diabetes mellitus in general brazilian population (7.6%. CONCLUSION: In this group of patients
Parrish, R K
BACKGROUND/PURPOSE: To determine the relation between visual impairment, visual functioning, and the global quality of life in patients with glaucoma. METHODS: Visual impairment, defined with the American Medical Association Guides to the Evaluation of Permanent Impairment; visual functioning, measured with the VF-14 and the Field Test Version of the National Eye Institute-Visual Functioning Questionnaire (NEI-VFQ); and the global quality of life, assessed with the Medical Outcomes Study 36-I...
Chandra P; Gaur A; Varma S
Peeyush Chandra1, Ajit Gaur1, Shambhu Varma21Chandra Eye Research Institute, Allahabad, UP, India; 2Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USAPurpose: Coffee and tea are very common nonalcoholic beverages. However, their intake, particularly that of coffee, has been suggested to increase intraocular pressure (IOP) in patients with open angle glaucoma/ocular hypertension. The causative agent has been suggested to be their caff...
Zhen-Zhen Guo; Shan-Ming Jiang; Li-Ping Zeng; Li Tang; Ni Li; Zhu-Ping Xu; Xin Wei
Sleep accounts for a third of one’s lifetime, partial or complete deprivation of sleep could elicit sever disorders of body function. Previous studies have reported the higher prevalence of sleep disorders in glaucoma patients, but the definite mechanism for this phenomenon is unknown. On the other hand, it is well known by us that the intrinsically photosensitive retinal ganglion cells (ipRGCs) serve additional ocular functions, called non-image-forming (NIF) functions, in the regulation of ...
Blondeau, Pierre; Carbonneau, Marjorie; Esper, Philip; Turcotte, Pierre-Christophe
To study the impact of a 2-hour information session and 3 patients' phone calls on patient persistence with glaucoma medication. All patients with glaucoma treatment, part of a 27-year old solo glaucoma practice, were invited to attend the information session. Patients who attended the session (n=342) were contacted by phone 1, 4, 10 months later and regular use of drops was stressed. Patients were unaware of the study. We compared the persistence of the patients before and after attending the session, and their persistence to that of patients who did not attend (n=1187). Persistence with glaucoma medication was assessed by examination of data (2002 to 2007) from a provincial medical and drug insurance database. Patients attending the session had glaucoma for 10 years. They had a better persistence than those who did not attend (P<0.05). Their persistence remained the same 1 year after attending the session but tended to be improved in the first 180 days (P<0.076). During the study period, there was a 4% increase in overall persistence (P<0.05). This could be due to an increase in prostaglandins prescriptions and changes in β-blockers formulation. The information session and patient's recalls had a limited impact on patient persistence. This could be due to the selection of a population already persistent (78.9%). The results could have been different in less persistent patients and new patients. It could be different in another practice setting.
Goh, David; de Korne, Dirk F; Ho, Henrietta; Mathur, Ranjana; Chakraborty, Bibhas; Van Hai, Nguyen; Wai, Charity; Perera, Shamira; Aung, Tin; Wong, Tien Y; Lamoureux, Ecosse L
The purpose of this article is to assess the quality of care and economic benefits of a shared care model managing patients with stable glaucoma in a primary eye care (PEC) clinic compared with a tertiary specialist outpatient clinic (SOC) in Singapore. A randomized equivalence feasibility trial was preformed comparing the PEC with SOC models. Participants recruited from the SOC had no visual field progression or change in management for at least 3 years, were on a maximum of a single glaucoma medication, had no previous tube-shunt implant and were at least 3-year posttrabeculectomy surgery.Primary outcomes were clinical assessment and management, economic benefits, and patient satisfaction. Differences were analyzed using equivalence testing and generalized odds ratios. The trial included 233 patients, consisting of 42.1% glaucoma disc suspects (PEC: 47.4%; SOC: 36.8%), 27.5% primary angle closure suspects (PEC: 25.0%; SOC: 29.9%), 13.7% with ocular hypertension (PEC: 13.8%; SOC: 13.7%), 3.9% with primary angle closure glaucoma (PEC: 4.3%; SOC: 3.4%), and 3.0% with primary open angle glaucoma (PEC: 1.7%; SOC: 4.3%). Glaucoma clinical care for patients at PEC was as good as SOC [rate difference, 6.83%; 95% confidence interval (CI), 2.84-11.12) and management (rate difference, 7.69%; 95% CI, 3.21-12.17). In 23 cases (9.9%), 5.2% at PEC and 14.5% at SOC, there was disconcordance with the gold standard of senior consultant. Patient satisfaction at the PEC was equally high when compared with SOC (generalized odds ratio, 1.43; CI, 0.50-2.00). Direct costs per patient visit were 43% lower at PEC compared with SOC. Managing stable glaucoma patients at a primary care setting is a cost saving, safe, and effective shared care while enhancing professional collaboration between hospital and community settings.
Wang, Jieqiong [Chinese Academy of Sciences, State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Beijing (China); Li, Ting; Xian, Junfang [Capital Medical University, Department of Radiology, Beijing Tongren Hospital, Beijing (China); Wang, Ningli [Capital Medical University, Department of Ophthalmology, Beijing Tongren Hospital, Beijing (China); He, Huiguang [Chinese Academy of Sciences, State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Beijing (China); Chinese Academy of Sciences, Research Center for Brain-Inspired Intelligence, Institute of Automation, Beijing (China)
Most previous glaucoma studies with resting-state fMRI have focused on the neuronal activity in the individual structure of the brain, yet ignored the functional communication of anatomically separated structures. The purpose of this study is to investigate the efficiency of the functional communication change or not in glaucoma patients. We applied the resting-state fMRI data to construct the connectivity network of 25 normal controls and 25 age-gender-matched primary open angle glaucoma patients. Graph theoretical analysis was performed to assess brain network pattern differences between the two groups. No significant differences of the global network measures were found between the two groups. However, the local measures were radically reorganized in glaucoma patients. Comparing with the hub regions in normal controls' network, we found that six hub regions disappeared and nine hub regions appeared in the network of patients. In addition, the betweenness centralities of two altered hub regions, right fusiform gyrus and right lingual gyrus, were significantly correlated with the visual field mean deviation. Although the efficiency of functional communication is preserved in the brain network of the glaucoma at the global level, the efficiency of functional communication is altered in some specialized regions of the glaucoma. (orig.)
Sample, P A; Weinreb, R N; Boynton, R M
Recent studies have suggested that the recognition of blue-yellow color vision deficits may have some predictive value in determining which ocular hypertensives are at risk of developing glaucoma and in monitoring the progress of the disease in glaucoma patients. This article reviews current theories of normal color vision and the differences that may occur in glaucoma, outlining methods of color vision testing and interpretation, and summarizing the results of recent studies.
Asfuroglu, Mahmut; Cavdarli, Busranur; Koz, Ozlem G; A Yarangumeli, Ahmet; Ozdemir, Emine Y
To investigate the genetic association of lysyl oxidase-like 1 (LOXL1) gene polymorphisms in patients with pseudoexfoliation (PEX) syndrome and PEX glaucoma of Turkish descent. Three LOXL1 single nucleotide polymorphisms (SNPs) (rs1048661, rs3825942, and rs2165241) were analyzed in 109 Turkish patients (44 patients with PEX syndrome, 65 patients with PEX glaucoma) and 47 healthy subjects. "A" allele of SNP rs3825942 was underrepresented in control group compared with the glaucoma [odds ratio (OR)=4.5, confidence interval (CI): 95%] and syndrome (OR=4.5, CI: 95%) groups. "AA+AG" genotype of SNP rs3825942 was more frequent in the syndrome group (OR=10, CI: 95%) rather than the control group. "GT" genotype of SNP rs1048661 was presented less frequently in the control group compared with the glaucoma group (OR=4.25, CI: 95%). "T" allele of SNP rs1048661 was more frequent in glaucoma group (OR=2.05, CI: 95%) compared with control group. "T" allele of SNP rs2165241 was more frequent in the syndrome (OR=2.59, CI: 95%) and the glaucoma group (OR=3.78, CI: 95%) compared with the control group. "TT" genotype of SNP rs2165241 was underrepresented in control group compared with the syndrome (OR=3.85, CI: 95%) and the glaucoma (OR=6.58, CI: 95%) group. Findings of this current study indicate a different LOXL1 gene expression pattern compared with a recent study that was also performed in the Turkish population. Other gene replication studies are required to accurately assess genetic factors in the pathogenesis of PEX syndrome and glaucoma.
Balekudaru, Shantha; Sankaranarayanan, Nandhini; Agarkar, Sumita
To assess the prevalence, incidence, and risk factors for the development of glaucoma in patients with aniridia. Retrospective analysis of case records of patients diagnosed as having congenital aniridia between January 1986 and December 2011 was performed. Patients with a follow-up of more than 12 months were included. Ninety-one patients (180 eyes) with the diagnosis of aniridia were identified from the case records. Two eyes were excluded from the final analysis; one had developed phthisis and the other had been enucleated. Seventy-four patients (81.3%) were younger than 18 years at initial presentation. The prevalence of glaucoma at presentation was 28.8%, which could be further categorized as ocular hypertension in 19 eyes (10.5%) and glaucoma in 33 eyes (18.3%). Thirty-one eyes (28.4%) developed elevated intraocular pressure (IOP) during the follow-up period: ocular hypertension in 23 eyes (17.9%) and glaucoma in 8 eyes (6.25%). The mean IOP at the time of diagnosis was 33.9 ± 8.6 mm Hg (range: 24 to 60 mm Hg). The mean duration of follow-up was 8.1 ± 5.7 years (range: 1 to 28 years). The cumulative probability of developing elevated IOP was 4% at the end of 8 years of follow-up; this increased to 88% at the end of 28 years of follow-up. Univariate logistic regression analysis identified higher baseline IOP (odds ratio [OR]: 1.2; 95% confidence interval [CI]: 1.2 to 1.4) and limbal stem cell deficiency (OR: 2.8; 95% CI: 1.4 to 5.6) as significant risk factors for the development of elevated IOP. Higher baseline IOP remained significant on multivariate analysis (OR: 1.2; 95% CI: 1.2 to 1.4). Glaucoma occurs in a substantial proportion of patients with aniridia. Eyes with increased IOP at baseline are at a higher risk. [J Pediatr Ophthalmol Strabismus. 2017;54(4):250-255.]. Copyright 2017, SLACK Incorporated.
Full Text Available Sleep accounts for a third of one’s lifetime, partial or complete deprivation of sleep could elicit sever disorders of body function. Previous studies have reported the higher prevalence of sleep disorders in glaucoma patients, but the definite mechanism for this phenomenon is unknown. On the other hand, it is well known by us that the intrinsically photosensitive retinal ganglion cells (ipRGCs serve additional ocular functions, called non-image-forming (NIF functions, in the regulation of circadian rhythm, melatonin secretion, sleep, mood and others. Specifically, ipRGCs can directly or indirectly innervate the central areas such as suprachiasmatic nucleus (SCN, downstream pineal gland (the origin of melatonin, sleep and wake-inducing centers and mood regulation areas, making NIF functions of ipRGCs relate to sleep. The more interesting thing is that previous research showed glaucoma not only affected visual functions such as the degeneration of classical retinal ganglion cells (RGCs, but also affected ipRGCs. Therefore, we hypothesize that higher prevalence of sleep disorders in glaucoma patients maybe result from the underlying glaucomatous injuries of ipRGCs leading to the abnormalities of diverse NIF functions corresponding to sleep.
Koo, Euna B; Hou, Jing; Han, Ying; Keenan, Jeremy D; Stamper, Robert L; Jeng, Bennie H
The aim of this study was to assess the effect of various tube parameters on corneal endothelial cell density (ECD) after insertion of Ahmed valves. Thirty-nine eyes of 33 patients with previous superotemporal (ST) Ahmed valve implantation and 20 eyes of 13 participants with previous uncomplicated phacoemulsification and intraocular lens implantation but no history of glaucoma surgery were evaluated. Various tube parameters were measured with anterior segment optical coherence tomography. ST, central, and inferonasal (IN) ECD and pachymetry were measured. Endothelial cell loss and corneal thickness in the ST cornea was compared with those in the IN cornea. The mean age of the operated patients was 58 ± 22 years, and the mean time since glaucoma surgery was 2.5 ± 2.6 years. Thirty-two of the 39 study eyes were pseudophakic. The ECD was significantly lower in the ST endothelium than in the IN endothelium in eyes with glaucoma tube surgery (P cornea and distance from the tip of the tube to the cornea were significant risk factors for decreased ST endothelial cell loss when assessed relative to the IN ECD (P = 0.01 and P = 0.02, respectively). In multivariate analysis, only the distance of the tube tip to the cornea remained significantly associated with ST endothelial cell loss. Although this was a retrospective study with inherent limitations, tubes that are closer to the cornea seem to lead to increased loss of adjacent endothelial cells.
Music may have multiple influences on the human organism. A possible therapeutic effect for patients with glaucoma has been postulated, aside from the known impact of music on the cardiovascular system, psychogenic effects and a short-term improvement in mental performance (Mozart effect). The higher level of mental stress in patients with glaucoma and type-A personality behaviour may be related to higher intraocular pressure in patients with glaucoma. Relaxing music may have a positive impact in these patients, related to a reduction in intraocular pressure or its fluctuations. However, only limited data exist on the effects of music on intraocular pressure. No clinical studies have yet been performed to investigate the effect of music or music therapy on glaucoma progression. The music of Mozart may influence visual field examinations, possibly due to a positive short term effect on mental performance. This factor needs to be addressed in studies dealing with the effect of music in glaucoma. The relevance of intraocular pressure increases in professional wind instrument players is controversial. An increased level of care might be advisable in patients with advanced glaucoma. The influences of music on humans, altered personality profiles in patients with glaucoma and the studies showing some effect of stress on intraocular pressure stress the relevance of psychological support for glaucoma patients, who are confronted with a disease with a high longterm risk of blindness. Georg Thieme Verlag KG Stuttgart · New York.
Gracitelli, Carolina P B; Duque-Chica, Gloria Liliana; Roizenblatt, Marina; Moura, Ana Laura de Araújo; Nagy, Balazs V; Ragot de Melo, Geraldine; Borba, Paula Delegrego; Teixeira, Sérgio H; Tufik, Sergio; Ventura, Dora Fix; Paranhos, Augusto
To use the pupillary light reflex and polysomnography to evaluate the function of intrinsically photosensitive retinal ganglion cells (ipRGCs) and to correlate this function with structural damage in glaucoma. Cross-sectional study. A study was conducted on both eyes of 45 participants (32 patients with glaucoma and 13 healthy subjects). For the pupillary reflex evaluation, patients were tested in the dark using a Ganzfeld system (RETIport; Roland Consult, Brandenburg, Germany); pupil diameter was measured with an eye tracker system. To preferentially stimulate ipRGCs, we used a 1-second 470-nm flash with a luminance of 250 cd/m(2). To stimulate different retinal photoreceptors, we used a 1-second 640-nm flash with a luminance of 250 cd/m(2). All of the subjects underwent polysomnography. Subjects underwent standard automated perimetry and optical coherence tomography (Cirrus HD-OCT; Carl Zeiss Meditec Inc, Dublin, CA). Correlations between ipRGC activity, as measured by the pupillary light reflex, and polysomnography parameters, and correlations between retinal nerve fiber layer (RNFL) thickness and the pupillary light reflex and polysomnography parameters. The mean patient ages in the healthy and glaucoma groups were 56.8±7.8 years and 61.5±11.6 years, respectively (P = 0.174). Patients with glaucoma had significantly lower average total sleep time, sleep efficiency, and minimum oxyhemoglobin saturation compared with the healthy subjects (P = 0.008, P = 0.002, and P = 0.028, respectively). Patients with glaucoma had significantly higher arousal durations after falling asleep and more periodic limb movements (P = 0.002 and P = 0.045, respectively). There was an inverse correlation between the rapid eye movement latency and the peak of the pupillary response to the blue flash (P = 0.004). The total arousals were inversely correlated with the sustained blue flash response (P = 0.029). The RNFL thickness was associated with the peak and sustained responses to
Schwartz, Gail F; Tan, Jason; Kotak, Sameer
To develop a model to estimate and compare the cost of changing therapy due to hyperemia in glaucoma patients treated initially either with latanoprost, bimatoprost, or travoprost monotherapy. Data collected from the HealthCore Integrated Research Database, as part of the Glaucoma Adherence and Persistency Study (GAPS), were used to populate the model. Patients with a documented diagnosis of glaucoma who were newly treated (no ocular hypotensive medication and no glaucoma-related procedure during 6 months before first prescription) with latanoprost, bimatoprost, or travoprost monotherapy were identified. The time horizon for the base-case model was the duration of chart abstraction (mean = 4.1 years); a 3-month model also was developed. Physician-reported rates of hyperemia were obtained from chart reviews of 300 patients. Transition rates reflected events related to reports of hyperemia where a physician-driven change (switch or discontinuation) in therapy was documented. The per-patient direct cost (2008) due to hyperemia-driven change in therapy was calculated as the sum of the cost of the initial prescription plus the cost of the office visit where the patient was evaluated and the decision to change therapy was made. Costs were stratified by whether patients were hyperemia free or discontinued the initial therapy due to hyperemia. From the sample of 13,977 newly treated patients, 8,743 patients were started on a prostaglandin monotherapy only. Of these, 5,726 received latanoprost, 1,633 were treated with bimatoprost, and 1,384 received travoprost index monotherapy. Across all treatment groups, costs among hyperemia-free patients were US$73.67 versus US$140.02 for those who discontinued the initial prostaglandin due to hyperemia. Per-patient costs were lowest in the group treated initially with latanoprost. For the base-case model, with latanoprost as the reference, total per-patient incremental costs due to hyperemia-driven change in therapy were US$5.92 for
Marina Lotto Cordeiro
was achieved at 60 minutes for both eyes (Se/Sp: 90% . All patients described a slight burning after ibopamine's instillation. CONCLUSION: The results of this study suggests that topical 2% ibopamine is a secure alternative to evaluate outflow system impairment in eyes with glaucoma.
Full Text Available Quang H Nguyen Division of Ophthalmology, Scripps Clinic, La Jolla, CA, USA Abstract: Glaucoma is one of the leading causes of blindness and is characterized by optic nerve damage that results in visual field loss. Elevated intraocular pressure (IOP has been associated with glaucoma progression; thus, IOP-lowering medications are the standard of care for glaucoma. Guidelines suggest monotherapy with IOP-lowering agents such as β-blockers (eg, timolol, prostaglandin analogs, carbonic anhydrase inhibitors (eg, brinzolamide, and α2-receptor agonists (eg, brimonidine. However, monotherapy may provide insufficient IOP reduction in some patients, thereby necessitating the use of multiple IOP-lowering medications. Multidrug regimens may be complex, may increase the risk of preservative-related ocular symptoms, and may potentially reduce overall drug exposure as a consequence of drug washout during closely timed sequential administrations; these difficulties may reduce overall drug efficacy and decrease patient persistence and adherence with multidrug treatment regimens. Fixed-combination medications that provide two IOP-lowering therapies within a single solution are available and may overcome some of these challenges. However, all currently available fixed combinations combine timolol with another IOP-lowering agent, indicating that additional fixed-combination alternatives would be beneficial. To meet this demand, a novel fixed combination of brinzolamide 1% and brimonidine 0.2% (BBFC has recently been developed. In two randomized, double-masked, multinational clinical trials, BBFC had greater IOP-lowering efficacy than brinzolamide or brimonidine monotherapy after 3 months of treatment in patients with open-angle glaucoma or ocular hypertension. In both studies, the overall safety profile of BBFC was consistent with that of brinzolamide and brimonidine. Comparative studies with BBFC versus other IOP-lowering monotherapy and fixed
Giannaccare, Giuseppe; Vagge, A; Gizzi, C; Bagnis, A; Sebastiani, S; Del Noce, C; Fresina, M; Traverso, C E; Campos, E C
To assess the safety and efficacy of ultrasound coagulation of the ciliary body in refractory glaucoma. This prospective multicenter interventional study was conducted in two Italian university-affiliated glaucoma centers: St. Orsola-Malpighi Teaching Hospital (Bologna, Italy) and University Eye Clinic of Genoa (Genoa, Italy). The main inclusion criterion was the diagnosis of glaucoma with a baseline intraocular pressure (IOP) ≥ 21 mmHg while on maximum topical and systemic medical hypotensive treatment. The EyeOP1 device (Eye Tech Care, Rillieux-la-Pape, France), which was employed in the study, uses miniaturized transducers to produce high-intensity focused ultrasound (HIFU). Treatment consisted of the sequential activation of each transducer lasting 4 s (group 1), 6 s (group 2) or 8 s (group 3). Hypotensive medications were interrupted after surgery and then prescribed only if postoperative IOP was ≥ 21 mmHg during follow-up visits. Patients were assessed before and 1, 7, 14, 30, 90 and 180 days after the procedure. Primary outcomes were the mean IOP reduction in the overall population and in groups 1, 2 and 3, and the rates of complete success, qualified success and failure. Thirty eyes (16 open-angle, 10 angle-closure and 4 neovascular glaucoma) of 30 patients were included. The mean preoperative IOP was 30.1 ± 10.5 mmHg. Twenty-nine patients completed the entire study follow-up; one patient exited from the study 3 months after HIFU and underwent trabeculectomy. At days 1 and 180, the mean IOP was significantly reduced (18.4 ± 7.2 and 20.2 ± 6.2 mmHg, respectively; all p glaucoma. The increase in ultrasound exposure time appears to improve the response rate and the global efficacy of the procedure, with no detrimental effect on safety.
Husain, Maria Q; Alsheikh, Oday
This case describes difficulty with conjunctival closure in an 80-year-old woman with CREST syndrome, a subset of systemic scleroderma. The patient underwent uneventful glaucoma drainage device implantation, but friability of the conjunctiva was noted during closure. Amniotic membrane was used to ensure secure closure, and the patient had a successful outcome. There is a paucity of existing studies on patients with CREST syndrome and their ocular findings. This report sheds light on ocular findings in this autoimmune disease and the necessity for alternative closure methods in special cases.
Pahlitzsch, Milena; Klamann, Matthias K J; Pahlitzsch, Marie-Luise; Gonnermann, Johannes; Torun, Necip; Bertelmann, Eckart
This study was conducted to assess the impact on the Quality of Life (QOL) of micro-invasive glaucoma surgery (MIGS: iStent, Trabectome) and a penetrating technique such as Trabeculectomy (TE). This study evaluated 88 eyes of 88 open angle glaucoma patients undergoing glaucoma surgery: 43 (mean age 72.8 ± 8.8y, female 59.5 %, male 40.5 %) Trabectome (NeoMedix, Inc., Tustin, CA, USA), 20 (mean age 68.6 ± 16.4y, female 60 %, male 40 %) iStent (Glaucos Corporation, Laguna Hills, CA, USA), and 25 TE patients (mean age 74.2 ± 9.1y female 58.3 %, male 41.7 %). The National Eye Institute-Visual Functioning Questionnaire (VFQ-25) survey was used to assess the QOL at 6 months post surgery. The following 12 QOL parameters were evaluated: general health, ocular pain, general vision, near and distance activities, mental health, social functioning, role difficulties, dependency, driving, color vision, and peripheral vision. Intraocular pressure (IOP), number of topical medications, and visual acuity (VA) were examined preoperatively, 1 day, 6 weeks, 3 months, and 6 months post surgery. Statistical data were calculated using SPSS (v20.0, SPSS, Inc.). There was no significant difference between TE and MIGS in the quality of life 6 months postoperatively. IOP was significantly lower in TE compared to MIGS at 6 weeks and 3 months postoperatively (p = 0.046 and p = 0.046). Number of medications was significantly decreased in TE compared to MIGS (p glaucoma medication outcome.
Fernanda A. Cintra
Full Text Available OBJETIVO: Avaliar o resultado da implementação de um programa de educação à saúde a glaucomatosos; fornecer subsídios para a implantação de um programa de educação à saúde aos portadores de glaucoma atendidos em um serviço universitário. MÉTODOS: Foi realizada entrevista individual com 50 portadores de glaucoma, através de questionário, seguida de reunião na qual se aplicou o programa de educação à saúde. Após um intervalo médio de 2,7 meses, realizou-se nova entrevista onde os portadores de glaucoma foram submetidos ao mesmo questionário, com o acréscimo de questões sobre a importância atribuída às orientações recebidas e sobre as modificações no autocuidado. RESULTADOS: Não houve melhora significativa no conhecimento sobre a identificação da doença ocular, os efeitos colaterais, o significado do glaucoma, a importância do tratamento, a finalidade da terapêutica e o valor normal da pressão intra-ocular. Houve melhora significativa na técnica de instilação dos colírios e em relação ao conhecimento sobre a importância da hereditariedade e a finalidade da campimetria. CONCLUSÃO: Os autores concluem que o programa foi insuficiente para a apreensão de todo o seu conteúdo cognitivo. Os resultados podem ser conseqüentes ao tipo de processo ensino-aprendizagem, desenvolvido de forma vertical, que não atende à necessidade de informação dos glaucomatosos e à sua dificuldade de compreensão, decorrente do baixo nível cultural, de escolaridade e de fatores psicossociais relacionados à doença e condições de vida.PURPOSE: To analyze the results of an educational program applied to glaucoma patients; to serve as a guideline for a definitive educational program to be developed at the Glaucoma Service of the University of Campinas. METHODS: Fifty glaucoma patients were given information about the disease and its treatment by an experienced nurse and answered the same questionnaire before and 2
Resende, Arthur F; Moster, Marlene R; Patel, Neal S; Lee, Daniel; Dhami, Hermandeep; Pro, Michael J; Waisbourd, Michael
Glaucoma patients with markedly elevated intraocular pressure (IOP) are at risk for developing severe hypotony-related complications. The goal of this study was to compare the surgical outcomes of the Ahmed Glaucoma Valve (AGV) and the Baerveldt Glaucoma Implant (BGI) in this patient population. Patients with preoperative IOP≥30 mm Hg were included. Outcome measures were: (1) surgical failure (IOP>21 mm Hg or AGV group and 38 in the BGI group. The mean±SD follow-up was 2.3±1.6 years for the AGV group and 2.4±1.7 years for the BGI group (P=0.643). Mean preoperative IOP was 38.7±6.5 mm Hg for the AGV group and 40.8±7.6 mm Hg for the BGI group. At the last follow-up, 10 (27.0%) patients failed in the AGV group compared with 6 (15.8%) patients in the BGI group (P=0.379). The BGI group had higher rate of flat or shallow anterior chamber (n=4, 10%) compared with the AGV group (n=0, 0%) (P=0.043). Failure rates of AGV and BGI in patients with IOP≥30 mm Hg were comparable. There were more early hypotony-related complications in the BGI group; however, none were vision threatening. Both glaucoma drainage implants were effective in treating patients with uncontrolled glaucoma in an emergency setting.
Xu, Huan; Yu, Jian; Kong, Xiangmei; Sun, Xinghuai; Jiang, Chunhui
To evaluate and compare macular microvasculature changes in eyes with primary open-angle glaucoma (POAG) to normal eyes, and to assess associations among the retinal microvasculature, neural structural damage, and visual field loss.Ninety-nine eyes (68 patients with POAG and 31 normal subjects) were enrolled in this study. Thirty-five eyes with early-stage glaucoma (EG), 33 eyes with advanced-stage glaucoma (AG), and 31 normal eyes were included. An optical coherence tomography system with a split-spectrum amplitude-decorrelation angiography algorithm was used to measure the macular capillary vessel area density and retinal thickness. Visual field testing (30-2 and 10-2 programs) was performed using a Humphrey field analyzer. Correlations between the capillary vessel area density, retinal thickness, and visual field parameters were analyzed.Compared to normal eyes, those with EG and AG had a lower macular capillary vessel area density and lesser retinal thickness (P microvasculature network is closely associated with visual field defects, which are dependent on structural damage due to POAG.
Pieragostino, Damiana; Bucci, Sonia; Agnifili, Luca; Fasanella, Vincenzo; D'Aguanno, Simona; Mastropasqua, Alessandra; Ciancaglini, Marco; Mastropasqua, Leonardo; Di Ilio, Carmine; Sacchetta, Paolo; Urbani, Andrea; Del Boccio, Piero
Primary open angle (POAG) and pseudoexfoliative glaucoma (PXG) are the most common primary and secondary forms of glaucoma, respectively. Even though the patho-physiology, aqueous humor composition, risk factors, clinical features, therapy and drug induced ocular surface changes in POAG and PXG have been widely studied, to date information concerning tear protein characterization is lacking. Tears are a source of nourishment for ocular surface tissues and a vehicle to remove local waste products, metabolized drugs and inflammatory mediators produced in several ophthalmic diseases. In glaucoma, the proteomic definition of tears may provide insights concerning patho-physiology of the disease and ocular surface modifications induced by topical therapy. Our study aimed at characterizing protein patterns in tears of patients with medically controlled POAG and PXG. A comparative tears proteomic analysis by label-free LC-MS(E) highlighted differences in the expression of several proteins in the two glaucoma sub-types and control subjects, highlighting inflammation pathways expressed in both diseases. Results were independently reconfirmed by SDS-PAGE and linear MALDI-TOF MS, validating altered levels of Lysozyme C, Lipocalin-1, Protein S100, Immunoglobulins and Prolactin Inducible Protein. Moreover, we found a differential pattern of phosphorylated Cystatin-S that distinguishes the two pathologies. The most relevant results suggest that in both pathologies there may be active inflammation pathways related to the disease and/or induced by therapy. We show, for the first time, tear protein patterns expressed under controlled intraocular pressure conditions in POAG and PXG subjects. These findings could help in the understanding of molecular machinery underlying these ophthalmologic diseases, resulting in early diagnosis and more specific therapy.
J, Michael Selbach; Schallenberg, Maurice; Kramer, Sebastian; Anastassiou, Gerasimos; Steuhl, Klaus-Peter; Vilser, Walthard; Kremmer, Stephan
To determine the effects of surgical IOP reduction (trabeculectomy) on retinal blood flow parameters in glaucoma patients using Dynamic Vessel Analysis (DVA). 26 eyes of 26 patients with progressive primary open-angle glaucoma (POAG) despite maximal topical therapy were examined before and after trabeculectomy. The responses of the retinal vessels to flickering light provocation were measured with DVA the day before surgery and 4 to 6 weeks after trabeculectomy. Between 3 and 4 weeks before surgery all local therapies were stopped and a systemic therapy with acetazolamide and conservative free topic steroidal eye drops was started. In 19 patients (73%), an inadequate response to the flicker stimulation was measured preoperatively. In these patients, the maximum dilation of arteries and veins was reduced significantly as compared to healthy eyes. In this group, the maximum dilation of the arteries following the flicker provocation improved from 1.4% before to 3.8% following trabeculectomy (p<0.01). In retinal veins, this parameter increased from 3.1% to 4.6% (p<0.05). In the 7 patients whose arterial and venous reactions to flickering light provocation preoperatively did not differ from healthy eyes, there was no significant change after surgery. The initial baseline values of arteries and veins (MU) did not deviate significantly in both groups. POAG patients with progressive disease and impaired vascular regulation profit from IOP lowering trabeculectomy concerning vascular reactivity and dilative reserve, indicating a possible improvement of retinal perfusion following effective IOP control. Future studies with long-term follow-up must determine the clinical importance of these findings for the treatment of glaucoma patients.
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May 5, 1999 ... All patients with. PXS and glaucoma or ocular HPN were included in this study, except those secondary glaucoma cases due to trauma, intraocular inflammation and anterior adherent leucoma. For the purpose of this study, glaucoma is defined as an IOF222 mmHg with glaucomatous cupping of the optic.
Turki, Mohamed Amin; Craiu, Andreea-Mădălina
Glaucoma is not just an unique affliction but a group of afflictions that have in common optic nerve damage and loss of visual field. The 2 main types of glaucoma are POAG and PACG. AS early stages of glaucoma are largely asymptomatic, patients tend to seek help rather late, especially in low-income countries. Once vision is lost, no matter what type of glaucoma is involved, it cannot be done anything to restore it!!!
Vital Paulino Costa
Full Text Available PURPOSE: To examine the prevalence of ocular surface complaints in Brazilian patients with glaucoma or ocular hypertension who used topical intraocular pressure (IOP-lowering regimens. METHODS: In this multicenter, noninterventional, single-visit study, adults with glaucoma or ocular hypertension treated with an IOP-lowering regimen were administered the 12-item ocular surface disease index (OSDI questionnaire. Each response was scored on a 5-point scale, with 0 indicating symptom present none of the time and 4 indicating symptom present all of the time. The average of the 12 item responses for each patient was transformed to a scale from 0 to 100, with higher scores representing worse disabilities. OSDI results then were categorized as absence of OSD (scores of 0-12, mild OSD (scores of 13-22, moderate OSD (scores of 23-32, or severe OSD (scores of 33100. RESULTS: The 173 enrolled patients had a mean age of 61.2 years, were women in 65.3% of cases, and had glaucoma in 89.0% of cases and ocular hypertension in 11.0% of cases. OSDI scores for 158 patients using 1 IOP-lowering therapy indicated no OSD in 37.3% of patients (59/158, mild OSD in 20.9% (33/158, moderate OSD in 17.1% (27/158, and severe OSD in 24.7% (39/158. For the 120 patients using 1 IOP-lowering medication and having a known duration of diagnosis of glaucoma or ocular hypertension, mean OSDI scores were numerically higher (worse for the 39 patients with a diagnosis ≥6 years long (score 25 [± 20], indicating moderate OSD than for the 81 patients with a diagnosis lasting <6 years (score 22 [± 20], indicating mild OSD; however, no significant differences in OSDI scores by duration of diagnosis were evident in means (P=0.49, distributions (P≥0.26, or correlation (P=0.77. CONCLUSIONS: A large proportion of Brazilian patients treated with 1 IOP-lowering therapy had some ocular surface complaints.
Full Text Available AIM:To study the effect of postural change on intraocular pressure(IOPfluctuation in open angle glaucoma patients after trabeculectomy, and to discuss the value of this investigation on prognosis. METHODS: Fifty-one cases(62 eyesof primary open angle glaucoma were selected as the research object. Perkins ophthalmotonometer was used to test IOP at the time when patient seat(first seat. The patients were asked to lie supine for 25min, detected IOP, and the patients seated again(final seat, sustaining for 15min, detected IOP. According to whether the IOP range was more than 5mmHg, they were divided into high volatility fluctuation group and low volatility fluctuation group. We recorded their visual field progression(with AGIS score, HPA staging, in order to evaluate the correlation of IOP range with them. Reviews were made 3mo a time, and lasted for 1a, in order to evaluate the relation between IOP range and AGIS scores.RESULTS: The IOP of first seat was 18.1+2.2mmHg. There was no significant difference in the same position(P>0.05. The IOP range was 4.1±1.5mmHg. Low volatility fluctuation group was more likely to have low AGIS score and to be early vision HPA(PPr=0.412, PPCONCLUSION: Visual field progression is related to the degree of IOP fluctuation in open angle glaucoma patients after trabeculectomy, so we can predict the prognosis of patients simply by detect IOP fluctuation. This is good to adjust the IOP control scheme.
Full Text Available AIM:To evaluate the influence on intraocular pressure(IOPof the postural change and daily activities in the early morning in suspected glaucoma patients.METHODS:The supine and sitting IOP were measured and analyzed on 51 suspected glaucoma patients(100 eyeswith Icare rebound tonometer before and after getting up and daily activities in the early morning. RESULTS: The mean of sitting IOP of 51 patients was 17.12±4.53mmHg, which was significantly lower than the mean of supine IOP(19.14±5.51mmHg. The mean of IOP before and after daily activity of 51 patients were 17.12±4.53mmHg and 14.44±3.90mmHg respectively, which showed significantly difference. CONCLUSION:Postural change and daily activities can result in significant changes of IOP in suspected glaucoma patients.
Perucho-González, Lucía; Méndez-Hernández, Carmen Dora; González-de-la-Rosa, Manuel; Fernández-Pérez, Cristina; Sáez-Francés, Federico; Andrés-Guerrero, Vanesa; García-Feijoó, Julián
To evaluate the effectiveness of quantifying color changes in the optic nerve head in retinal photographs of patients with childhood glaucoma. In this observational study, three photographs of the optic nerve head were obtained in 28 patients with childhood glaucoma and 28 age- and sex-matched healthy participants (the childhood glaucoma and control groups, respectively). The Laguna Optic Nerve Head Hemoglobin (ONhE) software (Insoft SL, Tenerife, Spain) was used to determine hemoglobin levels in the optic nerve head. The following parameters were quantified: the hemoglobin levels in the optic nerve head across the whole disc, in 24 sectors (the optic nerve head divided by two concentric rings and eight 45-degree radial sectors), and in the vertical disc diameter (sectors 8 and 20), and the estimated cup-disc ratio and Glaucoma Discriminant Function, which combines the slope of the hemoglobin amount with the mean vertical disc diameter. Patient ages ranged from 9 to 14 years (median: 11 years) in the childhood glaucoma group, and 7 to 13 years (median: 9 years) in the control group (P glaucoma group showed a significantly higher cup-disc ratio compared to eyes in the control group (0.6 ± 0.2 vs 0.5 ± 0.1, respectively; P glaucoma group, the Glaucoma Discriminant Function was found to be significantly lower than in the control group (-6.5 ± 31.1 vs 9.4 ± 17.1, respectively; P glaucoma and control groups (58.2% ± 10.9% vs 58.5% ± 6.7%, respectively; P = .847). The Laguna ONhE software showed good reproducibility in measuring percentages of hemoglobin levels in both groups. The Laguna ONhE software is useful for patients with childhood glaucoma. However, hemoglobin levels in the optic nerve head across the whole disc may have normal values. This method had good reliability and is easy to implement in routine clinical practice. [J Pediatr Ophthalmol Strabismus. 2017;54(6):387-394.]. Copyright 2017, SLACK Incorporated.
Full Text Available Purpose: To study the current profile of secondary glaucomas for their incidence and to identify risk factors. Materials and Methods: In this retrospective chart review, 2997 patients newly diagnosed and referred with glaucoma to our tertiary glaucoma center in the year 2005 were included. Evaluation of all cases was done on the basis of a detailed history and recorded examination including vision, intraocular pressure (IOP, anterior segment examination, gonioscopy and fundus evaluation by glaucoma specialists. Demographic data, etiology of secondary glaucoma, and any other significant findings were noted. Results: Of 2997 referred patients, 2650 had glaucoma or were glaucoma suspects. Of all glaucoma patients or glaucoma suspects, 579 patients (21.84% had secondary glaucoma. Age distribution was as follows: 25% were between 0-20 years; 27% were between 21-40 years; 30% were between 41-60 years and 18% were> 60 years. The male female ratio was 2.2. Frequent causes of secondary glaucoma were post - vitrectomy 14%, trauma 13%, corneo-iridic scar 12%, aphakia 11%, neovascular glaucoma 9%. Post-vitrectomy glaucoma eyes had vitreous substitutes in 83% cases of which 66% eyes had retained silicone oil for more than three months. Vision ≤20/200 was present in 63% eyes, 57% eyes had baseline IOP > 30 mm Hg. Of all traumatic glaucoma patients, 71% cases were < 30 years of age. Fifty per cent had baseline IOP of> 30 mm Hg and vision ≤20/200. Conclusions: Most patients with secondary glaucoma have poor vision (≤20/200 with high IOP and advanced fundus changes at presentation.
Tojo, Naoki; Abe, Shinya; Miyakoshi, Mari; Hayashi, Atsushi
Ab interno trabeculectomy (AIT) with the Trabectome has been shown to reduce intraocular pressure (IOP) in eyes with pseudoexfoliation (PEX) glaucoma. Here, we examined the change of IOP fluctuations before and after only AIT or AIT with cataract surgery in PEX patients using the contact lens sensor Triggerfish(®). This was a prospective open-label study. Twenty-four consecutive patients with PEX glaucoma were included. Twelve patients underwent cataract surgery and AIT (triple-surgery group), and 12 patients underwent only AIT (single-surgery group). In each eye, IOP fluctuations over 24 h were measured with the contact lens sensor before and at 3 months after the surgery. We compared the change of IOP fluctuation before and after operation. We also evaluated the difference in IOP changes between the triple- and single-surgery groups. At 3 months after the surgeries, the mean IOP was significantly reduced from 23.5±6.5 mmHg to 14.6±2.8 mmHg in the single-surgery group and from 22.5±3.0 mmHg to 11.5±2.9 mmHg in the triple-surgery group. The mean IOP reduction rate was significantly higher in the triple-surgery group compared to the single-surgery group (p=0.0358). In both groups, the mean range of IOP fluctuations was significantly decreased during nocturnal periods. The mean range of 24 h IOP fluctuations was decreased in the triple-surgery group (p=0.00425), not in the single-surgery group (p=0.970). Triple surgery could decrease IOP value and the IOP fluctuations to a greater extent than single surgery in PEX glaucoma patients.
Moore, Daniel B; Walton, Charlene; Moeller, Kristy L; Slabaugh, Mark A; Mudumbai, Raghu C; Chen, Philip P
One barrier to patient adherence with chronic topical glaucoma treatment is an inadequate amount of medication available between prescription refills. We examined the self-reported prevalence of early exhaustion of glaucoma eye drops prior to a scheduled refill, and associated risk factors. This cross-sectional survey was performed at a University-based clinical practice. Glaucoma patients at the University of Washington who were experienced with eye drop application and were on a steady regimen of self-administered glaucoma drops in both eyes took a survey at the time of clinic examination. The main outcome measure was self-reported early eye drop bottle exhaustion. 236 patients were eligible and chose to participate. In general, patients included were relatively healthy (mean 2.3 comorbid medical conditions). Sixty patients (25.4%) reported any problem with early exhaustion of eye drop bottles, and this was associated with visual acuity ≤ 20/70 in the better eye (P = .049). Twelve patients (5.1%) reported that they "often" (5-7 times per year), "usually" (8-11 times per year) or "always" ran out of eye drops prior to a scheduled refill. Patients affected by this higher level (≥ 5 times yearly) of eye drop bottle exhaustion were more likely to have poor visual acuity in their worse eye ≤ 20/70 (P = .015) and had significantly lower worse-eye logMAR (P = .043). Self-reported early glaucoma bottle exhaustion regularly affected 5% of patients in our population and 25% reported early exhaustion at least once; the main risk factor was poor vision in at least one eye. These results may not be generalizable to a broad patient population, or to those inexperienced with eye drop self-administration. However, this pilot study compels further evaluation and consideration of early eye drop bottle exhaustion in glaucoma patients.
Full Text Available AIM: To establish the efficacy and safety of bimatoprost 0.03% monotherapy in glaucoma and ocular hypertension (OHT patients with inadequate intraocular pressure (IOPon current therapy. METHODS: Pre- and post-switch IOPs were analyzed for 59 consecutive patients who were switched from current therapy to bimatoprost monotherapy between 2011-2015. Demographic information, diagnosis, and any adverse events were recorded. Change in IOP post-pre switch was analyzed using a 2-sided Student's paired t-test at the 5% significance level. RESULTS: There was a statistically significant mean reduction in IOP at the first follow up visit, which was maintained at subsequent follow up visits for patients regardless of diagnosis, or pre-switch treatment (P<0.001. Subgroup analysis also demonstrated a statistically significant mean reduction in IOP when looking at OHT patients only, as well as patients with any diagnosis switched from latanoprost monotherapy to bimatoprost monotherapy (P<0.001. CONCLUSION: This is the largest independent data set which supports switching glaucoma patients with poor response to current treatment onto bimatoprost monotherapy before considering other adjuvant medical or more invasive therapy.
Marija M Bozic
Full Text Available Context: In attempt to find an alternative way to determine conversion from ocular hypertension to primary open angle glaucoma (POAG (besides visual field and optic disc changes, we analyzed intraocular pressure (IOP pulse wave in spectral domain. Aims: The aim of this study was to test the potential differences in spectral content of IOP pulse wave between ocular hypertension and POAG patients, which could indicate conversion. Settings and Design: Cross-sectional study designed to test the differences in the spectral content of pressure pulse wave between nontreated ocular hypertensive and nontreated, freshly diagnosed POAG patients. Methods: The total of 40 eyes of 40 subjects was included: 20 previously untreated ocular hypertensive patients, and 20 previously untreated POAG patients. Continuous IOP measuring gained by dynamic contour tonometry was submitted to fast Fourier transform signal analysis and further statistical data processing. Statistics Analysis Used: Ocular and systemic characteristics of the tested subjects were compared by analysis of variance appropriate for this study design. A P < 0.05 was considered to be statistically significant. Results: Higher spectral components of the IOP pulse wave was discerned up to the fifth harmonic in both of the tested groups. No statistically significant differences were found in any of the tested harmonic amplitudes. Conclusions: There are no differences in the spectral content of IOP pulse wave between ocular hypertensive and primary open angle glaucoma patients which could be indicative for conversion.
Nicholas D. Smith
Full Text Available Reading is often cited as a demanding task for patients with glaucomatous visual field (VF loss, yet reading speed varies widely between patients and does not appear to be predicted by standard visual function measures. This within-person study aimed to investigate reading duration and eye movements when reading short passages of text in a patient’s worse eye (most VF damage when compared to their better eye (least VF damage. Reading duration and saccade rate were significantly different on average in the worse eye when compared to the better eye (P<0.001 in 14 patients with glaucoma that had median (interquartile range between-eye difference in mean deviation (MD; a standard clinical measure for VF loss of 9.8 (8.3 to 14.8 dB; differences were not related to the size of the difference in MD between eyes. Patients with a more pronounced effect of longer reading duration on their worse eye made a larger proportion of “regressions” (backward saccades and “unknown” EMs (not adhering to expected reading patterns when reading with the worse eye when compared to the better eye. A between-eye study in patients with asymmetric disease, coupled with eye tracking, provides a useful experimental design for exploring reading performance in glaucoma.
Full Text Available Kenji Inoue1, Minako Shiokawa1, Michitaka Sugahara1, Risako Higa1, Masato Wakakura1, Goji Tomita21Inouye Eye Hospital, Tokyo, Japan; 2Second Department of Ophthalmology, Toho University School of Medicine, Tokyo, JapanPurpose: To prospectively investigate adverse reactions to bimatoprost in Japanese patients with glaucoma or ocular hypertension. We also examined patient attitudes to adverse reactions via a questionnaire.Methods: Fifty-two Japanese patients with glaucoma or ocular hypertension were enrolled. Iridial, eyelid, and eyelash photographs were taken before and at 6 months after bimatoprost treatment. Increase in eyelid pigmentation, iridial pigmentation, eyelash growth and bristle, and vellus hair of the lid was assessed from the photographs. Questionnaires completed by patients provided insight into their subjective judgment of adverse reactions.Results: Increase in eyelash bristle (53.8%, iris pigmentation (50.0%, eyelash growth (46.2%, vellus hair of the lid (40.4%, and eyelid pigmentation (7.7% was evident after bimatoprost treatment. The objective and subjective assessments were in agreement in terms of increase in eyelash bristle, eyelash growth, and increase in vellus hair of the lid.Conclusion: Most patients were conscious of these adverse reactions. Before administering bimatoprost, sufficient explanation of potential adverse reactions should be provided; after initiating treatment, careful observation is required.Keywords: bimatoprost, adverse reaction, eyelid pigmentation, changes in eyelashes, iris pigmentation
Chandra, Peeyush; Gaur, Ajit; Varma, Shambhu
Coffee and tea are very common nonalcoholic beverages. However, their intake, particularly that of coffee, has been suggested to increase intraocular pressure (IOP) in patients with open angle glaucoma/ocular hypertension. The causative agent has been suggested to be their caffeine content. The objective of this study was to determine if this represents a direct caffeine effect. This study was therefore done using pure caffeine applied directly to the eyes. The study was conducted with five human volunteers with open angle glaucoma/ ocular hypertension. IOP was measured using a Perkins applanation tonometer. Eye drops of 1% caffeine were prepared in-home. Following the initial (basal) measurement of the IOP, 50 μL of the eye drop preparation was instilled in the eye at 0-, 4-, and 6-hour intervals. IOPs were measured 30 minutes after each instillation. A second study was also undertaken following the first. In this study, the same patients instilled the eye drops three times per day for 1 week at home and then returned to the clinic on day 7. They were then again treated with caffeine eye drops as above and IOPs measured. In the 1-day study, the mean basal IOP was 23.6 ± 2.80 mmHg. Thirty minutes after instillation of the drops as described, the pressures were 23.2 ± 1.93, 22.2 ± 1.99, and 22.6 ± 2.31. The basal reading was taken at 10 am and another reading was then taken at 10.30 am. Additional eye drops were instilled at 2 and 8 pm and readings taken 30 minutes after each instillation. In the 1 week study, the basal value was 22.6 ± 2.32. After instillation of the drops as above the values were 23 ± 2.16, 22.4 ± 2.27, and 23 ± 1.94. Administration of caffeine into the eyes of patients did not have any effect on IOP and it remained relatively unchanged. This was true in the 1-day study as well as in the 1-week study. A cumulative effect was not visible. The results therefore demonstrate that caffeine has no significant effect on IOP in patients with
Prata, Tiago S; Lima, Verônica C; Guedes, Lia M; Biteli, Luis G; Teixeira, Sergio H; de Moraes, Carlos G; Ritch, Robert; Paranhos, Augusto
To investigate the association between corneal biomechanics and optic nerve head morphology in newly diagnosed primary open-angle glaucoma patients. Hospital based prospective study. Forty-two untreated newly diagnosed primary open-angle glaucoma patients. Patients underwent corneal hysteresis measurement using the Ocular Response Analyzer and confocal scanning laser ophthalmoscopy for optic nerve head topography evaluation. One eye was selected randomly for analysis. Data collected included age, race, gender, intraocular pressure and central corneal thickness. Multiple regression analysis (controlling for baseline intraocular pressure and disc area) was used to investigate factors associated with the following optic nerve head topographic parameters: linear cup-to-disc ratio and mean cup depth. Mean age of participants was 66.7 ± 11.8 years. Corneal hysteresis was the only factor significantly associated with both mean cup depth (correlation coefficient [r] = -0.34, P = 0.03) and cup-to-disc ratio (r = -0.41, P = 0.01). Central corneal thickness was significantly associated with mean cup depth (r = -0.35, P = 0.02), but not with cup-to-disc ratio (r = -0.25, P = 0.13). Although a trend towards a positive association between age and cup-to-disc ratio was identified (r = 0.26, P = 0.08), age was not significantly associated with mean cup depth (r = 0.06, P = 0.72). When comparing fellow eyes of patients with bilateral glaucoma, the eye with higher corneal hysteresis had smaller cup-to-disc ratio in 75% of the cases. In untreated newly diagnosed primary open-angle glaucoma patients, those with thinner corneas and mainly lower corneal hysteresis values had a larger cup-to-disc ratio and deeper cup, independently of intraocular pressure values and disc size. © 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.
Full Text Available Objective. The purpose of this study was to examine how patient, physician, and situational factors are associated with the extent to which providers educate patients about glaucoma and glaucoma medications, and which patient and provider characteristics are associated with whether providers educate patients about glaucoma and glaucoma medications. Methods. Patients with glaucoma who were newly prescribed or on glaucoma medications were recruited and a cross-sectional study was conducted at six ophthalmology clinics. Patients’ visits were videotape recorded and patients were interviewed after visits. Generalized estimating equations were used to analyze the data. Results. Two hundred and seventy-nine patients participated. Providers were significantly more likely to educate patients about glaucoma and glaucoma medications if they were newly prescribed glaucoma medications. Providers were significantly less likely to educate African American patients about glaucoma. Providers were significantly less likely to educate patients of lower health literacy about glaucoma medications. Conclusion. Eye care providers did not always educate patients about glaucoma or glaucoma medications. Practice Implications. Providers should consider educating more patients about what glaucoma is and how it is treated so that glaucoma patients can better understand their disease. Even if a patient has already been educated once, it is important to reinforce what has been taught before.
Stewart, Michael W; Bolling, James P; Bendel, Rick E
To report a case of endophthalmitis due to Nocardia brasiliensis in an eye with an exposed, infected Ahmed glaucoma drainage implant (GDI). Retrospective case report. A patient with an exposed GDI experienced recurrent episodes of endophthalmitis despite repeated intravitreal injections of antibiotics and steroids. The tube was initially repositioned and finally removed. Whereas repeated cultures from the anterior chamber and vitreous were negative, cultures from the removed tube grew Nocardia brasiliensis. Despite oral trimethoprim-sulfamethoxazole and intravitreal amikacin the eye became phthisical and lost light perception. An exposed GDI may lead to endophthalmitis due to Nocardia brasiliensis and may require explantation to establish a diagnosis.
Full Text Available AIM:To explore the efficacy and safety of mitomycin C used in trabeculectomy by analyzing intraocular pressure and blood flow. METHODS: A total of 103 patients with glaucoma were divided into 2 groups randomly, and all patients were treated with trabeculectomy, while patients in the observation group were given mitomycin C extra. At 6～12mo follow-up were completed after operation, and the clinical efficacy, complications and hemodynamic characteristics of central retinal artery were compared between groups. RESULTS: The clinical efficacy of the observation group was higher than that of the controls(PP>0.05, but the complication type was differentiate to some extent. Low intraocular pressure and photophobia symptoms occurred mostly in the observation group, while cicatricial obstruction occurred mostly in the controls. Before treatment, there was no significant difference in hemodynamic characteristics between groups(P>0.05. One month after treatment, the peak systolic velocity(PSVand end diastolic velocity(EDVof the observation group were obviously lower, while resistance index(RIand pulsatility index(PIwere higher than those of the controls, the difference was statistically significant(PPCONCLUSION: Mitomycin C has a short-term harmful effect on glaucoma patients after trabeculectomy, but its long-term effect is safe and reliable.
Schoenberg, Evan D; Levin, Ken H; Savetsky, Michael J; Mcintire, Lisa U; Ayyala, Ramesh S
To study the surgical outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with previous Ahmed glaucoma valve (AGV) implantation. Retrospective chart review of all patients who underwent DSAEK by a single surgeon in the setting of prior AGV implantation between December 2009 and September 2011 with at least 12 months follow-up. Preoperative and postoperative endothelial cell counts, visual acuity, intraocular pressure, and glaucoma medications were recorded. Eighteen eyes of 13 patients were included. The average endothelial cell count (cells/mm2) was 3087.7 (SD 390.8) preoperatively, 1974.3 (SD 646.0) at 6 months, 1831.7 (SD 851.2) at 12 months, and 1821.3 (SD 762.2) at 24 months. The average IOP (mm Hg) was 13.7 (SD 4.3) preoperatively, 15.1 (SD 5.0) at 6 months, 15.5 (SD 6.6) at 12 months, and 15.1 (SD 4.8) at 24 months. Average visual acuity (VA) preoperatively was 20/100 (logMAR 0.73, SD 0.27) and average best VA postoperatively was 20/60 (logMAR 0.5, SD 0.27). Nine of the 18 eyes (50%) had failed DSAEK grafts at 9.3 (SD 6.0) months. Six of these eyes had peripheral anterior synechiae (PAS) preoperatively, 3 had a history of uveitis, and 4 failures had multiple AGVs. Intraocular pressure control (AGV implantation, with success rates comparable to those of penetrating keratoplasty in the same population. Higher failure rate of DSAEK with prior AGV appears to be associated with the presence of chronic angle closure glaucoma with 360-degree PAS with shallow chambers, the presence of multiple AGVs, and presence of uveitis.
Muñoz de Escalona-Rojas, José Enrique; Cantero-Hinojosa, Jesús; Garrido-Pareja, Fermín; García-Serrano, José Luis; Padilla-Torres, José Francisco
We sought to study the association of glaucoma with vascular disease, with 2 independent pathways: the association of glaucoma with cardiovascular disease (CVD) and the study of ocular hemodynamic variables (OHV) in glaucoma. Cross-sectional study consisting of 73 patients: 25 without glaucoma, 28 primary open-angle glaucoma (POAG) and 20 normal-tension glaucoma (NTG). OHV, cardiovascular risk factors (CVRF) and CVD were determined. We found a greater number of CVRF and CVD in patients affected by POAG (P=.002 and P=.016) and NTG (P=.001 and P=.010) compared to the control group. With regard to OHV, in patients suffering from POAG, we found lower systolic and diastolic velocities and higher resistance index in the central retinal artery (P<.05). Moreover, in both types of glaucoma, we found higher resistance index in the posterior ciliary artery (P<.05). There is a statistically significant association between the presence of CVD and/or CVRF and glaucomatous disease, a finding that is supplemented with data from the OHV. These values indicate a worst ocular perfusion in patients with glaucomatous disease. Copyright © 2013 Elsevier España, S.L. All rights reserved.
Dave, Pujan; Villarreal, Guadalupe; Friedman, David S.; Kahook, Malik Y.; Ramulu, Pradeep Y.
Objective To determine the accuracy of patient-physician communication regarding topical ophthalmic medication use based on bottle cap color, particularly amongst individuals who may have acquired color vision deficiency from glaucoma. Design Cross-sectional, clinical study. Participants Patients ≥ 18 years old with primary open-angle, primary angle-closure, pseudoexfoliation, or pigment dispersion glaucoma, bilateral visual acuity of 20/400 or better, and no concurrent conditions that may affect color vision. Methods One hundred patients provided color descriptions of 11 distinct medication bottle caps. Patient-produced color descriptors were then presented to three physicians. Each physician matched each color descriptor to the medication they thought the descriptor was describing. Main Outcome Measures Frequency of patient-physician agreement, occurring when all three physicians accurately matched the patient-produced color descriptor to the correct medication. Multivariate regression models evaluated whether patient-physician agreement decreased with degree of better-eye visual field (VF) damage, color descriptor heterogeneity, and/or color vision deficiency, as determined by Hardy-Rand-Rittler (HRR) score and the Lanthony D15 testing index (D15 CCI). Results Subjects had a mean age of 69 (±11) years, with mean VF mean deviation of −4.7 (±6.0) and −10.9 (±8.4) dB in the better- and worse-seeing eyes, respectively. Patients produced 102 unique color descriptors to describe the colors of the 11 tested bottle caps. Among individual patients, the mean number of medications demonstrating patient-physician agreement was 6.1/11 (55.5%). Agreement was less than 15% for 4 medications (prednisolone acetate [generic], betaxolol HCl [Betoptic], brinzolamide/brimonidine [Simbrinza], and latanoprost [Xalatan]). Lower HRR scores and higher D15 CCI (both indicating worse color vision) were associated with greater VF damage (pbottle cap color is frequently incorrect
Shah, Shima; Theodossiades, Julia; Chapman, Kristin; Murdoch, Ian
Glaucoma is a chronic ocular disease, which is usually managed with long-term daily medical therapy, in the form of eye drops. Patients who are intolerant to preservatives in topical medicines require preservative-free versions. From early 2011 patients attending Moorfields Eye Hospital, London, UK, started to report recurring problems with the supply of the following preservative-free glaucoma medications: Timolol 0.25% (Timoptol 0.25%, MSD UK); Dorzolamide (Trusopt, MSD UK); Dorzolamide and Timolol 0.5% (Cosopt, MSD UK). This study investigates the impact of the supply problems of these medications at Moorfields Eye Hospital from a patient, administrative and clinical perspective. Information was sought by interviewing both patients and hospital staff, and by a retrospective case note review between April 2010 and May 2013. Many hospital roles, both administrative and clinical, were involved in attempting to resolve the impact of the supply problems. All staff reported a considerable increase in their workload. At the peak of the problem, the glaucoma secretaries received about 150 enquiries per week. A review of 83 sets of patient notes, retrieved from a random sample of 125 patients, showed that 22% encountered a supply problem. Of these, more than one-third attended Moorfields Eye Hospital Accident & Emergency (A&E) for repeat supplies and 89% eventually had their medication changed. In telephone interviews with 39 of a random sample of 50 patients (a subset of the 83 notes retrieved), 59% of the interviewees reported a supply problem. Of these, one-third attended Moorfields Eye Hospital A&E for repeat supplies and half eventually required an alternative medication. Some patients reported going to considerable lengths to obtain ongoing supplies in the community. This study shows that medication supply problems can have a major impact on patients and hospital services. Supply problems occur across many fields of medicine and with increasing frequency. The
Background: Glaucoma is the commonest cause of irreversible blindness in the world. Some glaucoma patients start out as glaucoma suspects for years. Aim: To determine the prevalence of glaucoma suspects and pattern of intra-ocular pressure distribution in glaucoma suspects. Methods: This survey was carried out in ...
Full Text Available Thomas Bertelmann, Ilse Strempel Department of Ophthalmology, Philipps-University Marburg, Baldingerstraβe, Marburg, Germany Purpose: To evaluate whether additive relaxation music (RM has an adjuvant short-term effect on physiological and psychological parameters in patients with primary open-angle glaucoma.Methods: Prospective, randomized clinical trial. Patients in the therapy group (TG received a 30-minute RM via headphones, whereas members of the control group (CG did not. Best corrected visual acuity, intraocular pressure, visual field testing, short- and long-term mental states, and blood levels of different stress hormones were analyzed and compared.Results: A total of 25 (61%/16 (39% patients were assigned to the TG/CG. Best corrected visual acuity, daily intraocular pressure, and short-term mental state (KAB development were significantly better in the TG in comparison to controls. Visual field testing, long-term mental well-being (profile of mood states, and adrenalin, cortisol, and endothelin-I blood levels did not differ significantly between both groups.Conclusion: Additive RM applied on a daily basis can positively impact various physiological and psychological parameters in the short term. Keywords: primary open angle glaucoma, POAG, music therapy, intraocular pressure, IOP, mental health
Chiseliţă, Dorin; Pantalon, Anca Delia; Cantemir, Alina; Gălăţanu, Cătălina
Aim: our study tried to find a mathematical conversion method of the measurements obtained in Time Domain (TD) OCT to Spectral Domain (SD) OCT. Material and method: A prospective randomized, double blind study that included 244 eyes, from 121 patients (normal subjects, glaucoma suspects, glaucoma), in whom we analyzed the retinal nerve fiber layer (RNFL) and the optic disc in the same session by using TD OCT (Stratus) and SD OCT (Cirrus), was performed. The means for RNFL thickness (overall value and per quadrants), neural area and cup/ disc (C/ D) ratio, were measured. Results: We found statistically significant differences between parameters measured in TD OCT and SD OCT (pOCT machines. Data dispersion showed a linear relation between measurements. One can use the following mathematical equations for conversion: Mean RNFL (Cirrus) = 15.77 + 0.748 x Mean RNFL (Stratus) Mean neural area (Cirrus) = 0.508 + 0.388 x Mean neural area (Stratus) Mean C/ D ratio (Cirrus) = 0.157 + 0.792 x Mean C/ D (Stratus) Conclusions: data based on our calculated mathematical conversion equations can be converted into SD OCT. Therefore, we offered a useful tool for the long term monitoring of our patients although the initial measurements in TD OCT made comparisons for patients later measured with SD OCT impossible. Abbreviations: RNFL = retinal nerve fiber layer, TD OCT = time domain optical coherence tomography, SD OCT = spectral domain optical coherence tomography, VF = visual field, CI = confidence interval, ISNT segments = inferior, superior, nasal, temporal segment.
Mendes, Marcio Henrique; Betinjane, Alberto Jorge; Quiroga, Veronica Andrea
To identify the correlation between the difference of intraocular pressure measurements (IOP) obtained using the Goldmann applanation tonometer (GAT) and three others tonometers (Handheld applanation tonometer - HAT, Dynamic contour tonometer - DCT and Tono-Pen®) with biometric characteristics (corneal diameter, pachymetry, keratometry and axial length) in patients with congenital glaucoma. A cross-sectional study was performed on 46 eyes from 46 patients with congenital glaucoma. IOP measurements were obtained in all patients using GAT, HAT, DCT and Tono-Pen®. Keratometry, pachymetry, biometry and corneal diameter measurements were performed after the IOP measurement. The order of the tonometries was randomized. The correlations between the differences of IOP values of GAT and the other tonometers (Delta-IOP), and the different biometric parameters were studied. Tono-Pen® Delta IOP revealed moderate positive correlation to keratometry (r=0.41, p=0.004). The other Delta-IOPs showed no correlation with any of the biometric characteristics evaluated. IOP differences between GAT (gold standard) and GAT, HAT, DCT or Tono-Pen tonometers seem not to correlate with majority of ocular biometric characteristics. The only exception was the keratometry, which correlated in a positive and moderate way with Tono-Pen® Delta-IOP. This result suggests that the differences of IOP values of Tono-Pen® and GAT increase with the steepness of the cornea.
Chansangpetch, Sunee; Panpruk, Rawiphan; Manassakorn, Anita; Tantisevi, Visanee; Rojanapongpun, Prin; Hurst, Cameron P; Lin, Shan C
We evaluated the impact of myopia on corneal biomechanical properties in primary open-angle glaucoma (POAG) and nonglaucoma patients, and the effect of modification of glaucoma on myopic eyes. This cross-sectional study included 66 POAG eyes (33 myopia, 33 nonmyopia) and 66 normal eyes (33 myopia, 33 nonmyopia). Seven corneal biomechanical parameters were measured by ultra-high-speed Scheimpflug imaging, including corneal deformation amplitude (CDA), inward/outward corneal applanation length (ICA, OCA), inward/outward corneal velocity (ICV, OCV), radius, and peak distance (PD). Mean age (SD) of the 65 male (49%) and 67 female (51%) patients was 59 (9.82) years. Myopia was associated with significantly higher CDA (adjusted effect = 0.104, P = 0.001) and lower OCV (adjusted effect = -0.105, P myopia on corneal biomechanics. Percentage differences in the adjusted myopic effect between POAG and nonglaucoma patients was 31.65, 27.27, 31.65, 50.00, 22.09, and 60.49 for CDA, ICA, OCA, ICV, OCV, and radius, respectively. Myopia had a significant impact on corneal biomechanical properties in the POAG and nonglaucoma groups. The differences in corneal biomechanical parameters suggest that myopia is correlated with significantly lower ocular rigidity. POAG may enhance the effects of myopia on most of these parameters.
Tanhehco, Tasha; Jacobs, Deborah S
The Boston Ocular Surface Prosthesis (BOS-P) (Boston Foundation for Sight, Needham, MA) is a fluid-ventilated rigid gas-permeable scleral lens that is utilized for the treatment of irregular corneal astigmatism and severe ocular surface disease. Recent reports have highlighted the utility of the BOS-P as a therapeutic device in cases of persistent epithelial defects, corneal neovascularization, ocular graft versus host disease, and exposure keratopathy. Patients with significant cornea disease might also have glaucoma, and those who have undergone glaucoma surgery, which typically disrupts the limbus, present a challenge when fitting the BOS-P. This report describes five patients with a history of both corneal disease and glaucoma surgery who were successfully fitted with the BOS-P.
A. N. Ruban
Full Text Available The article presents the risk factors for neovascular glaucoma in patients after miniinvasive diabetic vitrectomy. This was a retrospective study of 237 eyes (237 patients who underwent combined sutureless vitrectomy 23/25G for the complications of proliferative diabetic retinopathy. Indications for the surgery were vitreous hemorrhage and tractional retinal detachment. The main predictive clinical features of neovascular glaucoma after diabetic vitrectomy were: previously not performed laser phothocoagulation, level of HbA1 c >8 %, neovascular glaucoma contralateral eye, neovascularization of iris, type of diabetis, sex, vitreous hemorrhage, “table-type” of fractional retinal detachment, Marcus-Gunn defect, size of nonperfusion >2 quadrants, previously not injected inhibitor of VEGF.
Full Text Available To investigate whether patients with primary open angle glaucoma (POAG have a higher proportion of ischemic heart disease (IHD development.A population-based retrospective cohort study, using the National Health Insurance Database (NHID from 1st January, 2001, to 31st December, 2011, in Taiwan.3510 subjects with POAG were enrolled into the POAG group and 14040 subjects without glaucoma into the comparison group. The comparison group consisted of randomly selected individuals, matched with the POAG group based on age, gender, and index date (date of enrollment at a ratio of 1:4. The participants of both groups should have no IHD before the index date, and they were followed until the end of 2011 to see whether they had new-onset IHD or not. Kaplan-Meier curves were used to compare the cumulative incidence of IHD between the two groups. Frailty model, a specialized form of Cox regression analysis, was used to estimate the crude and adjusted hazard ratio (HR of IHD. Analyses were adjusted by age, gender, and systemic comorbidities (i.e. diabetes, hypertension, hyperlipidemia, atrial fibrillation and congestive heart failure.The mean age of the cohort was 57.6±11.0 years. There were slightly more males than females (51.6% vs. 48.4%. A log-rank test comparing Kaplan-Meier curves of the two groups revealed a significantly higher cumulative incidence of IHD in the POAG group (p-value<0.001. In the univariate analysis by Frailty model, POAG patients had a significantly higher hazard of IHD (unadjusted HR = 2.32; 95% confidence interval 1.93 to 2.79. After adjustment, results remained significant (adjusted HR = 1.41; 95% confidence interval 1.16 to 1.72.People with POAG may suffer from IHD more often than those without glaucoma.
Full Text Available Karanjit Kooner,1 Matthew Harrison,1 Zohra Prasla,1 Mohannad Albdour,1 Beverley Adams-Huet21Department of Ophthalmology, 2Department of Clinical Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX, USAPurpose: To report demographic and ocular features of pediatric glaucoma suspects in an ethnically diverse population of North Central Texas.Design: Retrospective cross-sectional chart review.Participants: Subjects included 75 (136 eyes pediatric glaucoma suspects. Patients with one or more of the following risk factors were included: cup-to disc (C/D ratio of ≥0.6; intraocular pressure (IOP ≥21 mmHg; family history of glaucoma; congenital glaucoma in the opposite eye; history of blunt trauma to either eye; and presence of either Sturge–Weber or Axenfeld–Rieger syndrome, or oculodermal melanocytosis.Methods: Data were extracted from electronic patient medical records. Patient records with incomplete data were excluded. The main outcome measures were race, sex, age, IOP, C/D, family history of glaucoma; and glaucoma treatment.Results: Subjects included 28 (37.3% Hispanics, 20 (26.6% African Americans, 20 (26.6% Caucasians, and seven (9.3% Asians. Forty (53.3% of the patients were male. Suspicious optic disc was seen in 57 (76%; elevated IOP in 25 (33.3%; presence of family history in 13 (17.3%, and Sturge–Weber syndrome in nine (12% patients. The average C/D ratio was 0.58±0.2. The C/D ratios of African American (0.65±0.2, Hispanic (0.63±0.2, and Asian (0.62±0.15 patients were significantly greater than those of Caucasians (0.43±0.18; P=0.0004, 0.0003, and 0.0139, respectively. Caucasian patients were the youngest (7.9±4.8 years. Eleven cases (14.7% required medication.Conclusion: Thirty-three point seven percent of patients seen in the glaucoma clinic were glaucoma suspects. The most common risk factors for suspected glaucoma were suspicious optic discs, elevated IOP, and family history
Full Text Available Altaf A Kondkar,1 Taif A Azad,1 Faisal A Almobarak,1 Hatem Kalantan,1 Saleh A Al-Obeidan,1 Khaled K Abu-Amero1,2 1Glaucoma Research Chair, Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA Background: Tumor necrosis factor alpha (TNF-α is a pro-inflammatory cytokine, which plays a role in glaucomatous neurodegeneration. Based on the plausible role of inflammation in the pathogenesis of pseudoexfoliation glaucoma (PEG, we investigated whether there is any relationship between the levels of plasma TNF-α and PEG or any of its clinical indices in comparison to normal controls.Methods: The study was designed as a retrospective analysis. Plasma samples from 49 PEG patients and 88 non-glaucomatous controls were evaluated for TNF-α levels using an enzyme-linked immunosorbent assay (ELISA. The assay was performed in duplicates on a biochemical/ELISA analyzer.Results: The two study groups were similar in age, sex and systemic disease distribution. The mean TNF-α concentration was significantly higher in the PEG patients (5.54±4.58 pg/mL than in the control subjects (0.93±1.49 pg/mL; 95% confidence interval [CI] =3.50–5.72; p=0.000. The overall dose–response trend was significant (χ2=57.07, df=2; p=0.000. A moderate positive and significant correlation was seen between TNF-α level and cup/disc ratio, an important clinical index for PEG. Besides, binary logistic regression analysis showed that the risk of PEG was most significantly affected by TNF-α level as compared to no association with age and sex. In receiver operating characteristic analysis, the area under the curve was 0.777 (95% CI =0.682–0.872 and statistically significant (p=0.000.Conclusion: Elevated systemic levels of inflammatory marker, TNF-α, are associated with PEG and may possibly serve as a biomarker for undiagnosed early
Glaucoma is a condition of increased fluid pressure inside the eye. The increased pressure causes compression of ... nerve which can eventually lead to nerve damage. Glaucoma can cause partial vision loss, with blindness as ...
David P Crabb
Full Text Available BACKGROUND: Glaucoma is a progressive eye disease and a leading cause of visual disability. Automated assessment of the visual field determines the different stages in the disease process: it would be desirable to link these measurements taken in the clinic with patient's actual function, or establish if patients compensate for their restricted field of view when performing everyday tasks. Hence, this study investigated eye movements in glaucomatous patients when viewing driving scenes in a hazard perception test (HPT. METHODOLOGY/PRINCIPAL FINDINGS: The HPT is a component of the UK driving licence test consisting of a series of short film clips of various traffic scenes viewed from the driver's perspective each containing hazardous situations that require the camera car to change direction or slow down. Data from nine glaucomatous patients with binocular visual field defects and ten age-matched control subjects were considered (all experienced drivers. Each subject viewed 26 different films with eye movements simultaneously monitored by an eye tracker. Computer software was purpose written to pre-process the data, co-register it to the film clips and to quantify eye movements and point-of-regard (using a dynamic bivariate contour ellipse analysis. On average, and across all HPT films, patients exhibited different eye movement characteristics to controls making, for example, significantly more saccades (P<0.001; 95% confidence interval for mean increase: 9.2 to 22.4%. Whilst the average region of 'point-of-regard' of the patients did not differ significantly from the controls, there were revealing cases where patients failed to see a hazard in relation to their binocular visual field defect. CONCLUSIONS/SIGNIFICANCE: Characteristics of eye movement patterns in patients with bilateral glaucoma can differ significantly from age-matched controls when viewing a traffic scene. Further studies of eye movements made by glaucomatous patients could
Miopia aguda e glaucoma de ângulo fechado associados ao uso de topiramato em paciente jovem: relato de caso Acute myopia and angle closure glaucoma associated with topiramate use in a young patient: case report
Mariana Neves Brandão
Full Text Available O glaucoma agudo de ângulo fechado pode ser secundário, dentre outras causas, ao uso de medicações sistêmicas, como o anticonvulsivante topiramato. Esse trabalho descreve o caso de uma paciente jovem com quadro agudo bilateral de miopia e glaucoma de ângulo fechado induzidos por terapia com topiramato para prevenção de crises de enxaqueca, fazendo relação com casos semelhantes descritos na literatura e revisão bibliográfica referentes à entidade.Acute angle-closure glaucoma may be induced, among other causes, by therapy with systemic drugs, such as the anticonvulsant topiramate. This paper reports the case of an young patient with acute myopia and angle-closure glaucoma associated with migraine prevention with topiramate. We make a link with similar cases described in medical journals and in a bibliographic review related to this entity.
Fea, Antonio M; Dogliani, Monica; Machetta, Federica; Lale-Lacroix, Gabriella; Brogliatti, Beatrice; Grignolo, Federico M
To describe the 1-year success of a trabecular stent implant in a pseudophakic glaucoma patient. The stent is implanted through a small corneal incision under gonioscopic control. Intraocular pressure control was reported in cultured human anterior segment. Observational case report. We report the case of a patient who was implanted and followed-up for 1 year at the Dipartimento di Fisiopatologia Clinica. The main outcome measures were intraocular pressure and visual field. The patient's intraocular pressure was controlled with topical beta-blockers for 6 months and without therapy for 6 months. Two diurnal curves demonstrated achievement of target pressure during the day. The 1-year visual field was unchanged. We are not aware of previous reports of trabecular stent implantation in pseudophakic patients. The trabecular stent had minimal peri-operative morbidity. Identification of the implantation site is challenging and reduction of efficacy over time may occur.
Full Text Available Primary angle closure glaucoma causes elevation of intra ocular pressure (IOP due to obstruction to aqueous outflow by partial or complete closure of angle by iris. Apart from medical management with topical drugs and filtration surgery, laser iridotomy is an effective primary treatment option in cases with primary angle closure. The present study was carried out in 81 patients presented with PACS, PAC and PACG who had Nd YAG laser iridotomy averaging 20 mj spread over 6 shots and also as prophylaxis in fellow eyes of patients with PACS and PAC. 93% of the patients with PAC and 71% of the patients with PACS had good control of IOP and none developed glaucomatous optic neuropathy. The complications were minimal and managed with medical treatment. Nd YAG la ser iridotomy is safe and minimally invasive procedure with least complications in our experience and follow up observations included uniformly good control of IOP and stable visual fields.
Full Text Available This cross-sectional study evaluated VRQOL in Chinese glaucoma patients and the potential factors influencing VRQOL. The VRQOL was assessed using the Chinese-version low vision quality of life questionnaire. Visual field loss was classified by the Hodapp-Parrish-Anderson method. The correlations of VRQOL to the best corrected visual acuity and the VF loss were investigated. The potential impact factors to VRQOL of glaucoma patients were screened by single factor analysis and were further analyzed by multiple regression analysis. There were significant differences in VRQOL scores between mild VF loss group and moderate VF loss group, moderate VF loss group and severe VF loss group, and mild VF loss group and severe VF loss group according to the better eye. In multiple linear regression, the binocular weighted average BCVA significantly affected the VRQOL scores. Binocular MD was the second influencing factor. In logistic regression, binocular severe VF loss and stroke were significantly associated with abnormal VRQOL. Education was the next influencing factor. This study showed that visual acuity correlated linearly with VRQOL, and VF loss might reach a certain level, correlating with abnormal VRQOL scores. Stroke was significantly associated with abnormal VRQOL.
Full Text Available Purpose: To evaluate the correlation between lamina cribrosa (LC morphology and glaucoma severity in patients with primary forms of open-angle glaucoma (OAG using enhanced depth imaging spectral-domain optical coherence tomography (SD-OCT and Humphrey visual field test (HVF. Subjects and Methods: Patients with OAG (n = 166, divided into normal-tension glaucoma (NTG and high-tension glaucoma (HTG groups (n = 66 and n = 100, were imaged using SD-OCT to obtain horizontal B-scan images of the optic nerve head (ONH. Laminar depth (LD and laminar thickness (LT were measured at the center of ONH. Results: The mean (±standard deviation values of LD, LT, and visual field mean deviation (MD were 555.4 ± 142.3 μm, 179.9 ± 49.7 μm, and − 5.7 ± 6.4 dB, respectively. In the multivariate linear regression analysis, LD, LT, and intraocular pressure (IOP were significantly correlated with MD (P = 0.007, P = 0.037, and P = 0.004, respectively. In the subgroup analyses, only LD was associated with MD in the NTG group (n = 66, whereas LT and IOP were correlated with MD in the HTG group (n = 100. Neither axial length nor central corneal thickness was associated with LD or LT. Conclusions: Glaucoma severity, as measured by HVF MD, shows significant correlations with LD and LT, with greater severity associated with increasing LD and decreasing LT. Normal- and high-tension OAG patients have different associations with LD and LT, which implies that the pathogenesis of these two entities might be different.
Full Text Available Peeyush Chandra1, Ajit Gaur1, Shambhu Varma21Chandra Eye Research Institute, Allahabad, UP, India; 2Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USAPurpose: Coffee and tea are very common nonalcoholic beverages. However, their intake, particularly that of coffee, has been suggested to increase intraocular pressure (IOP in patients with open angle glaucoma/ocular hypertension. The causative agent has been suggested to be their caffeine content. The objective of this study was to determine if this represents a direct caffeine effect. This study was therefore done using pure caffeine applied directly to the eyes.Methods: The study was conducted with five human volunteers with open angle glaucoma/ocular hypertension. IOP was measured using a Perkins applanation tonometer. Eye drops of 1% caffeine were prepared in-home. Following the initial (basal measurement of the IOP, 50 µL of the eye drop preparation was instilled in the eye at 0-, 4-, and 6-hour intervals. IOPs were measured 30 minutes after each instillation. A second study was also undertaken following the first. In this study, the same patients instilled the eye drops three times per day for 1 week at home and then returned to the clinic on day 7. They were then again treated with caffeine eye drops as above and IOPs measured.Results: In the 1-day study, the mean basal IOP was 23.6 ± 2.80 mmHg. Thirty minutes after instillation of the drops as described, the pressures were 23.2 ± 1.93, 22.2 ± 1.99, and 22.6 ± 2.31. The basal reading was taken at 10 am and another reading was then taken at 10.30 am. Additional eye drops were instilled at 2 and 8 pm and readings taken 30 minutes after each instillation. In the 1 week study, the basal value was 22.6 ± 2.32. After instillation of the drops as above the values were 23 ± 2.16, 22.4 ± 2.27, and 23 ± 1.94.Conclusion: Administration of caffeine into the eyes of patients did not
Agorastos, Agorastos; Skevas, Christos; Matthaei, Mario; Otte, Christian; Klemm, Maren; Richard, Gisbert; Huber, Christian G
... of “circadian misalignment,” sleep disorders, anxiety, and depression. Patients with severe glaucoma, versus glaucoma patients without visual-field defects, showed higher comorbidity with trait-anxiety, depression, and sleep disturbance...
Mizoue, Shiro; Nitta, Koji; Shirakashi, Motohiro; Nitta, Akiyoshi; Yamabayashi, Shigeki; Kimura, Tairo; Ueda, Toshihiko; Takeda, Ryuji; Matsumoto, Shun; Yoshikawa, Keiji
This study compared the efficacy and safety of adjunctive brimonidine tartrate 0.1% ophthalmic solution (brimonidine) and timolol maleate 0.5% ophthalmic solution (timolol) in prostaglandin analogue (PGA)-treated normal-tension glaucoma (NTG), assessing the non-inferiority of brimonidine in terms of intraocular pressure (IOP) reduction. In this multicenter, randomized, investigator-masked, parallel-group, clinical study, adjunctive brimonidine or timolol was administered twice daily for 12 weeks in eyes with NTG that had been treated with PGA for at least 90 days and required additional treatment despite an IOP of 16 mmHg or less. IOP was measured on at least three visits before add-on therapy (mean baseline IOP), and at weeks 4, 8, and 12 after adjunctive administration. Systolic/diastolic blood pressure, pulse rate, and adverse events (AEs) were recorded at each visit. A total of 152 individuals were enrolled and 128 (84.2%) were eligible for efficacy analyses. IOP in both groups at each visit decreased significantly from baseline (P brimonidine (-1.05 ± 1.81 mmHg) and timolol (-1.41 ± 1.40 mmHg) groups was 0.36 mmHg (95% confidence interval [CI] [-0.21, 0.92]), which exceeded the value of the non-inferiority margin (0.75 mmHg). Baseline systolic/diastolic blood pressure decreased significantly in both groups at certain visits (P brimonidine group. AE-related treatment discontinuation occurred in 2/71 (2.8%) and 2/75 (2.7%) patients in the brimonidine and timolol groups, respectively. This study demonstrated an add-on effect of brimonidine to PGAs, although non-inferiority of brimonidine to timolol as adjunctive therapy in PGA-treated NTG in terms of IOP reduction was not observed. Brimonidine was associated with no adverse effects on pulse rate. Senju Pharmaceutical Co., Ltd. UMIN Clinical Trials Registry identifier, UMIN000014810.
Dada, T; Konkal, V; Tandon, R; Singh, R; Sihota, R
To study the corneal topographic response to IOP reduction in vernal keratoconjunctivitis (VKC) with steroid-induced glaucoma. A total of 42 eyes of 21 patients with VKC and steroid-induced glaucoma (Group I) and 66 eyes of 33 patients with VKC without glaucoma (Group II) underwent an evaluation by Orbscan topography. In eyes with glaucoma, the IOP was controlled medically and the corneal topography was repeated at 3 months to evaluate effect on corneal parameters. The mean baseline IOP was 36.40+/-13.08 mmHg in Group I, 14.67+/-4.62 mmHg in Group II (P<0.0001). The IOP after treatment at 3 months follow-up was 15.00+/-5.41 mmHg in Group I (P<0.0001). In Group I, the mean maximum Sim K decreased from 44.86+/-3.21 D to 43.87+/-2.62 D (P=0.031) and mean posterior corneal elevation decreased from 64.9+/-22.36 microm to 35.7+/-28.91 microm at 3 months after reduction of IOP (P=0.001). There was a significant positive correlation between the reduction in the IOP and the decrease in the posterior corneal elevation (r=0.664, P=0.001). Eyes with VKC with and without glaucoma have similar corneal topography. Increased IOP associated with steroid-induced glaucoma and VKC may contribute to an increase in the corneal curvature and posterior corneal elevation. These changes may be reversed by a reduction in the IOP with medical therapy.
Van Bergen T
Full Text Available Tine Van Bergen,1 Sarah Van de Velde,1 Evelien Vandewalle,3 Lieve Moons,2 Ingeborg Stalmans1,31Laboratory of Ophthalmology, KU Leuven, 2Unit Animal Physiology and Neurobiology, KU Leuven, 3Department of Ophthalmology, University Hospitals Leuven, Leuven, BelgiumAbstract: Of all the treatments currently used to lower intraocular pressure in glaucoma patients, filtration surgery is known to be the most effective. However, in a significant percentage of cases, the constructed channel closes due to excessive scar formation, resulting in surgical failure. The process of postoperative wound healing is characterized by the coagulative and inflammatory phase, followed by the proliferative and repair phase, and finally the remodeling phase. Perioperative antimitotic agents, such as mitomycin C and 5-fluorouracil, are known to modulate the process of wound healing and to improve surgical outcome, but they carry a risk of vision-threatening complications. New alternative strategies to prevent filtration failure, such as inhibition of transforming growth factor-β, vascular endothelial growth factor, and placental growth factor, have shown promising results in the improvement of surgical success. However, it remains necessary to broaden the therapeutic approach by focusing on combined therapies and on extended drug delivery.Keywords: glaucoma filtration surgery, filtration failure, wound healing, wound modulating agents
Malvankar-Mehta, Monali S; Iordanous, Yiannis; Chen, Yufeng Nancy; Wang, Wan Wendy; Patel, Sangita Shantilal; Costella, John; Hutnik, Cindy M L
Minimally invasive glaucoma surgeries (MIGS) have attracted significant attention, as they have been reported to lower intra-ocular pressure (IOP) and have an excellent safety profile. The iStent is an example of a minimally invasive glaucoma device that has received particular attention due to its early and wide spread utilization. There is a growing body of evidence supporting its use at the time of phacoemulsification to help lower IOP. However, it is still not clear how much of the IOP lowering effect can be attributed to the iStent, the crystalline lens extraction or both when inserted concurrently at the time of phacoemulsification. This has been an important issue in understanding its potential role in the glaucoma management paradigm. To conduct a systematic review and meta-analysis comparing the IOP lowering effect of iStent insertion at the time of phacoemulsification versus phacoemulsification alone for patients with glaucoma and cataracts. A systematic review was conducted utilizing various databases. Studies examining the IOP lowering effect of iStent insertion in combination with phacoemulsification, as well as studies examining the IOP lowering effect of phacoemulsification alone were included. Thirty-seven studies, reporting on 2495 patients, met the inclusion criteria. The percentage reduction in IOP (IOPR%) and mean reduction in topical glaucoma medications after surgery were determined. The standardized mean difference (SMD) was computed as a measure of the treatment effect for continuous outcomes taking into account heterogeneity. Fixed-effect and random-effect models were applied. A 4% IOP reduction (IOPR%) from baseline occurred following phacoemulsification as a solo procedure compared to 9% following an iStent implant with phacoemulsification, and 27% following 2 iStents implants with phacoemulsification. Compared with cataract extraction alone, iStent with phacoemulsification resulted in significant reduction in the post-operative IOP (IOPR
Tamcelik, Nevbahar; Ozkok, Ahmet; Sarıcı, Ahmet Murat; Atalay, Eray; Yetik, Huseyin; Gungor, Kivanc
To present and compare the long-term results of Dr. Tamcelik's previously described technique of Tenon advancement and duplication with the conventional Ahmed glaucoma valve (AGV) implantation technique in patients with refractory glaucoma. This study was a multicenter, retrospective case series that included 303 eyes of 276 patients with refractory glaucoma who underwent glaucoma valve implantation surgery. The patients were divided into three groups according to the surgical technique applied and the outcomes compared. In group 1, 96 eyes of 86 patients underwent AGV implant surgery without patch graft; in group 2, 78 eyes of 72 patients underwent AGV implant surgery with donor scleral patch; in group 3, 129 eyes of 118 patients underwent Ahmed valve implant surgery with "combined short scleral tunnel with Tenon advancement and duplication technique". The endpoint assessed was tube exposure through the conjunctiva. In group 1, conjunctival tube exposure was seen in 11 eyes (12.9 %) after a mean 9.2 ± 3.7 years of follow-up. In group 2, conjunctival tube exposure was seen in six eyes (2.2 %) after a mean 8.9 ± 3.3 years of follow-up. In group 3, there was no conjunctival exposure after a mean 7.8 ± 2.8 years of follow-up. The difference between the groups was statistically significant. (P = 0.0001, Chi-square test). This novel surgical technique combining a short scleral tunnel with Tenon advancement and duplication was found to be effective and safe to prevent conjunctival tube exposure after AGV implantation surgery in patients with refractory glaucoma.
Davydova, N G; Kuznetsova, T P; Borisova, S A; Abdulkadyrova, M Zh
The paper presents the results of an investigation of the effect of the nootropic agents pantogam and nooclerine on visual functions in patients with primary open-angle glaucoma. These agents have been found to have a beneficial effect on the functional activity of the retina and optic nerve, light sensitivity, hemo- and hydrodynamics of the eye.
Insull, Elizabeth; Nicholas, Simon; Ang, Ghee Soon; Poostchi, Ali; Chan, Kenneth; Wells, Anthony
To examine the relationships between optic disc area and parameters measured at the cornea; central corneal thickness (CCT), corneal hysteresis (CH) and ocular pulse amplitude (OPA) in glaucoma subjects and controls. In this prospective experimental study, patients underwent measurement of CCT, OPA, CH and optic disc imaging with the Heidelberg Retina Tomograph II (HRT-II). Pearson's correlation coefficient was calculated to assess the associations between optic disc area and CCT, OPA and CH. A total of 100 patients, 38 with glaucoma and 62 controls were examined. In a univariate analysis of this group, CCT and CH were significantly lower in glaucoma patients (P = 0.01). CCT was inversely correlated with optic disc surface area (Pearson's correlation coefficient r = -0.200; P = 0.05). This inverse correlation did not achieve statistical significance when glaucoma patients and controls were analysed separately. There was no statistically significant association between optic disc area and OPA or CH. There was an inverse relationship between CCT and optic disc area in this study group. No association was found between optic disc area and OPA or CH. © 2010 The Authors. Clinical and Experimental Ophthalmology © 2010 Royal Australian and New Zealand College of Ophthalmologists.
Knani, L; Gatfaoui, F; Mahjoub, A; Ghorbel, M; Mahjoub, H; Ben Hadj Hamida, F
To assess the vision-specific quality-of-life (VS-QoL) of glaucoma patients followed at Farhat Hached university hospital, Sousse-Tunisia, and identify clinical and sociodemographic factors potentially affecting it. This was a cross-sectional study enrolling one-hundred twenty patients followed for primary open angle glaucoma (POAG). All the patients successfully responded to the Arabic version of the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ 25). Quality of life was quantified in terms of scores (0-100) and correlated with sociodemographic and clinical factors. One hundred and twenty patients were studied. The mean age was 62.38±10.68years. The global mean score (GMS) score was 70.11±18.45% ranging from 23.71 to 98%. Urban residence was associated with a better total score (P=0.01). Educational background was correlated with the subscale scores of distant activities (P=0.01), social functioning (P=0.03), physical activity limitations (P=0.01) and peripheral vision (P=0.01). The total NEI-VFQ 25 had a statistically significantly negative correlation with the duration of the glaucoma (P=0.002), the cup to disc ratio of the better and the worse eye (Pglaucoma medications had a negative impact on the total score (P=0.03) and the subscales of physical activity limitations (P=0.04) and driving (P=0.002). Vision-specific quality of life of glaucoma patients, as measured by the NEI-VFQ 25, is correlated to many sociodemographic and clinical elements. QoL evaluation is an essential factor to be considered in the management of glaucoma patients. In our context, research should be directed first to the validation of a questionnaire in the local dialect. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Gupta, Divakar; Slabaugh, Mark; Francis, Courtney E.
Hypotony maculopathy is a condition that may result in visual deterioration from choroidal folds or optic disc edema. Optic disc edema can result from altered translaminar pressure gradients (lowered intraocular pressure, increased cerebrospinal fluid pressure, or increased orbital pressure). We report a case of bilateral optic disc edema in a patient with glaucoma and thyroid-related orbitopathy. The patient's disc edema was initially presumed to be secondary to her orbitopathy, but persisted after bilateral orbital decompression. Ultimately, disc edema and choroidal folds in the right eye resolved after trabeculectomy revision and an increase in intraocular pressure. This case serves as a reminder of the causes of optic disc edema and demonstrates delayed reversal of hypotony maculopathy. PMID:26600789
Page, C J; Merritt, J C; Evans, B
Afferent pupillary defects may accompany asymmetric primary open-angle glaucoma, though the exact incidence has not been reported. Charts were reviewed on 89 patients attending the Glaucoma/Uveitis Clinic at the North Carolina Memorial Hospital in Chapel Hill, North Carolina over a five-year period. All patients had primary open-angle glaucoma diagnosed by: (1) increased ocular tensions (22 mmHg) in the presence of open-anterior-chamber angles and (2) optic-nerve cupping and atrophy compatible with (3) pressure-dependent, visual-field loss. No subjects with secondary glaucomas, primary-angle-closure glaucoma, or ocular hypertension are included.The presence of the relative afferent pupillary defect was noted in 21 of 89 patients (23 percent). Sixteen of 70 black patients had relative afferent pupillary defect in the more severely affected eye, while five of 19 white patients demonstrated afferent pupils. Other demographic characteristics of this population are described. Two typical primary-open-angle glaucoma patients are discussed to demonstrate comparable changes within the optic nerves and Goldmann visual fields. The presence of the relative afferent pupillary defect best correlates with asymmetric, visual-field loss in the more severely affected eye.
Sadhana V Kulkarni
Full Text Available Sadhana V Kulkarni1,2, Karim F Damji1,2, Yvonne M Buys31University of Ottawa Eye Institute, Ottawa, ON, Canada; 2Ottawa Health Research Institute, Ottawa, ON, Canada; 3Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, CanadaAbstract: Primary open angle glaucoma is a chronic optic neuropathy often requiring lifelong treatment. Patient compliance, adherence and persistence with therapy play a vital role in improved outcomes by reducing morbidity and the economic consequences that are associated with disease progression. A literature review including searches of The Cochrane Library, MEDLINE, PubMed, conference proceedings, and bibliographies of identified articles reveals the enormous public health burden in various populations due to the impact of glaucoma associated visual impairment on the overall quality of life eg, fear of blindness, inability to work in certain occupations, driving restrictions, motor vehicle accidents, falls, and general health status. Providing specific definitions for the frequently misunderstood terms “compliance, persistence and adherence” with reference to medication use is central not only for monitoring patients’ drug dosing histories and clinical outcomes but also for subsequent research. In this review article, a summary of the advantages/disadvantages including cost-effectiveness of various medical approaches to glaucoma treatment, techniques employed for measuring patient compliance and actual patient preferences for therapy are outlined. We conclude by identifying the key barriers to ongoing treatment and suggest some best practices to enhance compliance and persistence.Keywords: glaucoma, compliance, persistence, medication therapy management
Nordmann, Jean-Philippe; Baudouin, Christophe; Renard, Jean-Paul; Denis, Philippe; Lafuma, Antoine; Laurendeau, Caroline; Jeanbat, Viviane; Berdeaux, Gilles
To identify and characterize treatment compliance profiles of glaucoma patients and evaluate the association with intraocular pressure (IOP). A computerized device (Travalert((R))) that recorded daily instillation times and eye-drop counts was given for 3 months. Patients were declared compliant when at least 2 drops were instilled per day. Compliance rates were calculated for weekdays and weekends, separately, over 8 consecutive weeks. A principal components analysis (PCA) was followed by an ascendant hierarchical classification (AHC) to identify compliance groups. 140 patients were recruited (mean age 65.5 years; 51.8% female) of whom 83.6% had primary open-angle glaucoma with mean IOP 23.9 mmHg before Travalert((R)) use. 60.7% were treated with DuoTrav((R)) (travoprost timolol fixed combination) and 39.3% with travoprost. The PCA identified two axes (compliance and treatment weeks). The AHC identified 3 compliance groups: 'high' (56.6%, approx. 80% compliance), 'medium' (21.2%, approx. 50% compliance), and 'low' (22.1%, approx. 20% compliance). Demographics and glaucoma parameters did not predict low compliance. Final mean IOP was 16.1 mmHg, but higher in the low compliance group (17.7 mmHg, P = 0.02). Compliance measurement by a medical device showed compliance rates IOP control. No demographic or glaucoma variable was associated with low compliance.
Ammar M. Al-Mahmood
Full Text Available Glaucoma after corneal transplantation is a leading cause of ocular morbidity after penetrating keratoplasty. The incidence reported is highly variable and a number of etiologic factors have been identified. A number of treatment options are available; surgical intervention for IOP control is associated with a high incidence of graft failure. IOP elevation is less frequently seen following deep anterior lamellar keratoplasty. Descemet's striping-automated endothelial keratoplasty is also associated with postprocedure intraocular pressure elevation and secondary glaucoma and presents unique surgical challenges in patients with preexisting glaucoma surgeries. Glaucoma exists in up to three-quarters of patients who undergo keratoprosthesis surgery and the management if often challenging. The aim of this paper is to highlight the incidence, etiology, and management of glaucoma following different corneal transplant procedures. It also focuses on the challenges in the diagnosis of glaucoma and intraocular pressure monitoring in this group of patients.
Full Text Available Eleni Bagli, Christos Gartzios, Ioannis Asproudis, Georgios KitsosUniversity Eye Clinic of Ioannina, Ioannina, GreecePurpose: The comparison of one-site versus two-site phacotrabeculectomy in patients with pseudoexfoliation glaucoma (PEXG and primary open-angle glaucoma (POAG, with respect to intraocular pressure (IOP, antiglaucomatous medication (AM requirements and visual acuity (VA.Methods: Forty-seven patients (eyes with cataract and POAG and 46 sex- and age-matched patients with cataract and PEXG were randomized to one- or two-site phacotrabeculectomy and reviewed with a follow-up at three years.Results: Mean preoperative IOP was 22.04 ± 2.27 mmHg and 22.92 ± 2.35 mmHg in POAG and PEXG groups (p > 0.05 using a mean of 2.76 ± 0.74, 2.74 ± 0.69 AM, respectively (p > 0.05. After three years of follow-up, the mean IOP was 15.04 ± 1.57 mmHg in the one-site, 15.04 ± 1.99 mmHg in the two-site group with POAG, 15 ± 1.8 mmHg in the one-site, 15.32 ± 1.31 mmHg in the two-site group with PEXG, using a mean of 0.68 ± 0.69, 0.84 ± 0.75, 0.96 ± 0.67, and 0.8 ± 0.62 AM, respectively. Mean IOP and AM postoperatively were significantly less compared to preoperatively for each group (p < 0.05. No difference was observed in mean IOP and AM between the four groups at three years postoperatively (p > 0.05. VA improved similarly in four groups at the three-year follow-up (p < 0.05. Intraoperative, postoperative complications, and need for 5-fluorouracil injections were similar between the surgical groups.Conclusion: One-site and two-site phacotrabeculectomy without the use of antimetabolites intraoperatively were similarly safe and effective in IOP control over a three-year follow-up period in patients with POAG and PEXG.Keywords: phacotrabeculectomy, pseudoexfoliation, glaucoma
... born with glaucoma. Read her story » Learn About Glaucoma Glaucoma is a complicated disease in which damage ... Christopher doesn't ever want to go blind » Glaucoma 360 Glaucoma 360 — three days of events uniting ...
Almousa, Radwan; Lake, Damian B
To analyze the control of intraocular pressure (IOP) with an Ahmed glaucoma drainage device (AGDD) in two groups of glaucoma patients--one with cicatricial ocular surface disease (COSD) and one with aniridia. This is a retrospective comparative case series of nine patients (11 eyes) with COSD and six patients (8 eyes) with aniridia who underwent AGDD surgery to control IOP. The main outcome measure in both groups was stability of IOP between 6 and 21 mmHg. Mean IOP decreased significantly in both groups after AGDD surgery (29.6 ± 8.7 vs 14.7 ± 2.5, p = 0.008 in the COSD group; 26.3 ± 8.2 vs 15.3 ± 5.8, p = 0.008 in the aniridia group). Over a mean post-surgery follow-up of 37.1 months in the COSD group, we managed to control IOP in nine eyes; IOP control was successful in 87 % of eyes at 12 months and 58 % of eyes at 26 months. Over a mean post-surgery follow-up of 37.4 months in the aniridia group, we managed to control the IOP in seven eyes; IOP control was successful in 87 % of eyes at 12 months. AGDD surgery had no significant deleterious effect on visual acuity in either group. A severe complication occurred in one eye (1/8) in the aniridia group (lost vision due to retinal detachment) and in one eye (1/11) in the COSD group (tube exposure). AGDD surgery is effective in controlling IOP and has a low complication rate in COSD and aniridia patients; however, some of the complications are severe and prompt management is needed to prevent deleterious results.
Full Text Available The presence of a family history of glaucoma is a known risk factor for primary open-angle glaucoma (POAG in middle-aged and older individuals. In this study, our aim was to demonstrate possible early glaucomatous alterations in young first- and second-degree relatives of POAG patients by spectral-domain optical coherence tomography. A total of 104 participants (52 relatives of POAG patients and 52 healthy individuals were recruited in this cross-sectional study. All the participants were between 17 years and 45 years of age. All eyes underwent testing with spectral-domain optical coherence tomography. Peripapillary retinal nerve fiber layer thickness, hemifield macular thickness, macular ganglion cell complex thickness, posterior pole asymmetry analysis, and retinal arteriolar caliber measurements were taken for comparison between the study and control groups. The mean peripapillary retinal nerve fiber layer thickness was 104.9 ± 8.8 μm in the study group and 105.6 ± 7.4 μm in the control group (p = 0.68. Although whole macular thickness measurements were higher in the control group when compared with the study group (p = 0.008, the macular ganglion cell complex thickness was similar in both groups (p = 0.87. The posterior pole asymmetry analysis revealed no statistically significant difference between the groups in the aspect of consecutive black squares (p = 0.79. The mean retinal arteriolar caliber was 85.9 ± 4.8 μm in the study group and 86.0 ± 5.0 μm in the control group (p = 0.90. In conclusion, young relatives of POAG patients do not show characteristic glaucomatous damage when compared with the controls.
Hennessy, Amy L; Katz, Joanne; Covert, David; Protzko, Colleen; Robin, Alan L
Objectively evaluate the ability of visually disabled glaucoma patients to successfully administer a single drop onto their eye. Prospective, observational study. Experienced glaucoma patients with Early Treatment of Diabetic Retinopathy Study visual acuity (VA) of ≤ 6/18 (≤ 20/60) ≥ 1 eye, or moderate or severe visual field damage in ≥ 1 eye. Subjects were "low vision" (20/60 ≤ VA 6 months. Subjects used a mean of 1.9 ± 1.1 bottles of intraocular pressure-lowering medications to treat their glaucoma. Seventy-six percent (155/204) of subjects had severe visual field damage, with a mean deviation of -14.5 ± 8.0. Twenty-six percent (54/204) had acuity of ≤ 20/200 in ≥ 1 eye, and subjects had a mean logarithm of minimal angle of resolution acuity of 0.8 ± 0.9. Seventy-one percent of subjects were able to get a drop onto the eye; only 39% instilled 1 drop onto the eye without touching the ocular surface, instilling a mean 1.4 ± 1.0 drops, using 1.2 ± 0.6 attempts. Of the 142 subjects who denied touching the bottle to the ocular surface, 24% did touch the bottle to the eye. Multiple factors were tested for ability to predict successful application of an eyedrop; however, only age (visually impaired glaucoma patients, we evaluated the difficulty this population has instilling eyedrops, most important, the use of multiple drops per instillation, potential contamination of a chronically used bottle, and poor patient understanding of the situation. Ability to self-administer eyedrops and cost considerations of wasted drops must be thought out before institution of glaucoma therapy. Efforts to determine better methods of eyedrop administration need to be undertaken. Copyright © 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Le, Jimmy T; Viswanathan, Shilpa; Tarver, Michelle E; Eydelman, Malvina; Li, Tianjing
Minimally invasive glaucoma surgical (MIGS) devices are one option for lowering intraocular pressure in patients with glaucoma. To examine how often existing clinical studies of MIGS devices registered on ClinicalTrials.gov measure patient-centric outcomes that patients value directly. We searched ClinicalTrials.gov, a registry of publicly and privately supported clinical studies, on February 20, 2015, for records of MIGS device studies involving patients with glaucoma. Two investigators independently abstracted study design and outcome details from eligible records. We classified outcomes as patient-centric or not patient-centric using a prespecified definition. Proportion of patient-centric and nonpatient-centric outcomes registered on ClinicalTrials.gov. We identified 51 eligible studies specifying 127 outcomes. Reduction in intraocular pressure was the most frequent outcome specified (78/127; 61%) and a primary outcome in 41 studies. Patient-centric outcomes-such as adverse events (n = 19; 15%), topical medication use (n = 16; 13%), visual acuity (n = 4; 3%), and health-related quality of life (n = 1; 1%)-were less frequently specified (n = 40; 32%) and a primary outcome in only 12 studies. Patient-centric outcomes that provide insight into the relative desirability and acceptability of the benefits and risks of MIGS devices are not well represented in current clinical studies.
Hwang, Hyung Bin; Han, Jae Wook; Yim, Hye Bin; Lee, Na Young
We evaluated the effects of adjuvant intravitreal bevacizumab injection on the outcomes of Ahmed glaucoma valve (AGV) implantation in patients with neovascular glaucoma (NVG) through a systematic literature review. An extensive search of PubMed, EMBASE, and the Cochrane Library was performed in November 2014 for selection of relevant studies. The weighted mean difference of the percentage of intraocular pressure reduction (IOPR%) from baseline to endpoint was used as the primary efficacy estimate, and Mantel-Haenszel odds ratios and 95% confidence intervals (CIs) of the success rate were used as the secondary efficacy estimates. The incidence of adverse events was also documented through a review of the studies. Six studies involving 252 patients (256 eyes) were included in this systematic review. The differences in the means and 95% CIs of the IOPR% of 6 studies showed that adjuvant bevacizumab treatment tended to be more effective than AGV implantation alone. Comparison of the outcomes of AGV implantation only with those of AGV implantation+adjuvant bevacizumab showed a success rate in favor of AGV implantation+adjuvant bevacizumab. The incidence of bleeding-associated complications such as hyphema, vitreous hemorrhage, and suprachoroidal hemorrhage was lower in association with combination treatment than with AGV implantation only. Combination treatment seemed to be associated with a lower incidence of other adverse effects such as hypotony, flat chamber, choroidal detachment/effusion, tube-associated complications, and corneal decompensation. AGV implantation with adjuvant bevacizumab was more effective and had a higher success rate than surgery alone for lowering IOP in patients with NVG. The combined procedure tended to show a lower incidence of bleeding-associated complications, such as hyphema.
Kiilgaard, Jens Folke; Pedersen, D B; Eysteinsson, T
The authors have previously reported that carbonic anhydrase inhibitors such as acetazolamide and dorzolamide raise optic nerve oxygen tension (ONPO(2)) in pigs. The purpose of the present study was to investigate whether timolol, which belongs to another group of glaucoma drugs called beta...
Wang, Jieqiong; Miao, Wen; Li, Jing; Li, Meng; Zhen, Zonglei; Sabel, Bernhard; Xian, Junfang; He, Huiguang
The lateral geniculate nucleus (LGN) is a key relay center of the visual system. Because the LGN morphology is affected by different diseases, it is of interest to analyze its morphology by segmentation. However, existing LGN segmentation methods are non-automatic, inefficient and prone to experimenters' bias. To address these problems, we proposed an automatic LGN segmentation algorithm based on T1-weighted imaging. First, the prior information of LGN was used to create a prior mask. Then region growing was applied to delineate LGN. We evaluated this automatic LGN segmentation method by (1) comparison with manually segmented LGN, (2) anatomically locating LGN in the visual system via LGN-based tractography, (3) application to control and glaucoma patients. The similarity coefficients of automatic segmented LGN and manually segmented one are 0.72 (0.06) for the left LGN and 0.77 (0.07) for the right LGN. LGN-based tractography shows the subcortical pathway seeding from LGN passes the optic tract and also reaches V1 through the optic radiation, which is consistent with the LGN location in the visual system. In addition, LGN asymmetry as well as LGN atrophy along with age is observed in normal controls. The investigation of glaucoma effects on LGN volumes demonstrates that the bilateral LGN volumes shrink in patients. The automatic LGN segmentation is objective, efficient, valid and applicable. Experiment results proved the validity and applicability of the algorithm. Our method will speed up the research on visual system and greatly enhance studies of different vision-related diseases. Copyright © 2015 Elsevier B.V. All rights reserved.
Murata, Noriaki; Miyamoto, Daiki; Togano, Tetsuya; Fukuchi, Takeo
To investigate the relationship between silent reading performance and visual field defects in patients with glaucoma using an eye tracking system. Fifty glaucoma patients (Group G; mean age, 52.2 years, standard deviation: 11.4 years) and 20 normal controls (Group N; mean age, 46.9 years; standard deviation: 17.2 years) were included in the study. All participants in Group G had early to advanced glaucomatous visual field defects but better than 20/20 visual acuity in both eyes. Participants silently read Japanese articles written horizontally while the eye tracking system monitored and calculated reading duration per 100 characters, number of fixations per 100 characters, and mean fixation duration, which were compared with mean deviation and visual field index values from Humphrey visual field testing (24-2 and 10-2 Swedish interactive threshold algorithm standard) of the right versus left eye and the better versus worse eye. There was a statistically significant difference between Groups G and N in mean fixation duration (G, 233.4 msec; N, 215.7 msec; P = 0.010). Within Group G, significant correlations were observed between reading duration and 24-2 right mean deviation (rs = -0.280, P = 0.049), 24-2 right visual field index (rs = -0.306, P = 0.030), 24-2 worse visual field index (rs = -0.304, P = 0.032), and 10-2 worse mean deviation (rs = -0.326, P = 0.025). Significant correlations were observed between mean fixation duration and 10-2 left mean deviation (rs = -0.294, P = 0.045) and 10-2 worse mean deviation (rs = -0.306, P = 0.037), respectively. The severity of visual field defects may influence some aspects of reading performance. At least concerning silent reading, the visual field of the worse eye is an essential element of smoothness of reading.
Full Text Available The research goal was to estimate the effectiveness of complex pharmacophysiotherapy of patients with initial glaucoma simplex on the basis of analysis of morphology, visual cortex electrobiological activity and regional blood flow level. 80 patients (149 eyes aged 60-75 were examined. All of them had an initial glaucoma simplex of II or III stage and normalized intraocular pressure. Depending on the stage of glaucoma there were two groups of patients and each group contained two sub-groups. patients of sub-group A were treated by percutaneous electrostimulation with feedback based on visual evoked biopotentials; and patients of sub-group В were treated by traditional electrostimulation. All patients got complex eye examination before and after the therapeutic course, and in 3 months after it. Method of selection of optimal electrostimulation parameters was worked out for the appropriate retina ganglionary cell effect. Individually selected electrostimulation in combination with nootropics contributes to eye hemodynamics improvement. Addition of magnetotherapy to the complex therapy of patients with eye hemodynamics leads to improvement of functional results. the increase of functional results of complex therapy with magnetotherapy that affects cervical sympathetic ganglia has been determined in patients with eye hemodynamics
Keenan, Jonathan; Shahid, Humma; Bourne, Rupert R; White, Andrew J; Martin, Keith R
With a higher life expectancy, there is an increased demand for hospital glaucoma services in the United Kingdom. The Cambridge community Optometry Glaucoma Scheme (COGS) was initiated in 2010, where new referrals for suspected glaucoma are evaluated by community optometrists with a special interest in glaucoma, with virtual electronic review and validation by a consultant ophthalmologist with special interest in glaucoma. 1733 patients were evaluated by this scheme between 2010 and 2013. Clinical assessment is performed by the optometrist at a remote site. Goldmann applanation tonometry, pachymetry, monoscopic colour optic disc photographs and automated Humphrey visual field testing are performed. A clinical decision is made as to whether a patient has glaucoma or is a suspect, and referred on or discharged as a false positive referral. The clinical findings, optic disc photographs and visual field test results are transmitted electronically for virtual review by a consultant ophthalmologist. The number of false positive referrals from initial referral into the scheme. Of the patients, 46.6% were discharged at assessment and a further 5.7% were discharged following virtual review. Of the patients initially discharged, 2.8% were recalled following virtual review. Following assessment at the hospital, a further 10.5% were discharged after a single visit. The COGS community-based glaucoma screening programme is a safe and effective way of evaluating glaucoma referrals in the community and reducing false-positive referrals for glaucoma into the hospital system. © 2014 Royal Australian and New Zealand College of Ophthalmologists.
Malvankar-Mehta, Monali S; Chen, Yufeng Nancy; Iordanous, Yiannis; Wang, Wan Wendy; Costella, John; Hutnik, Cindy M L
Glaucoma is a leading cause of irreversible blindness. It is firmly entrenched in the traditional treatment paradigm to start with pharmacotherapy. However, pharmacotherapy is not benign and has been well documented to have a number of significant challenges. Minimally invasive glaucoma surgery (MIGS) that targets the outflow pathway with minimal to no scleral dissection has resulted in the need to reconsider the glaucoma treatment paradigm. To perform a systematic review and meta-analysis to evaluate and quantify the effect on post-operative intraocular pressure (IOP) and number of topical glaucoma medications, in patients receiving the iStent MIGS device as the solo procedure without concurrent cataract surgery. A systematic review was conducted by searching various databases between January 1, 2000, and June 30, 2014. Studies reporting up to a maximum follow-up period of 24 months were retrieved and screened using the EPPI-Reviewer 4 gateway. Percentage reduction in IOP (IOPR%), and mean reduction in topical glaucoma medications after surgery were computed. Meta-analysis was performed using STATA v. 13.0. The standardized mean difference (SMD) was calculated as the effect size for continuous scale outcomes. Heterogeneity was determined using the I2 statistics, Z-value, and χ2 statistics. Fixed-effect and random-effect models were developed based on heterogeneity. Sub-group analysis was performed based on the number of iStents implanted and the follow-up period. The outcome measures were changes in the IOP and number of glaucoma medications. The search strategy identified 105 records from published literature and 9 records from the grey literature. Five studies with 248 subjects were included for quantitative synthesis. A 22% IOP reduction (IOPR%) from baseline occurred at 18-months after one iStent implant, 30% at 6-months after two iStents implantations, and 40% at 6-months after implantation of three iStents. A mean reduction of 1.2 bottles per patient of
Full Text Available AIM: To explore the effects of mindfulness-based stress reduction(MBSRon anxiety, compliance and visual function in primary open angle glaucoma(POAGpatients.METHODS:Totally 64 patients, who were treated with topical medication and were diagnosed with POAG in the department of ophthalmology at Shaanxi Provincial People's Hospital, were randomly divided into the intervention group(n=32and the control group(n=32. Both groups received conventional mental health education while the intervention group was complemented with MBSR intervention. The patient's anxiety status, compliance rates and MD before and after the intervention were evaluated.RESULTS:After the MBSR intervention, the scores of HAMA of the intervention group were significantly lower than that of the control group(PPCONCLUSION:The MBSR intervention can effectively relieve the anxiety of patients and improve the compliance in primary open angle glaucoma patients. It can be promoted and put into clinical application.
Ni, Nina; Sperling, Brian J; Dai, Yang; Hannush, Sadeer B
To evaluate outcomes after Descemet stripping automated endothelial keratoplasty in eyes with glaucoma drainage devices. This is a retrospective review of 24 cases performed by a single surgeon (S.B.H.) on 20 eyes. Data were gathered on demographics, ocular history, surgical details, and postoperative outcomes. Outcome measures included primary graft failure, secondary graft failure, endothelial cell density (ECD), central corneal thickness (CCT), intraocular pressure, and visual acuity. With a mean follow-up of 30.3 ± 19.6 months, there was no occurrence of primary graft failure, and the rate of secondary graft failure was 29%. Survival rates at 1, 2, and 3 years, respectively, were 87% [95% confidence interval (CI): 65%-96%], 80% (95% CI: 55%-92%), and 70% (95% CI: 39%-88%). Compared with ECD of the donor lenticule, endothelial cell loss was 49 ± 16% (n = 21) at postoperative month 3, 59 ± 16% (n = 20) at month 6, 61 ± 20% (n = 16) at month 12, and stabilized at 75 ± 17% (n = 9) by month 18. Compared with CCT during the visit before surgery, CCT decreased to 83 ± 18% (n = 18) at postoperative month 3 and gradually increased to 95 ± 11% (n = 6) at month 24. There were 4 (17%) cases of intraocular pressure elevation above 25 mm Hg. Improved visual acuity occurred in 71% of patients. Descemet stripping automated endothelial keratoplasty in eyes with corneal edema secondary to endothelial dysfunction in the presence of a previous glaucoma drainage device is a successful procedure. However, intermediate term endothelial cell loss is significant, as is the graft failure rate.
Yener, Arif Ü; Korucu, Osman
The aim of the study was to compare the visual fields during pain attacks in the patients with migraine without aura and tension-type headache using automated perimetry. In this study 25 patients with migraine and 25 patients with tension-type headache were evaluated.The optic disc, macula and retina were assessed and patients with normal values were enrolled into the study. Intraocular pressure of all patients were measured. Furthermore, visual field test was applied to both groups using Humphrey field analyzer (Carl-Zeiss Meditec, model-745 i, Dublin, CA, USA). Both mean deviation and pattern standart deviation values of these two goups were not statistically significant.
Verma, Sushma; Nongpiur, Monisha E; Atalay, Eray; Wei, Xin; Husain, Rahat; Goh, David; Perera, Shamira A; Aung, Tin
To evaluate visual field (VF) progression and rate of glaucomatous VF loss in patients with primary angle-closure glaucoma (PACG) using pointwise linear regression (PLR) trend analysis. Clinic-based retrospective study. Primary angle-closure glaucoma patients with 5 or more reliable VF tests and with 5 years or more of follow-up. Visual field progression was assessed by PROGRESSOR software version 3.7 (Medisoft, Leeds, United Kingdom) and was defined by the presence of at least 2 adjacent testing points located within the same hemifield that showed progression with a change of -1 dB/year or more (P regression analysis to determine the variables associated with rapid progression (defined as mean slope of progressing points ≥-1.5 dB/year). Visual field progression and rate of VF loss. Of the 1296 patients who were assessed, 398 (30.7%) fulfilled the inclusion criteria of 5 or more VFs and 5 years or more of follow-up. Visual field progression was observed in 63 of 398 eyes (15.8%) according to the PLR criteria. The overall mean rate of VF change for these patients was -0.12±0.51 dB/year over a mean follow-up period of 10.4±3.7 years. There were no significant differences in the age, gender distribution, follow-up duration, or number of VFs between those who showed progression and those who did not (all P > 0.05). The most common sector of VF progression was the superior arcuate area (65%). Rapid progression was found in 36 patients (57%). Multiple logistic regression analysis revealed older age and higher vertical cup-to-disc ratio (VCDR) at presentation as predictors of rapid progression (all P < 0.005) in the progressing group (n = 63). In patients with PACG being managed in a hospital setting, VF progression was noted in 15.8%, and the overall rate of VF loss was -0.12±0.51 dB/year. The superior arcuate was the most common sector of progression. Older age and higher VCDR at presentation were associated with rapid progression. Copyright © 2017 American
Dave, Pujan; Villarreal, Guadalupe; Friedman, David S; Kahook, Malik Y; Ramulu, Pradeep Y
To determine the accuracy of patient-physician communication regarding topical ophthalmic medication use based on bottle cap color, particularly among individuals who may have acquired color vision deficiency from glaucoma. Cross-sectional, clinical study. Patients aged ≥18 years with primary open-angle, primary angle-closure, pseudoexfoliation, or pigment dispersion glaucoma, bilateral visual acuity of ≥20/400, and no concurrent conditions that may affect color vision. A total of 100 patients provided color descriptions of 11 distinct medication bottle caps. Color descriptors were then presented to 3 physicians. Physicians matched each color descriptor to the medication they thought the descriptor was describing. Frequency of patient-physician agreement, occurring when all 3 physicians accurately matched the color descriptor to the correct medication. Multivariate regression models evaluated whether patient-physician agreement decreased with degree of better-eye visual field (VF) damage, color descriptor heterogeneity, or color vision deficiency, as determined by the Hardy-Rand-Rittler (HRR) score and Lanthony D15 color confusion index (D15 CCI). Subjects had a mean age of 69 (±11) years, with VF mean deviation of -4.7 (±6.0) and -10.9 (±8.4) decibels (dB) in the better- and worse-seeing eyes, respectively. Patients produced 102 unique color descriptors to describe the colors of the 11 bottle caps. Among individual patients, the mean number of medications demonstrating agreement was 6.1/11 (55.5%). Agreement was less than 15% for 4 medications (prednisolone acetate [generic], betaxolol HCl [Betoptic; Alcon Laboratories Inc., Fort Worth, TX], brinzolamide/brimonidine [Simbrinza; Alcon Laboratories Inc.], and latanoprost [Xalatan; Pfizer, Inc., New York, NY]). Lower HRR scores and higher D15 CCI (both indicating worse color vision) were associated with greater VF damage (P bottle cap color is frequently incorrect, particularly in patients with glaucoma who
Glavind, Karin; Bjørk, Jonna; Kousgaard, Sabrina Just
INTRODUCTION: This prospective study investigates sexual function in women after a tension-free vaginal tape (TVT) operation and compares short-term and long-term effects. METHODS: Sixty-three women had a TVT operation performed at Aalborg University Hospital, Department of Gynecology...... negative emotional reactions during intercourse, less coital incontinence, and less fear of being incontinent during intercourse after the TVT operation. CONCLUSION: This study shows that a woman's sex life does not deteriorate after a TVT operation, that their sexual function improves somewhat...
Mansouri, Kaweh; Medeiros, Felipe A.; Tafreshi, Ali; Weinreb, Robert N.
Purpose To determine the safety, tolerability, and reproducibility of intraocular pressure (IOP) patterns during repeated continuous 24-hour IOP monitoring with a telemetric contact-lens sensor (CLS). Design Prospective clinical trial. Participants Forty patients with suspect (n=21) or established glaucoma (n=19). Methods Patients participated in two 24-hour IOP monitoring sessions (S1 and S2) at a 1-week interval using the SENSIMED Triggerfish CLS (Sensimed AG, Switzerland). Patients pursued daily activities and sleep behavior was not controlled. The recordings were analyzed for differences between daytime and nighttime data and for reproducibility of signal patterns between the 2 sessions. Pearson correlations were obtained by pairing intervals across sessions. Main Outcome Measures Adverse events (AE), tolerability using the visual analogue score (VAS), and reproducibility of IOP patterns. Results Mean age was 55.5 ± 15.7 years and 60.0% were male. Main AEs were blurred vision (82.5%), conjunctival hyperemia (80.0%), and superficial punctate keratitis (15.0%). Patients reported a mean VAS of 27.2 ± 18.5 (S1) and 23.8 ± 18.7 (S2) (P = 0.216). Positive linear slopes of the sensor signal from the wake to the sleep period were detected for the ‘no glaucoma medication’ group (slope: 0.14 ± 0.15, p < 0.01, S1; slope: 0.12 ± 0.17, p = 0.03, S2) and for the ‘glaucoma medication’ group (slope: 0.03 ± 0.24, p = 0.52, S1; slope: 0.11 ± 0.16, p = 0.02, S2). Overall correlation between the two sessions was 0.59 (0.51 ‘no glaucoma medication’; 0.63 ‘glaucoma medication’) (P = 0.117). Conclusions Repeated use of the CLS demonstrated good safety and tolerability. The recorded IOP patterns showed fair reproducibility, suggesting that data from 24-h continuous IOP monitoring may be useful in the management of glaucoma patients. PMID:22892888
The history of glaucoma pharmacology begins in 1862 with the isolation of physostigmine from the calabar bean. The discovery of epinephrine's intraocular pressure lowering capacity came along some 40 years later. During the 20th century, drug discovery and development accelerated, with the introduction of carbonic anhydrase inhibitors, beta blockers, and prostaglandin analogs. This survey of the history of glaucoma medications reviews some of the pivotal stories behind the development of the drugs that we use daily to manage our patients with glaucoma. In addition, some unmet needs that persist in glaucoma pharmacology are discussed.
Full Text Available Yogesh Patodia,1 Elizabeth Golesic,2 Alex Mao,2 Cindy ML Hutnik2 1Department of Medicine, Ross University, Iselin, NJ, USA; 2Department of Ophthalmology, University of Western Ontario, London, ON, Canada Purpose: The aim of this trial is to study the effectiveness of currently available low-vision devices in glaucoma patients with moderate-to-severe vision loss. Design: This is a randomized pilot clinical trial. Participants: Sixteen low-vision glaucoma patients participated in this study. Methods: Patients with a best-corrected visual acuity between 20/70 and 20/400 in the better eye and a diagnosis of stable primary or secondary open-angle glaucoma were randomized to a low-vision treatment group or a nonintervention control group. A telephone interview was conducted before and after the 4-week testing period to assess functional vision. Patients placed in the treatment group received a low-vision examination and used various currently available low-vision aids. Patients placed in the control group received a low-vision examination only. Changes in patients’ reading ability and overall visual ability were chosen as the primary outcomes. Other visual functioning domains (mobility, visual information processing and visual motor skills were considered as secondary outcomes. Results: Ten patients in the treatment group showed a significant improvement in reading ability and overall visual ability compared to the control group. The difference in mean score for reading ability was 2.52 logits (2.02; P<0.05 and overall visual ability was 0.78 logits (0.64; P<0.05. However, no significant improvement was noted in the other visual functioning domains involving mobility and visual motor skills. Conclusion: Currently available low-vision devices primarily enhance central vision with limited benefits to functional activities relying on peripheral vision. Keywords: low vision, glaucoma, quality of life, activities of daily living
Protas, Meredith E; Weh, Eric; Footz, Tim; Kasberger, Jay; Baraban, Scott C; Levin, Alex V; Katz, L Jay; Ritch, Robert; Walter, Michael A; Semina, Elena V; Gould, Douglas B
Mutations in FOXC1 and PITX2 constitute the most common causes of ocular anterior segment dysgenesis (ASD), and confer a high risk for secondary glaucoma. The genetic causes underlying ASD in approximately half of patients remain unknown, despite many of them being screened by whole exome sequencing. Here, we performed whole genome sequencing on DNA from two affected individuals from a family with dominantly inherited ASD and glaucoma to identify a 748-kb deletion in a gene desert that contains conserved putative PITX2 regulatory elements. We used CRISPR/Cas9 to delete the orthologous region in zebrafish in order to test the pathogenicity of this structural variant. Deletion in zebrafish reduced pitx2 expression during development and resulted in shallow anterior chambers. We screened additional patients for copy number variation of the putative regulatory elements and found an overlapping deletion in a second family and in a potentially-ancestrally-related index patient with ASD and glaucoma. These data suggest that mutations affecting conserved non-coding elements of PITX2 may constitute an important class of mutations in patients with ASD for whom the molecular cause of their disease have not yet been identified. Improved functional annotation of the human genome and transition to sequencing of patient genomes instead of exomes will be required before the magnitude of this class of mutations is fully understood. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: email@example.com.
Full Text Available Pseudoexfoliation syndrome (PEX Sy is a common age–related disorder of the extracellular matrix that is frequently associated with severe secondary chronic open-angle glaucoma and cataract. Pseudoexfoliation glaucoma (PEX gl is one of the most common causes of optic disc damage, low visual accuracy, damage of visual field and blidness. Deposits of white material on the anterior lens surface are the most consistent and important diagnostic feature of PEX syndrome/glaucoma. It is thought that PEX represents aberrant extracellular matrix synthesis. The aim of this paper was to evaluate the gender-related difference in the level of matrix metalloproetinases MMP-2 and tissue inhibitor of matrix metalloproetinases (TIMP-1, TIMP-2, TIMP-3, TIMP-4 in aqueous humor in patients with pseudoexfoliation syndrome/glaucoma.Aqueous humor was aspirated during surgery from 15 patients with PEX syndrome without glaucoma, 42 patients with PEX glaucoma, 36 patients with POAG and 14 age-matched control patients with cataract during cataract surgery or trabeculectomy. Data about medical history, medications, and demographic information were obtained from case notes. In all patients we determined Intra Ocular Pressure (IOP by (measurement by Goldman aplanation tonometry, PEX appereance (determined with slet lamp examination. Fluorokine MultiAnalite Profiling kits (R&D Systems, Minneapolis, MN and Luminex technology (Luminex Corporation, Austin, TX were used to simultaneously measure MMP-2, and TIMP-1, TIMP-2, TIMP-3 and TIMP-4 in aqueous humor samples.Patients with PEX glaucoma are older and of male sex compared to the patients with POAG. Male patients with PEX glaucoma and POAG were significantly older than female patients. Patients with PEX Sy have bilateral ocular changes more often compared to other groups. There were no significant gender differences in aqueous humour MMP-2, TIMP-2, TIMP-3, TIMP-4 levels among examined groups. In the group with PEX syndrome a
Lisboa, Renato; Chun, Yeoun Sook; Zangwill, Linda M; Weinreb, Robert N; Rosen, Peter N; Liebmann, Jeffrey M; Girkin, Christopher A; Medeiros, Felipe A
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. To evaluate the association between binocular rates of visual field change and VRQOL in patients with glaucoma. DESIGN Observational cohort study. Patients were recruited from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. 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. 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. Thirty-two patients (8.0%) had abnormal VRQOL as determined by the results of the NEI VFQ-25. Patients with abnormal VRQOL had 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. Patients with faster rates of BVF change were at higher risk of reporting abnormal VRQOL. Assessment of rates of BVF change
Full Text Available Objective: To describe the background and strategy required for the prevention of blindness from glaucoma in developing countries. Materials and Methods: Extrapolation of existing data and experience in eye care delivery and teaching models in an unequally developed country (India are used to make recommendations. Results: Parameters like population attributable risk percentage indicate that glaucoma is a public health problem but lack of simple diagnostic techniques and therapeutic interventions are barriers to any effective plan. Case detection rather than population-based screening is the recommended strategy for detection. Population awareness of the disease is low and most patients attending eye clinics do not receive a routine comprehensive eye examination that is required to detect glaucoma (and other potentially blinding eye diseases. Such a routine is not taught or practiced by the majority of training institutions either. Angle closure can be detected clinically and relatively simple interventions (including well performed cataract surgery can prevent blindness from this condition. The strategy for open angle glaucoma should focus on those with established functional loss. Outcomes of this proposed strategy are not yet available. Conclusions: Glaucoma cannot be managed in isolation. The objective should be to detect and manage all potential causes of blindness and prevention of blindness from glaucoma should be integrated into existing programs. The original pyramidal model of eye care delivery incorporates this principle and provides an initial starting point. The routine of comprehensive eye examination in every clinic and its teaching (and use in residency programs is mandatory for the detection and management of potentially preventable blinding pathology from any cause, including glaucoma. Programs for detection of glaucoma should not be initiated unless adequate facilities for diagnosis and surgical intervention are in place and
Full Text Available Glaucoma is a degenerative optic neuropathy characterized by retinal ganglion cell (RGC loss and visual field defects. It is known that in some glaucoma patients, death of RGCs continues despite intraocular pressure (IOP reduction. Neuroprotection in the field of glaucoma is defined as any treatment, independent of IOP reduction, which prevents RGC death. Glutamate antagonists, ginkgo biloba extract, neurotrophic factors, antioxidants, calcium channel blockers, brimonidine, glaucoma medications with blood regulatory effect and nitric oxide synthase inhibitors are among compounds with possible neuroprotective activity in preclinical studies. A few agents (such as brimonidine or memantine with neuroprotective effects in experimental studies have advanced to clinical trials; however the results of clinical trials for these agents have not been conclusive. Nevertheless, lack of compelling clinical evidence has not prevented the off-label use of some of these compounds in glaucoma practice. Stem cell transplantation has been reported to halt experimental neurodegenerative disease processes in the absence of cell replacement. It has been hypothesized that transplantation of some types of stem cells activates multiple neuroprotective pathways via secretion of various factors. The advantage of this approach is a prolonged and targeted effect. Important concerns in this field include the secretion of unwanted harmful mediators, graft survival issues and tumorigenesis. Neuroprotection in glaucoma, pharmacologically or by stem cell transplantation, is an interesting subject waiting for broad and multidisciplinary collaborative studies to better clarify its role in clinical practice.
Rabner, Jonathan; Caruso, Alessandra; Zurakowski, David; Lazdowsky, Lori; LeBel, Alyssa
To examine symptoms indicating central nervous system (CNS) autonomic dysfunction in pediatric patients with migraine and tension-type headache. A retrospective chart review assessed six symptoms (i.e. constipation, insomnia, dizziness, blurry vision, abnormal blood pressure, and cold and clammy palms and soles) indicating central nervous system (CNS) autonomic dysfunction in 231 patients, ages 5-18 years, diagnosed with migraine, tension-type headache (TTH), or Idiopathic Scoliosis (IS). Higher frequencies of "insomnia," "dizziness," and "cold and clammy palms and soles" were found for both migraine and TTH patients compared to the IS control group (P pediatric headache patients is discussed.
Kao, Shu-Ting; Lee, Shwu-Huey; Chen, Yi-Chun
Hypotony maculopathy is a sight-threatening complication after trabeculectomy. We report on a 34-year-old man with juvenile open-angle glaucoma and high myopia, who developed hypotony maculopathy 14 years after trabeculectomy without bleb leak. This represents the longest known period from trabeculectomy to the development of hypotony maculopathy without bleb leak. The possible mechanisms for the development of late-onset hypotony maculopathy in the highly myopic patient are progressive scleral thinning, reduced scleral rigidity, and scleral morphologic change with aging. These changes might weaken the biomechanical properties of sclera and then contribute to the collapse of the scleral wall during hypotony. This case serves as a reminder that hypotony maculopathy can happen up to 14 years after tabeculectomy even without bleb leak and hypotony should be avoided after trabeculectomy in highly myopic patients with juvenile open-angle glaucoma.
Avetisov, S E; Bubnova, I A; Antonov, A A
The biomechanical properties of the cornea were studied by bidirectional applanation in a control group of healthy individuals and in patients with normotensive and primary open-angle glaucoma. The studies were performed before and after use of antihypertensive drugs. Static perimetric findings were used to evaluate the stabilization of a glaucomatous process. Elevated intraocular pressure was found to be attended by a lower corneal hysteresis-corneal resistance factor ratio. Lowered intraocular pressure resulted in increases in corneal hysteresis and the ratio up to the normal values, which was accompanied by visual field stabilization. An investigation of the biomechanical properties of the cornea and keratopachymetrium should be included into a complex of examination and monitoring of patients with normotensive and primary open-angle glaucoma since hypodiagnosis of elevated intraocular pressure may be due to the possible effect of corneal properties on tonometric parameters.
[Effects of reading, exercise and exercise combined with reading on intraocular pressure for patients sustaining primary glaucoma (open angle) or ocular hypertension, both clinically controlled with topic medication].
Medina, Alice Maria Corrêa; Lima, Núbia Vanessa dos Anjos; Santos, Regina Cândida Ribeiro dos; Pereira, Marco César Araújo; Santos, Procópio Miguel dos
To check intraocular pressure (IOP) in individuals using prostaglandin, prostamide or beta-blocker analogues, who sustain either primary open angle glaucoma or ocular hypertension after reading, exercise or exercise combined with reading. 40 individuals (79 eyes), subdivided in to five groups: G1 (with arterial hypertension and either glaucoma or ocular hypertension, all users of prostaglandin or prostamide analogues); G2 (with arterial hypertension and either glaucoma or ocular hypertension, all users of beta-blockers); G3 (not sustaining arterial hypertension but suffering from either glaucoma or ocular hypertension, all users of prostaglandin or prostamide analogues); G4 (not sustaining arterial hypertension but suffering from either glaucoma or ocular hypertension, all users of beta-blockers) and G5 (not sustaining arterial hypertension and also not suffering from either glaucoma or ocular hypertension) had their intraocular pressure checked before and after undergoing reading, exercise, and exercise combined with reading. Each type of test was conducted in a different day, always in the afternoon. No significant statistical difference has been noticed between the initial and final intraocular pressure mean in the different groups, when reading, performing exercises or exercises combined with reading. To read and to work out--either separately or jointly--does not pose an aggravating factor to the intraocular pressure of patients with primary open glaucoma or ocular hypertension, using prostaglandin, prostamide or beta-blocker analogues.
Joshi, Sachin R; Akat, Pramod B; Ramanand, Jaiprakash B; Ramanand, Sunita J; Karande, Vitthal B; Jain, Suyog S
The aim of present study was to compare the efficacy and safety of fixed combination of brimonidine and timolol with individual components used as monotherapy in patients of primary open angle glaucoma. Patients were randomly assigned to receive brimonidine or timolol or brimonidine-timolol fixed combination, with 30 patients in each group. The mean reduction in intraocular pressure in brimonidine, timolol, and brimonidine-timolol group were 4.29 ± 1.97 mm Hg, 4.34 ± 1.21 mm Hg, and 5.54 ± 1.87 mm Hg respectively at 2 weeks and 4.86 ± 1.16 mm Hg, 5.42 ± 1.50 mm Hg, and 7.36 ± 2.58 mm Hg respectively at 6 weeks. When values of mean reduction in intraocular pressure were compared between brimonidine-timolol fixed combination with brimonidine and timolol, it was found to be statistically significant (P < 0.05) at 2 weeks and highly significant (0.001) at 6 weeks. The overall frequency of adverse effects was similar in all three groups. PMID:24008808
Sachin R Joshi
Full Text Available The aim of present study was to compare the efficacy and safety of fixed combination of brimonidine and timolol with individual components used as monotherapy in patients of primary open angle glaucoma. Patients were randomly assigned to receive brimonidine or timolol or brimonidine-timolol fixed combination, with 30 patients in each group. The mean reduction in intraocular pressure in brimonidine, timolol, and brimonidine-timolol group were 4.29 ± 1.97 mm Hg, 4.34 ± 1.21 mm Hg, and 5.54 ± 1.87 mm Hg respectively at 2 weeks and 4.86 ± 1.16 mm Hg, 5.42 ± 1.50 mm Hg, and 7.36 ± 2.58 mm Hg respectively at 6 weeks. When values of mean reduction in intraocular pressure were compared between brimonidine-timolol fixed combination with brimonidine and timolol, it was found to be statistically significant ( P < 0.05 at 2 weeks and highly significant (0.001 at 6 weeks. The overall frequency of adverse effects was similar in all three groups.
O. I. Borzunov
Full Text Available Aim: of this study is to evaluate ophthalmoneuroprotectional treatment of patients with POAG and diabetes mellitus type II in a specialized hospital.Material and methods: We have performed retro — and prospective analysis of the combined treatment of 130 patients (248 eyes with a combination of primary open-angle glaucoma and diabetic retinopathy. Evaluation of the effectiveness of treatment was conducted on the following criteria: the severity of the hypotensive effect, the degreeof improvement and duration of remission of major ophthalmic indicators. The patients were divided into four clinical — homogeneous groups: primary — 40 people (77 eyes, the comparison group I — 37 persons (71 eyes, the comparison group II — 33 people (60 eyes, the control group — 20 people (40 eyes.Results: Combination of different treatment strategy of laser and conservative treatment was tested. The result has been designed for optimal balance improving performance and reducing ocular side effects. Retinalamin ® 5 mg parabulbare number 10, Tanakan 1 tablet 3 times a day — 3 months. The optimal timing of re-treatment (at least 1time in 9 months, in the case of significant progression of glaucomatous optic neuropathy — the timing is solved individually.
Duan, Xiaoming; Xue, Peng; Wang, Ningli; Dong, Zhe; Lu, Qingjun; Yang, Fuquan
Primary open angle glaucoma (POAG) is a leading cause of irreversible blindness on a global level. Researchers have yet to specify the exact mechanisms of POAG; the respective relationships between POAG and elevated intraocular pressure (IOP), as well as optic neuropathy, remain particularly unclear. It is known, however, that the expression profile for some proteins in the aqueous humor (AH) changes in some diseases, and that AH changes play important roles in elevated IOP. To identify the possible roles of these AH proteins in POAG, a proteomic analysis of the AH compositions of POAG patients' eyes was performed and compared with those derived from paired, non-POAG cataract (control) eyes. We used Bradford's method to determine total protein concentration in AH, and analyzed separation profiles via two-dimensional (2D) gel electrophoresis. We used silver stain to determine gel proteins, and analyzed separation profiles to assess spot density differences between POAG and non-POAG patients. These gel spots were isolated and identified via mass spectrometry. Prostaglandin H2 D-isomerase (PGDS) in AH were analyzed by western Blotting. There was no significant difference between the total protein concentration in AH of POAG patients and that in AH of non-POAG patients. A total of seven spots were increased in 2D gels from POAG patients. The spots were derived from PGDS, caspase 14 precursor, transthyretin, cystain C, albumin precursor, and tranferrin. And PGDS in AH from patients was more than from controls. The protein composition in AH was significantly different in POAG patients versus non-POAG patients. The identified proteins could be a potential biomarker for POAG and may play a role in the mechanisms of elevated IOP and optic neuropathy in POAG.
Full Text Available Jesús Tellez-Vazquez On behalf of the Dry Eye In Glaucoma Study Group (DEIGSG Glaucoma Section, Ophthalmology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain Purpose: The purpose of this study is to assess the effectiveness and tolerability of a dietary supplement with a combination of omega-3 fatty acids and antioxidants on dry eye symptoms caused by chronic instillation of antihypertensive eye drops in patients with glaucoma. Patients and methods: A total of 1,255 patients with glaucoma and dry eye symptoms related to antiglaucoma topical medication participated in an open-label, uncontrolled, prospective, and multicenter study and were instructed to take three capsules a day of the nutraceutical formulation (Brudypio® 1.5 g for 12 weeks. Dry eye symptoms (graded as 0–3 [none to severe, respectively], conjunctival hyperemia, tear breakup time, Schirmer I test, Oxford grading scheme, and intraocular pressure were assessed. Results: After 12 weeks of administration of the dietary supplement, all dry eye symptoms improved significantly (P<0.001 (mean 1.3 vs 0.6 for scratching, 1.4 vs 0.7 for stinging sensation, 1.6 vs 0.7 for grittiness, 1.0 vs 0.4 for tired eyes, 1.1 vs 0.5 for grating sensation, and 0.8 vs 0.3 for blurry vision. The Schirmer test scores and the tear breakup time also increased significantly. There was an increase in the percentage of patients grading 0–I in the Oxford scale and a decrease in those grading IV–V. Compliance was recorded in 62.5% of patients. In compliant patients, the mean differences at 12 weeks vs baseline of dry eye symptoms were statistically significant as compared to noncompliant patients. Conclusion: Dietary supplementation with Brudypio® may be a clinically valuable additional option for the treatment of dry eye syndrome in patients with glaucoma using antiglaucoma eye drops. These results require confirmation with an appropriately designed randomized controlled study
Charles W. McMonnies
Full Text Available Apart from the risk of developing glaucoma there is also the risk that it is not detected and irreversible loss of vision ensues. Some studies of methods of glaucoma diagnosis have examined the results of instrument-based examinations with great if not complete reliance on objective findings in arriving at a diagnosis. The very valuable advances in glaucoma detection instrument technologies, and apparent increasing dependence on them, may have led to reduced consideration of information available from a patient history in those studies. Dependence on objective evidence of glaucomatous pathology may reduce the possibility of detecting glaucoma suspects or patients at risk for becoming glaucoma suspects. A valid positive family history of glaucoma is very valuable information. However, negative family histories can often be unreliable due to large numbers of glaucoma cases being undiagnosed. No evidence of family history is appropriate rather than no family history. In addition the unreliability of a negative family history is increased when patients with glaucoma fail to inform their family members. A finding of no family history can only be stated as no known family history. In examining the potential diagnostic contribution from a patient history, this review considers, age, frailty, race, type and degree of refractive error, systemic hyper- and hypotension, vasospasm, migraine, pigmentary dispersion syndrome, pseudoexfoliation syndrome, obstructive sleep apnea syndrome, diabetes, medication interactions and side effects, the degree of exposure to intraocular and intracranial pressure elevations and fluctuations, smoking, and symptoms in addition to genetics and family history of the disease.
Sng, Chelvin C A; Ang, Marcus; Barton, Keith
The purpose of this review is to summarize the role of central corneal thickness (CCT) in the clinical management of a glaucoma patient. The prognostic value of CCT is well recognized in patients with ocular hypertension. However, its predictive value in other glaucoma suspects and patients with established glaucoma is less certain. Tonometry artefacts can result from variations in CCT. However, an adequately validated correction algorithm for Goldmann applanation tonometry measurements does not exist. Newer methods of tonometry are potentially less influenced by CCT but are limited in their clinical use. There may also be biological and genetic associations between corneal thickness and glaucoma. Demographics, environmental factors, glaucoma treatment and the measurement device used have a significant influence on CCT, and should be considered when interpreting the effect of cornea thickness in patients with glaucoma. New measurements of the biomechanical properties of the cornea are likely to be better approximations of the globe biomechanics than CCT, but these require further evaluation. The clinical significance of CCT is well recognized in the context of glaucoma diagnosis and management, though the extent of its importance remains debatable. Corneal biomechanical properties may be more significantly associated with glaucoma than CCT.
Cate Heidi; Bhattacharya Debi; Clark Allan; Fordham Richard; Notley Caitlin; Broadway David C
Abstract Background Poor glaucoma education is thought to be a causative factor of non-adherence to glaucoma therapy. However, the multi-factorial nature of non-adherent behaviour may explain the failure of purely educational interventions to achieve significant improvement in adherence. Behaviour Change Counselling (BCC) allows both the imparting of information and assessment of patient ambivalence to medication use and may elicit behaviour change in order to achieve better adherence. The ch...
Salonikiou, Angeliki; Founti, Panayiota; Kilintzis, Vassilis; Antoniadis, Antonis; Anastasopoulos, Eleftherios; Pappas, Theofanis; Raptou, Anastasia; Topouzis, Fotis
To provide population-based data on the maximum tolerable rate of progression to avoid visual impairment (maxTRoP_VI) and blindness (maxTRoP_BL) from open-angle glaucoma (OAG). Participants with OAG in the Thessaloniki Eye Study (cross-sectional, population-based study in a European population) were included in the analysis. Visual impairment was defined as mean deviation (MD) equal to or worse than -12 dB and blindness as MD equal to or worse than -24 dB. Additional thresholds for visual impairment were tested. For each participant maxTRoP_VI was defined as the rate of progression which would not lead to visual impairment during expected lifetime. MaxTRoP_BL was defined accordingly. Both parameters were calculated for each OAG subject using age, sex, MD and life expectancy data. The eye with the better MD per subject was included in the analysis. Among 135 subjects with OAG, 123 had reliable visual fields and were included in the analysis. The mean age was 73±6 years and the median MD was -3.65±5.28 dB. Among those, 69.1% would have a maxTRoP_VI slower than -1 dB/year and 18.7% would have a maxTRoP_VI between -1 and -2 dB/year. Also, 72.4% would have a maxTRoP_BL slower than -2 dB/year. For all tested thresholds for visual impairment, approximately 86% of the OAG study participants would not be able to tolerate a rate of progression equal to or faster than -2 dB/year. The majority of patients with glaucoma in our study would have a maximum tolerable rate of progression slower than -1 dB/year in their better eye. Patient-tailored strategies to monitor the visual field are important, but raise the issue of feasibility with regard to the number of visual field tests needed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Warrian, K J; Spaeth, G L; Lankaranian, D; Lopes, J F; Steinmann, W C
To determine the effect of personality on vision-specific health-related quality of life (HRQoL). Based on power calculations, 148 individuals diagnosed as having glaucoma or ocular hypertension, without ocular comorbidity, were selected using criteria that included age over 30, no recent or upcoming surgery, the absence of a diagnosis of clinical depression or any other psychiatric illness. Qualifying participants completed the 25-Item National Eye Institute's Visual Function Questionnaire (VFQ), the Neuroticism, Extraversion and Openness Personality Inventory Revised (NEO PI-R) and the 15-Item Geriatric Depression Scale (GDS-15), and provided information regarding their demographic characteristics and past medical history. Each patient also underwent an ocular examination. Data analysis was conducted to determine the relationship between NEO PI-R personality profiles and VFQ scoring, while controlling for the effects of a range of demographic, psychiatric, past medical and clinical ophthalmic variables. Multivariate analysis indicated that after controlling for a range of covariates, three out of five NEO PI-R personality domains shared statistically significant associations with a variety of VFQ total and subscale score measurements. Normal variations in personality characteristics influence how patients report their vision-specific HRQoL.
Obara, Elisabeth Anne; Hannibal, Jens; Heegaard, Steffen
Purpose: Multiple studies have shown overwhelming evidence supporting the impairment of melanopsin function due to glaucoma. However, few studies have been carried out in humans analyzing the histology of melanopsin-expressing retinal ganglion cells (mRGCs) in retinas with glaucoma. The aim...... of this study was to analyze the pattern of expression of mRGCs relative to RGCs in the normal retina and retinas harboring varying stages of glaucoma. Methods: Paraffin-embedded human donor eyes with glaucoma (n = 11) and age-matched controls (n = 10) were obtained from Department of Pathology at Rigshospital...... difference was observed in mRGC expression in the normal retinas and mild-staged retinas with glaucoma; the densities of mRGCs were 3.08 ± 0.47 and 3.00 ± 0.13 cell counts/mm2, respectively. However, the severely staged retinas with glaucoma showed a significant loss in mRGCs density, 1.09 ± 0.35 cell counts...
Objective: To show the value of glaucoma valve implant surgery in the management of glaucoma in Nigerians. Design: A prospective study of two glaucoma patients who had an Ahmed glaucoma valve implant at the University of Benin Teaching Hospital and DDS Eye Surgery in Benin City. Materials and method: One ...
Hernández-Martínez, F J; Piñas-García, P; Lleó-Pérez, A V; Zanón-Moreno, V C; Bendala-Tufanisco, E; García-Medina, J J; Vinuesa-Silva, I; Pinazo-Durán, M D
To investigate the lipid peroxidation (PEROX) processes in primary open-angle glaucoma (POAG) patients, and whether this mechanism may be related to disease progression. A prospective, observational, cross-sectional, non-experimental, and analytical study was conducted on a case and a comparison group, consisting of 175 surgical patients divided into: 1) POAG group (GG; n=88) and 2) comparison group of patients with cataracts (CG; n=87). Demographic data, patient characteristics, lifestyle data, as well as ophthalmological examination were registered in an Excel spreadsheet. Biochemical data were obtained by processing the aqueous humor collected at the beginning of surgery. Determination of malondialdehyde/thiobarbituric acid reactive substances (MDA/TBARS) and total antioxidant activity (AAO) was assayed using enzymatic-colorimetric methods in the aqueous humor samples. Statistical analysis was performed using SPSS 15.0 software. Aqueous humor MDA/TBARS levels were significantly higher (P<.001) and the AAO significantly lower (P<.001) in the GG than in the GC. The MDA/TBARS directly correlated with intraocular pressure (IOP) values and the cup-to-disc ratio (CDR). Decreased AAO activity correlated inversely with IOP and CDR. Differences between groups were noticeably higher in the GG as regards obesity, alcohol consumption, anxiety, depression, and sedentary lifestyle. In the multivariate analysis, the variables that showed a better predictive ability were: MDA/TBARS, PIO, AAO, CDR, and depression. The POAG patients have a PEROX background that is reflected in the aqueous humor by variations in MDA/TBARS and AAO. Moreover, both the MDA/TBARS and AAO correlated with IOP values and the CDR. We propose that determination of MDA/TBARS and AAO in the aqueous humor of POAG patients can be used as biomarkers for monitoring the disease, as well the changes in lifestyle and other related risk factors. Copyright © 2016 Sociedad Española de Oftalmología. Published by
Full Text Available Abstract Background Poor glaucoma education is thought to be a causative factor of non-adherence to glaucoma therapy. However, the multi-factorial nature of non-adherent behaviour may explain the failure of purely educational interventions to achieve significant improvement in adherence. Behaviour Change Counselling (BCC allows both the imparting of information and assessment of patient ambivalence to medication use and may elicit behaviour change in order to achieve better adherence. The chronic and complex nature of glaucoma means that patient non-adherence to glaucoma therapy does not easily correlate with measureable objective clinical endpoints. However, electronic medication monitoring offers an objective method of measuring adherence without reliance on clinical endpoints. Methods/design The study is a randomised controlled trial (RCT with glaucoma (open angle or ocular hypertension patients attending a glaucoma clinic and prescribed travoprost. The study will determine whether additional glaucoma education using BCC is beneficial and cost effective in improving adherence with glaucoma therapy. An 8-month follow-up period, using an electronic adherence monitoring device (Travalert® dosing aid, TDA, will indicate if the intervention is likely to be sustained in the longer term. Additionally, a cost-effectiveness framework will be used to estimate the cost benefit of improving adherence. The development of a novel intervention to deliver glaucoma education using BCC required practitioner training and fidelity testing. Five practitioners were successfully trained to become Glaucoma Support Assistants able to deliver the BCC intervention. The research group had prior clinical and investigative experience in this setting, and used multiple strategies to design a method to address the study objectives. Discussion This RCT, using BCC to improve adherence to ocular hypotensive therapy, to our knowledge is the first within this disease area
Aptel, Florent; Denis, Philippe; Rouland, Jean-François; Renard, Jean-Paul; Bron, Alain
To evaluate the efficacy and safety of the ultrasonic circular cyclocoagulation procedure in patients with open-angle glaucoma naïve of previous filtering surgery. Prospective non-comparative interventional clinical study conducted in five French University Hospitals. Thirty eyes of 30 patients with open-angle glaucoma, intra-ocular pressure (IOP) > 21 mmHg and with no previous filtering glaucoma surgeries were sonicated with a probe comprising six piezoelectric transducers. The six transducers were activated with a 6-s exposure time. Complete ophthalmic examinations were performed before the procedure and at 1 day, 1 week, 1, 2, 3, 6 and 12 months after the procedure. Primary outcomes were qualified surgical success (defined as IOP reduction from baseline ≥20% and IOP > 5 mmHg with possible re-intervention and without hypotensive medication adjunction) and complete surgical success (defined as IOP reduction from baseline ≥20%, IOP > 5 mmHg and IOP surgery. © 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Lawrence Y Ho
Full Text Available Lawrence Y Ho1, Larissa Camejo1, Malik Y Kahook2, Robert Noecker11UMPC Eye Center, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; 2Rocky Mountain Lions Institute, University of Colorado, CO, USAAbstract: We studied the effects of audible and visual alarms on adherence with a recommended dosing regimen in the management of glaucoma. Forty-two patients were begun on therapy with the Travatan® Dosing Aid (TDA and randomly divided into two observation groups-one with visual and audible alarm functions turned on and the other with alarms off. Dosing information was analyzed for mean rates of adherence, missed days, and dosing at the wrong time. Twenty patients were randomized to the TDA alarm on group and 22 to the alarm off group. The rates of adherence were 87.9% and 79.7% (p = 0.02, rates of missed dosing were 7.6% and 14.4% (p = 0.03, and rates of dosing at the incorrect times were 7.1% and 9.8% (p = 0.19, respectively for alarm on versus alarm off groups. In the alarm on group, the adherence rate was significantly higher and proportion of missed dosing was significantly lower. It is still yet to be determined whether there is a relationship between adherence and progression of glaucoma.Keywords: adherence, glaucoma, Travatan® Dosing Aid, audible alarms, visual alarms
Parihar, Jitendra Kumar Singh; Jain, Vaibhav Kumar; Kaushik, Jaya; Mishra, Avinash
To compare the outcome of pars-plana-modified Ahmed glaucoma valve (AGV) versus limbal-based conventional AGV into the anterior chamber, in patients undergoing penetrating keratoplasty (PK) for glaucoma with coexisting corneal diseases. In this prospective randomized clinical trial, 58 eyes of 58 patients with glaucoma and coexisting corneal disease were divided into two groups. Group 1 (29 eyes of 29 patients) included patients undergoing limbal-based conventional AGV into the anterior chamber (AC) along-with PK and group 2 (29 eyes of 29 patients) included those undergoing pars-plana-modified AGV along-with PK. Outcome measures included corneal graft clarity, intraocular pressure (IOP), number of antiglaucoma medications, and postoperative complications. Patients were followed up for a minimum period of 2 years. Out of 58 eyes (58 patients), 50 eyes (50 patients: 25 eyes of 25 patients each in group 1 and group 2) completed the study and were analyzed. Complete success rate for AGV (group 1: 76%; group 2: 72%; p = 0.842) and corneal graft clarity (group 1: 68%; group 2: 76%; p = 0.081) were comparable between the two groups at 2 years. Graft failure was more in conventional AGV (32%) as compared to pars plana-modified AGV (24%) but not statistically significant (p = 0.078) at 2 years. Though both procedures were comparable in various outcome measures, pars-plana-modified AGV is a viable option for patients undergoing PK, as it provides a relatively better corneal graft survival rate and lesser complications that were associated with conventional AGV.
Richardson, Cliff; Brunton, Lisa; Olleveant, Nicola; Henson, David B; Pilling, Mark; Mottershead, Jane; Fenerty, Cecilia H; Spencer, Anne Fiona; Waterman, Heather
Adherence with therapy could influence the progression of glaucoma and ultimately affect the onset of visual impairment in some individuals. This feasibility study evaluated the measures to be used for a future randomized controlled trial assessing the effects of group-based education on adherence with eye drops. People diagnosed with glaucoma within the previous 12 months attending a regional ophthalmology clinic in the North West of England were recruited. A two-session education program delivered one week apart had been devised as part of a previous project. A combined adult learning and health needs approach to education was taken. Outcomes measured were knowledge of glaucoma, self-report of adherence, illness perception, beliefs about medicines, patient enablement, and general health (Short Form-12). Adherence was also measured objectively using a Medical Events Monitoring System device. Twenty-six participants consented to undertake the educational program and 19 produced analyzable data. Knowledge of glaucoma, illness perception, beliefs about medicine, and patient enablement all showed statistically significant improvements after education. Mean adherence with eye drops was maintained above 85% before and for 3 months after attendance at the educational program. Self-report exaggerated adherence by at least 10% when compared with the objective Medical Events Monitoring System data, and in fact the kappa agreement was zero. All questionnaires other than the Short Form-12 were considered to be valuable measures and use of a Medical Events Monitoring System device was considered to be an objective surrogate measure for adherence with eye drops. A multicenter, randomized, controlled equivalence trial of group versus individualized education using adherence as the primary outcome is the next step.
Fanihagh, Farsad; Kremmer, Stephan; Anastassiou, Gerasimos; Schallenberg, Maurice
To determine the correlations and strength of association between different imaging systems in analyzing the retinal nerve fiber layer (RNFL) of glaucoma patients: optical coherence tomography (OCT), scanning laser polarimetry (SLP) and confocal scanning laser ophthalmoscopy (CSLO). 114 eyes of patients with moderate open angle glaucoma underwent spectral domain OCT (Topcon SD-OCT 2000 and Zeiss Cirrus HD-OCT), SLP (GDx VCC and GDx Pro) and CSLO (Heidelberg Retina Tomograph, HRT 3). Correlation coefficients were calculated between the structural parameters yielded by these examinations. The quantitative relationship between the measured RNFL thickness globally and for the four regions (superior, inferior, nasal, temporal) were evaluated with different regression models for all used imaging systems. The strongest correlation of RNFL measurements was found between devices using the same technology like GDx VCC and GDx Pro as well as Topcon OCT and Cirrus OCT. In glaucoma patients, the strongest associations (R²) were found between RNFL measurements of the two optical coherence tomography devices Topcon OCT and Cirrus OCT (R² = 0.513) and between GDx VCC and GDx Pro (R² = 0.451). The results of the OCTs and GDX Pro also had a strong quantitative relationship (Topcon OCT R² = 0.339 and Cirrus OCT R² = 0.347). GDx VCC and the OCTs showed a mild to moderate association (Topcon OCT R² = 0.207 and Cirrus OCT R² = 0.258). The confocal scanning laser ophthalmoscopy (HRT 3) had the lowest association to all other devices (Topcon OCT R² = 0.254, Cirrus OCT R² = 0.158, GDx Pro R² = 0.086 and GDx VCC R² = 0.1). The measurements of the RNFL in glaucoma patients reveal a high correlation of OCT and GDx devices because OCTs can measure all major retinal layers and SLP can detect nerve fibers allowing a comparison between the results of this devices. However, CSLO by means of HRT topography can only measure height values of the retinal surface but it cannot distinguish
Full Text Available Purpose. To assess differences in translaminar pressure gradient (TPG and neuroretinal rim area (NRA in patients with normal tension glaucoma (NTG, high tension glaucoma (HTG, and healthy controls. Methods. 27 patients with NTG, HTG, and healthy controls were included in the prospective pilot study (each group consisted of 9 patients. Intraocular pressure (IOP, intracranial pressure (ICP, and confocal laser scanning tomography were assessed. TPG was calculated as the difference of IOP minus ICP. ICP was measured using noninvasive two-depth transcranial Doppler device. The level of significance P 0.05. The difference between TPG for healthy (5.4(7.7 mmHg and glaucomatous eyes (NTG 6.3(3.1 mmHg, HTG 15.7(7.7 mmHg was statistically significant (P < 0.001. Higher TPG was correlated with decreased NRA (r = −0.83; P = 0.01 in the NTG group. Conclusion. Translaminar pressure gradient was higher in glaucoma patients. Reduction of NRA was related to higher TPG in NTG patients. Further prospective studies are warranted to investigate the involvement of TPG in glaucoma management.
Reche-Sainz, J A; Gómez de Liaño, R; Toledano-Fernández, N; García-Sánchez, J
To describe the possible impairment of binocular vision in primary open angle glaucoma (POAG) patients. A cross-sectional study was conducted on 58 glaucoma patients, 76 ocular hypertensives and 82 normal subjects. They were examined with a battery of binocular tests consisting of the measurement of phoria angles, amplitudes of fusion (AF), near point of convergence (NPC) assessment, an evaluation of suppression (Worth test), stereoacuity according to Titmus, and TNO tests. The patients with glaucoma showed significantly increased phoria angles, especially in near vision, compared with the ocular hypertensives and controls (P=.000). AF were reduced mainly in near distances compared to hypertensives and controls (P=.000). The NPC of glaucoma was higher than the other two groups (P=.000). No differences were found in the near-distance suppression test between the three groups (P=.682), but there were differences in the distance vision of patients with glaucoma compared to hypertensives (OR=3.867, 95% CI; 1.260-11.862; P=.008) and controls (OR= 5.831, 95% CI; 2.229-15.252; P=.000). The stereoacuity of patients with glaucoma was reduced in both tests (P=.001). POAG is mostly associated with, an increased exophoria in near vision, a decreased AF in near vision, a far-distance NPC, central suppression in far-vision, and a loss of stereoacuity. These changes do not seem to appear early as they were not observed in hypertensive patients versus controls. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier España, S.L. All rights reserved.
Detry-Morel, Michèle; Jamart, Jacques; Hautenauven, Frédéric; Pourjavan, Sayeh
To compare corneal hysteresis (CH) and corneal resistance factor (CRF) measured with the Ocular Response Analyzer(®) tonometer (ORA) between (i) African normals and treated primary open-angle glaucoma (POAG) patients and (ii) between normals and treated POAG Caucasians. To analyse the correlation of CH and CRF with visual field (VF) defects in the two groups. This comparative study included 59 African (29 (POAG), 30 normals) and 55 Caucasians (30 POAG and 25 normals) subjects. Goldmann applanation tonometry (GAT) and ORA measurements were performed in a randomized sequence. Visual field was tested with the Swedish interactive threshold algorithms standard strategy of the Humphrey perimeter. Hoddap classification was used to estimate the severity of VF defects. Primary open-angle glaucoma Africans were younger than POAG Caucasians (p glaucoma Africans had higher IOPcc values than Caucasian POAGs (p glaucoma damage in Africans compared with Caucasians at diagnosis. © 2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation.
Almeida Jr ED
Full Text Available Eglailson Dantas Almeida Júnior1, Luciano Moreira Pinto1,2, Rodrigo Antonio Brant Fernandes1,2, Tiago Santos Prata1,31Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil; 2Cerpo Oftalmologia, São Paulo, Brazil; 3Hospital Medicina dos Olhos, São Paulo, BrazilObjective: To compare the pattern of intraocular pressure (IOP reduction following selective laser trabeculoplasty (SLT versus argon laser trabeculoplasty (ALT in open-angle glaucoma (OAG patients, and to investigate the ability of initial IOP reduction to predict mid-term success.Methods: A prospective, nonrandomized, interventional case series was carried out. Consecutive uncontrolled OAG glaucoma patients underwent SLT or ALT; the same preoperative medical regimen was maintained during follow-up. Data collected included age, type of OAG, pre- and postoperative IOP, number of glaucoma medications, and surgical complications. Post-treatment assessments were scheduled at day 1 and 7 and months 1, 3, and 6.Results: A total of 45 patients (45 eyes were enrolled [SLT group (n = 25; ALT group (n = 20]. Groups were similar for age, baseline IOP, and number of glaucoma medications (P ≥ 0.12. We found no significant differences in mean IOP reduction between SLT (5.1 ± 2.5 mmHg; 26.6% and ALT (4.4 ± 2.8 mmHg; 22.8% groups at month 6 (P = 0.38. Success rates (IOP ≤ 16 mmHg and IOP reduction ≥25% at last follow-up visit were similar for SLT (72% and ALT (65% groups (P = 0.36. Comparing the pattern of IOP reduction (% of IOP reduction at each visit between groups, we found a greater effect following SLT compared with ALT at day 7 (23.7% ± 13.7% vs 8.1% ± 9.5%; P < 0.001. No significant differences were observed at other time points (P ≥ 0.32. Additionally, the percentage of IOP reduction at day 7 and at month 6 were significantly correlated in the SLT group (R2 = 0.36; P < 0.01, but not in the ALT group (P = 0.89. Early postoperative success predicted late
Full Text Available Noriko Kato,1,2 Genichiro Takahashi,1,2 Koichi Kumegawa,1,2 Yoshiaki Kabata,1,2 Hiroshi Tsuneoka1 1Department of Ophthalmology, Jikei University, School of Medicine, 2Katsushika Medical Center, Tokyo, Japan Background: We investigated indications and early postoperative treatment for Ex-PRESS® insertion for glaucoma by comparing postoperative outcomes with those for standard trabeculectomy. Methods: Ex-PRESS insertion was performed in 21 eyes and standard trabeculectomy (TLE in 22 eyes. Mean intraocular pressure (IOP in the 6 months after surgery, success rate for postoperative IOP decline, postoperative complications, postoperative treatment, filtering blebs, and indications were then retrospectively investigated. Results: Mean postoperative IOP did not differ significantly between the groups at any observation time for 6 months after surgery. Further, it did not differ between either the groups of patients with primary open-angle glaucoma (POAG and neovascular glaucoma (NTG, or the patients with primary open-angle glaucoma and NTG in the Ex-PRESS group. Comparison of success rates in reduction of postoperative IOP between the groups under the following four survival conditions showed no significant differences: postoperative IOP <30% of the preoperative IOP, complete success (no additional ophthalmic solution, and qualified success (ophthalmic solution required; 5 mmHg ≤ postoperative IOP ≤21 mmHg, complete success (no additional ophthalmic solution, and qualified success (ophthalmic solution required. With regard to postoperative complications and postoperative treatment, the incidence of hyphema was significantly lower in the Ex-PRESS group, but no other significant intergroup differences were seen. The height of the filtering bleb was lower in the Ex-PRESS group. Conclusion: Postoperative outcomes in the Ex-PRESS and TLE groups were comparable. The incidence of hyphema was significantly lower in the Ex-PRESS group. Ex-PRESS insertion
Full Text Available To objectively classify the optic discs of open-angle glaucoma (OAG patients into Nicolela's four disc types, i.e., focal ischemic (FI, myopic (MY, senile sclerotic (SS, and generalized enlargement (GE, with swept-source optical coherence tomography (SS-OCT.This study enrolled 113 eyes of 113 OAG patients (mean age: 62.5 ± 12.6; Humphrey field analyzer-measured mean deviation: -9.4 ± 7.3 dB. Newly developed software was used to quantify a total of 20 optic disc parameters in SS-OCT (DRI OCT-1, TOPCON images of the optic disc. The most suitable reference plane (RP above the plane of Bruch's membrane opening was determined by comparing, at various RP heights, the SS-OCT-measured rim parameters and spectral-domain OCT-measured circumpapillary retinal nerve fiber layer thickness (cpRNFLT, with Pearson's correlation analysis. To obtain a discriminant formula for disc type classification, a training group of 72 eyes of 72 OAG patients and a validation group of 60 eyes of 60 OAG patients were set up.Correlation with cpRNFLT differed with disc type and RP height, but overall, a height of 120 μm minimized the influence of disc type. Six parameters were most significant for disc type discrimination: disc angle (horizontal, average cup depth, cup/disc ratio, rim-decentering ratio, average rim/disc ratio (upper and lower nasal. Classifying the validation group with these parameters returned an identification rate of 80.0% and a Cohen's Kappa of 0.73.Our new, objective SS-OCT-based method enabled us to classify glaucomatous optic discs with high reproducibility and accuracy.
Latina, M A; Melamed, S; March, W F; Kass, M A; Kolker, A E
The purpose of this study is to evaluate the safety and efficacy of gonioscopic ab interno laser sclerostomy (GLS) in patients with glaucoma. The technique of GLS involves iontophoresis of methylene blue dye (1%) at the limbus to focally dye the sclera and to provide subsequent delivery of 10-microsecond pulsed laser energy to the dyed area through a goniolens. The laser emits at 660 nm, a wavelength that is maximally absorbed by the methylene blue dye. Patients were evaluated for fistula formation, intraocular pressure (IOP) reduction, and adverse sequelae. Thirty-eight treatments were performed in 35 eyes. Successful complete sclerostomies were achieved in 21 eyes (55%), which was associated with an acute mean reduction in IOP of 23 mmHg. Mean preoperative IOP for all patients was 35 mmHg, and 1 hour after treatment it was reduced to 18.5 mmHg. In 4 of the 38 treatments, there was no acute IOP reduction, and these eyes were judged as failures. The mean follow-up time was 8.2 months with a maximum follow-up of 15 months. By 9 months, 50% of patients had an IOP of 22 mmHg or lower. The number of antiglaucoma medications decreased from 3.1 to 1.7 for all eyes over the 15-month follow-up period. Hyphemas (13%) were the only major complication, and these resolved spontaneously. In only one case did the IOP increase after the procedure. The results of this trial indicate that GLS is technically feasible, and preliminary results of IOP control are promising.
Xu, Xian; Ma, Ying-Yan; Zou, Hai-Dong
To assess the cost-effectiveness of cataract surgery in advanced glaucoma (AG) patients. A total of 93 patients with AG who underwent cataract surgeries were collected prospectively from June 2010 through June 2013 in Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, and were followed up for at least 3 months. A standard phacoemulsification technique was used to remove cataract(s). No complications occurred intraoperatively or postoperatively. Costs associated with surgery were recorded. Utility values of cataract surgery were obtained by using time trade-off method. Quality-adjusted life-years (QALYs) were calculated using the patients' life expectancy at a 3% discounted rate. Incremental cost-utility analysis was performed (compared with no treatment) by calculating the incremental cost-effectiveness ratio (ICER), that is, the mean incremental cost for each QALY. The bootstrap method was used for statistical analysis, and sensitivity analyses were performed to test robustness of the results. The mean incremental cost of cataract surgery was 9876 Chinese yuan (CNY) [1593 US dollar (USD)] [95% confidence interval (CI), 9144-10,570 CNY (1475-1705 USD)].The mean additional QALYs gained were 2.20 (95% CI, 1.85-2.54), and the incremental cost for each additional QALY was 4508 CNY (727 USD) [95% CI, 3890-5234 CNY (627-844 USD)], far lower than the per capita annual disposable income in Shanghai, 40,188 CNY (6482 USD). For AG patients, cataract surgery does help obtain more QALYs and was highly cost effective.
Mansouri, Kaweh; Shaarawy, Tarek
The authors report their initial clinical results with a novel wireless ocular telemetry sensor (OTS) (Sensimed AG, Switzerland) for continuous intraocular pressure (IOP) monitoring in patients with open angle glaucoma. This was a prospective, observational cohort of 15 patients. The OTS is a disposable silicone contact lens with an embedded micro-electromechanical system, which measures changes in corneal curvature induced by variations in IOP. An antenna, mounted around the eye, receives the data, which are then transmitted to a recorder. A signal was recorded in all patients. Thirteen (87%) patients completed 24-h IOP monitoring: one patient discontinued IOP monitoring due to device intolerance, and incomplete recordings were obtained in a second patient due to technical device malfunction. In 9/13 (69%) patients, the highest signals were recorded during the nocturnal period. No serious adverse events were recorded. The OTS shows good safety and functionality to monitor IOP fluctuations in patients over 24 h. This technology has the potential to provide hitherto unobtainable data on the chronobiology of IOP, possibly leading to improved care of glaucoma patients.
Full Text Available Purpose. To determine the agreement between Moorfields Regression Analysis (MRA, Glaucoma Probability Score (GPS of Heidelberg retinal tomograph (HRT III, and peripapillary nerve fibers thickness by iVue Optical Coherence Tomography (OCT. Methods. 72 eyes with ocular hypertension or primary open angle glaucoma (POAG were included in the study: 54 eyes had normal visual fields (VF and 18 had VF damage. All subjects performed achromatic 30° VF by Octopus Program G1X dynamic strategy and were imaged with HRT III and iVue OCT. Sectorial and global MRA, GPS, and OCT parameters were used for the analysis. Kappa statistic was used to assess the agreement between methods. Results. A significant agreement between iVue OCT and GPS for the inferotemporal quadrant (κ: 0.555 was found in patients with abnormal VF. A good overall agreement between GPS and MRA was found in all the eyes tested (κ: 0.511. A good agreement between iVue OCT and MRA was shown in the superonasal (κ: 0.656 and nasal (κ: 0.627 quadrants followed by the superotemporal (κ: 0.602 and inferotemporal (κ: 0.586 sectors in all the studied eyes. Conclusion. The highest percentages of agreement were found per quadrant of the MRA and the iVue OCT confirming that in glaucoma damage starts from the temporal hemiretina.
Full Text Available A 55-year-old woman was referred to our clinic because of a one-week history of visual loss and raised intraocular pressure in the left eye followed 4 days later by visual loss in the right eye. Slit-lamp examination showed bilateral conjunctival hyperemia, slight diffuse corneal edema, shallow anterior chamber and fixed and dilated pupil in both eyes. Splitting of the anterior layers of the iris with fibrillar degeneration extending for approximately one quadrant inferiorly was presented in each eye. Fundus examination showed opitc disc edema with no vascular tortuosity and no cup in both eyes. The condition was treated as bilateral acute angle-closure glaucoma in a patient with irisdoschisis. After medical treatment and improvement of visual acuity, perimetry revealed a significant visual field defect especially in left eye; this case represents a rare concurrence of acute angle-closure glaucoma and bilateral nonarteritic ischemic optic neuropathy. Although most cases of elevated intraocular pressure, including acute angle-closure glaucoma, do not result in optic disc edema and irreversible vision loss, variations in the vascular supply of the nerve optic head along with others ocular systemic risk factors, may predispose certain individuals to nonarteritic ischemic optic neuropathy during periods of elevated intraocular pressure.
Roh, Hyun Cheol; Park, Choul Yong; Kim, Martha
Purpose. To investigate the effect of uneventful cataract surgery on macular ganglion cell-inner plexiform layer (mGC-IPL) thickness in glaucoma patients. Methods. This retrospective study included 65 eyes of 65 subjects who underwent uneventful cataract surgery, including 13 glaucoma eyes and 52 normal eyes. Using spectral domain optical coherence tomography, the mGC-IPL thickness was measured and compared between glaucoma and normal eyes preoperatively as well as 1 month and 3 months postoperatively. Linear regression analysis was used to determine the factors associated with postoperative change in mGC-IPL thickness. Results. The mean mGC-IPL significantly increased in both groups 1 month and 3 months after surgery (all P values equal to or less than 0.001). The postoperative changes between groups were not significantly different (P = 0.171). In the multivariate regression analysis, preoperative mGC-IPL thickness showed a significant association with the change of average mGC-IPL thickness 1 month and 3 months after surgery (all P values IPL thickness was increased after cataract surgery, and the postoperative mGC-IPL thickness changes were associated with preoperative mGC-IPL thickness in both groups and axial length in normal eye. The effects of cataract surgery on mean mGC-IPL thickness were not different in glaucomatous and normal eyes.
Hyun Cheol Roh
Full Text Available Purpose. To investigate the effect of uneventful cataract surgery on macular ganglion cell-inner plexiform layer (mGC-IPL thickness in glaucoma patients. Methods. This retrospective study included 65 eyes of 65 subjects who underwent uneventful cataract surgery, including 13 glaucoma eyes and 52 normal eyes. Using spectral domain optical coherence tomography, the mGC-IPL thickness was measured and compared between glaucoma and normal eyes preoperatively as well as 1 month and 3 months postoperatively. Linear regression analysis was used to determine the factors associated with postoperative change in mGC-IPL thickness. Results. The mean mGC-IPL significantly increased in both groups 1 month and 3 months after surgery (all P values equal to or less than 0.001. The postoperative changes between groups were not significantly different (P=0.171. In the multivariate regression analysis, preoperative mGC-IPL thickness showed a significant association with the change of average mGC-IPL thickness 1 month and 3 months after surgery (all P values < 0.001. Conclusions. The mean mGC-IPL thickness was increased after cataract surgery, and the postoperative mGC-IPL thickness changes were associated with preoperative mGC-IPL thickness in both groups and axial length in normal eye. The effects of cataract surgery on mean mGC-IPL thickness were not different in glaucomatous and normal eyes.
Francisco G Junoy Montolio
Full Text Available In glaucoma, the density of retinal ganglion cells is reduced. It is largely unknown how this influences retinal information processing. An increase in spatial summation and a decrease in contrast gain control and contrast adaptation have been reported. A decrease in lateral inhibition might also arise. This could result in a larger than expected response to some stimuli, which could mask ganglion cell loss on functional testing (structure-function discrepancy. The aim of this study was to compare lateral inhibition between glaucoma patients and healthy subjects; we used a case-control design. Cases (n = 18 were selected to have advanced visual field loss in combination with a normal visual acuity. Controls (n = 50 were not allowed to have symptoms or signs of any eye disease. Lateral inhibition was measured psychophysically on a computer screen, with (1 a modified illusory movement experiment and (2 a contrast sensitivity (CS test. Illusory movement was quantified by nulling it with a real movement; measure of lateral inhibition was the amount of illusory movement. CS was measured at 1 and 4 cycles per degree (cpd; measure of lateral inhibition was the difference between log CS at 4 and 1 cpd. Both measures were compared between cases and controls; analyses were adjusted for age and gender. There was no difference between cases and controls for these two measures of lateral inhibition (p = 0.58 for illusory movement; p = 0.20 for CS. The movement threshold was higher in cases than in controls (p = 0.008 and log CS was lower, at both 1 (-0.20; p = 0.008 and 4 (-0.28; p = 0.001 cpd. Our results indicate that spatially antagonistic mechanisms are not specifically affected in glaucoma, at least not in the intact center of a severely damaged visual field. This suggests that the structure-function discrepancy in glaucoma is not related to a decrease in lateral inhibition.
Full Text Available Yoichiro Shinohara, Hideo Akiyama, Mikiya Magori, Shoji Kishi Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan Background: The purpose of this study was to investigate postoperative clinical outcomes in patients with neovascular glaucoma (NVG who underwent trabeculectomy or EX-PRESS implantation and to identify predictors of successful EX-PRESS implantation. Methods: The study designed as a retrospective observational analysis and was set in a single tertiary center. Eighty-nine patients (89 eyes with NVG, were treated using trabeculectomy alone (Trab group; n=39 or EX-PRESS implantation (EX group; n=50. All patients with a history of glaucoma surgery were excluded. The main outcome measures were postoperative intraocular pressure (IOP, visual acuity (VA, number of medications, complications, additional therapy, and success rate. Results: The mean follow-up duration was 4.6 months in the Trab group and 4.2 months in the EX group. There was no significant difference in IOP between the groups except at 1-month follow-up (P=0.045. The number of patients with early postoperative hypotony, a shallow anterior chamber, hyphema, or anterior chamber irrigation was significantly lower in the EX group than in the Trab group (P=0.016, 0.008, 0.019, and 0.014, respectively. The other outcomes, ie, VA, number of medications, and success rate, were similar between the two groups. In the EX group, the success rate was significantly lower in 15 patients with a history of vitrectomy compared to that in 35 patients without a history of vitrectomy (P=0.047. Conclusion: Implantation of an EX-PRESS device may be more effective and safer than trabeculectomy alone in patients with NVG. However, a history of vitrectomy may affect the surgical success rate when using EX-PRESS. Keywords: trabeculectomy, EX-PRESS, neovascular glaucoma, surgery, tube shunt
Riva, Ivano; Katsanos, Andreas; Floriani, Irene; Biagioli, Elena; Konstas, Anastasios G P; Centofanti, Marco; Quaranta, Luciano
The aim of the study was to evaluate the long-term 24-hour intraocular pressure (IOP) efficacy of travoprost monotherapy in primary open-angle glaucoma patients. A total of 36 previously untreated primary open-angle glaucoma patients were enrolled in this 5-year study. Patients underwent an untreated 24-hour IOP evaluation. Subsequently all patients were assigned to topical therapy with travoprost 0.004% eye-drops preserved with benzalkonium chloride (Travatan, Alcon Laboratories Inc., Fort Worth, TX) administered once in the evening (8:00 PM) in both eyes. All patients were then scheduled for a 24-hour IOP assessment approximately 12 months after the baseline visit. This schedule of follow-up was maintained for the whole duration of the trial. The predetermined range of target IOP reduction selected in this cohort of patients ranged between 20% and 30%. A total of 34 patients completed all phases of the investigation. The mean survival time was 57.3±2.0 months and the cumulative survival rate was 0.82±0.6 at 60 months. Travoprost reduced the mean 24-hour IOP from 23.4±1.7 mm Hg at baseline to 16.8±2.4 mm Hg (28.4%), 16.8±2.5 mm Hg (28.1%), 16.8±2.4 mm Hg (28.5%), 16.7±2.5 mm Hg (28.6%), and 16.9±2.4 mm Hg (27.8%), respectively at the end of the first, second, third, fourth, and fifth year follow-up. No drug-related serious adverse events were registered during the study. The present study demonstrated the long-term 24-hour efficacy of travoprost for the treatment of primary open-angle glaucoma.
Full Text Available Cliff Richardson,1 Lisa Brunton,1 Nicola Olleveant,1 David B Henson,1 Mark Pilling,1 Jane Mottershead,2 Cecilia H Fenerty,2 Anne Fiona Spencer,2 Heather Waterman1 1School of Nursing, Midwifery and Social Work, University of Manchester, 2Royal Manchester Eye Hospital, Central Manchester Foundation Trust, Manchester, United Kingdom Background: Adherence with therapy could influence the progression of glaucoma and ultimately affect the onset of visual impairment in some individuals. This feasibility study evaluated the measures to be used for a future randomized controlled trial assessing the effects of group-based education on adherence with eye drops. Methods: People diagnosed with glaucoma within the previous 12 months attending a regional ophthalmology clinic in the North West of England were recruited. A two-session education program delivered one week apart had been devised as part of a previous project. A combined adult learning and health needs approach to education was taken. Outcomes measured were knowledge of glaucoma, self-report of adherence, illness perception, beliefs about medicines, patient enablement, and general health (Short Form-12. Adherence was also measured objectively using a Medical Events Monitoring System device. Results: Twenty-six participants consented to undertake the educational program and 19 produced analyzable data. Knowledge of glaucoma, illness perception, beliefs about medicine, and patient enablement all showed statistically significant improvements after education. Mean adherence with eye drops was maintained above 85% before and for 3 months after attendance at the educational program. Self-report exaggerated adherence by at least 10% when compared with the objective Medical Events Monitoring System data, and in fact the kappa agreement was zero. Conclusion: All questionnaires other than the Short Form-12 were considered to be valuable measures and use of a Medical Events Monitoring System device was
Wallsh, Josh O; Gallemore, Ron P; Taban, Mehran; Hu, Charles; Sharareh, Behnam
To assess the safety and efficacy of a modified technique for pars plana placement of the Ahmed valve in combination with pars plana vitrectomy in the treatment of glaucoma associated with posterior segment disease. Thirty-nine eyes with glaucoma associated with posterior segment disease underwent pars plana vitrectomy combined with Ahmed valve placement. All valves were placed in the pars plana using a modified technique, without the pars plana clip, and using a scleral patch graft. The 24 eyes diagnosed with neovascular glaucoma had an improvement in intraocular pressure from 37.6 mmHg to 13.8 mmHg and best-corrected visual acuity from 2.13 logarithm of minimum angle of resolution to 1.40 logarithm of minimum angle of resolution. Fifteen eyes diagnosed with steroid-induced glaucoma had an improvement in intraocular pressure from 27.9 mmHg to 14.1 mmHg and best-corrected visual acuity from 1.38 logarithm of minimum angle of resolution to 1.13 logarithm of minimum angle of resolution. Complications included four cases of cystic bleb formation and one case of choroidal detachment and explantation for hypotony. Ahmed valve placement through the pars plana during vitrectomy is an effective option for managing complex cases of glaucoma without the use of the pars plana clip.
Mizoguchi, Takanori; Ozaki, Mineo; Wakiyama, Harumi; Ogino, Nobuchika
To determine the prevalence of plateau iris in Japanese patients with primary angle closure (PAC) and primary angle closure glaucoma (PACG) and analyze the biometric parameters in patients with plateau iris using ultrasound biomicroscopy (UBM). In this cross-sectional observational study, subjects aged >50 years with PAC and PACG who had previously undergone a patent laser peripheral iridotomy underwent UBM in one eye. UBM images were qualitatively analyzed using standardized criteria. Plateau iris in a quadrant was defined by anteriorly directed ciliary body, absent ciliary sulcus, steep iris root from its point of insertion followed by a downward angulation, flat iris plane, and irido-angle contact. At least two quadrants had to fulfill these UBM criteria for an eye to be classified as having plateau iris. A-scan biometry was used to measure anterior segment parameters. Ninety-one subjects with PAC (58 subjects) or PACG (33 subjects) and 68 normal controls were recruited. The mean (standard deviation) ages of PAC and PACG patients and normal controls were 73.5 (6.2) and 72.6 (7.3), respectively. Based on UBM criteria, plateau iris was found in 16 eyes (17.6%) of 91 eyes. In these 16 eyes, quadrant-wise analysis showed ten eyes (62.5%) had plateau iris in two quadrants; four eyes (25%) had plateau iris in three quadrants; and two eyes (12.5%) had plateau iris in four quadrants. Anterior chamber depth, lens thickness, axial length, lens position, and relative lens position were not statistically significant between the group having plateau iris and that not having plateau iris, respectively. Approximately 20% of Japanese subjects with PAC and PACG with a patent laser peripheral iridotomy were found to have plateau iris on UBM. No morphological difference was noted in the anterior segment of the eye between those with or without plateau iris.
Perucho-González, Lucía; Sáenz-Francés, Federico; Morales-Fernández, Laura; Martínez-de-la-Casa, José María; Méndez-Hernández, Carmen D; Santos-Bueso, Enrique; Brookes, John L; García-Feijoó, Julián
To determine whether a set of ocular morphometric and biomechanical variables are able to discriminate between healthy volunteers and patients suffering from primary congenital glaucoma (PCG). Case-control study in which 66 patients with PCG and 94 age-matched healthy subjects were evaluated using ocular response analyser (ORA) to record corneal biomechanical properties. Topographic corneal variables were obtained using the Pentacam in both groups. To determine the ability to discern between both groups, a multivariate binary logistic model was constructed. The outcome was the diagnosis of PCG and the predictors; the corneal variables analysed along with their first-term interactions. Sensitivity and specificity of this model along with the area under the receiver characteristic operating curve (AUC of ROC) were determined. The best model to discriminate between both groups included the following predictors: corneal hysteresis (CH), corneal resistance factor (CRF), posterior maximum elevation (PME), anterior maximum elevation (AME) and central corneal thickness (CCT). This model, for a cut-point of 50%, presents a sensitivity of 86.67%, a specificity of 86.89% and an AUC of the ROC curve of 93.16% [95% confidence interval (CI): 88.97-97.35]. The adjusted odds ratios of those predictors which showed a significant discriminating capacity were as follows: for CH, 0.27 (95% confidence interval: 0.15-0.46); for CRF, 2.13 (95% CI: 1.33-3.40); for PME, 1.06 (95% CI: 1.01-1.12); and for AME, 1.35 (95% CI: 1.10-1.66). Corneal hysteresis (CH), CRF, PME and AME are able to discern between patients with PCG and healthy controls. This fact suggests that there are structural and biomechanical differences between these groups. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Mansouri, Kaweh; Medeiros, Felipe A; Tafreshi, Ali; Weinreb, Robert N
To examine the safety, tolerability, and reproducibility of intraocular pressure (IOP) patterns during repeated continuous 24-hour IOP monitoring with a contact lens sensor. Forty patients suspected of having glaucoma(n=21) or with established glaucoma (n=19) were studied.Patients participated in two 24-hour IOP monitoring sessions (S1 and S2) at a 1-week interval (SENSIMED Triggerfish CLS; Sensimed AG). Patients pursued daily activities,and sleep behavior was not controlled. Incidence of adverse events and tolerability (visual analog scale score)were assessed. Reproducibility of signal patterns was assessed using Pearson correlations. The mean (SD) age of the patients was 55.5(15.7) years, and 60% were male. Main adverse events were blurred vision (82%), conjunctival hyperemia (80%),and superficial punctate keratitis (15%). The mean (SD)visual analog scale score was 27.2(18.5) mm in S1 and 23.8(18.7) mm in S2 (P=.22). Overall correlation between the 2 sessions was 0.59 (0.51 for no glaucoma medication and 0.63 for glaucoma medication) (P=.12). Mean(SD) positive linear slopes of the sensor signal from wake to 2 hours into sleep were detected in both sessions for the no glaucoma medication group (S1: 0.40 [0.34],P.001; S2: 0.33[0.30], P.01) but not for the glaucoma medication group (S1: 0.24 [0.60], P=.06; S2:0.40[0.40], P.001). Repeated use of the contact lens sensor demonstrated good safety and tolerability. The recorded IOP patterns showed fair to good reproducibility,suggesting that data from continuous 24-hour IOP monitoring may be useful in the management of patients with glaucoma. clinicaltrials.gov Identifier: NCT01319617
Full Text Available Derrick S Fung, M Allison Roensch, Karanjit S Kooner, H Dwight Cavanagh, Jess T WhitsonDepartment of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USAPurpose: Few studies have provided epidemiological characteristics of childhood glaucoma in a large, multiethnic population. This information is important if we are to better screen for and characterize this specific type of glaucoma. In this study, we evaluate the characteristics of patients with childhood glaucoma, including glaucoma suspects, as identified through the Dallas Glaucoma Registry (DGR.Patients and methods: The DGR catalogs the characteristics of glaucoma patients seen at University of Texas Southwestern Medical Center, an academic tertiary referral center for a large, multiethnic, urban population in the United States. We analyzed these patients with respect to race, medical and surgical treatment, cup-to-disc ratio, intraocular pressure, and visual outcomes.Results: The study comprised 376 eyes of 239 childhood glaucoma patients, of whom 19% had primary congenital glaucoma, 4% had primary juvenile glaucoma, 45% had secondary glaucoma, and 31% were glaucoma suspects. Trauma and postsurgical aphakia were the most common causes for secondary glaucoma. Thirty-eight percent of patients were Hispanic, 30% were Caucasian, 21% were African American, 3% were Asian, and 9% were unknown or unreported. Male sex was more common at 56%. Of all eyes with glaucoma, 65% received surgical intervention while 70% required at least one medication for intraocular pressure control. Trabeculotomy and tube-shunt surgery were the most common surgeries performed. Of patients who could have Snellen visual acuity measured, glaucoma suspect eyes had the largest proportion of eyes (96% with good visual acuity (better than 20/40 while primary congenital glaucoma eyes had the smallest proportion (41% with good visual acuity. Secondary glaucoma eyes had the largest proportion of eyes
N. A. Baranova
Full Text Available Currently, the most scientifically based local risk and progressive factors are elevated levels of intraocular pressure and its instability during the day, caused by local hydromechanical disturbances. However, the other factors affecting the circadian changes of intraocular pressure levels are still evaluated. It was found that light is one of the most important factors affecting the intensity of the cyclical fluctuations of various biological processes, including, and fluctuations of intraocular pressure. At the same time, glaucoma can lead to a variety of sleep disorders, due to a mismatch between cycles «sleep-wake». One if this reason is the death of retinal ganglion cells and their axons. Such damage indirectly lead to a decrease in production of the pigment melanopsin, which is located in the retina. It is not involved in the visual process, but ensures the implementation of circadian rhythms «sleep-wake» and mediated suppression of epiphyseal melatonin. Most likely, melatonin plays a protective role in the occurrence and progression of glaucoma, protecting retinal cells against free radicals and has a direct impact on the intraocular pressure level. Several studies have shown that the circadian change in intraocular pressure levels, and in particular, its substantial reduction, is influenced by melatonin. In this regard, glaucoma is a disease in which the death of retinal cells, including producing melanopsin, a unique opportunity to study violations of cyclic rhythms. Melatonin acts on such established risk factors and progression of glaucoma as hypertension and diabetes. There are published results of the use of melatonin agonists in the experiment and clinical practice. So, in addition to local and systemic hypotensive action, normalizes sleep patients. Data about the melatonin’s effects on the direct and indirect reduction of intraocular pressure, neuroprotective effects and reducing symptoms of depression can
Suh, Min Hee; Park, Ki Ho
The association between optic disk hemorrhage and glaucoma has been studied for many years. Recently, randomized clinical trials have confirmed that disk hemorrhage is a risk factor for development and progression of glaucoma. Disk hemorrhage is more commonly detected in open-angle glaucoma with normal tension than in open-angle glaucoma with high tension. Development of disk hemorrhage possibly is associated with the biomechanical properties of the lamina cribrosa and surrounding tissues, including the intraocular pressure (IOP)-cerebrospinal pressure gradient, arterial pressure, and venous pressure. Disk hemorrhage may be a marker of rapid glaucoma progression, in that localized subclinical structural change predisposes to disk hemorrhage, after which subsequent disease progression is accelerated, and recurrent optic disk hemorrhages are related to rapid structural progression of glaucomatous damage. IOP-lowering therapy can be helpful in halting post-hemorrhage glaucoma progression. Copyright © 2014 Elsevier Inc. All rights reserved.
Full Text Available Abstract Background To describe, a yet non-documented complication of GDI surgery (glaucoma drainage incision surgery - anterior to posterior segment migration of Ahmed Glaucoma Valve (AGV tube. Case Presentation We report a young 9 year old boy, diagnosed with refractory glaucoma with Reiger anomaly. History included of poor vision in both eyes, left more than right with glare since childhood. He underwent GDI surgery with AGV implantation following which he developed posterior migration of AGV tube. The detailed ocular history, ophthalmic findings, clinical course, surgical management and development of the posterior tube migration is discussed. Conclusion Posterior Migration of AGV tube has yet not been described. Also there is a role of expectant management of the complication in this case as evidenced by the benign course of events.
Background To describe, a yet non-documented complication of GDI surgery (glaucoma drainage incision surgery) - anterior to posterior segment migration of Ahmed Glaucoma Valve (AGV) tube. Case Presentation We report a young 9 year old boy, diagnosed with refractory glaucoma with Reiger anomaly. History included of poor vision in both eyes, left more than right with glare since childhood. He underwent GDI surgery with AGV implantation following which he developed posterior migration of AGV tube. The detailed ocular history, ophthalmic findings, clinical course, surgical management and development of the posterior tube migration is discussed. Conclusion Posterior Migration of AGV tube has yet not been described. Also there is a role of expectant management of the complication in this case as evidenced by the benign course of events. PMID:20849582
Song, Ji Hun; Jang, Seran; Cho, Eun Hyung; Ahn, Jaehong
When vitrectomy is performed in eyes that have undergone glaucoma surgery, the site of sclerotomy often overlaps with the previous glaucoma operation site. It can lead to serious complications such as postoperative hypotony, leakage, and/or infection. Our technique involves modification of surgeon's position and two sclerotomy sites 45° away from the original position, with an infusion cannula inserted infranasally to avoid damage to the glaucoma drainage implant or filtering bleb. The modified approach was applied to seven eyes with various indications. Vitrectomy was successfully completed, and there were no sclerotomy site complications, leakage, or hypotony in any case. Good intraocular pressure control was maintained throughout the postoperative course in all cases. © Copyright: Yonsei University College of Medicine 2017.
Full Text Available Riyam Faihan Rashid, Qasim K Farhood Department of Ophthalmology, College of Medicine, University of Babylon, Babylon, Iraq Background: The measurement of central corneal thickness (CCT plays an important role in the diagnosis and treatment of glaucoma and many corneal diseases.Objective of the study: To compare the measurement of CCT by ultrasonic pachymeter with that measured by oculus pentacam in both normal subjects and patients with well-controlled glaucoma.Patients and methods: In 173 eyes of both controls and patients with open-angle glaucoma (normal intraocular pressure attending Ibn Al Haitham Teaching Eye Hospital, CCT was measured by oculus pentacam and then by ultrasound pachymeter at the same morning by the same technicians.Results: The results showed no significant difference in CCT readings measured by the two devices in both glaucoma and control groups (glaucoma group: 547.29±49.32 µm with pentacam vs 547.66±45.24 µm with ultrasound pachymeter; control group: 551.02±36.28 µm with pentacam vs 541.25±34.96 µm with ultrasound pachymeter. P-values were >0.05 in both groups (statistically not significant.Conclusion and recommendation: Ultrasonic pachymeter and oculus pentacam can be used interchangeably in measuring CCT, and we recommend a nontouch method (in this study, pentacam Scheimpflug camera for measuring CCT during assessment of patients with glaucoma or any ocular disease or surgery. Keywords: CCT, open-angle glaucoma, ultrasound pachymeter, Scheimpflug camera
Nath, Tirupati; Roy, Subham Sinha; Kumar, Himanshu; Agrawal, Rachit; Kumar, Santosh; Satsangi, S K
Exposure to corticosteroids is known to be associated with an increased risk of cataract and glaucoma. This study was undertaken to determine the prevalence of steroid-induced cataract and glaucoma in patients with chronic obstructive pulmonary disease (COPD) and to assess a dose-response relationship between them. This was a prospective observational study. We identified all COPD patients aged 50 years or older, with minimum steroid exposure of 4 months and on inhaled corticosteroids from March 2014 to March 2015. Average daily dose of inhaled corticosteroids was defined as low (1-250 µg), medium (251-500 µg), and high (501-1000 µg) using fluticasone propionate equivalents. We screened 405 COPD patients, of which 48 were dropouts. We identified 58 cataract and 14 glaucoma patients with a prevalence of 16.24% and 3.92%, respectively. We also observed a dose-response relationship with the highest prevalence of cataract (39.6%) and glaucoma (42.8%) at daily doses of 501-1000 µg fluticasone propionate equivalents. It is evident that higher doses and longer duration of inhaled corticosteroid in COPD patients are associated with a higher prevalence of cataract and glaucoma. Copyright© 2017 Asia-Pacific Academy of Ophthalmology.
Full Text Available Congenital glaucoma is a global problem and poses a diagnostic and therapeutic challenge to the ophthalmologist. A detailed evaluation under general anesthesia is advisable to establish the diagnosis and plan for management. Medical therapy has a limited role and surgery remains the primary therapeutic modality. While goniotomy or trabeculotomy ab externo is valuable in the management of congenital glaucoma, primary combined trabeculotomy-trabeculectomy offers the best hope of success in advanced cases. Trabeculectomy with antifibrotic agent and glaucoma drainage devices has a role in the management of refractory cases, and cyclodestructive procedures should be reserved for patients where these procedures have failed. Early diagnosis, prompt therapeutic intervention and proper ref