Ophthalmology. Glaucoma最新文献

{"title":"Effect of Early Aqueous Suppression After Valved Tube Shunt Surgery for Uveitic Glaucoma","authors":"Minjia Tang BA ,&nbsp;Nathan P. Gill PhD ,&nbsp;Angelo P. Tanna MD","doi":"10.1016/j.ogla.2023.08.002","DOIUrl":"10.1016/j.ogla.2023.08.002","url":null,"abstract":"<div><h3>Purpose</h3><p>To compare outcomes of early aqueous suppression (EAS) and standard therapy (ST) after Ahmed Glaucoma Valve (AGV) implantation for uveitic glaucoma.</p></div><div><h3>Design</h3><p>Retrospective comparative cohort study.</p></div><div><h3>Participants</h3><p>All patients with uveitic glaucoma underwent AGV implantation from January 2010 to October 2020 at Northwestern Medicine.</p></div><div><h3>Methods</h3><p>Excluding the first postoperative day 1 (POD1), only eyes with IOP 10–15 mmHg at their first visit with IOP ≥ 10 mmHg were included in the main analysis. Early aqueous suppression (EAS) was defined as initiation of ocular hypotensive therapy when IOP was first 10–15 mmHg. Standard therapy was initiation of therapy at any later time. Failure was defined as IOP &gt; 21 mmHg, &lt; 5 mmHg, or &lt; 20% reduction in IOP from baseline after 3 months, for 2 consecutive study visits. Hypotony was defined as IOP ≤ 5 mmHg for ≥ 2 visits. Hypertensive phase was defined as IOP &gt; 21 mmHg for 2 consecutive visits in the first 3 months.</p></div><div><h3>Main Outcome Measures</h3><p>Proportion achieving overall success; incidence of hypotony and hypertensive phase.</p></div><div><h3>Results</h3><p>Twenty-eight eyes of 26 patients were in the EAS group and 20 eyes of 19 patients were in the ST group, with a mean follow-up of 17.7 and 28.2 months, respectively. Baseline IOP was similar in the EAS (31.2 ± 10.1 mmHg) and ST (34.6 ± 12.2 mmHg) groups; <em>P</em> = 0.18. Final IOP was lower in the EAS group (12.9 ± 4.6 mmHg) than the ST group (16.4 ± 5.7 mmHg; <em>P</em> = 0.02) on 2.6 ± 0.9 medications in the EAS group and 1.8 ± 1.5 in the ST group (<em>P</em> = 0.07). Overall success was achieved in 87% of EAS eyes and 74% of ST eyes (<em>P</em><span> = 0.43). There were no statistically significant differences in the occurrence of additional glaucoma surgery (4% for EAS, 20% for ST; </span><em>P</em> = 0.11), hypotony (7% for EAS, 0% for ST; <em>P</em> = 0.50), or hypertensive phase (4% for EAS, 21% for ST; <em>P</em> = 0.09).</p></div><div><h3>Conclusions</h3><p>EAS was associated with a lower final IOP after AGV in uveitic glaucoma eyes; however, more medications were in use at the final visit. No statistically significant differences in overall success or the incidence of adverse events were observed.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 1","pages":"Pages 37-46"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10129304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ocular Oil Odyssey: Hyper-Oleon","authors":"Sagarika Snehi DNB, FAICO,&nbsp;Puja Hingorani-Bang MS,&nbsp;Nidhi Mamtani MS","doi":"10.1016/j.ogla.2023.11.004","DOIUrl":"10.1016/j.ogla.2023.11.004","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 1","pages":"Page 46"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138489242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking Prophylactic Laser Peripheral Iridotomy in Primary Angle-Closure Suspects","authors":"Theodoros Filippopoulos MD ,&nbsp;John Danias MD, PhD ,&nbsp;Efthymios Karmiris MD, PhD ,&nbsp;Gordana Sunaric Mégevand MD ,&nbsp;Douglas J. Rhee MD ,&nbsp;Gus Gazzard MD, FRCOphth ,&nbsp;Fotis Topouzis MD, PhD ,&nbsp;Benjamin Xu MD, PhD","doi":"10.1016/j.ogla.2023.06.004","DOIUrl":"10.1016/j.ogla.2023.06.004","url":null,"abstract":"<div><h3>Purpose</h3><p><span>To examine the generalizability, discuss limitations, and critically appraise recommendations on the management of primary angle-closure suspects (PACSs) that emerged as a result of recent randomized clinical trials challenging the widely accepted clinical practice of offering laser peripheral </span>iridotomy (LPI) to PACS patients. To synthetize findings from these and other studies.</p></div><div><h3>Design</h3><p>Narrative review.</p></div><div><h3>Subjects</h3><p>Patients classified as PACS.</p></div><div><h3>Methods</h3><p>The Zhongshan Angle-Closure Prevention (ZAP)–Trial and the Singapore Asymptomatic Narrow Angle Laser Iridotomy Study (ANA-LIS) along with accompanying publications were reviewed. Epidemiologic studies reporting on the prevalence of primary angle-closure glaucoma and other precursor forms of the disease were also analyzed along with publications reporting on the natural course of the disease or studies reporting on outcomes after prophylactic LPI.</p></div><div><h3>Main Outcome Measures</h3><p>Incidence of progression to more severe forms of angle closure.</p></div><div><h3>Results</h3><p>Patients recruited in recent randomized clinical trials are asymptomatic, do not have cataracts, may be younger, and have, on average, deeper anterior chambers depth compared with patients treated with LPI in clinics.</p></div><div><h3>Conclusions</h3><p>The ZAP-Trial and ANA-LIS clearly represent the best available data on PACS management, additional parameters however may need to be considered when physicians face patients in clinic. PACS patients encountered at tertiary referral centers may represent more advanced cases with respect to ocular biometric<span> parameters and may be at higher risk for disease progression compared with those recruited through population-based screening.</span></p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"6 6","pages":"Pages 657-667"},"PeriodicalIF":2.9,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10128470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glaucoma Fellows-in-Training Recent Surgery Trends","authors":"Grace E. Nipp BS ,&nbsp;Ahmad A. Aref MD, MBA ,&nbsp;Sandra S. Stinnett DrPH ,&nbsp;Kelly W. Muir MD, MHSc","doi":"10.1016/j.ogla.2023.06.006","DOIUrl":"10.1016/j.ogla.2023.06.006","url":null,"abstract":"<div><h3>Purpose</h3><p><span>The volume of microinvasive glaucoma surgery (MIGS) has increased dramatically in recent years, from 31 059 in 2013 to 69 420 in 2018. We investigated the impact of this trend on trainees by determining the proportion of glaucoma surgeries performed by fellows-in-training comprised by MIGS, </span>trabeculectomies, and aqueous shunts.</p></div><div><h3>Design</h3><p>Retrospective analysis.</p></div><div><h3>Participants</h3><p>Fellows-in-training at Glaucoma Fellowship Programs certified by the Association of University Professors of Ophthalmology Fellowship Compliance Committee (AUPO-FCC)</p></div><div><h3>Methods</h3><p>We analyzed aggregate summaries of surgeries performed by fellows as reported to the AUPO-FCC from the academic years (AYs) beginning in 2014 through AY 2020. Each report lists the average number of procedures performed per surgery type per fellow. We combined these averages to create a sum “average number surgeries performed” across glaucoma surgeries and computed the proportion that each surgery type (MIGS, trabeculectomies, and aqueous shunts) represented within the total average number of surgeries performed per year.</p></div><div><h3>Main Outcome Measures</h3><p>Average number of procedures performed for each surgery type as well as the proportion that each surgery type (MIGS, trabeculectomies, and aqueous shunts) represented within the total average number of procedures performed per year.</p></div><div><h3>Results</h3><p>Average number of MIGS performed is significantly greater in later years compared with earlier years (<em>P</em> &lt; 0.001). The average number of trabeculectomies performed between AYs 2014 and AY 2020 ranged from 21.8 to 31.9 and decreased, on average, by − 0.80 year-to-year. The average number of aqueous shunts performed between AY 2014 and AY 2020 ranged from 44.7 to 49.5, with an average increase of + 0.8 year-to-year. The total average number of procedures performed (across all 3 surgical subtypes) increased on average by + 4.8 procedures each year.</p></div><div><h3>Conclusions</h3><p>Since 2014, fellows are performing increasing numbers of MIGS procedures, whereas the total number of trabeculectomies and aqueous shunt surgeries performed each year remain similar, resulting in a net increase in total number of procedures performed per fellow each year. This suggests the increase in MIGS is not associated with a substantial decline in trabeculectomies or aqueous shunts performed by glaucoma fellows.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"6 6","pages":"Pages 651-656"},"PeriodicalIF":2.9,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9950195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Calculation in the Medication Arm of the Ocular Hypertension Treatment Study","authors":"Ari Leshno MD ,&nbsp;Carlos Gustavo De Moraes MD, PhD ,&nbsp;George A. Cioffi MD ,&nbsp;Michael Kass MD ,&nbsp;Mae Gordon PhD ,&nbsp;Jeffrey M. Liebmann MD","doi":"10.1016/j.ogla.2023.06.005","DOIUrl":"10.1016/j.ogla.2023.06.005","url":null,"abstract":"<div><h3>Purpose</h3><p>Risk assessment is integral to the management of individuals with ocular hypertension<span> (OHTN). This study aims to determine the predictive accuracy of the Ocular Hypertension Treatment Study 5-year risk calculator (OHTS calculator) among treated patients with OHTN by applying it to patients randomized to the Ocular Hypertension Treatment Study (OHTS) medication arm.</span></p></div><div><h3>Design</h3><p>Post hoc secondary analysis of a randomized clinical trial.</p></div><div><h3>Subjects</h3><p>Individuals participating in the OHTS who were randomized to the medication arm. Only participants with complete baseline data in both eyes were included (n = 726).</p></div><div><h3>Methods</h3><p>The hazard ratios (HRs) of the medication group in OHTS were compared to the HR used for the OHTS calculator using the z-test statistic to establish the OHTS calculator's generalizability to the OHTS medication arm. The performance of the OHTS calculator among the OHTS medication group was evaluated twice, using both untreated baseline intraocular pressure (IOP) and average treated IOP during the first 24 months for the IOP variable.</p></div><div><h3>Main Outcome Measures</h3><p>The performance was determined based on the model’s accuracy in estimating the risk of reaching an OHTS primary open-angle glaucoma (POAG) end point using calibration chi-square and discriminating between participants who did or did not develop POAG.</p></div><div><h3>Results</h3><p>The HRs for the OHTS medication arm were not significantly different from those used in the OHTS calculator for untreated OHTN derived from observation arm data (<em>P</em> &gt; 0.1). Based on the calibration chi-square test for the medication group, the OHTS calculator prediction model had good predictive accuracy when using the mean treated IOP and poorer predictive accuracy with the untreated baseline IOP (chi-square 10 and 29, respectively). The model had good discrimination with treated IOP (c-statistic = 0.77), comparable to what has been reported for the OHTS calculator in the OHTS observation group.</p></div><div><h3>Conclusions</h3><p>The OHTS calculator can be applied to treated patients with OHTN, and repeat risk calculation after initiating IOP reduction may provide useful information that can aid in disease management.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"6 6","pages":"Pages 592-598"},"PeriodicalIF":2.9,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9855163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single Administration of Bimatoprost Implant","authors":"Robert N. Weinreb MD ,&nbsp;William C. Christie MD ,&nbsp;Felipe A. Medeiros MD, PhD ,&nbsp;E. Randy Craven MD ,&nbsp;Kimmie Kim PhD ,&nbsp;Ashley Nguyen PharmD ,&nbsp;Marina Bejanian PhD ,&nbsp;David L. Wirta MD","doi":"10.1016/j.ogla.2023.06.007","DOIUrl":"10.1016/j.ogla.2023.06.007","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate the effects of a single bimatoprost implant administration on 24-hour intraocular pressure (IOP) lowering at 8 weeks, and 1-year IOP-lowering efficacy and safety outcomes.</p></div><div><h3>Design</h3><p>Multicenter, open-label, 12-month, phase 3b study (NCT04285580).</p></div><div><h3>Participants</h3><p>Adults with open-angle glaucoma or ocular hypertension.</p></div><div><h3>Methods</h3><p>Participants (n = 31) received 10-μg bimatoprost implant in the study eye on day 1; IOP (sitting and/or supine) was measured with pneumatonometry every 2 hours throughout a 24-hour period at baseline and week 8. IOP was measured by Goldmann applanation tonometry (GAT) at hour 0 (8 <span>am</span> ± 1 hour) at baseline, weeks 8 and 16, and months 6, 9, and 12.</p></div><div><h3>Main Outcome Measures</h3><p>The primary endpoint was the week-8 hour-matched change from baseline in habitual position IOP over 24 hours assessed with pneumatonometry. Hour 0 IOP change from baseline measured with GAT in study eyes that received no additional (rescue) IOP-lowering treatment, treatment-emergent adverse events (TEAEs), and central corneal endothelial cell density (CECD) were evaluated through 12 months.</p></div><div><h3>Results</h3><p>The mean (standard deviation [SD]) baseline IOP at hour 0 was 24.2 (2.70) mmHg and 25.3 (7.15) mmHg by GAT and pneumatonometry, respectively. Pneumatonometer measurements of IOP taken over 24 hours at week 8 with the participant in habitual position (sitting from 8 <span>am</span> to 10 <span>pm</span>, supine from 12 <span>am</span> to 6 <span>am</span>) showed consistent IOP lowering through the day and night and reduced fluctuation in IOP. The range in IOP measurements over 24 hours was reduced from baseline by a mean (SD) of −1.6 (2.98) mmHg. All 31 bimatoprost implant–treated participants completed the 12-month study; 23 (74%) required no rescue IOP-lowering treatment. The mean (SD) IOP reduction from baseline at month 12 in nonrescued eyes was −4.3 (3.35) mmHg. The most common TEAE was conjunctival hyperemia (incidence 35.5%, 11/31). No implant-treated eye had a ≥ 15% loss in CECD from baseline.</p></div><div><h3>Conclusions</h3><p>A single intracameral administration of the bimatoprost implant lowered IOP in the habitual position consistently throughout the day and night at week 8. The majority of participants continued to have reduced IOP for 1 year without additional therapy. The 1-year safety profile was favorable.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"6 6","pages":"Pages 599-608"},"PeriodicalIF":2.9,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589419623001096/pdfft?md5=686e94a4555220229f1fb387bd84dd22&pid=1-s2.0-S2589419623001096-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9875958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intermediate Outcomes of the Novel 63-μm Gelatin Microstent versus the Conventional 45-μm Gelatin Microstent","authors":"Isra M. Hussein MD, MSc ,&nbsp;Ticiana De Francesco MD ,&nbsp;Iqbal Ike K. Ahmed MD, FRCSC","doi":"10.1016/j.ogla.2023.05.001","DOIUrl":"10.1016/j.ogla.2023.05.001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;p&gt;&lt;span&gt;To determine intermediate intraocular pressure (IOP)-lowering and adverse event profile of the 63-μm gelatin microstent (Xen63) with &lt;/span&gt;mitomycin C (MMC) compared with the 45-μm gelatin microstent (Xen45) with MMC.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;p&gt;Single center, consecutive, retrospective cohort study.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;p&gt;Eighty-four glaucomatous eyes (42 63-μm gelatin microstent and 42 45-μm gelatin microstent) with or without previous subconjunctival glaucoma surgery.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;Consecutive eyes that underwent 63-μm gelatin microstent implantation with MMC from February 2020 to June 2021 were compared with eyes that underwent 45-μm gelatin microstent implantation with MMC. Standalone and combined cases with phacoemulsification were included.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;p&gt;Primary outcome was the hazard ratio of failure of 45-μm gelatin microstent vs. 63-μm gelatin microstent eyes at 12 months, with failure defined as 2 consecutive IOPs, (1) &gt;17 mmHg, (2) &lt;6 mmHg with 2 lines of vision loss&lt;span&gt;, or (3) &lt;20% reduction from baseline IOP, without (complete) or with (qualified) glaucoma medications&lt;span&gt;. Secondary outcomes included IOP thresholds of 14 mmHg and 21 mmHg, postoperative IOP, medications, adverse events, interventions, and reoperations.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;The complete success rate was higher in the 63-μm gelatin microstent group (59.5% vs. 28.6%, &lt;em&gt;P&lt;/em&gt; = 0.009) at the primary IOP threshold of 6 to 17 mmHg but did not differ significantly for qualified success (66.7% vs. 45.2%, &lt;em&gt;P&lt;/em&gt; = 0.08). The crude hazard ratio of failure of 45-μm gelatin microstent relative to 63-μm gelatin microstent was 2.28 (95% confidence interval [CI], 1.21–4.32), and the adjusted hazard ratio was 7.90 (95% CI, 2.12–29.43). 63-μm gelatin microstent eyes had significantly lower mean IOP (12.7 ± 4.8 vs. 15.5 ± 5.1 mmHg, &lt;em&gt;P&lt;/em&gt; = 0.001) and fewer medication classes (0.6 ± 1.1 vs. 1.7 ± 1.6 medications, &lt;em&gt;P&lt;/em&gt; = 0.0005), with the degree of reduction in IOP and medication count being significantly greater in 63-μm gelatin microstent eyes. There were 28 and 21 distinct interventions in 63-μm gelatin microstent and 45-μm gelatin microstent eyes respectively, with 11.9% of eyes undergoing needling in each group. There were 34 and 19 distinct adverse events, in 63-μm gelatin microstent and 45-μm gelatin microstent eyes, respectively, most of which were early and transient. Nine Xen63 eyes (21.4%) and 6 45-μm gelatin microstent eyes (14.3%) underwent reoperation.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;63-μm gelatin microstent resulted in higher surgical success rates and fewer medications compared with 45-μm gelatin microstent. This was tempered by more postoperative interventions and adverse events, although most were transient.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Financial Disclosure(s)&lt;/h3&gt;&lt;p&gt;Proprietary or commercial disclosure may be found i","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"6 6","pages":"Pages 580-591"},"PeriodicalIF":2.9,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10101906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved Prediction of Perimetric Loss in Glaucomatous Eyes Using Latent Class Mixed Modeling","authors":"Swarup S. Swaminathan MD ,&nbsp;Alessandro A. Jammal MD, PhD ,&nbsp;J. Sunil Rao PhD ,&nbsp;Felipe A. Medeiros MD, PhD","doi":"10.1016/j.ogla.2023.05.003","DOIUrl":"10.1016/j.ogla.2023.05.003","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate whether the identification of distinct classes within a population of glaucoma patients improves estimates of future perimetric loss.</p></div><div><h3>Design</h3><p>Longitudinal cohort study.</p></div><div><h3>Participants</h3><p>A total of 6558 eyes of 3981 subjects from the Duke Ophthalmic<span> Registry with ≥ 5 reliable standard automated perimetry (SAP) tests and ≥ 2 years of follow-up.</span></p></div><div><h3>Methods</h3><p>Standard automated perimetry mean deviation (MD) values were extracted with associated timepoints. Latent class mixed models (LCMMs) were used to identify distinct subgroups (classes) of eyes according to rates of perimetric change over time. Rates for individual eyes were then estimated by considering both individual eye data and the most probable class membership for that eye. Data were split into training (80%) and test sets (20%), and test set mean squared prediction errors (MSPEs) were estimated using LCMM and ordinary least squares (OLS) regression.</p></div><div><h3>Main Outcome Measures</h3><p>Rates of change in SAP MD in each class and MSPE.</p></div><div><h3>Results</h3><p>The dataset contained 52 900 SAP tests with an average of 8.1 ± 3.7 tests per eye. The best-fitting LCMM contained 5 classes with rates of −0.06, −0.21, −0.87, −2.15, and +1.28dB/year (80.0%, 10.2%, 7.5%, 1.3%, and 1.0% of the population, respectively) labeled as slow, moderate, fast, catastrophic progressors, and “improvers” respectively. Fast and catastrophic progressors were older (64.1 ± 13.7 and 63.5 ± 16.9 vs. 57.8 ± 15.8, <em>P</em> &lt; 0.001) and had generally mild-moderate disease at baseline (65.7% and 71% vs. 52%, <em>P</em> &lt; 0.001) than slow progressors. The MSPE was significantly lower for LCMM compared to OLS, regardless of the number of tests used to obtain the rate of change (5.1 ± 0.6 vs. 60.2 ± 37.9, 4.9 ± 0.5 vs. 13.4 ± 3.2, 5.6 ± 0.8 vs. 8.1 ± 1.1, 3.4 ± 0.3 vs. 5.5 ± 1.1 when predicting the fourth, fifth, sixth, and seventh visual fields (VFs) respectively; <em>P</em> &lt; 0.001 for all comparisons). MSPE of fast and catastrophic progressors was significantly lower with LCMM versus OLS (17.7 ± 6.9 vs. 48.1 ± 19.7, 27.1 ± 8.4 vs. 81.3 ± 27.1, 49.0 ± 14.7 vs. 183.9 ± 55.2, 46.6 ± 16.0 vs. 232.4 ± 78.0 when predicting the fourth, fifth, sixth, and seventh VFs respectively; <em>P</em> &lt; 0.001 for all comparisons).</p></div><div><h3>Conclusions</h3><p>Latent class mixed model successfully identified distinct classes of progressors within a large glaucoma population that seemed to reflect subgroups observed in clinical practice. Latent class mixed models were superior to OLS regression in predicting future VF observations.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosuremay be found after the references.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"6 6","pages":"Pages 642-650"},"PeriodicalIF":2.9,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9635527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Neighborhood Environment with the Outcomes of Childhood Glaucoma","authors":"Abdelrahman M. Elhusseiny MD, MSc ,&nbsp;Isdin Oke MD ,&nbsp;Jean Adomfeh MD ,&nbsp;Muhammad Z. Chauhan MA, MS ,&nbsp;Deborah K. VanderVeen MD","doi":"10.1016/j.ogla.2023.06.001","DOIUrl":"10.1016/j.ogla.2023.06.001","url":null,"abstract":"<div><h3>Purpose</h3><p>To determine the association between different neighborhood environment factors and the outcomes of childhood glaucoma.</p></div><div><h3>Design</h3><p>A retrospective cohort.</p></div><div><h3>Participants</h3><p>Childhood glaucoma patients ≤ 18 years of age at the time of diagnosis.</p></div><div><h3>Methods</h3><p>A retrospective chart review of childhood glaucoma patients who presented to Boston Children’s Hospital between 2014 and 2019. Data collected included etiology, intraocular pressure (IOP), management, and visual outcomes. Child Opportunity Index (COI) was used as a metric of neighborhood quality.</p></div><div><h3>Main Outcomes Measures</h3><p>The association of visual acuity (VA) and IOP with COI scores using linear mixed-effect models, adjusting for individual demographics.</p></div><div><h3>Results</h3><p><span><span>A total of 221 eyes (149 patients) were included. Of these, 54.36% were male and 56.4% were non-Hispanic Whites. The median age at the time of presentation was 5 months for primary glaucoma and 5 years for </span>secondary glaucoma<span>. The median age at the last follow-up was 6 and 13 years for primary and secondary glaucoma, respectively. A chi-square test revealed that the COI, health and environment, social and economic, and education indexes between primary and secondary glaucoma patients were comparable. For primary glaucoma, the overall COI and a higher education index were associated with a lower final IOP (</span></span><em>P</em><span> &lt; 0.05), and higher education index was associated with a lower number of glaucoma medications at the last follow-up (</span><em>P</em> &lt; 0.05). For secondary glaucoma, higher overall COI, health and environment, social and economic, and education indices were associated with better final VA (lower logarithms of the minimum angle of resolution VA) (<em>P</em> &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>Neighborhood environment quality is a potentially important variable for predicting outcomes in childhood glaucoma. Lower COI scores were associated with worse outcomes.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"6 6","pages":"Pages 636-641"},"PeriodicalIF":2.9,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9780648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Filtering Blebs in a Young Woman","authors":"Sonam Yangzes MS,&nbsp;Faisal Thattaruthody MS,&nbsp;Surinder Singh Pandav MS","doi":"10.1016/j.ogla.2023.08.008","DOIUrl":"10.1016/j.ogla.2023.08.008","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"6 6","pages":"Page 656"},"PeriodicalIF":2.9,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10573059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}