Ophthalmology. Glaucoma最新文献

{"title":"Frontloading SITA-Faster Can Increase Frequency and Reliability of Visual Field Testing at Minimal Time Cost","authors":"Jeremy C.K. Tan MD, FRANZCO ,&nbsp;Michael Kalloniatis PhD ,&nbsp;Jack Phu PhD","doi":"10.1016/j.ogla.2023.03.006","DOIUrl":"10.1016/j.ogla.2023.03.006","url":null,"abstract":"<div><h3>Purpose</h3><p>To report the outcomes of frontloaded visual field (VF) testing (2 tests per eye on the same visit) over 2 longitudinal, consecutive visits using SITA-Faster (SFR) in terms of global indices, reliability metrics, and test duration.</p></div><div><h3>Design</h3><p>Prospective longitudinal study.</p></div><div><h3>Subjects</h3><p>A total of 902 eyes of 463 subjects with normal, suspect, or manifest glaucoma.</p></div><div><h3>Methods</h3><p><span>Two intravisit SFR VF tests (T1 and T2) per eye at an initial (T</span>_i) and follow-up (T_f) visit.</p></div><div><h3>Main Outcome Measures</h3><p>Intra- and intervisit global indices, reliability metrics, and test durations.</p></div><div><h3>Results</h3><p>The mean age of the subjects was 63.6 years, and 58.3% were male. Seven hundred ninety eyes (87.4%) had a diagnosis of glaucoma or glaucoma suspicion. The mean duration between visits was 265.0 (standard deviation 98.8) days. In total, 3608 VF tests were analyzed, with the correlation of mean deviation (MD) values of the frontloaded tests at each visit high (T1/T2 MD correlation at initial visit <em>r</em> = 0.83, root mean squared error [RMSE] = 1.26, follow-up visit <em>r</em> = 0.83, RMSE = 1.25, <em>P</em> &lt; 0.0001) and greater than the correlation of MD between visits (T_i1/T_f1 MD correlation <em>r</em> = 0.72, RMSE = 1.31). There was a significant intra-visit decrease in rates of abnormally high sensitivity in the glaucoma hemifield test (3.2% vs. 1.6%, <em>P</em> = 0.0023) and rates of unreliable test results (15.4% vs. 9.2%, <em>P</em> = 0.002) from T1 to T2 in both visits, with a corresponding significant decrease in MD (–1.28 dB vs. –1.68 dB, <em>P</em> &lt; 0.0001) and VF index (<em>P</em> = 0.03). The mean duration of each SFR test was 132.6 (SD 27.2) seconds.</p></div><div><h3>Conclusions</h3><p>Frontloading VFs using SFR produced sets of repeatable perimetric data with significant improvement of reliability indices from the first to second test. This may help increase testing frequency at minimal time cost to meet recommended guidelines and for evaluating patients prone to high variability.</p></div><div><h3>Financial Disclosure(s)</h3><p>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"6 5","pages":"Pages 445-456"},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9348274","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":"Choroidal Effusions after Glaucoma Drainage Implant Surgery","authors":"Stephanie Ying AB ,&nbsp;Sara J. Coulon MD ,&nbsp;Alcina K. Lidder MD ,&nbsp;Mary Labowsky MD ,&nbsp;Christopher P. Cheng AB ,&nbsp;Kateki Vinod MD ,&nbsp;Paul A. Sidoti MD ,&nbsp;Joseph F. Panarelli MD","doi":"10.1016/j.ogla.2023.03.002","DOIUrl":"https://doi.org/10.1016/j.ogla.2023.03.002","url":null,"abstract":"<div><h3>Objective</h3><p>To report the incidence of patients who developed choroidal effusions after glaucoma drainage implant (GDI) surgery and determine risk factors for and outcomes of surgical intervention.</p></div><div><h3>Design</h3><p>Retrospective case series.</p></div><div><h3>Subjects</h3><p>Medical records of 605 patients who underwent GDI surgery from January 1, 2017 to June 7, 2021 at New York University Langone Health and New York Eye and Ear Infirmary of Mount Sinai were reviewed.</p></div><div><h3>Methods</h3><p>Preoperative, intraoperative, and postoperative clinical data were obtained. Multivariate logistic regression<span><span> evaluated the factors associated with the need for surgical intervention. Patient records were analyzed for effusion resolution, intraocular pressure (IOP), </span>visual acuity<span> (VA), and complications across treatment modalities.</span></span></p></div><div><h3>Main Outcome Measures</h3><p>Incidence of choroidal effusion development and need for surgical intervention.</p></div><div><h3>Results</h3><p><span>Choroidal effusions developed in 110 (18%) patients (110 eyes). Surgical intervention to drain the effusion or ligate the implant tube was performed in 19 (17%) patients. The average time to surgical intervention was 47.6 days. Among patients who developed postoperative effusions, risk factors for requiring surgical intervention included history of selective laser trabeculoplasty (SLT) (</span><em>P</em> = 0.004; odds ratio [OR], 14.4), prior GDI surgery (<em>P</em> = 0.04; OR 8.7), 350-mm²<span> Baerveldt glaucoma implant placement (</span><em>P</em><span> = 0.05; OR, 4.8), and anterior chamber shallowing (AC; </span><em>P</em> &lt; 0.001; OR, 25.1) in the presence of effusions. The subgroup that required multiple surgeries for effusion resolution had a significantly lower mean IOP at the most recent follow-up compared with those who received medical management only (<em>P</em> &lt; 0.001). A higher percentage of patients who required surgical intervention lost VA at the most recent follow-up compared with patients whose effusions resolved with conservative management (i.e., medical management, AC viscoelastic injection).</p></div><div><h3>Conclusions</h3><p>Choroidal effusions after GDI surgery resolved with conservative management in most patients. A history of SLT or GDI placement, implantation of a BGI-350, and the presence of a shallow chamber were risk factors for surgical intervention. Although interventions, such as surgical drainage are at times necessary, a better understanding of their impacts can help guide postoperative decisions. The risks and benefits of these procedures must be carefully considered in these high-risk eyes.</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 5","pages":"Pages 530-540"},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49807023","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":"Comparison of Perimetric Outcomes from a Tablet Perimeter, Smart Visual Function Analyzer, and Humphrey Field Analyzer","authors":"Joyce Kang BA ,&nbsp;Sofia De Arrigunaga MD, MPH ,&nbsp;Sandra E. Freeman BA ,&nbsp;Yan Zhao MS ,&nbsp;Michael Lin MD ,&nbsp;Daniel L. Liebman MD ,&nbsp;Ana M. Roldan MD ,&nbsp;Julia A. Kim BS ,&nbsp;Dolly S. Chang MD, PhD ,&nbsp;David S. Friedman MD, PhD ,&nbsp;Tobias Elze PhD","doi":"10.1016/j.ogla.2023.03.001","DOIUrl":"10.1016/j.ogla.2023.03.001","url":null,"abstract":"<div><h3>Purpose</h3><p>The tablet-based Melbourne Rapid Fields (MRF) visual field (VF) test and the IMOvifa Smart Visual Function Analyzer (SVFA) are portable perimeters that may allow for at-home monitoring and more frequent testing. We compared tablet and SVFA results with outputs from the Humphrey Field Analyzer (HFA) 24-2 Swedish Interactive Threshold Algorithm Standard program.</p></div><div><h3>Design</h3><p>Observational cross-sectional study.</p></div><div><h3>Subjects</h3><p>Adult participants with a diagnosis of glaucoma, suspected glaucoma, or ocular hypertension seen in the Massachusetts Eye and Ear glaucoma clinic were enrolled. All participants were reliable and experienced HFA testers.</p></div><div><h3>Methods</h3><p>Participants were tested with the SVFA and HFA. The study staff also trained participants on the MRF tablet with instructions to take weekly tests at home for 3 months. Visual field results from the 3 devices were compared.</p></div><div><h3>Main Outcome Measures</h3><p>Mean deviation (MD), pattern standard deviation (PSD), reliability parameters, and point sensitivity.</p></div><div><h3>Results</h3><p>Overall, 79 participants (133 eyes) with a mean age of 61 ± 13 years (range, 26–79 years) were included; 59% of the participants were female, and the mean HFA MD was −2.7 ± 3.9 dB. The global indices of MD and PSD did not significantly vary between HFA and the 2 novel devices, except that the tablet VF reported a 0.6 dB higher PSD compared with HFA. However, tablet and SVFA sensitivities significantly differed from those of the HFA at 36 and 39 locations, respectively, out of 52 locations. Relative to HFA, the tablet overestimated light sensitivity in the nasal field while underestimating the temporal field. The SVFA generally underestimated light sensitivity, but its results were more similar to HFA results compared with the tablet.</p></div><div><h3>Conclusions</h3><p>Although average MD values from the 2 novel devices suggest that they provide similar results to the HFA, point-by-point comparisons highlight notable deviations. Differences in specific point sensitivity values were significant, especially between the tablet and the other 2 devices. These differences may in part be explained by differences in the devices' normative databases as well as how MD is calculated. However, the tablet had substantial differences based on location, indicating that the tablet design itself may be responsible for differences in local sensitivities.</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 5","pages":"Pages 509-520"},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10495534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10601675","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":"The Journal Receives Its Initial Impact Factor","authors":"Henry D. Jampel MD, MHS,&nbsp;May B. Piotrowski MA","doi":"10.1016/j.ogla.2023.07.008","DOIUrl":"10.1016/j.ogla.2023.07.008","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"6 5","pages":"Pages 443-444"},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41145240","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":"Evaluating Measurement Properties of Patient-Reported Outcome Measures in Glaucoma","authors":"Anastasiya Vinokurtseva MD ,&nbsp;Matthew P. Quinn MD, PhD ,&nbsp;Mandy Wai BSc ,&nbsp;Victoria Leung BMSc ,&nbsp;Monali Malvankar-Mehta PhD ,&nbsp;Cindy M.L. Hutnik MD, PhD","doi":"10.1016/j.ogla.2023.04.007","DOIUrl":"https://doi.org/10.1016/j.ogla.2023.04.007","url":null,"abstract":"<div><h3>Topic</h3><p>The purpose of the current study was to systematically identify and evaluate existing patient-reported outcome measures (PROMs) for clinical glaucoma practice.</p></div><div><h3>Clinical Relevance</h3><p>Understanding and incorporating patient preferences into decision-making is now recognized as critical for optimal resource allocation, especially in technologically advancing areas, such as minimally invasive surgeries. Patient-reported outcome measures are instruments designed to evaluate the health outcomes that are most important to patients. Despite their recognized importance, especially in the era of patient-centered care, their routine use in clinical settings remains low.</p></div><div><h3>Methods</h3><p>A systematic literature search was conducted in 6 databases (EMBASE, MEDLINE, PsycINFO, Scopus, BIOSIS, and Web of Science) from the date of inception. Studies were included in the qualitative review if they reported measurement properties of PROMs in adult patients with glaucoma. COnsensus-based Standards for the selection of health Measurement INstruments guidelines were used to assess the included PROMs. The study protocol is registered with PROSPERO (registration number: CRD42020176064).</p></div><div><h3>Results</h3><p>The literature search yielded 2661 records. After deduplication, 1259 studies entered level 1 screening, and based on title and abstract review, 164 records proceeded to full-text screening. In 48 included studies, 70 instrument reports discuss 43 distinct instruments in 3 major categories: glaucoma-specific, vision-specific, and general health-related quality of life. Most used measures were glaucoma-specific (Glaucoma Quality of Life [GQL] and Glaucoma Symptom Scale [GSS]) and vision-specific (National Eye Institute Visual Function Questionnaire [NEI VFQ-25]). All 3 have sufficient validity (especially construct), with GQL and GSS having sufficient internal consistency, cross-cultural validity, and reliability, with reports suggesting high methodological quality.</p></div><div><h3>Conclusion</h3><p>The GQL, GSS, and NEI VFQ-25 are the 3 most used questionnaires in a research setting, having considerable validation in a patient population with glaucoma. Limited reports on interpretability, responsiveness, and feasibility in all 43 identified instruments make identifying a single optimal questionnaire for clinical use challenging and highlight the need for further studies.</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 5","pages":"Pages 541-563"},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49807022","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":"Ab Externo SIBS Microshunt with Mitomycin C for Open-Angle Glaucoma","authors":"James J. Armstrong MD, PhD ,&nbsp;Ticiana De Francesco MD ,&nbsp;Jenny Ma MD ,&nbsp;Matthew B. Schlenker MD, MSc ,&nbsp;Iqbal Ike K. Ahmed MD","doi":"10.1016/j.ogla.2023.04.002","DOIUrl":"https://doi.org/10.1016/j.ogla.2023.04.002","url":null,"abstract":"<div><h3>Purpose</h3><p>To determine the effectiveness, risk factors for surgical failure, and adverse events in a large cohort of patients receiving stand-alone ab externo poly(styrene-block-isobutylene-block-styrene) (SIBS) microshunt implantation with mitomycin C (MMC) over 3 years of follow-up.</p></div><div><h3>Design</h3><p>Retrospective, interventional case series.</p></div><div><h3>Participants</h3><p>Glaucomatous eyes on maximally tolerated medical therapy with no previous subconjunctival glaucoma surgery.</p></div><div><h3>Methods</h3><p>Records of eyes that underwent ab externo SIBS microshunt with MMC between July 2015 and November 2017 were reviewed. Data from all follow-up visits were utilized and included intraocular pressure (IOP), medication use, postoperative interventions, complications, and reoperations.</p></div><div><h3>Main Outcome Measures</h3><p>The primary outcome was proportion of eyes at 3 years with (1) no 2 consecutive IOPs &gt; 17 mmHg (or &lt; 6 mmHg with &gt; 2 lines of vision loss from baseline); (2) ≥ 20% reduction from baseline IOP; and (3) using no glaucoma medications (complete success). Secondary outcomes included 14 and 21 mmHg upper IOP thresholds with and without ≥ 20% IOP reduction from baseline, qualified success (with glaucoma medications), risk factors for failure, median IOP/medications, postoperative interventions, complications, and reoperations.</p></div><div><h3>Results</h3><p>One hundred fifty-two eyes from 135 patients were included. Complete and qualified success was achieved in 55.6% and 74.8% of eyes, respectively. Time to first glaucoma medication use was a median of 16.9 (interquartile range [IQR], 12.1–34.1) months; however, 59.4% of eyes remained medication free at 3 years. Significant risk factors for failure included receiving &lt; 0.4 mg/ml of MMC (adjusted hazard ratio [HR], 2.42; 95% confidence interval [CI], 1.44–4.05) and baseline IOP &lt; 21 mmHg (adjusted HR, 1.79; 95% CI, 1.03–3.13). The most common complications were choroidal detachment, hyphema, and anterior chamber shallowing, occurring in 7%, 5%, and 5% of eyes, respectively. The needling rate was 15.1%, with significantly higher frequency for baseline IOP &gt; 21 mmHg (HR, 3.21; 95% CI, 1.38–7.48). Revisions occurred in 7% of eyes and reoperations in 2.6%. Eyes receiving &lt; 0.4 mg/ml of MMC underwent more revisions (odds ratio, 4.9; 95% CI, 1.3–18.3).</p></div><div><h3>Conclusions</h3><p>Three-year follow-up data from this large cohort continues to support promising rates of qualified and complete success, with decreased medication burden postoperatively and few postoperative complications and interventions. Comparisons to other filtering surgeries will further facilitate integration of the SIBS microshunt into the surgical treatment paradigm.</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 5","pages":"Pages 480-492"},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49807042","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":"Forecasting Risk of Future Rapid Glaucoma Worsening Using Early Visual Field, OCT, and Clinical Data","authors":"Patrick Herbert ,&nbsp;Kaihua Hou ,&nbsp;Chris Bradley PhD ,&nbsp;Greg Hager PhD ,&nbsp;Michael V. Boland MD, PhD ,&nbsp;Pradeep Ramulu MD, PhD ,&nbsp;Mathias Unberath PhD ,&nbsp;Jithin Yohannan MD, MPH","doi":"10.1016/j.ogla.2023.03.005","DOIUrl":"10.1016/j.ogla.2023.03.005","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;p&gt;To assess whether we can forecast future rapid visual field (VF) worsening using deep learning models (DLMs) trained on early VF, OCT, and clinical data.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;p&gt;A retrospective cohort study.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Subjects&lt;/h3&gt;&lt;p&gt;In total, 4536 eyes from 2962 patients. Overall, 263 (5.80%) eyes underwent rapid VF worsening (mean deviation slope less than &lt;span&gt;&lt;math&gt;&lt;mrow&gt;&lt;mo&gt;−&lt;/mo&gt;&lt;/mrow&gt;&lt;/math&gt;&lt;/span&gt;1 dB/year across all VFs).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;We included eyes that met the following criteria: (1) followed for glaucoma or suspect status; (2) had at least 5 longitudinal reliable VFs (VF&lt;sub&gt;1&lt;/sub&gt;, VF&lt;sub&gt;2&lt;/sub&gt;, VF&lt;sub&gt;3&lt;/sub&gt;, VF&lt;sub&gt;4&lt;/sub&gt;, and VF&lt;sub&gt;5&lt;/sub&gt;); and (3) had 1 reliable baseline OCT scan (OCT&lt;sub&gt;1&lt;/sub&gt;) and 1 set of baseline clinical measurements (clinical&lt;sub&gt;1&lt;/sub&gt;) at the time of VF&lt;sub&gt;1&lt;/sub&gt;. We designed a DLM to forecast future rapid VF worsening. The input consisted of spatially oriented total deviation values from VF&lt;sub&gt;1&lt;/sub&gt; (including or not including VF&lt;sub&gt;2&lt;/sub&gt; and VF&lt;sub&gt;3&lt;/sub&gt;&lt;span&gt; in some models) and retinal nerve fiber layer thickness values from the baseline OCT. We passed this VF/OCT stack into a vision transformer feature extractor, the output of which was concatenated with baseline clinical data before putting it through a linear classifier to predict the eye’s risk of rapid VF worsening across the 5 VFs. We compared the performance of models with differing inputs by computing area under the curve (AUC) in the test set. Specifically, we trained models with the following inputs: (1) model V: VF&lt;/span&gt;&lt;sub&gt;1&lt;/sub&gt;; (2) VC: VF&lt;sub&gt;1&lt;/sub&gt;+ Clinical&lt;sub&gt;1&lt;/sub&gt;; (3) VO: VF&lt;sub&gt;1&lt;/sub&gt;+ OCT&lt;sub&gt;1&lt;/sub&gt;; (4) VOC: VF&lt;sub&gt;1&lt;/sub&gt;+ Clinical&lt;sub&gt;1&lt;/sub&gt;+ OCT&lt;sub&gt;1&lt;/sub&gt;; (5) V&lt;sub&gt;2&lt;/sub&gt;: VF&lt;sub&gt;1&lt;/sub&gt; + VF&lt;sub&gt;2&lt;/sub&gt;; (6) V&lt;sub&gt;2&lt;/sub&gt;OC: VF&lt;sub&gt;1&lt;/sub&gt; + VF&lt;sub&gt;2&lt;/sub&gt; + Clinical&lt;sub&gt;1&lt;/sub&gt; + OCT&lt;sub&gt;1&lt;/sub&gt;; (7) V&lt;sub&gt;3&lt;/sub&gt;: VF&lt;sub&gt;1&lt;/sub&gt; + VF&lt;sub&gt;2&lt;/sub&gt; + VF&lt;sub&gt;3&lt;/sub&gt;; and (8) V&lt;sub&gt;3&lt;/sub&gt;OC: VF&lt;sub&gt;1&lt;/sub&gt; + VF&lt;sub&gt;2&lt;/sub&gt; + VF&lt;sub&gt;3&lt;/sub&gt; + Clinical&lt;sub&gt;1&lt;/sub&gt; + OCT&lt;sub&gt;1&lt;/sub&gt;.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;p&gt;The AUC of DLMs when forecasting rapidly worsening eyes.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Model V&lt;sub&gt;3&lt;/sub&gt;OC best forecasted rapid worsening with an AUC (95% confidence interval [CI]) of 0.87 (0.77–0.97). Remaining models in descending order of performance and their respective AUC (95% CI) were as follows: (1) model V&lt;sub&gt;3&lt;/sub&gt; (0.84 [0.74–0.95]), (2) model V&lt;sub&gt;2&lt;/sub&gt;OC (0.81 [0.70–0.92]), (3) model V&lt;sub&gt;2&lt;/sub&gt; (0.81 [0.70–0.82]), (4) model VOC (0.77 [0.65–0.88]), (5) model VO (0.75 [0.64–0.88]), (6) model VC (0.75 [0.63–0.87]), and (7) model V (0.74 [0.62–0.86]).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Deep learning models can forecast future rapid glaucoma worsening with modest to high performance when trained using data from early in the disease course. Including baseline data from multiple modalit","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"6 5","pages":"Pages 466-473"},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10509314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9389058","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":"Comparing the Effectiveness of Phacoemulsification + Endoscopic Cyclophotocoagulation Laser versus Phacoemulsification Alone for the Treatment of Primary Open Angle Glaucoma in Patients with Cataract (CONCEPT)","authors":"Tom Sherman FRCOphth ,&nbsp;Ian A.S. Rodrigues FRCOphth ,&nbsp;Saurabh Goyal FRCS, FRCOphth ,&nbsp;Pouya Alaghband MD, FRCOphth ,&nbsp;Philip Bloom FRCS, FRCOphth ,&nbsp;Keith Barton MD, FRCS ,&nbsp;Hari Jayaram PhD, FRCOphth ,&nbsp;Mohammed Abu-Bakra FRCOphth ,&nbsp;Melody Ni PhD ,&nbsp;Kin Sheng Lim MD, FRCOphth","doi":"10.1016/j.ogla.2023.03.004","DOIUrl":"https://doi.org/10.1016/j.ogla.2023.03.004","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the methodology of the Comparing the Effectiveness of Phacoemulsification + Endoscopic Cyclophotocoagulation Laser and Phacoemulsification Alone for the Treatment of Primary Open Angle Glaucoma in Patients with Cataract (CONCEPT) study, a randomized controlled trial.</p></div><div><h3>Design</h3><p>Double-masked, randomized controlled trial.</p></div><div><h3>Subjects, Participants, and/or Controls</h3><p>Participants will be recruited from 5 United Kingdom–based centers. One hundred and sixty eyes with a diagnosis of primary open-angle glaucoma and visually significant cataract will be included. Eighty eyes will be randomized to undergo cataract surgery alone and eighty to undergo cataract surgery with endoscopic cyclophotocoagulation (ECP).</p></div><div><h3>Methods</h3><p>The baseline diurnal washout intraocular pressure (IOP) will be measured. The participants will be randomized to undergo cataract surgery alone or cataract surgery with ECP upon completion of uncomplicated cataract surgery. At the 1- and 2-year post surgery follow-up visits, the measurements of washout diurnal IOP will be repeated.</p></div><div><h3>Main Outcome Measures</h3><p>Diurnal washout IOP, use of glaucoma medications, and adverse events.</p></div><div><h3>Conclusions</h3><p>We described the methodology of the first randomized controlled trial comparing cataract surgery alone with cataract surgery combined with ECP in the context of patients with primary open-angle glaucoma and symptomatic cataract.</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 5","pages":"Pages 474-479"},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49807021","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":"Evaluating Discrepancies in Self-Reported Glaucoma and Electronic Health Records in the National Institutes of Health All of Us Database","authors":"Megan E. Paul BA ,&nbsp;Victoria L. Tseng MD, PhD ,&nbsp;Ken Kitayama MD, MPH ,&nbsp;Fei Yu PhD ,&nbsp;Anne L. Coleman MD, PhD","doi":"10.1016/j.ogla.2023.03.003","DOIUrl":"10.1016/j.ogla.2023.03.003","url":null,"abstract":"<div><h3>Purpose</h3><p>Patient understanding of glaucoma diagnosis is critical for disease management and it is unclear if there are racial/ethnic differences in this regard. The purpose of this study was to determine the level of agreement between glaucoma diagnosis by self-report and electronic health record (EHR) data using the National Institute of Health’s “All of Us (AoU)” database and to examine the association between race/ethnicity and discordance of glaucoma diagnosis between self-report and EHR data.</p></div><div><h3>Design</h3><p>Cross-sectional study.</p></div><div><h3>Participants</h3><p>Individuals in AoU who answered a survey question about glaucoma diagnosis and had EHR data availability.</p></div><div><h3>Methods</h3><p>The agreement between self-reported glaucoma and EHR data was estimated using Cohen’s κ coefficient<span>. Multivariable logistic regression<span> was performed, adjusting for age, sex, education level, income, and health care literacy, to examine the associations between race/ethnicity and discordance between self-reported glaucoma and EHR diagnosis.</span></span></p></div><div><h3>Main Outcome Measures</h3><p>Agreement between self-reported glaucoma and EHR diagnosis.</p></div><div><h3>Results</h3><p>Of all 87 782 individuals, 1985 (2.26%) had both self-reported and EHR glaucoma, 81 781 (92.16%) had no glaucoma, 2022 (2.31%) individuals had EHR-only glaucoma, and 1994 (2.27%) had self-report-only glaucoma (Cohen’s κ = 0.47). In the multivariable regression, Black or African American (adjusted odds ratio [aOR], 1.67; 95% confidence interval [CI], 1.40–1.98), Asian (aOR, 2.63; 95% CI, 1.97–3.44), and Hispanic or Latino (aOR, 1.63; 95% CI, 1.33–1.99) individuals were more likely to have EHR-only glaucoma than White individuals. Additionally, Black or African American (aOR, 2.30; 95% CI, 1.97–2.67) and Hispanic or Latino individuals (aOR,1.47; 95% CI, 1.21–1.79) were more likely to have self-report–only glaucoma compared with White individuals.</p></div><div><h3>Conclusions</h3><p>In the AoU database, we found that Black or African American and Hispanic or Latino individuals had higher odds of discordance between glaucoma diagnosis by self-report and EHR. Future studies are needed to examine the issues leading to this discordance, such as a lack of patient understanding regarding their diagnosis or a lack of culturally appropriate physician explanation/teaching.</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 5","pages":"Pages 521-529"},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9305853","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":"Intraocular Pressure and Rates of Macular Thinning in Glaucoma","authors":"Abia Ahmed BSc ,&nbsp;Alessandro A. Jammal MD, PhD ,&nbsp;Tais Estrela MD ,&nbsp;Samuel I. Berchuck PhD ,&nbsp;Felipe A. Medeiros MD, PhD","doi":"10.1016/j.ogla.2023.03.008","DOIUrl":"10.1016/j.ogla.2023.03.008","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate the effect of intraocular pressure<span> (IOP) on the rates of macular thickness (ganglion cell layer [GCL] and ganglion cell–inner plexiform layer [GCIPL]) change over time measured by spectral-domain (SD) OCT.</span></p></div><div><h3>Design</h3><p>Retrospective cohort study.</p></div><div><h3>Participants</h3><p>Overall, 451 eyes of 256 patients with primary open-angle glaucoma.</p></div><div><h3>Methods</h3><p><span>Data were extracted from the Duke Ophthalmic Registry, a database of </span>electronic medical records of patients observed under routine clinical care at the Duke Eye Center, and satellite clinics. All records from patients with a minimum of 6 months of follow-up and at least 2 good-quality Spectralis SD-OCT macula scans were included. Linear mixed models were used to investigate the relationship between average IOP during follow-up and rates of GCL and GCIPL thickness change over time.</p></div><div><h3>Main Outcome Measures</h3><p>The effect of IOP on the rates of GCL and GCIPL thickness loss measured by SD-OCT.</p></div><div><h3>Results</h3><p>Eyes had a mean follow-up of 1.8 ± 1.3 years, ranging from 0.5 to 10.2 years. The average rate of change for GCL thickness was −0.220 μm/year (95% confidence interval [CI], −0.268 to −0.172 μm/year) and for GCIPL thickness was −0.231 μm/year (95% CI, −0.302 to −0.160 μm/year). Each 1-mmHg higher mean IOP during follow-up was associated with an additional loss of −0.021 μm/year of GCL thickness (<em>P</em> = 0.001) and −0.032 μm/year of GCIPL thickness (<em>P</em> = 0.001) after adjusting for potentially confounding factors, such as baseline age, disease severity, sex, race, central corneal thickness, and follow-up time.</p></div><div><h3>Conclusions</h3><p>Higher IOP was significantly associated with faster rates of GCL and GCIPL loss over time measured by SD-OCT, even during relatively short follow-up times. These findings support the use of SD-OCT GCL and GCIPL thickness measurements as structural biomarkers for the evaluation of the efficacy of IOP-lowering therapies in slowing down the progression of glaucoma.</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 5","pages":"Pages 457-465"},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10523920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9414553","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}