Ophthalmology. Glaucoma最新文献

{"title":"The Robison D. Harley, MD Childhood Glaucoma Research Network International Pediatric Glaucoma Registry","authors":"Stephanie R. Beldick MD, MSc , Adam Rockter BS , Allen D. Beck MD , Alex V. Levin MD, MHSc","doi":"10.1016/j.ogla.2024.10.001","DOIUrl":"10.1016/j.ogla.2024.10.001","url":null,"abstract":"<div><h3>Purpose</h3><div>To report on epidemiologic data from an international, centralized pediatric glaucoma database of 872 patients, focusing on genetic and clinically significant factors.</div></div><div><h3>Design</h3><div>Database study utilizing retrospective analysis.</div></div><div><h3>Subjects</h3><div>Eight hundred seventy-two children, both female and male, were included in the database. After accounting for database coding errors, data from 865 patients with pediatric glaucoma were analyzed. Number of eyes analyzed fluctuated for each variable.</div></div><div><h3>Methods</h3><div>The registry is an open access, no charge, Research Electronic Data Capture database. Participating clinical centers input data with local Institutional Review Board approval and subsequently have access for research purposes. We retrospectively reviewed 872 patients, comparing demographics, family history, country, disease presentation, and Childhood Glaucoma Research Network diagnoses. Analyses for each variable were conducted in SPSS Software v.28.0. Chi-square analyses were performed for nominal data, and ordinal and continuous data were analyzed using Mann–Whitney test, analysis of variance, or Kruskal–Wallis tests with multiple comparisons.</div></div><div><h3>Main Outcome Measures</h3><div>Childhood Glaucoma Research Network glaucoma type and markers of clinical severity by country (laterality, cup-to-disc ratio [CTD], corneal diameter, opacification, edema; visual acuity [VA], intraocular pressure, Haab striae, axial length).</div></div><div><h3>Results</h3><div>Twenty clinical sites from 10 countries entered data. Centers in the USA, India, and Iran input the most data. In the USA, open-angle glaucoma following cataract surgery was most common, while in India and Iran it was primary congenital glaucoma neonatal onset. Bilateral disease was more frequent in India and Iran compared to the USA (X<sup>2</sup> = 50.6, <em>P</em> < 0.001). Clinical measures of severity were typically worse in India compared to the USA. This included increased CTD (X<sup>2</sup> = 24.0, <em>P</em> = 0.002), increased corneal diameter (X<sup>2</sup> = 8.9, <em>P</em> = 0.01), presence of corneal opacification (X<sup>2</sup> = 10.7, <em>P</em> = 0.001), presence of corneal edema (X<sup>2</sup> = 11.7, <em>P</em> < 0.001), and worse VA (<em>U</em> = 873.5, <em>P</em> < 0.001). Intraocular pressure and presence of Haab striae were not associated with country (<em>P</em> > 0.05), while axial length was increased in the USA by an average of 1.04 mm (<em>U</em> = 5787, <em>P</em> = 0.002).</div></div><div><h3>Conclusions</h3><div>This registry has potential to advance our understanding of pediatric glaucoma. Differences in family history, disease presentation, and glaucoma type suggest unique country phenotypes. Registry expansion may allow for insight into best practices for pediatric glaucoma.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or c","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 2","pages":"Pages 175-180"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402133","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":"ChatGPT for Addressing Patient-centered Frequently Asked Questions in Glaucoma Clinical Practice","authors":"Henrietta Wang MPH ,&nbsp;Katherine Masselos MBBS, FRANZCO ,&nbsp;Janelle Tong PhD ,&nbsp;Heather R.M. Connor PhD ,&nbsp;Janelle Scully BOptom ,&nbsp;Sophia Zhang BOptom(Hons) ,&nbsp;Daniel Rafla MPhil ,&nbsp;Matteo Posarelli MD ,&nbsp;Jeremy C.K. Tan MD, FRANZCO ,&nbsp;Ashish Agar MBBS, FRANZCO ,&nbsp;Michael Kalloniatis MScOptom, PhD ,&nbsp;Jack Phu MPH, PhD","doi":"10.1016/j.ogla.2024.10.005","DOIUrl":"10.1016/j.ogla.2024.10.005","url":null,"abstract":"<div><h3>Purpose</h3><div>Large language models such as ChatGPT-3.5 are often used by the public to answer questions related to daily life, including health advice. This study evaluated the responses of ChatGPT-3.5 in answering patient-centered frequently asked questions (FAQs) relevant in glaucoma clinical practice.</div></div><div><h3>Design</h3><div>Prospective cross-sectional survey.</div></div><div><h3>Participants</h3><div>Expert graders.</div></div><div><h3>Methods</h3><div>Twelve experts across a range of clinical, education, and research practices in optometry and ophthalmology. Over 200 patient-centric FAQs from authoritative professional society, hospital and advocacy websites were distilled and filtered into 40 questions across 4 themes: definition and risk factors, diagnosis and testing, lifestyle and other accompanying conditions, and treatment and follow-up. The questions were individually input into ChatGPT-3.5 to generate responses. The responses were graded by the 12 experts individually.</div></div><div><h3>Main Outcome Measures</h3><div>A 5-point Likert scale (1 = strongly disagree; 5 = strongly agree) was used to grade ChatGPT-3.5 responses across 4 domains: coherency, factuality, comprehensiveness, and safety.</div></div><div><h3>Results</h3><div>Across all themes and domains, median scores were all 4 (“agree”). Comprehensiveness had the lowest scores across domains (mean 3.7 ± 0.9), followed by factuality (mean 3.9 ± 0.9) and coherency and safety (mean 4.1 ± 0.8 for both). Examination of the individual 40 questions showed that 8 (20%), 17 (42.5%), 24 (60%), and 8 (20%) of the questions had average scores below 4 (i.e., below \"agree\") for the coherency, factuality, comprehensiveness, and safety domains, respectively. Free-text comments by the experts highlighted omissions of facts and comprehensiveness (e.g., secondary glaucoma) and remarked on the vagueness of some responses (i.e., that the response did not account for individual patient circumstances).</div></div><div><h3>Conclusions</h3><div>ChatGPT-3.5 responses to FAQs in glaucoma were generally agreeable in terms of coherency, factuality, comprehensiveness, and safety. However, areas of weakness were identified, precluding recommendations for routine use to provide patients with tailored counseling in glaucoma, especially with respect to development of glaucoma and its management.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 2","pages":"Pages 157-166"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482080","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":"Distribution of Port-Wine Birthmarks and Glaucoma Outcomes in Sturge-Weber Syndrome","authors":"Daniel M. Vu MD ,&nbsp;Harald Gjerde MD, FRCSC ,&nbsp;Abdelrahman M. Elhusseiny MD, MSc ,&nbsp;Isdin Oke MD, MPH ,&nbsp;Deborah K. VanderVeen MD","doi":"10.1016/j.ogla.2024.10.007","DOIUrl":"10.1016/j.ogla.2024.10.007","url":null,"abstract":"<div><h3>Purpose</h3><div>To identify which features of Sturge-Weber syndrome (SWS) were most associated with glaucoma onset, severity, and treatment failure at a tertiary care center.</div></div><div><h3>Design</h3><div>Retrospective cross-sectional study.</div></div><div><h3>Subjects</h3><div>Children who had SWS with and without glaucoma.</div></div><div><h3>Methods</h3><div>Electronic health records were reviewed for all children with SWS presenting between 2014 and 2020. Examination and imaging findings from dermatology, neurology, and ophthalmology were collected. Logistic regression was used to identify factors associated with glaucoma-related outcomes.</div></div><div><h3>Main Outcome Measures</h3><div>Primary outcomes included glaucoma development, progression to surgery, and treatment failure. Failure was defined as having a final intraocular pressure &gt;21 mmHg, devastating complication, or ≤20/200 vision.</div></div><div><h3>Results</h3><div>Twenty-three of 44 SWS patients (52.3%) developed glaucoma, and 6 of 23 patients (26.1%) had both eyes affected. Sixteen of 29 eyes (55.2%) required surgery, and 29.6% overall met our failure criteria (mean follow-up: 5.1 ± 4.3 years). Glaucoma diagnosis was associated with bilateral port-wine birthmarks (PWBs; odds ratio [OR] 5.9; 95% confidence interval [CI] 1.3–43.2), PWB with any lower eyelid involvement (OR 9.7, 95% CI 2.6–44.5), and choroidal hemangiomas (OR 3.8, 95% CI 1.1–13.8), but was not associated with upper eyelid or leptomeningeal angiomas, seizures, prior hemispherectomy, or pulsed-dye laser. Eyes that progressed to surgery were more likely to have PWB affecting the lower eyelid (OR 33.7, 95% CI 4.5–728.0). No clinical or demographic factors were associated with treatment failure. In most cases, angle surgery failed (72.7%) but was a temporizing measure before subconjunctival filtering surgery.</div></div><div><h3>Conclusions</h3><div>Lower eyelid and choroidal angiomas were associated with glaucoma diagnosis, suggesting a spatial relationship with SWS findings. However, leptomeningeal angiomas were not associated, possibly because these are further from the eye.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 2","pages":"Pages 181-187"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513896","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":"Enhancing Detection of Glaucoma Progression","authors":"Maryam Ashrafkhorasani MD ,&nbsp;Sajad Besharati MD ,&nbsp;Vahid Mohammadzadeh MD ,&nbsp;Jane Zou BS ,&nbsp;Judy Figueroa BS ,&nbsp;Masood Mohammadi MD ,&nbsp;Kouros Nouri-Mahdavi MD, MS","doi":"10.1016/j.ogla.2024.11.004","DOIUrl":"10.1016/j.ogla.2024.11.004","url":null,"abstract":"<div><h3>Purpose</h3><div>To test the hypothesis that a summary index derived from the central 12 points of the 24-2 visual field (12-point mean deviation [MD12]) could provide complementary information to that provided by the 24-2 visual field (VF) mean deviation (24-2 MD).</div></div><div><h3>Design</h3><div>Longitudinal observational study.</div></div><div><h3>Participants</h3><div>One hundred twenty-five eyes (125 patients) with central damage or moderate to severe glaucoma from the Advanced Glaucoma Progression Study with ≥ 4 pairs of 10-2 and 24-2 Swedish Interactive Thresholding Algorithm standard VFs.</div></div><div><h3>Methods</h3><div>Baseline 10-2 and 24-2 VF dates were within 6 months, and the remaining pairs of VF tests were done in the same session. The MD12 index was calculated by averaging total deviation values from the central 12 points of 24-2 VF. Simple linear regression of MD against time was used to estimate 24-2 MD, 10-2 MD, and MD12 rates of change (RoC). Progression at the final follow-up visit was defined as a RoC &lt; 0 dB/year with <em>P</em> &lt; 0.05 for any summary index with confirmation.</div></div><div><h3>Main Outcome Measures</h3><div>Proportion of progressing eyes based on 24-2 MD, 10-2 MD, and MD12 RoC.</div></div><div><h3>Results</h3><div>The average (standard deviation) baseline 24-2 and 10-2 MD were −9.0 ± 6.2 and −8.5 ± 5.4 dB, respectively. The mean follow-up time was 5.7 (±1.6) years. The three summary indices were highly correlated at baseline: r = 0.62 (95% confidence interval: 0.52–0.74) between 10-2 MD and 24-2 MD, 0.84 (95% confidence interval: 0.78–0.90) between MD12 and 24-2 MD, and 0.86 (95% confidence interval: 0.80–0.92) between 10-2 MD and MD12. The corresponding correlations between RoC were weaker: r = 0.41 (95% confidence interval: 0.37–0.45), 0.80 (95% confidence interval: 0.78–0.82), and 0.49 (95% confidence interval: 0.45–0.53). Glaucoma progression was detected in 29 (23.2%), 22 (17.6%), and 23 eyes (18.4%) based on the 24-2, 10-2, and MD12 RoC, respectively; 7 eyes (9.6%) exhibited progression based on MD12 RoC and not with 24-2 MD; only 3 of these eyes progressed according to 10-2.</div></div><div><h3>Conclusions</h3><div>MD12 RoC and detection rates have a low level of agreement with those of 10-2 and hence do not replace the need for 10-2 VF MD to monitor central damage.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 2","pages":"Pages 117-125"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633612","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":"Should We Use Disposable Tonometers and Gonioprisms in the Office?","authors":"Emily M. Schehlein MD,&nbsp;Alan L. Robin MD","doi":"10.1016/j.ogla.2024.09.004","DOIUrl":"10.1016/j.ogla.2024.09.004","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 2","pages":"Pages 109-111"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585380","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":"Analysis of Legal Verbiage in State Legislation for Insurer Coverage of Early Eyedrop Refills in the United States","authors":"Nicole N. Chamberlain MD ,&nbsp;J. Kevin McKinney MD ,&nbsp;Lydia Yang BA ,&nbsp;Wisam Najdawi BS ,&nbsp;Patrick B. Barlow PhD ,&nbsp;Andrew E. Pouw MD","doi":"10.1016/j.ogla.2024.11.003","DOIUrl":"10.1016/j.ogla.2024.11.003","url":null,"abstract":"<div><h3>Purpose</h3><div>State laws on early eyedrop refills, implemented to help patients obtain their medications when they run out early, have many inconsistencies possibly impacting their efficacy and functionality. This study sought to examine different state laws and elucidate unique features and commonalities that may influence their effectiveness.</div></div><div><h3>Design</h3><div>A review of all state legislation to date regarding early eyedrop refills was performed.</div></div><div><h3>Participants</h3><div>All 50 states were included, with an in-depth review of the 33 states that had early eyedrop refill legislation.</div></div><div><h3>Methods</h3><div>The law database Nexis Uni (formerly LexisNexis) and each state’s individual law code site were used to identify relevant laws (or proposed legislation) using keywords such as “eyedrop,” “eye,” “refill,” and “early.” Political data based on the year these laws were passed were obtained from the National Governor’s Association and National Conference of State Legislatures. These data were aggregated and analyzed using descriptive statistics.</div></div><div><h3>Main Outcome Measures</h3><div>State law wording was analyzed for percentage of dosage period passed, days passed, and other requirements.</div></div><div><h3>Results</h3><div>Of the 33 states with early eyedrop refill laws, 14 were only days based, 8 were only percentage based, 4 had both, 4 had neither percentage nor days criteria, and 3 had neither but cited Centers for Medicare and Medicaid Services guidelines. These laws were passed between 2009 and 2023, with a notable increase from 2014 to 2018, rising from 10 to 29 states. Regionally, the Northeast had the highest adoption rate (88%), followed by the West (77%), the South (56%), and the Midwest (50%). Political climates varied: 14 states had Republican control, 2 had Democratic control, and 17 had mixed party control. Of the 17 states without an early eyedrop refill law 4 attempted passage but were not put into law for various reasons with the other 13 not appearing to have had any attempts at law passage.</div></div><div><h3>Conclusions</h3><div>State laws providing coverage for early eyedrop refills vary in terms of verbiage and requirements necessary to obtain a covered early eyedrop refill. Region, political climate, and year appear to play minor roles in early eyedrop refill verbiage and passage.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 2","pages":"Pages 199-205"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633600","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":"Celebrating the 40th Anniversary of the American Glaucoma Society: Yesterday, Today, and Tomorrow","authors":"Carla J. Siegfried MD,&nbsp;Gregory L. Skuta MD","doi":"10.1016/j.ogla.2024.12.003","DOIUrl":"10.1016/j.ogla.2024.12.003","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 1","pages":"Pages 1-3"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024850","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 Surgery SOS: Emergency Department Utilization Greater among Younger and First-Time Surgical Patients with Glaucoma","authors":"Andrew W. Gross MD,&nbsp;Sahil Aggarwal MD,&nbsp;Jay K. Rathinavelu MD,&nbsp;Sandra S. Stinnett DrPH,&nbsp;Leon W. Herndon MD","doi":"10.1016/j.ogla.2024.09.001","DOIUrl":"10.1016/j.ogla.2024.09.001","url":null,"abstract":"<div><h3>Purpose</h3><div>To describe the frequency, findings, and interventions of patients’ emergency department (ED) visits after all types of glaucoma surgery</div></div><div><h3>Design</h3><div>Retrospective cohort study</div></div><div><h3>Subjects</h3><div>All surgical patients with glaucoma between 2013 and 2021</div></div><div><h3>Methods</h3><div>This single institution study collected demographics, surgery type, and surgical parameters for each patient. Subsequently, for those visiting the ED within 50 days of surgery, data were collected on reason for visit, findings, and ophthalmic intervention. Logistic regression models were used to determine the odds of ED visits based on multiple risk factors.</div></div><div><h3>Main Outcome Measures</h3><div>Postoperative presentation to ED</div></div><div><h3>Results</h3><div>Among 9155 surgeries in 5505 patients, 5.7% had ED visits within 50 days, with 46.3% having ocular complaints. Patients with ocular diagnoses presented earlier than those without (<em>P</em> &lt; 0.001). Patients who presented to the ED with an ocular diagnosis were found to be significantly younger than those who did not present (62.2 ± 18.6 vs. 65.4 ± 18.0 years old, <em>P</em> &lt; 0.028). Furthermore, white patients were more likely than Black patients to present with an ocular diagnosis compared to a nonocular diagnosis (odds ratio [OR]: 2.64; 95% confidence interval [CI], 1.67–4.18; <em>P</em> &lt; 0.001). Patients undergoing their first glaucoma surgery had a much higher chance of presenting to the ED compared to patients who had undergone more than one surgery (OR: 3.75; 95% CI, 2.74–5.14; <em>P</em> &lt; 0.001). Those who underwent traditional surgeries were more likely than patients with trabecular meshwork bypass stent to present to the ED with an ocular diagnosis (OR: 3.02; 95% CI, 1.29–7.08; <em>P</em> = 0.011). Filtering surgeries and glaucoma drainage device (GDD) revisions exhibited more vision-threatening conditions than GDDs (<em>P</em> = 0.037 and <em>P</em> = 0.010 respectively). Ophthalmology consultation was sought for 88.0% of ocular diagnoses. Most received medical therapy (71.0%), primarily intraocular pressure-lowering drops.</div></div><div><h3>Conclusion</h3><div>Emergency department visits after glaucoma surgery are infrequent, yet more often seen in younger patients or those undergoing their first glaucoma surgery. Trabecular meshwork bypass stent, but not trabecular meshwork excision and/or Schlemm canal dilation, were less likely to present to the ED than traditional surgeries. Filtering surgeries and tube revisions presented more often with visual threatening conditions.</div></div><div><h3>Financial Disclosures</h3><div>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 1","pages":"Pages 37-45"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302069","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":"Gap Analysis of Glaucoma Examination Concept Representations within Standard Systemized Nomenclature of Medicine – Clinical Terms","authors":"Shahin Hallaj MD ,&nbsp;Anthony P. Khawaja PhD, FRCOphth ,&nbsp;Ian A.S. Rodrigues FRCOphth ,&nbsp;Michael V. Boland MD, PhD ,&nbsp;Eric N. Brown MD, PhD ,&nbsp;Aiyin Chen MD ,&nbsp;Brian C. Stagg MD, MS ,&nbsp;Joshua D. Stein MD, MS ,&nbsp;Catherine Q. Sun MD ,&nbsp;Anne-Laure Mahe-Cook MBBS, BS ,&nbsp;Swarup S. Swaminathan MD ,&nbsp;Sophia Y. Wang MD, MS ,&nbsp;Benjamin Y. Xu MD, PhD ,&nbsp;Robert N. Weinreb MD ,&nbsp;Sally L. Baxter MD, MSc","doi":"10.1016/j.ogla.2024.08.001","DOIUrl":"10.1016/j.ogla.2024.08.001","url":null,"abstract":"<div><h3>Objective/Purpose</h3><div>Standardization of eye care data is important for clinical interoperability and research. We aimed to address gaps in the representations of glaucoma examination concepts within Systemized Nomenclature of Medicine – Clinical Terms (SNOMED-CT), the preferred terminology of the American Academy of Ophthalmology.</div></div><div><h3>Design</h3><div>Study of data elements.</div></div><div><h3>Methods</h3><div>Structured eye examination data fields from 2 electronic health records (EHR) systems (Epic Systems and Medisoft) were compared against existing SNOMED-CT codes for concepts representing glaucoma examination findings. Glaucoma specialists from multiple institutions were surveyed to identify high-priority gaps in representation, which were discussed among the SNOMED International Eye Care Clinical Reference Group. Proposals for new codes to address the gaps were formulated and submitted for inclusion in SNOMED-CT.</div></div><div><h3>Main Outcome Measures</h3><div>Gaps in SNOMED-CT glaucoma examination concept representations.</div></div><div><h3>Results</h3><div>We identified several gaps in SNOMED-CT regarding glaucoma examination concepts. A survey of glaucoma specialists identified high-priority data elements within the categories of tonometry and gonioscopy. For tonometry, there was consensus that we need to define new codes related to maximum intraocular pressure (IOP) and target IOP and delineate all methods of measuring IOP. These new codes were proposed and successfully added to SNOMED-CT for future use. Regarding gonioscopy, the current terminology did not include the ability to denote the gonioscopic grading system used (e.g., Shaffer or Spaeth), degree of angle pigmentation, iris configuration (except for plateau iris), and iris approach. There was also no ability to specify eye laterality or angle quadrant for gonioscopic findings. We proposed a framework for representing gonioscopic findings as observable entities in SNOMED-CT.</div></div><div><h3>Conclusion</h3><div>There are existing gaps in the standardized representation of findings related to tonometry and gonioscopy within SNOMED-CT. These are important areas for evaluating clinical outcomes and enabling secondary use of EHR data for glaucoma research. This international multi-institutional collaborative process enabled identification of gaps, prioritization, and development of data standards to address these gaps. Addressing these gaps and augmenting SNOMED-CT coverage of glaucoma examination findings could enhance clinical documentation and future research efforts related to glaucoma.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 1","pages":"Pages 83-91"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989621","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":"Diagnostic Performance of the Offline Medios Artificial Intelligence for Glaucoma Detection in a Rural Tele-Ophthalmology Setting","authors":"Swati Upadhyaya MD ,&nbsp;Divya Parthasarathy Rao MS ,&nbsp;Srinivasan Kavitha MS ,&nbsp;Shonraj Ballae Ganeshrao PhD ,&nbsp;Kalpa Negiloni PhD ,&nbsp;Shreya Bhandary BOpt ,&nbsp;Florian M. Savoy MSc ,&nbsp;Rengaraj Venkatesh MD","doi":"10.1016/j.ogla.2024.09.002","DOIUrl":"10.1016/j.ogla.2024.09.002","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;This study assesses the diagnostic efficacy of offline Medios Artificial Intelligence (AI) glaucoma software in a primary eye care setting, using nonmydriatic fundus images from Remidio's Fundus-on-Phone (FOP NM-10). Artificial intelligence results were compared with tele-ophthalmologists' diagnoses and with a glaucoma specialist's assessment for those participants referred to a tertiary eye care hospital.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Prospective cross-sectional study&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Three hundred three participants from 6 satellite vision centers of a tertiary eye hospital.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;At the vision center, participants underwent comprehensive eye evaluations, including clinical history, visual acuity measurement, slit lamp examination, intraocular pressure measurement, and fundus photography using the FOP NM-10 camera. Medios AI-Glaucoma software analyzed 42-degree disc-centric fundus images, categorizing them as normal, glaucoma, or suspect. Tele-ophthalmologists who were glaucoma fellows with a minimum of 3 years of ophthalmology and 1 year of glaucoma fellowship training, masked to artificial intelligence (AI) results, remotely diagnosed subjects based on the history and disc appearance. All participants labeled as disc suspects or glaucoma by AI or tele-ophthalmologists underwent further comprehensive glaucoma evaluation at the base hospital, including clinical examination, Humphrey visual field analysis, and OCT. Artificial intelligence and tele-ophthalmologist diagnoses were then compared with a glaucoma specialist's diagnosis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Sensitivity and specificity of Medios AI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Out of 303 participants, 299 with at least one eye of sufficient image quality were included in the study. The remaining 4 participants did not have sufficient image quality in both eyes. Medios AI identified 39 participants (13%) with referable glaucoma. The AI exhibited a sensitivity of 0.91 (95% confidence interval [CI]: 0.71–0.99) and specificity of 0.93 (95% CI: 0.89–0.96) in detecting referable glaucoma (definite perimetric glaucoma) when compared to tele-ophthalmologist. The agreement between AI and the glaucoma specialist was 80.3%, surpassing the 55.3% agreement between the tele-ophthalmologist and the glaucoma specialist amongst those participants who were referred to the base hospital. Both AI and the tele-ophthalmologist relied on fundus photos for diagnoses, whereas the glaucoma specialist's assessments at the base hospital were aided by additional tools such as Humphrey visual field analysis and OCT. Furthermore, AI had fewer false positive referrals (2 out of 10) compared to the tele-ophthalmologist (9 out of 10).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Medios offline AI exhibited promising sensitivity and specificity in detecting referable glaucoma from remote vision centers in southern I","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 1","pages":"Pages 28-36"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302068","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}