Ophthalmology. Glaucoma最新文献

{"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":"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":"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}

{"title":"Ophthalmological Examination and Imaging Features that Better Predict Risk of Angle Closure in Siblings","authors":"Shwetha Mudalegundi BS ,&nbsp;Aleksandra Mihailovic ScM ,&nbsp;Louay Almidani MD, MSc ,&nbsp;Elizabeth C. Ciociola MD ,&nbsp;Nazlee Zebardast MD, MS ,&nbsp;Sharmila Rajendrababu MD ,&nbsp;Mohideen Abdul Kader MD ,&nbsp;Ganesh V. Raman MD ,&nbsp;Venkatesh Rengaraj MD ,&nbsp;Kavitha Srinivasan MD ,&nbsp;Pradeep Y. Ramulu MD, PhD","doi":"10.1016/j.ogla.2024.09.003","DOIUrl":"10.1016/j.ogla.2024.09.003","url":null,"abstract":"<div><h3>Objective</h3><div>Characteristics of individuals with angle closure may be useful in targeted screening of family members. Here, we assess if findings gathered during examination and imaging of patients with a known angle-closure diagnosis (probands) could better determine the risk of angle closure in the patients’ siblings.</div></div><div><h3>Design</h3><div>Cross-sectional study of patients with known angle closure and their siblings.</div></div><div><h3>Participants</h3><div>South Indian patients (probands) 30 years and older with open angles, primary angle-closure suspect (PACS), or primary angle closure/primary angle-closure glaucoma (PAC/PACG) and a biological sibling age 30 years or older (<em>n</em> = 292 proband/sibling pairs).</div></div><div><h3>Methods</h3><div>Demographic data, relevant ocular history, and a comprehensive ophthalmic examination with anterior segment OCT (AS-OCT) were obtained. Three clinically relevant models were created to analyze the contribution of specific proband factors in predicting sibling angle-closure diagnosis, using demographic (age, sex), ocular examination (gonioscopy, optic nerve examination, visual acuity, intraocular pressure), and AS-OCT features to improve prediction beyond proband diagnosis alone evaluated by log likelihood ratio testing and statistical comparison of receiver operating characteristics (ROCs).</div></div><div><h3>Main Outcome Measures</h3><div>Sibling angle-closure diagnostic accuracy.</div></div><div><h3>Results</h3><div>Demographic and ocular examination metrics did not improve the prediction of sibling angle closure for all 3 outcomes (sibling diagnosis: (1) PACS/PAC/PACG vs. OA, (2) PAC/PACG vs. PACS/OA, and (3) PAC/PACG vs. PACS), adding no model improvement when compared to diagnosis alone. Models adding AS-OCT metrics to the prior model including proband diagnosis, demographics, and ocular examination measures led to significantly improved prediction of 2 of the 3 angle-closure outcomes. Specifically, improvement was noted via likelihood ratio testing for prediction of PAC/PACG vs. PACS/OA (<em>P</em> = 0.01) or PAC/PACG vs. PACS (<em>P</em> = 0.001). For all 3 angle-closure outcomes, ROC comparisons demonstrated significant improvement in area under the curve (AUC) between the 3 models predicting sibling outcomes, demonstrating an increase in AUC with each successive nested model across all 3 sibling angle-closure outcomes.</div></div><div><h3>Conclusions</h3><div>Structural features of eyes with angle closure may assist in stratifying the risk of angle closure in patients’ siblings. Further studies should consider evaluating this approach to achieve more targeted screenings.</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 12-21"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333474","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":"Characterizing Longitudinal Changes in Fear of Falling and Quality of Life in Patients with Varying Levels of Visual Field Damage","authors":"Louay Almidani MD, MSc ,&nbsp;Aleksandra Mihailovic ScM ,&nbsp;Zhuochen Yuan BS ,&nbsp;Chhavi Saini MD, MPH ,&nbsp;Pradeep Y. Ramulu MD, PhD","doi":"10.1016/j.ogla.2024.08.008","DOIUrl":"10.1016/j.ogla.2024.08.008","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the relationship between baseline visual field (VF) severity and rates of visual field loss with changes in quality of life (QoL) and fear of falling (FoF) in adults with glaucoma.</div></div><div><h3>Methods</h3><div>Prospective cohort study, including participants from the Falls In Glaucoma Study. Quality of life and FoF were assessed annually using the Glaucoma Quality of Life-15 Questionnaire, and the University of Illinois at Chicago FoF Questionnaire, respectively, with higher Rasch-analyzed scores (in logits) indicating better QoL and greater FoF. Mean deviation (MD) values of each eye were collected, with better-eye MD taken as the primary exposure. Change rates in better-eye MD, QoL, and FoF were computed using linear regression. Separate regression models were employed to explore the relationship between baseline better-eye MD and its rate of change with rates of change in QoL and FoF.</div></div><div><h3>Results</h3><div>The mean (standard deviation) rate of change in better-eye MD was −0.08 dB/year (0.5), rate of QoL change was −0.08 logits/year (0.4), and rate of FoF change was 0.16 logits/year (0.7). At baseline, better-eye MD (per dB worse) was significantly associated with worse baseline QoL (β = −0.10 logits [95% confidence interval [CI]: −0.13, −0.08]) and greater FoF (β = 0.06 logits [95% CI: 0.01, 0.10]). Baseline better-eye MD was associated with no significant change in QoL ( −0.004 logits/year, 95% CI: −0.02, 0.01) or FoF (–0.0001 logits/year, 95% CI: −0.02, 0.02) over time. Change rates in better-eye MD showed significant associations with faster increases in FoF over time (β = 0.26 logits/year [95% CI: 0.06, 0.45]; per dB loss/year), but not with changes in QoL (<em>P</em> = 0.79).</div></div><div><h3>Conclusions</h3><div>Patients with glaucoma generally showed worsening of QoL and FoF over time, though the degree of change was modest and not related to the degree of damage at baseline. Faster rates of better-eye MD change alone were associated with faster increases in FoF. Further studies are needed to evaluate the reasons (visual and nonvisual) for changes in QoL and functionality over time and find ways in which QoL and mobility can be improved for those with VF damage.</div></div><div><h3>Financial Disclosures</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 63-72"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147022","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":"Relationships between Frailty and the Risk of Glaucoma in Middle-aged and Older Adults","authors":"Jianqi Chen MD ,&nbsp;Xu Cao MD, PhD ,&nbsp;Xiaohua Zhuo OD ,&nbsp;Xuhao Chen MD, PhD ,&nbsp;Yuyao Ling MD ,&nbsp;Yuwen Wen MD ,&nbsp;Guitong Ye MD ,&nbsp;Yuan Zhang MD ,&nbsp;Jinan Zhan MD ,&nbsp;Hongmei Tan MD, PhD ,&nbsp;Yingting Zhu MD, PhD ,&nbsp;Yehong Zhuo MD, PhD","doi":"10.1016/j.ogla.2024.09.006","DOIUrl":"10.1016/j.ogla.2024.09.006","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;Increased frailty in older individuals increases health risks, but its relationship with glaucoma, the leading cause of irreversible blindness in middle-aged and older adults, is unclear. We investigated the association between frailty and glaucoma in a large-scale representative sample and explored possible causal relationships.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Combined cross-sectional and Mendelian randomization (MR) study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;In the cross-sectional analysis, we included 5744 participants of the US National Health and Nutrition Examination Surveys 2005 to 2008 ≥ 40 years of age. For the MR analysis, frailty genome-wide association study (GWAS) data were sourced from a UK Biobank and TwinGen meta-analysis, and GWAS data on glaucoma subtypes were derived from FinnGen.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;According to the 49-item frailty index, we classified participants into nonfrail (≤ 0.10), prefrail (0.10−0.21), and frail (&gt; 0.21) groups. Using survey-weighted logistic regression models adjusted for multiple covariates, we explored the association between frailty and glaucoma. We further assessed causation using MR.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;The associations between different levels of frailty (nonfrail, prefrail, and frail) and glaucoma, as well as causal relationships between genetically predicted frailty and various subtypes of glaucoma (primary open-angle glaucoma [POAG], primary angle-closure glaucoma [PACG], normotensive glaucoma [NTG], exfoliation glaucoma, and suspected glaucoma).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;After adjusting for covariates, higher frailty levels were significantly associated with glaucoma in frail individuals (odds ratio [OR] = 1.83, 95% confidence interval [CI] = 1.05–3.19, &lt;em&gt;P&lt;/em&gt; = 0.036) but not prefrail (OR = 1.90, 95% CI = 0.99–3.64, &lt;em&gt;P&lt;/em&gt; = 0.052). The association was significantly stronger among male participants (&lt;em&gt;P&lt;/em&gt; interaction = 0.042). The variation in the association between frailty and glaucoma did not reach statistical significance across age groups (&lt;em&gt;P&lt;/em&gt; interaction = 0.575) or race groups (&lt;em&gt;P&lt;/em&gt; interaction = 0.092). Mendelian randomization revealed that genetically predicted frailty was linked to greater risks for POAG (OR = 1.67, 95% CI = 1.24–2.25, &lt;em&gt;P&lt;/em&gt; = 0.001), PACG (OR = 2.78, 95% CI = 1.48–5.20, &lt;em&gt;P&lt;/em&gt; = 0.001), exfoliation glaucoma (OR = 1.70, 95% CI = 1.18–2.43, &lt;em&gt;P&lt;/em&gt; = 0.004), and suspected glaucoma (OR = 1.74, 95% CI = 1.30–2.34, &lt;em&gt;P&lt;/em&gt; &lt; 0.001) but not for NTG (OR = 1.01, 95% CI = 0.61–1.68, &lt;em&gt;P&lt;/em&gt; = 0.956).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Our study revealed an association between frailty and increased glaucoma risk and emphasized the significance of glaucoma screening in frail individuals. Targeted health-care strategies can help prevent or delay irreversible blindness among middle-aged and older adults.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Fin","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 1","pages":"Pages 73-82"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382582","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":"Incidence of Acute Cystoid Macular Edema after Starting a Prostaglandin Analog Compared with Other Classes of Glaucoma Medications","authors":"Yujia Zhou MD, MS ,&nbsp;Amanda K. Bicket MD, MS ,&nbsp;Shikha Marwah MS ,&nbsp;Joshua D. Stein MD, MS ,&nbsp;Krishna S. Kishor MD","doi":"10.1016/j.ogla.2024.07.010","DOIUrl":"10.1016/j.ogla.2024.07.010","url":null,"abstract":"<div><h3>Purpose</h3><div>There is a longstanding belief that prostaglandin analogs (PGAs) may predispose patients with glaucoma to develop acute cystoid macular edema (CME). However, there is little solid evidence supporting this notion. The purpose of this study is to compare CME incidence rates among patients initiating treatment with different glaucoma medication classes.</div></div><div><h3>Design</h3><div>Database study.</div></div><div><h3>Participants</h3><div>A total of 39 948 patients who were newly prescribed glaucoma medications</div></div><div><h3>Methods</h3><div>Using data from 10 health systems contributing data to the Sight Outcomes Research Collaborative Ophthalmology Data Repository, we identified all adults with glaucoma who had been newly started on a topical glaucoma medication. Patients with pre-existing documentation of macular edema were excluded. We assessed the incidence of CME among patients with glaucoma who were newly started on PGAs, topical beta blockers (BBs), alpha agonists (AAs), and carbonic anhydrase inhibitors (CAIs). Using multivariable logistic regression, and adjusting for sociodemographic factors, we assessed the odds of developing CME among patients prescribed each of the 4 glaucoma medication classes. We also performed a subset regression analysis including lens status as a covariate.</div></div><div><h3>Main outcome measures</h3><div>Incidence of CME within 3 months of initiating therapy with different topical glaucoma medications.</div></div><div><h3>Results</h3><div>Among the 39 948 patients who were newly treated with a topical glaucoma medication, 139 (0.35%) developed CME. The incidence of CME was 0.13%, 0.65%, 0.55%, and 1.76% for users of PGAs, BBs, AAs, and CAIs, respectively. After adjusting for sociodemographic factors, users of topical BBs, AAs, and CAIs had substantially higher odds of developing CME compared with PGA users (<em>P</em> &lt; 0.001 for all comparisons). The subset analysis also showed higher odds ratio of the non-PGA medication classes in association with CME.</div></div><div><h3>Conclusions</h3><div>Clinicians should reconsider the notion that PGAs carry a higher risk of CME versus other glaucoma medication classes. If additional studies support the findings of these analyses, clinicians may feel more comfortable prescribing PGAs to patients with glaucoma without fear they will predispose patients to CME.</div></div><div><h3>Financial Disclosures</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 4-11"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914759","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":"Federated Learning in Glaucoma","authors":"Shahin Hallaj MD ,&nbsp;Benton G. Chuter MS ,&nbsp;Alexander C. Lieu BS ,&nbsp;Praveer Singh PhD ,&nbsp;Jayashree Kalpathy-Cramer PhD ,&nbsp;Benjamin Y. Xu MD, PhD ,&nbsp;Mark Christopher PhD ,&nbsp;Linda M. Zangwill PhD ,&nbsp;Robert N. Weinreb MD ,&nbsp;Sally L. Baxter MD, MSc","doi":"10.1016/j.ogla.2024.08.004","DOIUrl":"10.1016/j.ogla.2024.08.004","url":null,"abstract":"<div><h3>Clinical Relevance</h3><div>Glaucoma is a complex eye condition with varied morphological and clinical presentations, making diagnosis and management challenging. The lack of a consensus definition for glaucoma or glaucomatous optic neuropathy further complicates the development of universal diagnostic tools. Developing robust artificial intelligence (AI) models for glaucoma screening is essential for early detection and treatment but faces significant obstacles. Effective deep learning algorithms require large, well-curated datasets from diverse patient populations and imaging protocols. However, creating centralized data repositories is hindered by concerns over data sharing, patient privacy, regulatory compliance, and intellectual property. Federated Learning (FL) offers a potential solution by enabling data to remain locally hosted while facilitating distributed model training across multiple sites.</div></div><div><h3>Methods</h3><div>A comprehensive literature review was conducted on the application of Federated Learning in training AI models for glaucoma screening. Publications from 1950 to 2024 were searched using databases such as PubMed and IEEE Xplore with keywords including “glaucoma,” “federated learning,” “artificial intelligence,” “deep learning,” “machine learning,” “distributed learning,” “privacy-preserving,” “data sharing,” “medical imaging,” and “ophthalmology.” Articles were included if they discussed the use of FL in glaucoma-related AI tasks or addressed data sharing and privacy challenges in ophthalmic AI development.</div></div><div><h3>Results</h3><div>FL enables collaborative model development without centralizing sensitive patient data, addressing privacy and regulatory concerns. Studies show that FL can improve model performance and generalizability by leveraging diverse datasets while maintaining data security. FL models have achieved comparable or superior accuracy to those trained on centralized data, demonstrating effectiveness in real-world clinical settings.</div></div><div><h3>Conclusions</h3><div>Federated Learning presents a promising strategy to overcome current obstacles in developing AI models for glaucoma screening. By balancing the need for extensive, diverse training data with the imperative to protect patient privacy and comply with regulations, FL facilitates collaborative model training without compromising data security. This approach offers a pathway toward more accurate and generalizable AI solutions for glaucoma detection and management.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 1","pages":"Pages 92-105"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115514","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":"Tibial Bone Keratoprosthesis: Seeing into the Third Decade","authors":"Dinukie-Chantal Perera BS ,&nbsp;James Chodosh MD, MPH ,&nbsp;Teresa C. Chen MD","doi":"10.1016/j.ogla.2024.10.003","DOIUrl":"10.1016/j.ogla.2024.10.003","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 1","pages":"Page e2"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649567","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":"Manometric Intraocular Pressure Reduction with Negative Pressure Using Ocular Pressure Adjusting Pump Goggles","authors":"Katherine S. Peters MD ,&nbsp;Enrico Brambilla ME ,&nbsp;Tanner Ferguson MD ,&nbsp;Brent Kramer MD ,&nbsp;Daniel Terveen MD ,&nbsp;John Berdahl MD","doi":"10.1016/j.ogla.2024.09.005","DOIUrl":"10.1016/j.ogla.2024.09.005","url":null,"abstract":"<div><h3>Objective</h3><div>The ocular pressure adjusting pump is a novel noninvasive and nonpharmacological intraocular pressure (IOP)-lowering device consisting of goggles attached to a negative pressure (NP) pump. This study aimed to determine the effect of NP in ocular pressure adjusting pump goggles on IOP using continuous direct manometry.</div></div><div><h3>Design</h3><div>Prospective, single-arm, single center, basic physiological research trial.</div></div><div><h3>Subjects</h3><div>Adult patients undergoing cataract surgery.</div></div><div><h3>Methods</h3><div>Direct manometry was performed via an anterior chamber cannula attached to an IOP sensor. This was placed just prior to each subject’s previously scheduled cataract surgery. Intraocular pressure was continuously monitored every 0.5 seconds through the following sequence of 30 seconds each: baseline IOP measurement, NP –10 mmHg, NP off, NP –20 mmHg, and NP off.</div></div><div><h3>Main Outcome Measures</h3><div>Intraocular pressure response to application of NP.</div></div><div><h3>Results</h3><div>All 17 subjects had a dose-dependent reduction in IOP, with a mean IOP decrease from 16.9 to 11.3 (33%) with –10 mmHg of NP and from 15.7 to 7.7 (51%) mmHg with –20 mmHg of NP. Intraocular pressure returned to baseline for each cycle when NP was discontinued. There were no patients with increased IOP.</div></div><div><h3>Conclusions</h3><div>Negative pressure with the ocular pressure adjusting pump results in a consistent dose-dependent reduction in IOP, with return to baseline IOP when NP is discontinued.</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 22-27"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333473","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}