Ophthalmology. Glaucoma最新文献

{"title":"Reverse Pupillary Block in Yamane Technique Scleral-Fixated Intraocular Lens.","authors":"Pietro Paolo Saba, Edoardo Panico, Mario R Romano","doi":"10.1016/j.ogla.2025.03.008","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.03.008","url":null,"abstract":"","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031324","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":"Disease progression, not intraocular pressure, should guide escalation of treatment in glaucoma.","authors":"Giovanni Montesano, David F Garway-Heath, Gus Gazzard","doi":"10.1016/j.ogla.2025.04.005","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.04.005","url":null,"abstract":"","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043434","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":"Re: Zhou et al.: Incidence of acute cystoid macular edema after starting a prostaglandin analog compared with other classes of glaucoma medications (Ophthalmol Glaucoma. 2025;8:4-11).","authors":"James O Robbins, Sanjay G Asrani","doi":"10.1016/j.ogla.2025.04.008","DOIUrl":"10.1016/j.ogla.2025.04.008","url":null,"abstract":"","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054088","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":"Meaningful Patient Partnerships: A Qualitative Study of Patient Perspectives and Shared Decision-Making Regarding Glaucoma Surgery.","authors":"Zayn Al-Timimi, Samrat Sarkar, Sapna Nand, Simon E Skalicky, Sartaj Sandhu, Hamish Dunn, Lisa Keay","doi":"10.1016/j.ogla.2025.04.006","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.04.006","url":null,"abstract":"<p><strong>Purpose: </strong>Patient-centered care is key to successful clinical outcomes and meaningful clinician-patient relationships. Accordingly, a comprehensive understanding of patient perspectives is essential to aligning the clinician's focus and patient's goals. However, our understanding of patients' perceptions of glaucoma surgery and involvement in surgical decision-making has not kept pace with the rapid treatment advances in the field and move toward earlier surgery with the advent of minimally invasive glaucoma surgery devices. The purpose of this study was to understand the perspectives and priorities of people with glaucoma when considering glaucoma surgery through qualitative analysis of semistructured interviews.</p><p><strong>Design: </strong>A qualitative study.</p><p><strong>Participants: </strong>Individuals diagnosed with glaucoma, above 18 years of age, and able to communicate effectively in English. Interviews were conducted with 40 participants: 23 participants who had undergone glaucoma surgery and 17 who had not.</p><p><strong>Methods: </strong>Interviews were conducted over telephone, using an interview guide developed in consultation with people with glaucoma and surgeons. The cohort was purposely sampled to ensure representation across age, sex, socioeconomic status, remoteness, glaucoma severity, clinic settings, and treatment histories. Transcripts were iteratively analyzed to identify key themes pertaining to perceptions of glaucoma surgery and involvement in decision-making.</p><p><strong>Main outcome measures: </strong>Surgical perception and involvement themes, including barriers and bridges to confidence in glaucoma surgery.</p><p><strong>Results: </strong>Six key themes were identified: (1) patients feeling rushed; (2) onus on the patient to seek information; (3) undercurrents of anxiety; (4) perceptions of surgery shaped by understanding and expectations of the disease and its treatment paradigm; (5) trust in surgeon imbuing confidence in surgery; and (6) empowerment through understanding of alternatives. Key barriers to patient involvement included patient anxiety, time pressures (real or perceived), and perceived urgency of intervention.</p><p><strong>Conclusions: </strong>Shared decision-making in glaucoma surgery remains aspirational. This study provides valuable insights into patient perceptions of glaucoma surgery, which can help inform patient-centered care. Readily applicable \"practice points\" are proposed to optimize patient involvement and empowerment.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061085","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 Methods to Deliver Mitomycin C in Trabeculectomy Surgery: a Systematic Review and Meta-analysis.","authors":"Alessandro Ghirardi, Siqi Fan, Karl Mercieca, Gianni Virgili, Stefano De Cillà, Alessandro Rabiolo","doi":"10.1016/j.ogla.2025.04.004","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.04.004","url":null,"abstract":"<p><strong>Topic: </strong>Compare different methods to deliver Mitomycin C (MMC) in trabeculectomy surgery.</p><p><strong>Clinical relevance: </strong>Knowing the best way to apply MMC may provide guidance to glaucoma surgeons and improve outcomes.</p><p><strong>Methods: </strong>Systematic review and meta-analysis (PROSPERO CRD42023394371) for studies comparing ≥2 methods to apply MMC in trabeculectomy published until February 22, 2023, from Medline, EMBASE, and CENTRAL. Randomized clinical trials (RCTs), quasi-randomized, and prospective non-randomized controlled studies published in English and conducted on human subjects were included. The primary outcome was surgical failure at one year. Secondary outcomes included intraocular pressure (IOP), number of glaucoma medications, postoperative complications, and interventions. Risk of bias was assessed with ROB2.0 and ROBINS-I tools. A random-effects meta-analysis was conducted for ≥3 studies, while a fixed-effect model was used for two studies. The certainty of evidence was assessed with GRADE score.</p><p><strong>Results: </strong>From 7,899 records, eight articles from seven RCTs compared intraoperative sub-Tenon MMC injection (315 participants) and intraoperative MMC-soaked sponges (327 participants). One RCT and one quasi-randomized study compared postoperative (60 participants) and intraoperative (60 participants) MMC-soaked sponges application. In the injection vs sponges comparison, no significant difference in surgical failure (relative risk [RR]: 0.78, 95% confidence interval [CI]: 0.48, 1.28; p=0.33, GRADE score moderate) or IOP (mean difference [MD]: -0.85 mmHg, 95%CI: -2.19, 0.49; p=0.21, GRADE score moderate) was found at one year. Sub-Tenon injection resulted in fewer postoperative medications (MD: -0.40, 95%CI: -0.63, -0.18; p<0.001; GRADE score moderate) and better bleb morphology (GRADE score high) in terms of height (MD: -0.39, 95%CI: -0.61, -0.18; p<0.001), extension (MD: 0.28, 95%CI: 0.11, 0.45; p=0.001), and vascularity (MD: -0.52, 95%CI: -0.72, -0.31; p<0.001) than sponges. Serious complication and reintervention rates were low and comparable between groups. We did not perform a meta-analysis comparing postoperative and intraoperative sponge application due to heterogeneity in the study designs of the included studies.</p><p><strong>Conclusions: </strong>Intraoperative sub-Tenon MMC injection is non-inferior to intraoperative MMC-soaked sponges in trabeculectomy surgery in terms of surgical failure and IOP control, with reduced number of medications, improved bleb morphology, and similar safety profile. Further research with long-term follow-up is necessary to confirm their long-term equivalence.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050407","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":"Rapid Reversal of Optic Nerve Cupping in Steroid-Induced Glaucoma.","authors":"Manasi Tripathi, Vinit Tanwar, Varun Gogia","doi":"10.1016/j.ogla.2025.03.005","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.03.005","url":null,"abstract":"","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059805","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":"Enhanced Aqueous Humor Outflow Following Trabeculotomy in Primary Congenital Glaucoma Eyes.","authors":"Shikha Gupta, Xiaowei Zhang, Arnav Panigrahi, Robert N Weinreb, Viney Gupta, Alex S Huang","doi":"10.1016/j.ogla.2025.04.002","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.04.002","url":null,"abstract":"","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063392","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":"The frontloading approach to meet guideline-recommended visual field testing for glaucoma: time and cost.","authors":"Henrietta Wang, Katherine Masselos, Jeremy C K Tan, Nimesh B Patel, Ashish Agar, Michael Kalloniatis, Jack Phu","doi":"10.1016/j.ogla.2025.04.003","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.04.003","url":null,"abstract":"<p><strong>Purpose: </strong>To measure the time and clinical resources taken to obtain six reliable visual field (VF) tests for glaucoma in a glaucoma clinic.</p><p><strong>Design: </strong>Longitudinal, prospective study in a glaucoma clinic.</p><p><strong>Subjects: </strong>10,010 SITA-Faster VF tests of 535 clinical subjects.</p><p><strong>Methods: </strong>The cumulative number of VF tests with false positive rates ≤15% for each eye of each subject was counted over time and from there, the time to achieve six VF tests was determined and compared under frontloaded (two VFs per eye per visit) and non-frontloaded (first VF within the frontloaded set) conditions. Costs to attain six VF tests were modelled.</p><p><strong>Main outcome measures: </strong>VF counts and costs for attainment.</p><p><strong>Results: </strong>8,931 of the 10,010 VF results had a false positive rate ≤15%. Approximately 90% of subjects had early or moderate open angle glaucoma. When using the frontloading protocol, it took an average of 1.4 years to attain 6 reliable VFs for right and left eyes, respectively. For the non-frontloaded protocol, the average times were 2.6 years and 2.5 years for right and left eyes, respectively. 82.5% of right eyes and 85.4% of left eyes achieved 6 reliable VFs within 2 years when frontloaded, but the proportion was only 15.8% and 18.8% when non-frontloaded for right and left eyes, respectively. There was a significantly lower cost for obtaining 6 reliable VFs with frontloading, compared to non-frontloading, due to fewer office visits.</p><p><strong>Conclusions: </strong>A frontloading approach and SITA-Faster paradigm led to patients attaining 6 reliable VFs over 14 months sooner compared to non-frontloaded, with over 84% receiving the recommended number of 6 tests in the first 2 years. The frontloading approach overall leads to savings in time and cost in comparison to non-frontloading for achieving 6 reliable VFs, and thus potentially provides an avenue for earlier detection of glaucomatous change.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Eye Drop Treated Diseases and Conditions that Can Impair Eye Drop Self-Administration.","authors":"Tianyi Wang, Hong Su An, Jaqueline Stoutin, Alexander D Valentine, Leah K Depperschmidt, Matthew Callewaert, Michael Goldstein, Joshua D Stein","doi":"10.1016/j.ogla.2025.04.001","DOIUrl":"https://doi.org/10.1016/j.ogla.2025.04.001","url":null,"abstract":"<p><strong>Objective: </strong>First-line treatment for glaucoma and dry eye disease (DED) is often with eye drops. Unfortunately, proper eye drop self-administration is difficult, and this is likely magnified in persons with comorbid rheumatological, neurological, or cognitive disorders. This study investigates the association between ocular conditions often treated with eye drops (glaucoma and DED) and medical conditions that may impair proper eye drop self-administration.</p><p><strong>Design: </strong>Retrospective database study PARTICIPANTS: 1,446,229 patients from 6 health systems participating in the Sight Outcomes Research Collaborative (SOURCE) between January 2012 and December 2021.</p><p><strong>Methods: </strong>We determined the proportion of patients with glaucoma or DED with medical conditions that may limit proper eye drop self-administration and created multivariable logistic regression models assessing associations between glaucoma or DED and comorbid conditions.</p><p><strong>Main outcome(s) and measure(s): </strong>Adjusted odds ratios (aOR) with 95% confidence intervals (CI) of glaucoma or DED RESULTS: Among 247,899 patients with glaucoma (mean (SD) age: 60.1 (15.1) years, 56.2% female, 19.5% Black), 106,927 (43%) had ≥1 comorbid condition that could affect eye drop self-administration. Among 321,941 patients with DED (mean (SD) age: 55.9 (16.1) years, 66.4% female, 12.6% Black), 156,811 (49%) had ≥1 condition that could hinder eye drop self-administration. Patients with ≥1 impairment affecting eye drop self-administration had 17% greater odds of glaucoma (aOR) 1.17, CI (1.16-1.18)) and 66% greater odds of DED (aOR 1.66, CI 1.65-1.68)) compared to those without any such conditions. Persons with 2, 3, 4+ conditions that may affect eye drop administration had 27%, 39%, and 53% higher odds of glaucoma, respectively, compared to persons without such conditions (p<0.0001). Persons with 2, 3, 4+ health conditions that may impair eye drop administration had 76%, 121%, and 156% higher odds of DED, respectively, compared to persons with no such conditions (p<0.0001).</p><p><strong>Conclusions: </strong>Nearly half of all patients with glaucoma or DED have ≥1 medical condition that may impair eye drop self-administration. This highlights the importance of clinicians assessing patients to ensure they are physically and mentally capable of self-administering eye drops. Some of these patients may benefit from alternative therapies that reduce or eliminate the need for eye drops.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059668","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":"Impact of the COVID-19 Pandemic on Medicare Reimbursement and Glaucoma Procedure Utilization: APayment-VolumeElasticity and Trends Analysis.","authors":"Jason Dossantos, Hoang-Viet Tran, Sinan Akosman, Julie Thomasian, David Belyea","doi":"10.1016/j.ogla.2025.03.012","DOIUrl":"10.1016/j.ogla.2025.03.012","url":null,"abstract":"<p><strong>Purpose: </strong>To examine how the coronavirus disease 2019 (COVID-19) pandemic impacted the relationship between Medicare reimbursement and glaucoma procedure service volume in the United States.</p><p><strong>Design: </strong>A retrospective, longitudinal database study.</p><p><strong>Participants: </strong>A complete dataset of all glaucoma procedures performed on Medicare Part B beneficiaries from 2019 to 2022.</p><p><strong>Methods: </strong>Linear mixed-effects model using Medicare Part B data, controlling for year, charges, denials, reimbursement-to-charge ratio (RCR), service setting, Current Procedural Terminology code, state, Medicare population, number of ophthalmologists, and median income. The RCR was calculated as the ratio of weighted mean reimbursement to weighted mean charge, representing the proportion of reimbursed charges. Weighted averages for denials, charges, and reimbursements (adjusted for inflation) were also calculated.</p><p><strong>Main outcome measures: </strong>Payment-volume elasticities, defined as the percent change in procedure volume per 1% change in Medicare payment, for traditional glaucoma surgeries (tubes and shunts), minimally invasive glaucoma surgeries (MIGSs), and laser procedures. Additional measures included weighted averages of charges, reimbursements, denials, and RCR across procedure categories and service settings.</p><p><strong>Results: </strong>Traditional surgeries showed a 2.3% decrease in volume per 1% payment increase (95% confidence interval [CI]: -2.9% to -1.7%; P < 0.001; Rc² = 0.89) and a 10.2% decline in volume. Mean reimbursement for traditional surgeries decreased by 5%, with a 7.7% drop in RCR. Laser procedures exhibited a 6.7% volume decrease per 1% payment increase (95% CI: -7.1% to -6.2%; P < 0.001; Rc² = 0.97) and a 16% total decline, with no change in RCR. Minimally invasive glaucoma surgeries declined by 16.2% overall but demonstrated an 8.3% volume increase per 1% payment rise (95% CI: 7.9%-8.7%; P < 0.001; Rc² = 0.90), with a 64% improvement in RCR. Overall, glaucoma procedure volumes fell by 15.6%, mean reimbursement decreased by 7.3%, and denied claims increased by 46.7%. Ambulatory surgical centers (ASCs) experienced a 15.2% volume decline but an 11.5% increase in reimbursement, supported by a 42.9% rise in RCR.</p><p><strong>Conclusions: </strong>Glaucoma procedure volumes declined between 2019 and 2022, particularly for traditional surgeries and MIGS. Traditional and laser procedures had negative payment-volume elasticities, whereas MIGS showed positive elasticity. These findings suggest factors beyond reimbursement rates, like shifts to less invasive treatments and COVID-19 disruptions, significantly influenced clinical decision-making.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":56368,"journal":{"name":"Ophthalmology. Glaucoma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060417","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}