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Fortune B. Optical coherence tomography evaluation of the optic nerve head neuro‐retinal rim in glaucoma. Clin Exp Optom 2021; 102:286-290. [DOI: 10.1111/cxo.12833] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/09/2018] [Indexed: 12/30/2022] Open
Affiliation(s)
- Brad Fortune
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Health, Portland, Oregon, USA,
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Lowry EA, Mansberger SL, Gardiner SK, Yang H, Sanchez F, Reynaud J, Demirel S, Burgoyne CF, Fortune B. Association of Optic Nerve Head Prelaminar Schisis With Glaucoma. Am J Ophthalmol 2021; 223:246-258. [PMID: 33166501 DOI: 10.1016/j.ajo.2020.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/24/2020] [Accepted: 10/27/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To compare the frequency of observing optic nerve head (ONH) prelaminar schisis by optical coherence tomography (OCT) in glaucoma and glaucoma suspect (GL/S) eyes vs healthy control (HC) eyes and to assess its association with other markers of glaucoma severity. METHODS This cross-sectional study included 298 eyes of 150 GL/S patients and 88 eyes of 44 HCs. OCT scans were obtained, including 24 radial B-scans, each composed of 768 A-lines spanning 15°, centered on the ONH. Two reviewers masked to all other clinical, demographic, and ocular information independently graded the OCT scans for the presence of ONH prelaminar schisis on a 4-point scale of 0 (none) to 3 (severe). The probability of ONH schisis was compared between groups and against demographic and ocular factors, including structural and functional measures of glaucoma severity. RESULTS The frequency and severity of ONH prelaminar schisis were greater in GL/S than in HC (P = .009). Among the GL/S group, 165 eyes (55.4%) had no visible schisis (Grade 0), 71 (23.8%) had Grade 1, 46 (15.4%) had Grade 2 and 16 (5.4%) had Grade 3 schisis. Among HC eyes, 59 (67.0%) had Grade 0, 24 (27.3%) had Grade 1, 5 (5.7%) had Grade 2, none had Grade 3. ONH schisis was more common in eyes with thinner MRW and a deeper cup. CONCLUSIONS ONH prelaminar schisis may be a sign of glaucomatous deformation and reflect ongoing pathophysiological damage. ONH prelaminar schisis can impact OCT image segmentation and diagnostic parameters, resulting in substantial overestimation of the true rim tissue thickness and underestimation of cup depth.
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3
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Lee EJ, Han JC, Park DY, Kee C. A neuroglia-based interpretation of glaucomatous neuroretinal rim thinning in the optic nerve head. Prog Retin Eye Res 2020; 77:100840. [PMID: 31982595 DOI: 10.1016/j.preteyeres.2020.100840] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/02/2020] [Accepted: 01/13/2020] [Indexed: 12/14/2022]
Abstract
Neuroretinal rim thinning (NRR) is a characteristic glaucomatous optic disc change. However, the precise mechanism of the rim thinning has not been completely elucidated. This review focuses on the structural role of the glioarchitecture in the formation of the glaucomatous NRR thinning. The NRR is a glia-framed structure, with honeycomb geometry and mechanically reinforced astrocyte processes along the transverse plane. When neural damage selectively involves the neuron and spares the glia, the gross structure of the tissue is preserved. The disorganization and loss of the glioarchitecture are the two hallmarks of optic nerve head (ONH) remodeling in glaucoma that leads to the thinning of NRR tissue upon axonal loss. This is in contrast to most non-glaucomatous optic neuropathies with optic disc pallor where hypertrophy of the glioarchitecture is associated with the seemingly absent optic disc cupping. Arteritic anterior ischemic optic neuropathy is an exception where pan-necrosis of ONH tissue leads to NRR thinning. Milder ischemia indicates selective neuronal loss that spares glia in non-arteritic anterior ischemic optic neuropathy. The biological reason is the heterogeneous glial response determined by the site, type, and severity of the injury. The neuroglial interpretation explains how the cellular changes underlie the clinical findings. Updated understandings on glial responses illustrate the mechanical, microenvironmental, and microglial modulation of activated astrocytes in glaucoma. Findings relevant to the possible mechanism of the astrocyte death in advanced glaucoma are also emerging. Ultimately, a better understanding of glaucomatous glial response may lead to glia-targeting neuroprotection in the future.
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Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Do Young Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea.
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4
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Park KH, Lee JW, Kim JM, Nouri-Mahdavi K, Caprioli J. Bruch's membrane opening-minimum rim width and visual field loss in glaucoma: a broken stick analysis. Int J Ophthalmol 2018; 11:828-834. [PMID: 29862184 PMCID: PMC5957037 DOI: 10.18240/ijo.2018.05.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 12/05/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To determine the Bruch's membrane opening-minimum rim width (BMO-MRW) tipping point where corresponding visual field (VF) damages become detectable. METHODS A total of 85 normal subjects and 83 glaucoma patients (one eye per participant) were recruited for the study. All of the patients had VF examinations and spectral-domain optical coherence tomography to measure the BMO-MRW. Total deviation values for 52 VF points were allocated to the corresponding sector according to the Garway-Heath distribution map. To evaluate the relationship between VF loss and BMO-MRW measurements, a "broken-stick" statistical model was used. The tipping point where the VF values started to sharply decrease as a function of BMO-MRW measurements was estimated and the slopes above and below this tipping point were compared. RESULTS A 25.9% global BMO-MRW loss from normative value was required for the VF loss to be detectable. Sectorally, substantial BMO-MRW thinning in inferotemporal sector (33.1%) and relatively less BMO-MRW thinning in the superotemporal sector (8.9%) were necessary for the detection of the VF loss. Beyond the tipping point, the slopes were close to zero throughout all of the sectors and the VF loss was unrelated to the BMO-MRW loss. The VF loss was related to the BMO-MRW loss below the tipping point. The difference between the two slopes was statistically significant (P≤0.002). CONCLUSION Substantial BMO-MRW loss appears to be necessary for VF loss to be detectable in patients with open angle glaucoma with standard achromatic perimetry.
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Affiliation(s)
- Keun-Heung Park
- Department of Ophthalmology, Pusan National University College of Medicine, Busan 49241, Korea
| | - Ji-Woong Lee
- Department of Ophthalmology, Pusan National University College of Medicine, Busan 49241, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea
| | - Jin-Mi Kim
- Department of Biostatistics, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea
| | - Kouros Nouri-Mahdavi
- Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles 90095, California, USA
| | - Joseph Caprioli
- Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles 90095, California, USA
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Sandberg Melin C, Nuija E, Alm A, Yu Z, Söderberg PG. Variance components in confocal scanning laser tomography measurements of neuro-retinal rim area and the effect of repeated measurements on the power to detect loss over time. Acta Ophthalmol 2016; 94:705-711. [PMID: 27233465 DOI: 10.1111/aos.13079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 03/03/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE To estimate the variation in measurements of neuro-retinal rim area (NRA) determined by confocal scanning laser tomography and consequences for clinical follow-up. METHODS Altogether, 24 healthy subjects were randomized on -320 μm, Moorfields and Standard NRA plane strategies. Additionally, NRA was measured in 32 glaucoma subjects. Variance components for subjects, visits and measurements were estimated with analysis of variance. Sample sizes required to detect a 6.0 × 10-2 mm2 NRA change were estimated assuming a significance level of 0.05 and a power of 0.8. Consequences for independent group, and paired comparison design, respectively, were analysed. Further, precision in estimates within subjects over time was investigated. RESULTS The variation of NRA among subjects was considerably larger than the variation among visits and measurements. For glaucoma subjects, the variation among visits and measurements were of the same order but larger than in healthy subjects. It was found that independent group comparisons require inconveniently large sample sizes. Within-subject paired comparisons over time require sample sizes of below 15 subjects. The estimated variations for glaucoma subjects imply that 54 months of follow-up is required for detection of change from baseline. CONCLUSIONS The variance for subjects is substantial in relation to those for visits and measurements. Cross-sectional independent group comparisons of levels of NRA are unsuitable, due to considerable subject variation. Levels of NRA differences within subjects between visits can be estimated with acceptable precision. Neuro-retinal rim area (NRA) measurement can be used for long-term follow-up of glaucoma progression.
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Affiliation(s)
- Camilla Sandberg Melin
- Gullstrand lab. Ophthalmology Department of Neuroscience Uppsala University Uppsala Sweden
- Centre for Research and Development Uppsala University/Region Gävleborg Gävle Sweden
| | - Eva Nuija
- Gullstrand lab. Ophthalmology Department of Neuroscience Uppsala University Uppsala Sweden
| | - Albert Alm
- Gullstrand lab. Ophthalmology Department of Neuroscience Uppsala University Uppsala Sweden
| | - Zhaohua Yu
- Gullstrand lab. Ophthalmology Department of Neuroscience Uppsala University Uppsala Sweden
| | - Per G. Söderberg
- Gullstrand lab. Ophthalmology Department of Neuroscience Uppsala University Uppsala Sweden
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Saunders LJ, Medeiros FA, Weinreb RN, Zangwill LM. What rates of glaucoma progression are clinically significant? EXPERT REVIEW OF OPHTHALMOLOGY 2016; 11:227-234. [PMID: 29657575 DOI: 10.1080/17469899.2016.1180246] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Clinically important rates of glaucoma progression (worsening) are ones that put a patient at risk of future functional impairment or reduction of vision-related quality of life. Rates of progression can be evaluated through measuring structural or functional changes of the optic nerve. Most treated eyes do not progress at rates that will lead to future visual impairment, but there are a significant proportion (3-17%) of eyes, that are at risk of impairment even under clinical care. While very fast rates of progression (e.g. MD progression of -1.5 dB/year) are generally problematic, much slower rates also may be deleterious for young patients, particularly those diagnosed with late disease. As a result, it is important to consider life expectancy, disease severity and vision-related quality of life based treatment targets to estimate future prognosis when evaluating whether a rate of glaucoma progression can be clinically relevant.
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Malik R, O'Leary N, Mikelberg FS, Balazsi AG, LeBlanc RP, Lesk MR, Nicolela MT, Trope GE, Chauhan BC. Neuroretinal Rim Area Change in Glaucoma Patients With Visual Field Progression Endpoints and Intraocular Pressure Reduction. The Canadian Glaucoma Study: 4. Am J Ophthalmol 2016; 163:140-147.e1. [PMID: 26705093 DOI: 10.1016/j.ajo.2015.11.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/23/2015] [Accepted: 11/23/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare rim area rates in patients with and without the visual field (VF) progression endpoint in the Canadian Glaucoma Study and determine whether intraocular pressure (IOP) reduction following the endpoint altered rim area rate. DESIGN Prospective multicenter cohort study. METHODS setting: University hospitals. PATIENT POPULATION Two hundred and six patients with open-angle glaucoma were examined at 4-month intervals with standard automated perimetry and confocal scanning laser tomography. INTERVENTION After the endpoint, IOP was reduced by ≥20%. OUTCOME MEASURES Univariate analysis for change in rim area rate and multivariable analysis to adjust for independent covariates (eg, age, sex, and IOP). RESULTS Patients with an endpoint (n = 59) had a worse rim area rate prior to the endpoint compared to those without (n = 147; median [interquartile range]: -14 [-32, 11] × 10(-3) mm(2)/y and -5 [-14, 5] × 10(-3) mm(2)/y, respectively, P = .02). In univariate analysis, there was no difference in rim area rate before and after the endpoint (median difference [95% CI], 8 (-10, 24) × 10(-3) mm(2)/y), but the muItivariate analysis showed that IOP reduction >2 mm Hg after the endpoint was strongly linked to a reduction in rim area rate decline (8 × 10(-3) mm(2)/y for each additional 1 mm Hg reduction). CONCLUSIONS Patients with a VF endpoint had a median rim area rate that was nearly 3 times worse than those without an endpoint. Lower mean follow-up IOP was independently associated with a slower decline in rim area.
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Affiliation(s)
- Rizwan Malik
- Departments of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada
| | - Neil O'Leary
- Departments of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada
| | - Frederick S Mikelberg
- Departments of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - A Gordon Balazsi
- Department of Ophthalmology, McGill University, Montreal, Canada
| | - Raymond P LeBlanc
- Departments of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada
| | - Mark R Lesk
- Department of Ophthalmology, Université de Montréal, Montreal, Canada
| | - Marcelo T Nicolela
- Departments of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada
| | - Graham E Trope
- Departments of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Canada
| | - Balwantray C Chauhan
- Departments of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada.
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8
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Rate and Pattern of Rim Area Loss in Healthy and Progressing Glaucoma Eyes. Ophthalmology 2015; 123:760-70. [PMID: 26746597 DOI: 10.1016/j.ophtha.2015.11.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 11/06/2015] [Accepted: 11/12/2015] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To characterize the rate and pattern of age-related and glaucomatous neuroretinal rim area changes in subjects of African and European descent. DESIGN Prospective longitudinal study. PARTICIPANTS Two hundred ninety-six eyes of 157 healthy subjects (88 patients of African descent and 69 of European descent) and 73 progressing glaucoma eyes of 67 subjects (24 patients of African descent and 43 of European descent) from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study were included. METHODS Global and sectoral rim areas were measured using confocal laser scanning ophthalmoscopy. Masked stereophotograph review determined progression of glaucomatous optic disc damage. The rates of absolute rim area loss and percentage rim area loss in healthy and progressing glaucomatous eyes were compared using multivariate, nested, mixed-effects models. MAIN OUTCOME MEASURES Rate of rim area loss over time. RESULTS The median follow-up time was 5.0 years (interquartile range, 2.0-7.4 years) for healthy eyes and 8.3 years (interquartile range, 7.5-9.9 years) for progressing glaucoma eyes. The mean rate of global rim area loss was significantly faster in progressing glaucomatous eyes compared with healthy eyes for both rim area loss (-10.2×10(-3) vs. -2.8×10(-3) mm(2)/year, respectively; P < 0.001) and percentage rim area loss (-1.1% vs. -0.2%/year, respectively; P < 0.001), but considerable overlap existed between the 2 groups. Sixty-three percent of progressing glaucoma eyes had a rate of change faster than the fifth quantile of healthy eyes. For both healthy and progressing eyes, the pattern of rim area loss and percentage rim area loss were similar, tending to be fastest in the superior temporal and inferior temporal sectors. The rate of change was similar in progressing eyes of patients of African or European descent. CONCLUSIONS Compared with healthy eyes, the mean rate of global rim area loss was 3.7 times faster and the mean rate of global percentage rim area loss was 5.4 times faster in progressing glaucoma eyes. A reference database of healthy eyes can be used to help clinicians distinguish age-related rim area loss from rim area loss resulting from glaucoma.
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Abstract
Detecting glaucoma progression remains one of the most challenging aspects of glaucoma management, since it can be hard to distinguish disease progression from exam variability and changes due to aging. In this review article, we discuss the use of perimetry, confocal scanning laser tomography and optical coherence tomography to detect glaucoma progression, and the techniques available to evaluate change with these modalities. Currently, there is no consensus on the best technique or criteria to detect glaucoma progression, or what amount of change would be clinically meaningful. New techniques have been developed to assess glaucoma progression, which make more comprehensive and complex use of data. They have the potential of detecting progression with better accuracy, with shorter follow-up periods, and generating better prognostics. Further validation of these new techniques is still required, but their incorporation into clinical practice is likely to yield significant benefits.
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Affiliation(s)
- Jayme R Vianna
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
| | - Balwantray C Chauhan
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada.
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10
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Fortune B. In vivo imaging methods to assess glaucomatous optic neuropathy. Exp Eye Res 2015; 141:139-53. [PMID: 26048475 DOI: 10.1016/j.exer.2015.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 05/13/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
The goal of this review is to summarize the most common imaging methods currently applied for in vivo assessment of ocular structure in animal models of experimental glaucoma with an emphasis on translational relevance to clinical studies of the human disease. The most common techniques in current use include optical coherence tomography and scanning laser ophthalmoscopy. In reviewing the application of these and other imaging modalities to study glaucomatous optic neuropathy, this article is organized into three major sections: 1) imaging the optic nerve head, 2) imaging the retinal nerve fiber layer and 3) imaging retinal ganglion cell soma and dendrites. The article concludes with a brief section on possible future directions.
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Affiliation(s)
- Brad Fortune
- Discoveries in Sight Research Laboratories, Devers Eye Institute and Legacy Research Institute, Legacy Health, 1225 NE Second Avenue, Portland, OR 97232, USA.
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De Montigny E, Madore WJ, Ouellette O, Bernard G, Leduc M, Strupler M, Boudoux C, Godbout N. Double-clad fiber coupler for partially coherent detection. OPTICS EXPRESS 2015; 23:9040-51. [PMID: 25968739 DOI: 10.1364/oe.23.009040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Double-clad fibers (DCF) have many advantages in fibered confocal microscopes as they allow for coherent illumination through their core and partially coherent detection through their inner cladding. We report a double-clad fiber coupler (DCFC) made from small inner cladding DCF that preserves optical sectioning in confocal microscopy while increasing collection efficiency and reducing coherent effects. Due to the small inner cladding, previously demonstrated fabrication methods could not be translated to this coupler's fabrication. To make such a coupler possible, we introduce in this article three new design concepts. The resulting DCFC fabricated using two custom fibers and a modified fusion-tapering technique achieves high multimodal extraction (≥70 %) and high single mode transmission (≥80 %). Its application to reflectance confocal microscopy showed a 30-fold increase in detected signal intensity, a 4-fold speckle contrast reduction with a penalty in axial resolution of a factor 2. This coupler paves the way towards more efficient confocal microscopes for clinical applications.
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12
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Jünemann AGM, Huchzermeyer C, Rejdak R. [Medicinal glaucoma therapy. What can we learn from large randomized clinical trials?]. Ophthalmologe 2015; 110:1134-48. [PMID: 24337205 DOI: 10.1007/s00347-012-2671-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The prospective multicenter randomized controlled clinical trials (RCTs) Ocular Hypertension Glaucoma Treatment Study (OHTS), Early Manifest Glaucoma Trial (EMGT), Advanced Glaucoma Intervention Study (AGIS), Collaborative Initial Glaucoma Treatment Study (CITGS) and Collaborative Normal Tension Glaucoma Study (CNGTS) are often named as landmarks for glaucoma management as the results of these studies provided the evidence for numerous therapeutic decisions in clinical practice. The studies confirmed the consensus that reduction of intraocular pressure reduces the risk of glaucoma progression covering the whole spectrum of glaucoma from ocular hypertension to advanced glaucoma. Furthermore, the identification of new risk factors allows a higher precision of assessment of the risk of progression. The RCTs achieved the main goal of high level of evidence, thus making progress in the understanding of glaucoma and its treatment and bridging consensus-based and evidence-based decisions. However, the implementation of the results into clinical practice needs adequate and accurate interpretation of the results.
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Affiliation(s)
- A G M Jünemann
- Klinik für Augenheilkunde, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 90154, Erlangen, Deutschland,
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13
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Boey PY, Mansberger SL. Ocular hypertension: an approach to assessment and management. Can J Ophthalmol 2014; 49:489-96. [PMID: 25433737 DOI: 10.1016/j.jcjo.2014.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/24/2014] [Accepted: 07/15/2014] [Indexed: 10/24/2022]
Abstract
Ocular hypertension is a common and important problem seen by eye care providers. This review presents a practical approach to individuals with ocular hypertension. It describes the common functional and structural investigations used in evaluation, as well as the advantages and disadvantages of each test. This review also discusses several landmark studies on ocular hypertension and provides a practical guide to the management of this problem.
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Affiliation(s)
- Pui Yi Boey
- Devers Eye Institute, Legacy Health System, Portland, Ore.; Singapore National Eye Centre, Singapore
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14
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Strouthidis NG, Chandrasekharan G, Diamond JP, Murdoch IE. Teleglaucoma: ready to go? Br J Ophthalmol 2014; 98:1605-11. [PMID: 24723617 PMCID: PMC4251299 DOI: 10.1136/bjophthalmol-2013-304133] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 01/22/2014] [Accepted: 03/16/2014] [Indexed: 01/28/2023]
Abstract
Telemedicine technologies and services allow today's ophthalmic clinicians to remotely diagnose, manage and monitor several ophthalmic conditions from a distance. But is this the case for glaucomas? There has been a proliferation of telemedicine friendly devices in recent years that improves the capabilities of the clinician in managing glaucomas. The existing instruments still need to align themselves with accepted industry standards. There are successful programmes running in several areas of the world. The safety and efficacy of these programmes needs further exploration. The inability of a single device or test to diagnose glaucomas satisfactorily has also hampered progress in remotely diagnosing these conditions. There is, however, significant potential for telemedicine-friendly devices to remotely monitor the progress of glaucoma and, thereby, reduce some of the workload on an overstretched health service.
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Affiliation(s)
- N G Strouthidis
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK Singapore Eye Research Institute, Singapore, Singapore
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15
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Medeiros FA. Biomarkers and surrogate endpoints in glaucoma clinical trials. Br J Ophthalmol 2014; 99:599-603. [PMID: 25034049 DOI: 10.1136/bjophthalmol-2014-305550] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/28/2014] [Indexed: 12/22/2022]
Abstract
Surrogate endpoints are often used as replacements for true clinically relevant endpoints in several areas of medicine, as they enable faster and less expensive clinical trials. However, without proper validation, the use of surrogates may lead to incorrect conclusions about the efficacy and safety of treatments. This article reviews the general requirements for validating surrogate endpoints and provides a critical assessment of the use of intraocular pressure (IOP), visual fields, and structural measurements of the optic nerve as surrogate endpoints in glaucoma clinical trials. A valid surrogate endpoint must be able to predict the clinically relevant endpoint and fully capture the effect of an intervention on that endpoint. Despite its widespread use in clinical trials, no proper validation of IOP as a surrogate endpoint has ever been conducted for any class of IOP-lowering treatments. Evidence has accumulated with regard to the role of imaging measurements of optic nerve damage as surrogate endpoints in glaucoma. These measurements are predictive of functional losses in the disease and may explain, at least in part, treatment effects on clinically relevant endpoints. The use of composite endpoints in glaucoma trials may overcome weaknesses of the use of structural or functional endpoints in isolation. Unless research is dedicated to fully develop and validate suitable endpoints that can be used in glaucoma clinical trials, we run the risk of inappropriate judgments about the value of new therapies.
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16
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Kim C, Demetriades AM, Radcliffe NM. One Year of Glaucoma Research in Review: 2012 to 2013. Asia Pac J Ophthalmol (Phila) 2014; 3:48-55. [PMID: 25177529 PMCID: PMC4148017 DOI: 10.1097/apo.0000000000000041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The objective of this study was to provide the practicing clinical ophthalmologist with an update of pertinent glaucoma literature published from 2012 to 2013. DESIGN Literature review. METHODS The authors conducted a 1-year (July 1, 2012, to September 30, 2013) English-language glaucoma literature search on PubMed using the following terms: glaucoma, automated perimetry, optic nerve imaging, optical coherence tomography, glaucoma structure and function, intraocular pressure, central corneal thickness, glaucoma medical therapy, neuroprotection, glaucoma laser treatment, secondary glaucoma, glaucoma surgery, and miscellaneous topics in glaucoma. RESULTS Of 2659 articles on glaucoma published during our time frame, this review selected original and review articles that reflect novel aspects and updates in the field of glaucoma, while excluding letters to the editor, unpublished works, and abstracts. Preference was given to human research. CONCLUSIONS This review focuses on literature that is applicable to ophthalmologists in practice and also highlights studies that may enhance the diagnosis and management of glaucoma.
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Affiliation(s)
- Charles Kim
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY
| | - Anna M Demetriades
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY
| | - Nathan M Radcliffe
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY
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