1
|
Jan C, He M, Vingrys A, Zhu Z, Stafford RS. Diagnosing glaucoma in primary eye care and the role of Artificial Intelligence applications for reducing the prevalence of undetected glaucoma in Australia. Eye (Lond) 2024; 38:2003-2013. [PMID: 38514852 PMCID: PMC11269618 DOI: 10.1038/s41433-024-03026-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/05/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024] Open
Abstract
Glaucoma is the commonest cause of irreversible blindness worldwide, with over 70% of people affected remaining undiagnosed. Early detection is crucial for halting progressive visual impairment in glaucoma patients, as there is no cure available. This narrative review aims to: identify reasons for the significant under-diagnosis of glaucoma globally, particularly in Australia, elucidate the role of primary healthcare in glaucoma diagnosis using Australian healthcare as an example, and discuss how recent advances in artificial intelligence (AI) can be implemented to improve diagnostic outcomes. Glaucoma is a prevalent disease in ageing populations and can have improved visual outcomes through appropriate treatment, making it essential for general medical practice. In countries such as Australia, New Zealand, Canada, USA, and the UK, optometrists serve as the gatekeepers for primary eye care, and glaucoma detection often falls on their shoulders. However, there is significant variation in the capacity for glaucoma diagnosis among eye professionals. Automation with Artificial Intelligence (AI) analysis of optic nerve photos can help optometrists identify high-risk changes and mitigate the challenges of image interpretation rapidly and consistently. Despite its potential, there are significant barriers and challenges to address before AI can be deployed in primary healthcare settings, including external validation, high quality real-world implementation, protection of privacy and cybersecurity, and medico-legal implications. Overall, the incorporation of AI technology in primary healthcare has the potential to reduce the global prevalence of undiagnosed glaucoma cases by improving diagnostic accuracy and efficiency.
Collapse
Affiliation(s)
- Catherine Jan
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia.
- Ophthalmology, Department of Surgery, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
- Lost Child's Vision Project, Sydney, NSW, Australia.
| | - Mingguang He
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Ophthalmology, Department of Surgery, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- Centre for Eye and Vision Research, The Hong Kong Polytechnic University, Kowloon, TU428, Hong Kong SAR
| | - Algis Vingrys
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Ophthalmology, Department of Surgery, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Zhuoting Zhu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Ophthalmology, Department of Surgery, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Randall S Stafford
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
2
|
Purola PKM, Taipale J, Väätäinen S, Harju M, Koskinen SVP, Uusitalo HMT. Price tag of glaucoma care is minor compared with the total direct and indirect costs of glaucoma: Results from nationwide survey and register data. PLoS One 2023; 18:e0295523. [PMID: 38117760 PMCID: PMC10732367 DOI: 10.1371/journal.pone.0295523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/21/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND The estimations of the economic burden of glaucoma have focused on comparing different treatment modalities; hence, the total direct and indirect costs of glaucoma at population level are not well known. OBJECTIVE To estimate the direct and indirect costs of glaucoma and its treatment in Finland. METHODS Economic and glaucoma data were collected from the cross-sectional nationwide Health 2000 health examination survey linked to multiple national registers, which allowed a 13-year follow-up between 1999-2011 among survey participants. Direct costs covered eye- and non-eye-related hospitalizations and outpatient visits, outpatient health care services, and travel costs among participants aged 30 years or older, adjusted for age and sex. Indirect costs covered premature retirement and productivity losses among participants aged 30-64 years. Glaucoma patients (n = 192) were compared with non-glaucomatous population (n = 6,952). RESULTS The annual additional total direct costs were EUR 2,660/glaucoma patient, EUR 1,769/glaucoma patient with medication, and EUR 3,979/operated glaucoma patient compared with persons without glaucoma. The respective additional total indirect costs were EUR 4,288, EUR 3,246, and EUR 12,902 per year. In total, the additional annual direct and indirect expenditures associated with glaucoma in Finland were EUR 202 million (0.86% of total expenditures of health care) and EUR 71 million (0.03% of the Finnish gross domestic product) arising mainly from non-eye-related hospitalizations and productivity losses, respectively. CONCLUSION Glaucoma is associated with an increased health care consumption mainly due to non-eye-related health care, which can be explained by the vision loss as well as increased number of co-morbidities among glaucoma patients. Therefore, glaucoma constitutes a major economic burden for the health care system and society, highlighting the importance of early glaucoma interventions. The difference in direct and indirect costs between glaucoma treatment groups is explained by the uneven distribution of co-morbidities.
Collapse
Affiliation(s)
- Petri K. M. Purola
- Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Register of Visual Impairment, Finnish Federation of the Visually Impaired, Helsinki, Finland
| | - Joonas Taipale
- Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Mika Harju
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Seppo V. P. Koskinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hannu M. T. Uusitalo
- Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Register of Visual Impairment, Finnish Federation of the Visually Impaired, Helsinki, Finland
- Tays Eye Center, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
3
|
Paul ME, Tseng VL, Kitayama K, Yu F, Coleman AL. Evaluating Discrepancies in Self-Reported Glaucoma and Electronic Health Records in the National Institutes of Health All of Us Database. Ophthalmol Glaucoma 2023; 6:521-529. [PMID: 36931428 DOI: 10.1016/j.ogla.2023.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/17/2023] [Accepted: 03/07/2023] [Indexed: 03/17/2023]
Abstract
PURPOSE Patient understanding of glaucoma diagnosis is critical for disease management and it is unclear if there are racial/ethnic differences in this regard. The purpose of this study was to determine the level of agreement between glaucoma diagnosis by self-report and electronic health record (EHR) data using the National Institute of Health's "All of Us (AoU)" database and to examine the association between race/ethnicity and discordance of glaucoma diagnosis between self-report and EHR data. DESIGN Cross-sectional study. PARTICIPANTS Individuals in AoU who answered a survey question about glaucoma diagnosis and had EHR data availability. METHODS The agreement between self-reported glaucoma and EHR data was estimated using Cohen's κ coefficient. Multivariable logistic regression was performed, adjusting for age, sex, education level, income, and health care literacy, to examine the associations between race/ethnicity and discordance between self-reported glaucoma and EHR diagnosis. MAIN OUTCOME MEASURES Agreement between self-reported glaucoma and EHR diagnosis. RESULTS Of all 87 782 individuals, 1985 (2.26%) had both self-reported and EHR glaucoma, 81 781 (92.16%) had no glaucoma, 2022 (2.31%) individuals had EHR-only glaucoma, and 1994 (2.27%) had self-report-only glaucoma (Cohen's κ = 0.47). In the multivariable regression, Black or African American (adjusted odds ratio [aOR], 1.67; 95% confidence interval [CI], 1.40-1.98), Asian (aOR, 2.63; 95% CI, 1.97-3.44), and Hispanic or Latino (aOR, 1.63; 95% CI, 1.33-1.99) individuals were more likely to have EHR-only glaucoma than White individuals. Additionally, Black or African American (aOR, 2.30; 95% CI, 1.97-2.67) and Hispanic or Latino individuals (aOR,1.47; 95% CI, 1.21-1.79) were more likely to have self-report-only glaucoma compared with White individuals. CONCLUSIONS In the AoU database, we found that Black or African American and Hispanic or Latino individuals had higher odds of discordance between glaucoma diagnosis by self-report and EHR. Future studies are needed to examine the issues leading to this discordance, such as a lack of patient understanding regarding their diagnosis or a lack of culturally appropriate physician explanation/teaching. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Megan E Paul
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Victoria L Tseng
- Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, California
| | - Ken Kitayama
- Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, California; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California
| | - Fei Yu
- Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, California; Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, California
| | - Anne L Coleman
- Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, California; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California.
| |
Collapse
|
4
|
Lemij HG, de Vente C, Sánchez CI, Vermeer KA. Characteristics of a large, labeled dataset for the training of artificial intelligence for glaucoma screening with fundus photographs. OPHTHALMOLOGY SCIENCE 2023; 3:100300. [PMID: 37113471 PMCID: PMC10127130 DOI: 10.1016/j.xops.2023.100300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/12/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
Purpose Significant visual impairment due to glaucoma is largely caused by the disease being detected too late. Objective To build a labeled data set for training artificial intelligence (AI) algorithms for glaucoma screening by fundus photography, to assess the accuracy of the graders, and to characterize the features of all eyes with referable glaucoma (RG). Design Cross-sectional study. Subjects Color fundus photographs (CFPs) of 113 893 eyes of 60 357 individuals were obtained from EyePACS, California, United States, from a population screening program for diabetic retinopathy. Methods Carefully selected graders (ophthalmologists and optometrists) graded the images. To qualify, they had to pass the European Optic Disc Assessment Trial optic disc assessment with ≥ 85% accuracy and 92% specificity. Of 90 candidates, 30 passed. Each image of the EyePACS set was then scored by varying random pairs of graders as "RG," "no referable glaucoma (NRG)," or "ungradable (UG)." In case of disagreement, a glaucoma specialist made the final grading. Referable glaucoma was scored if visual field damage was expected. In case of RG, graders were instructed to mark up to 10 relevant glaucomatous features. Main Outcome Measures Qualitative features in eyes with RG. Results The performance of each grader was monitored; if the sensitivity and specificity dropped below 80% and 95%, respectively (the final grade served as reference), they exited the study and their gradings were redone by other graders. In all, 20 graders qualified; their mean sensitivity and specificity (standard deviation [SD]) were 85.6% (5.7) and 96.1% (2.8), respectively. The 2 graders agreed in 92.45% of the images (Gwet's AC2, expressing the inter-rater reliability, was 0.917). Of all gradings, the sensitivity and specificity (95% confidence interval) were 86.0 (85.2-86.7)% and 96.4 (96.3-96.5)%, respectively. Of all gradable eyes (n = 111 183; 97.62%) the prevalence of RG was 4.38%. The most common features of RG were the appearance of the neuroretinal rim (NRR) inferiorly and superiorly. Conclusions A large data set of CFPs was put together of sufficient quality to develop AI screening solutions for glaucoma. The most common features of RG were the appearance of the NRR inferiorly and superiorly. Disc hemorrhages were a rare feature of RG. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
Collapse
|
5
|
Chan MPY, Khawaja AP, Broadway DC, Yip J, Luben R, Hayat S, Peto T, Khaw KT, Foster PJ. Risk factors for previously undiagnosed primary open-angle glaucoma: the EPIC-Norfolk Eye Study. Br J Ophthalmol 2022; 106:1684-1688. [PMID: 34172506 PMCID: PMC9685696 DOI: 10.1136/bjophthalmol-2020-317718] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 06/05/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND AIM Undiagnosed glaucoma is an invisible but important public health issue. At least half of glaucoma cases are estimated to be undiagnosed in western populations. The aim of this study is to examine risk factors for previously undiagnosed primary open-angle glaucoma (POAG). DESIGN Cross-sectional study within the European Prospective Investigation of Cancer-Norfolk Eye Study, a large-scale cohort study in the UK. PARTICIPANTS 314 study participants with POAG in either eye. METHODS Logistic regression was used to examine associations with previously undiagnosed POAG compared with previously diagnosed POAG. The factors examined included sociodemographic, ocular, physical and economic factors that could be barriers to eye care access. RESULTS 217 participants had previously diagnosed POAG and 107 participants were newly diagnosed with POAG during the study. After adjusting for covariables, the factors significantly associated with previously undiagnosed POAG were: a lower pretreatment intraocular pressure (IOP) (OR 0.71/mm Hg, 95% CI 0.63 to 0.80, p<0.0001), and to have reported no problems with their eyesight (OR 0.03, 95% CI 0.01 to 0.10, p<0.0001). CONCLUSIONS The risk factors for previously undiagnosed POAG identified in this study highlight the over-reliance on IOP level in glaucoma screening and the risk of missing glaucoma among lower IOP cases. It also suggests a role in improving glaucoma awareness in the community.
Collapse
Affiliation(s)
| | - Anthony P Khawaja
- NIHR Moorfields Biomedical Research Centre & UCL Institute of Ophthalmology, London, UK
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - David C Broadway
- Department Ophthalmology, Norfolk & Norwich University Hospital, Norwich, UK
| | - Jennifer Yip
- Clinical Research Department, International Centre for Evidence on Disability, London, UK
| | - Robert Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Shabina Hayat
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Tunde Peto
- Centre for Public Health, Blackwell's Queen's University Belfast, Belfast, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Paul J Foster
- NIHR Moorfields Biomedical Research Centre & UCL Institute of Ophthalmology, London, UK
| |
Collapse
|
6
|
Nealon CL, Halladay CW, Kinzy TG, Simpson P, Canania RL, Anthony SA, Roncone DP, Sawicki Rogers LR, Leber JN, Dougherty JM, Sullivan JM, Wu WC, Greenberg PB, Iyengar SK, Crawford DC, Peachey NS, Bailey JNC. Development and Evaluation of a Rules-based Algorithm for Primary Open-Angle Glaucoma in the VA Million Veteran Program. Ophthalmic Epidemiol 2022; 29:640-648. [PMID: 34822319 PMCID: PMC9583190 DOI: 10.1080/09286586.2021.1992784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/20/2021] [Accepted: 10/09/2021] [Indexed: 10/19/2022]
Abstract
The availability of electronic health record (EHR)-linked biobank data for research presents opportunities to better understand complex ocular diseases. Developing accurate computable phenotypes for ocular diseases for which gold standard diagnosis includes imaging remains inaccessible in most biobank-linked EHRs. The objective of this study was to develop and validate a computable phenotype to identify primary open-angle glaucoma (POAG) through accessing the Department of Veterans Affairs (VA) Computerized Patient Record System (CPRS) and Million Veteran Program (MVP) biobank. Accessing CPRS clinical ophthalmology data from VA Medical Center Eye Clinic (VAMCEC) patients, we developed and iteratively refined POAG case and control algorithms based on clinical, prescription, and structured diagnosis data (ICD-CM codes). Refinement was performed via detailed chart review, initially at a single VAMCEC (n = 200) and validated at two additional VAMCECs (n = 100 each). Positive and negative predictive values (PPV, NPV) were computed as the proportion of CPRS patients correctly classified with POAG or without POAG, respectively, by the algorithms, validated by ophthalmologists and optometrists with access to gold-standard clinical diagnosis data. The final algorithms performed better than previously reported approaches in assuring the accuracy and reproducibility of POAG classification (PPV >83% and NPV >97%) with consistent performance in Black or African American and in White Veterans. Applied to the MVP to identify cases and controls, genetic analysis of a known POAG-associated locus further validated the algorithms. We conclude that ours is a viable approach to use combined EHR-genetic data to study patients with complex diseases that require imaging confirmation.
Collapse
Affiliation(s)
| | | | - Tyler G. Kinzy
- VA Northeast Ohio Healthcare System, Cleveland, OH
- Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, OH
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | | | | | | | | | - Jenna N. Leber
- Ophthalmology Section, VA Western NY Health Care System, Buffalo NY
| | | | - Jack M. Sullivan
- Ophthalmology Section, VA Western NY Health Care System, Buffalo NY
| | - Wen-Chih Wu
- Cardiology Section, Medical Service, Providence VA Medical Center, Providence, RI
| | - Paul B. Greenberg
- Ophthalmology Section, Providence VA Medical Center, Providence, RI
- Division of Ophthalmology, Alpert Medical School, Brown University, Providence, RI
| | - Sudha K. Iyengar
- VA Northeast Ohio Healthcare System, Cleveland, OH
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Dana C. Crawford
- VA Northeast Ohio Healthcare System, Cleveland, OH
- Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, OH
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Neal S. Peachey
- VA Northeast Ohio Healthcare System, Cleveland, OH
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH
- Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Jessica N. Cooke Bailey
- VA Northeast Ohio Healthcare System, Cleveland, OH
- Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, OH
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
| | | |
Collapse
|
7
|
The performance of iPad-based noise-field perimeter versus Humphrey Field Analyser in detecting glaucomatous visual field loss. Eye (Lond) 2022; 36:800-811. [PMID: 33879855 PMCID: PMC8056996 DOI: 10.1038/s41433-021-01541-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 02/28/2021] [Accepted: 04/06/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To conduct a preliminary evaluation of the feasibility of visual field fast (VFF), a free iPad-based noise-field perimeter, in detecting glaucomatous scotomas versus the clinical-standard Humphrey visual field (HVF) test. VFF confronts subjects with a screen of flickering stimulus, allowing the immediate perception of scotomas. METHODS This was a cross-sectional observational study of 66 glaucoma patients (66 eyes) and 30 healthy controls (30 eyes). All patients had no other visual field disorders. VFF was compared against HVF in terms of whole field and quadrants for the following: (1) correspondence in scotoma detection. (2) Agreement and correlation of the scotoma size (percentage of abnormal visual field area). (3) Test duration. Other domains tested included: (1) correlation of VFF scotoma area with the severity of visual field loss on HVF (mean deviation, MD; visual field index, VFI). (2) Repeatability of VFF. (3) Patient descriptors of scotomas. RESULTS Using HVF pattern deviation plot as a reference, VFF detected 52/57 (91.2%) of glaucoma subjects with 1 false-positive (control) (kappa = 0.86). 146/184 (79.3%) of abnormal quadrants (visual field defect present) were localized and 23/157 (14.6%) healthy quadrants were falsely identified as abnormal (kappa = 0.61). VFF underestimated scotoma area as compared to HVF (21.0% versus 44.0%, p < 0.01) but correlated positively (r = 0.268, p = 0.044) with HVF area and negatively with VFI (r = -0.340, p = 0.01) and MD (r = -0.398, p < 0.01). Using HVF total deviation plot as reference, VFF's glaucoma detection rate remained unchanged (kappa = 0.86) with similar quadrant detection (kappa = 0.68). However, a greater underestimation of scotoma area was observed (21.0% versus 85.4%, p < 0.01). VFF's quantitative repeatability was excellent for whole field (intraclass correlation coefficient, ICC: 0.96; p < 0.0001) and quadrants (ICC: 0.82-0.96; all p < 0.001). Qualitatively, 35/37 (94.6%) of subjects reported reduced luminance and flicker in scotomas, with similar morphologies on retests. VFF is faster than HVF SITA-Standard in glaucoma (3.60 ± 1.85 min versus 6.92 ± 1.12 min, p < 0.01) and control (1.12 ± 0.486 min versus 5.16 ± 0.727 min, p < 0.01). CONCLUSION This early model of VFF accurately detected scotomas with high repeatability. However, its accuracy in localizing and quantifying the scotoma can be improved. Considering its portability and cost-effectiveness, VFF demonstrated potential as a general screening tool for moderate-to-severe glaucoma.
Collapse
|
8
|
Rewri P, Ali W. Erroneous assumption of ocular hypertension in patients with elevated intraocular pressure. Indian J Ophthalmol 2022; 70:564-568. [PMID: 35086238 PMCID: PMC9024004 DOI: 10.4103/ijo.ijo_938_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Purpose: To determine the proportion of erroneously assumed ocular hypertension (OHT) among referred patients of elevated intraocular pressure (IOP) seen in glaucoma clinic of a teaching hospital in Northern India. Methods: Retrospective review of case records of referred, diagnosed patients of OHT or unspecified glaucoma seen between January 2019 and March 2020. Using an algorithmic clinical approach, including gonioscopy, Goldmann applanation tonometry (GAT), and pachymetry, underlying cause for elevated-IOP was amended and proportion of erroneously assumed OHT was calculated. Results: Of 276 patients diagnosed either as OHT or unspecified glaucoma before being seen at our glaucoma clinic, 44 (16%) had IOP within normal range (10–21 mmHg) on GAT. In 97 (35%) cases elevated-IOP was associated with angle closure. The central corneal thickness (CCT) was >550 μm in 39 (14%) patients with elevated-IOP. The proportion of erroneously assumed OHT was 70% in this study. Conclusion: The elevated-IOP does not imply with OHT unless evident through comprehensive clinical examination and appropriate investigations.
Collapse
Affiliation(s)
- Parveen Rewri
- Glauco`ma Services, Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha, Hisar, Haryana, India
| | - Wazid Ali
- Glaucoma Services, Department of Ophthalmology, Maharaja Agrasen Medical College, Agroha, Hisar, Haryana, India
| |
Collapse
|
9
|
Chia MA, Trang E, Agar A, Vingrys AJ, Hepschke J, Kong GY, Turner AW. Screening for Glaucomatous Visual Field Defects in Rural Australia with an iPad. J Curr Glaucoma Pract 2021; 15:125-131. [PMID: 35173394 PMCID: PMC8807937 DOI: 10.5005/jp-journals-10078-1312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim and objective Developing improved methods for early detection of visual field defects is pivotal to reducing glaucoma-related vision loss. The Melbourne Rapid Fields screening module (MRF-S) is an iPad-based test, which allows suprathreshold screening with zone-based analysis to rapidly assess the risk of manifest glaucoma. The versatility of MRF-S has potential utility in rural areas and during infectious pandemics. This study evaluates the utility of MRF-S for detecting field defects in non-metropolitan settings. Materials and methods This was a prospective, multicenter, cross-sectional validation study. Two hundred and fifty-two eyes of 142 participants were recruited from rural sites through two outreach eye services in Australia. Participants were tested using MRF-S and compared with a reference standard; either Zeiss Humphrey Field Analyzer or Haag-Streit Octopus performed at the same visit. Standardized questionnaires were used to assess user acceptability. Major outcome measures were the area under the curve (AUC) for detecting mild and moderate field defects defined by the reference tests, along with corresponding performance characteristics (sensitivity, specificity). Results The mean test duration for MRF-S was 1.88 minutes compared with 5.92 minutes for reference tests. The AUCs for mild and moderate field defects were 0.81 [95% confidence interval (CI): 0.75–0.87] and 0.87 (95% CI: 0.83–0.92), respectively, indicating very good diagnostic accuracy. Using a risk criterion of 55%, MRF-S identified moderate field defects with a sensitivity and specificity of 88.4 and 81.0%, respectively. Conclusion and clinical significance The MRF-S iPad module can identify patients with mild and moderate field defects while delivering favorable user acceptability and short test duration. This has potential application within rural locations and amidst infectious pandemics. How to cite this article Chia MA, Trang E, Agar A, et al. Screening for Glaucomatous Visual Field Defects in Rural Australia with an iPad. J Curr Glaucoma Pract 2021;15(3):125–131.
Collapse
Affiliation(s)
- Mark A Chia
- Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia, Australia
| | - Edward Trang
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Ashish Agar
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia; Department of Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Algis J Vingrys
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Jenny Hepschke
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia; Department of Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - George Yx Kong
- Department of Glaucoma, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Centre for Eye Research Australia, East Melbourne, Victoria, Australia
| | - Angus W Turner
- Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia, Australia
| |
Collapse
|
10
|
Iwase A, Sawaguchi S, Araie M. Differentiating Diagnosed and Undiagnosed Primary Angle-Closure Glaucoma and Open-Angle Glaucoma: A Population-Based Study. Ophthalmol Glaucoma 2021; 5:160-169. [PMID: 34339876 DOI: 10.1016/j.ogla.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To study and compare factors contributing to the differentiation between diagnosed and undiagnosed primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) in the same population. DESIGN Population-based survey. PARTICIPANTS All residents 40 years of age and older in Kumejima, Japan. METHODS Primary angle-closure glaucoma and POAG were diagnosed according to the criteria of the International Society of Geographical and Epidemiological Ophthalmology. Factors contributing significantly to the differentiation between diagnosed and undiagnosed PACG and POAG were selected from various systemic, ocular, visual function, and fundus planimetric parameters using multivariate logistic regression analysis and were compared between the two diseases. MAIN OUTCOME MEASURES Factors contributing significantly to the differentiation between diagnosed and undiagnosed PACG and POAG. RESULTS The prevalence rates of PACG and POAG were 2.2% and 4.0%, respectively. A greater proportion of patients with PACG (34.1%) received a diagnosis previously compared with patients with POAG (17.2%; P = 0.004). Worse mean deviation on visual field (VF) testing (odds ratio, 0.869; 95% confidence interval, 0.788-0.959; P = 0.006) and the presence of signs suggestive of previous acute angle closure (odds ratio, 4.35; range, 1.66-11.36; P = 0.003) contributed to a established diagnosis of PACG at the time of screening. A greater vertical cup-to-disc ratio (3.74; range, 1.38-10.17; P = 0.012) contributed with marginal significance to an established diagnosis of POAG at the time of screening. CONCLUSIONS Primary angle-closure glaucoma was more likely to have been diagnosed previously than POAG during a screening examination. Examination of the anterior segment and VF may contribute more to the detection of PACG, and disc examination may contribute more to the detection of POAG.
Collapse
Affiliation(s)
- Aiko Iwase
- Tajimi Iwase Eye Clinic, Gifu, Tajimi, Japan.
| | - Shoichi Sawaguchi
- Department of Ophthalmology, University of the Ryukyus, Graduate School of Medicine, Okinawa, Japan
| | - Makoto Araie
- Department of Ophthalmology, Kanto Central Hospital of The Mutual Aid Association of Public School Teachers, Tokyo, Japan; Department of Ophthalmology, University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
11
|
Luu W, Zangerl B, Kalloniatis M, Palmisano S, Kim J. Vision Impairment Provides New Insight Into Self-Motion Perception. Invest Ophthalmol Vis Sci 2021; 62:4. [PMID: 33533880 PMCID: PMC7862735 DOI: 10.1167/iovs.62.2.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose Leading causes of irreversible blindness such as age-related macular degeneration (AMD) and glaucoma can, respectively, lead to central or peripheral vision loss. The ability of sufferers to process visual motion information can be impacted even during early stages of eye disease. We used head-mounted display virtual reality as a tool to better understand how vision changes caused by eye diseases directly affect the processing of visual information critical for self-motion perception. Methods Participants with intermediate AMD or early manifest glaucoma with near-normal visual acuities and visual fields were recruited for this study. We examined their experiences of self-motion in depth (linear vection), spatial presence, and cybersickness when viewing radially expanding patterns of optic flow simulating different speeds of self-motion in depth. Viewing was performed with the head stationary (passive condition) or while making lateral-sway head movements (active conditions). Results Participants with AMD (i.e., central visual field loss) were found to have greater vection strength and spatial presence, compared to participants with normal visual fields. However, participants with glaucoma (i.e., peripheral visual field loss) were found to have lower vection strength and spatial presence, compared to participants with normal visual fields. Both AMD and glaucoma groups reported reduced severity in cybersickness compared to healthy normals. Conclusions These findings strongly support the view that perceived self-motion is differentially influenced by peripheral versus central vision loss, and that patients with different visual field defects are oppositely biased when processing visual cues to self-motion perception.
Collapse
Affiliation(s)
- Wilson Luu
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Centre for Eye Health, University of New South Wales, Sydney, Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Centre for Eye Health, University of New South Wales, Sydney, Australia
| | - Michael Kalloniatis
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Centre for Eye Health, University of New South Wales, Sydney, Australia
| | - Stephen Palmisano
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Juno Kim
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| |
Collapse
|
12
|
Da Soh Z, Yu M, Betzler BK, Majithia S, Thakur S, Tham YC, Wong TY, Aung T, Friedman DS, Cheng CY. The Global Extent of Undetected Glaucoma in Adults: A Systematic Review and Meta-analysis. Ophthalmology 2021; 128:1393-1404. [PMID: 33865875 DOI: 10.1016/j.ophtha.2021.04.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 01/30/2023] Open
Abstract
TOPIC Glaucoma is the leading cause of irreversible blindness, despite having good prognosis with early treatment. We evaluated the global extent of undetected glaucoma and the factors associated with it in this systematic review and meta-analysis. CLINICAL RELEVANCE Undetected glaucoma increases the risk of vision impairment, which leads to detrimental effects on the quality-of-life and socioeconomic well-being of those affected. Detailed information on the extent and factors associated with undetected glaucoma aid in the development of public health interventions. METHODS We conducted a systematic review and meta-analysis of population-based studies published between January 1, 1990, and June 1, 2020. Article search was conducted in online databases (PubMED, Web-of-Science), grey literatures (OpenGrey), and nongovernment organization reports. Our outcome measure was the proportion of glaucoma cases that were undetected previously. Manifest glaucoma included any form of glaucoma reported in the original studies and may include primary open-angle glaucoma (POAG), primary angle-closure-glaucoma, secondary glaucoma, or a combination thereof. Undetected glaucoma was defined as glaucoma cases that were undetected prior to diagnosis in the respective study. Random-effect meta-analysis was used to estimate the pooled proportion of undetected glaucoma. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Meta-analysis of Observational Studies in Epidemiology guidelines in our study. RESULTS We identified 61 articles from 55 population-based studies (n = 189 359 participants; n = 6949 manifest glaucoma). Globally, more than half of all glaucoma cases were undetected previously on average in each geographical region. Africa (odds ratio [OR], 12.70; 95% confidence interval [CI], 4.91-32.86) and Asia (OR, 3.41; 95% CI, 1.63-7.16) showed higher odds of undetected glaucoma as compared with Europe. Countries with low Human Development Index (HDI; <0.55) showed a higher proportion of undetected manifest glaucoma as compared with countries of medium to very high HDI (≥0.55; all P < 0.001). In 2020, 43.78 million POAG cases were projected to be undetected, of which 76.7% were in Africa and Asia. DISCUSSION Undetected glaucoma is highly prevalent across diverse communities worldwide and more common in Africa and Asia. Strategies to improve detection are needed to prevent excess visual disability and blindness resulting from glaucoma.
Collapse
Affiliation(s)
- Zhi Da Soh
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Marco Yu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Shivani Majithia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Sahil Thakur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore
| | - David S Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore.
| |
Collapse
|
13
|
The Prevalence of Undiagnosed Age-Related Sight-Threatening Diseases in Self-Proclaimed Healthy Individuals. J Ophthalmol 2021; 2020:3709793. [PMID: 33489327 PMCID: PMC7798115 DOI: 10.1155/2020/3709793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/05/2020] [Accepted: 10/26/2020] [Indexed: 12/05/2022] Open
Abstract
Background Age-related conditions such as glaucoma, age-related macular degeneration, diabetic retinopathy, and cataract have become the major cause of visual impairment and blindness in high-income countries. The aim of the current study is to investigate the prevalence of these eye diseases in a cohort of self-proclaimed healthy elderly and thus get a rough estimation of the prevalence of undiagnosed age-related eye conditions in the Belgian population. Methods Individuals aged 55 and older without ophthalmological complaints were asked to fill in a general medical questionnaire and underwent an ophthalmological examination, which included a biomicroscopic examination, intraocular pressure measurement, axial length measurement, and acquisition of fundus pictures and optical coherence tomography scans. Information regarding follow-up was collected in those who received the advice of referral to an ophthalmologist or the advice to have more frequent follow-up visits, based on their study evaluation. Results The cohort included 102 people and comprised 46% men (median age 70 years, range 57–85 years). Referral for additional examinations was made in 26 participants (25%). The advice to have more regular follow-up ophthalmologist visits was given to nine additional participants (9%). No significant correlations between baseline characteristics and the need for referral could be identified. Follow-up information was available for 25 out of 26 referred volunteers. Out of these, four underwent a therapeutic intervention based on study referral, up until 18 months after study participation. All four interventions took place in the age group 65–74 years. Conclusions This study shows that, even in an elderly population with self-proclaimed healthy eyes and good general health, a significant proportion of subjects showed ocular findings that need regular follow-up and/or intervention. The frequency of prior ophthalmological examinations does not seem to be relevant to this proportion, meaning that everyone above 55 years old needs a routine ophthalmological evaluation.
Collapse
|
14
|
Kaushik N, Sasaki T, Takahashi Y, Nakazawa T, Hane K. MEMS-based wearable eyeglasses for eye health monitoring. Biomed Phys Eng Express 2019; 6:015006. [DOI: 10.1088/2057-1976/ab562e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
15
|
Karvonen E, Stoor K, Luodonpää M, Hägg P, Kuoppala J, Lintonen T, Ohtonen P, Tuulonen A, Saarela V. Prevalence of glaucoma in the Northern Finland Birth Cohort Eye Study. Acta Ophthalmol 2019; 97:200-207. [PMID: 30198084 DOI: 10.1111/aos.13912] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 08/09/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To report the prevalence of glaucoma in the Northern Finland Birth Cohort (NFBC) Eye Study. METHODS Subjects of the population-based Northern Finland 1966 Birth Cohort (NFBC), aged 45-49 years at the time of the field examination, were randomized to eye screening (50%) and control (50%) groups. The eye examination protocol included best corrected visual acuity (BCVA), measurements of intraocular pressure and central corneal thickness, Humphrey 24-2 perimetry, stereoscopic optic nerve head (ONH) and retinal nerve fibre layer (RNFL) photography and imaging with optical coherence tomography (OCT), scanning laser polarimetry (GDx) and scanning laser ophthalmoscopy (HRT). The diagnosis of glaucoma was made by two independent general ophthalmologists and three independent glaucoma experts based on the evaluation of the ONH and RNFL photographs and the visual fields. RESULTS Totally, 10 321 subjects of the NFBC main study were alive in Finland in 2011, and they were randomized to the NFBC Eye Study group (n = 5155) and the control group (n = 5166). Of the randomized subjects, 3039 of 5155 (59%) responded and had sufficient data for the study. Glaucoma was suspected in 172 subjects (5.7%) at the first phase of the evaluation protocol. The interobserver agreement between two screening ophthalmologists was moderately good (kappa value 0.54 [95% confidence intervals (CI) 0.46-0.61]). Finally, definite glaucoma was found in 33 subjects (1.1% [95% CI 0.8-1.5]). CONCLUSION The study provides up-to-date information on the prevalence of glaucoma in a middle-aged Caucasian population in Finland. The baseline data reported here allows the evaluation of the cost-effectiveness of screening later on.
Collapse
Affiliation(s)
- Elina Karvonen
- Department of Ophthalmology PEDEGO Research Unit and Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
| | - Katri Stoor
- Department of Ophthalmology PEDEGO Research Unit and Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
| | - Marja Luodonpää
- Department of Ophthalmology PEDEGO Research Unit and Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
| | - Pasi Hägg
- Department of Ophthalmology PEDEGO Research Unit and Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
| | | | - Timo Lintonen
- Department of Ophthalmology PEDEGO Research Unit and Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
| | - Pasi Ohtonen
- Division of Operative Care Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
| | - Anja Tuulonen
- Tays Eye Centre Tampere University Hospital Tampere Finland
| | - Ville Saarela
- Department of Ophthalmology PEDEGO Research Unit and Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
| |
Collapse
|
16
|
|
17
|
Founti P, Coleman AL, Wilson MR, Yu F, Anastasopoulos E, Harris A, Pappas T, Koskosas A, Kilintzis V, Salonikiou A, Raptou A, Topouzis F. Overdiagnosis of open-angle glaucoma in the general population: the Thessaloniki Eye Study. Acta Ophthalmol 2018; 96:e859-e864. [PMID: 30178607 DOI: 10.1111/aos.13758] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/12/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the overdiagnosis of open-angle glaucoma (OAG) and to investigate associated factors. METHODS This was a cross-sectional, population-based study of an urban Caucasian population in northern Greece. Randomly selected subjects ≥60 years (n = 2554) participated in the Thessaloniki Eye Study. The definition of OAG required the presence of structural and functional damage, irrespective of intraocular pressure (IOP). Non-OAG subjects were classified as overdiagnosed with OAG if they had reported at least one of the following (self-reported glaucoma): (i) prior diagnosis of glaucoma, (ii) prior laser for glaucoma, (iii) prior glaucoma surgery. Factors associated with the overdiagnosis of OAG were investigated using a logistic regression model. RESULTS Of 57 (2.2%) subjects with self-reported glaucoma, 34 (60%) were overdiagnosed with OAG, corresponding to a prevalence of 1.3% (34/2554). In a logistic regression model among non-OAG subjects, worse visual acuity (VA) (20/200 or worse versus 20/25 or better; odds ratio (OR) = 4.30, 95% Confidence Intervals (CI), 1.13-16.35), family history of glaucoma (OR = 8.69, 95% CI, 2.83-26.67) and history of cataract surgery (OR = 11.50, 95% CI, 3.85-34.36) were statistically significantly associated with the overdiagnosis of OAG. Age, sex, higher IOP, higher vertical cup-to-disc ratio and pseudoexfoliation were not statistically significant. CONCLUSION The overdiagnosis of OAG was substantial in this elderly, Caucasian population. The overdiagnosis of glaucoma has not been previously addressed in population-based studies and needs to be further explored.
Collapse
Affiliation(s)
- Panayiota Founti
- 1st Department of Ophthalmology; School of Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
- Glaucoma Unit; Moorfields Eye Hospital NHS Foundation Trust; London UK
| | - Anne L Coleman
- UCLA Stein Eye Institute; David Geffen School of Medicine at UCLA; University of California, Los Angeles; Los Angeles CA USA
| | | | - Fei Yu
- UCLA Stein Eye Institute; David Geffen School of Medicine at UCLA; University of California, Los Angeles; Los Angeles CA USA
| | - Eleftherios Anastasopoulos
- 1st Department of Ophthalmology; School of Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Alon Harris
- Indiana University School of Medicine; Indianapolis IN USA
| | - Theofanis Pappas
- 1st Department of Ophthalmology; School of Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Archimidis Koskosas
- 1st Department of Ophthalmology; School of Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Vassilis Kilintzis
- 1st Department of Ophthalmology; School of Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Angeliki Salonikiou
- 1st Department of Ophthalmology; School of Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Anastasia Raptou
- 1st Department of Ophthalmology; School of Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Fotis Topouzis
- 1st Department of Ophthalmology; School of Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| |
Collapse
|
18
|
John D, Parikh R. Cost-effectiveness of community screening for glaucoma in rural India: a decision analytical model. Public Health 2018; 155:142-151. [DOI: 10.1016/j.puhe.2017.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
|
19
|
Wu J, Lou S, Xiao Z, Geng L, Zhang F, Wang W, Liu M. Design of optical system for binocular fundus camera. Comput Assist Surg (Abingdon) 2017; 22:61-69. [PMID: 28956467 DOI: 10.1080/24699322.2017.1379143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
A non-mydriasis optical system for binocular fundus camera has been designed in this paper. It can capture two images of the same fundus retinal region from different angles at the same time, and can be used to achieve three-dimensional reconstruction of fundus. It is composed of imaging system and illumination system. In imaging system, Gullstrand Le Grand eye model is used to simulate normal human eye, and Schematic eye model is used to test the influence of ametropia in human eye on imaging quality. Annular aperture and black dot board are added into illumination system, so that the illumination system can eliminate stray light produced by corneal-reflected light and omentoscopic lens. Simulation results show that MTF of each visual field at the cut-off frequency of 90lp/mm is greater than 0.2, system distortion value is -2.7%, field curvature is less than 0.1 mm, radius of Airy disc is 3.25um. This system has a strong ability of chromatic aberration correction and focusing, and can image clearly for human fundus in which the range of diopters is from -10 D to +6 D(1 D = 1 m-1).
Collapse
Affiliation(s)
- Jun Wu
- a School of Electronics and Information Engineering , Tianjin Polytechnic University , Tianjin , PR China.,b Tianjin Key Laboratory of Optoelectronic Detection Technology and System , Tianjin , PR China
| | - Shiliang Lou
- a School of Electronics and Information Engineering , Tianjin Polytechnic University , Tianjin , PR China
| | - Zhitao Xiao
- a School of Electronics and Information Engineering , Tianjin Polytechnic University , Tianjin , PR China.,b Tianjin Key Laboratory of Optoelectronic Detection Technology and System , Tianjin , PR China
| | - Lei Geng
- a School of Electronics and Information Engineering , Tianjin Polytechnic University , Tianjin , PR China.,b Tianjin Key Laboratory of Optoelectronic Detection Technology and System , Tianjin , PR China
| | - Fang Zhang
- a School of Electronics and Information Engineering , Tianjin Polytechnic University , Tianjin , PR China.,b Tianjin Key Laboratory of Optoelectronic Detection Technology and System , Tianjin , PR China
| | - Wen Wang
- a School of Electronics and Information Engineering , Tianjin Polytechnic University , Tianjin , PR China.,b Tianjin Key Laboratory of Optoelectronic Detection Technology and System , Tianjin , PR China
| | - Mengjia Liu
- a School of Electronics and Information Engineering , Tianjin Polytechnic University , Tianjin , PR China
| |
Collapse
|
20
|
John D, Parikh R. Cost-effectiveness and cost utility of community screening for glaucoma in urban India. Public Health 2017; 148:37-48. [DOI: 10.1016/j.puhe.2017.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 10/19/2022]
|
21
|
Dong ZM, Wollstein G, Schuman JS. Clinical Utility of Optical Coherence Tomography in Glaucoma. Invest Ophthalmol Vis Sci 2017; 57:OCT556-67. [PMID: 27537415 PMCID: PMC4991023 DOI: 10.1167/iovs.16-19933] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Optical coherence tomography (OCT) has established itself as the dominant imaging modality in the management of glaucoma and retinal diseases, providing high-resolution visualization of ocular microstructures and objective quantification of tissue thickness and change. This article reviews the history of OCT imaging with a specific focus on glaucoma. We examine the clinical utility of OCT with respect to diagnosis and progression monitoring, with additional emphasis on advances in OCT technology that continue to facilitate glaucoma research and inform clinical management strategies.
Collapse
Affiliation(s)
- Zachary M Dong
- University of Pittsburgh Medical Center (UPMC) Eye Center Eye and Ear Institute, Department of Ophthalmology, University of Pittsburgh School of Medicine, Ophthalmology and Visual Science Research Center, Pittsburgh, Pennsylvania, United States
| | - Gadi Wollstein
- University of Pittsburgh Medical Center (UPMC) Eye Center Eye and Ear Institute, Department of Ophthalmology, University of Pittsburgh School of Medicine, Ophthalmology and Visual Science Research Center, Pittsburgh, Pennsylvania, United States 2Departmen
| | - Joel S Schuman
- University of Pittsburgh Medical Center (UPMC) Eye Center Eye and Ear Institute, Department of Ophthalmology, University of Pittsburgh School of Medicine, Ophthalmology and Visual Science Research Center, Pittsburgh, Pennsylvania, United States 2Departmen
| |
Collapse
|
22
|
Lowry EA, Hou J, Hennein L, Chang RT, Lin S, Keenan J, Wang SK, Ianchulev S, Pasquale LR, Han Y. Comparison of Peristat Online Perimetry with the Humphrey Perimetry in a Clinic-Based Setting. Transl Vis Sci Technol 2016; 5:4. [PMID: 27486554 PMCID: PMC4959820 DOI: 10.1167/tvst.5.4.4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/09/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose We determined the receiver operating characteristic (ROC) curves for Peristat online perimetry at detecting varying degrees of glaucoma and the correlation between Peristat online perimetry and Humphrey visual field. Methods A prospective, comparative study of Peristat online perimetry (an achromatic static computer threshold testing program) and Humphrey visual field (HVF) 24-2 SITA standard testing was performed by 63 glaucoma patients and 30 healthy controls in random order. The number of total adjacent abnormal test points were identified for each test, and compared with Spearman correlation. Receive operating characteristic curves were generated for Peristat online perimetry detection of mild and moderate-severe glaucoma patients using contrast sensitivity thresholds of −16.7, −21.7, and −26.7 dB. Results The area under the ROC curve for glaucoma detection ranged from 0.77 to 0.81 for mild disease (mean deviation [MD], >−6 dB on HVF) and 0.85 to 0.87 for moderate to severe disease (MD, <−6 dB on HVF) depending on contrast threshold. Peristat online perimetry and Humphrey visual field abnormal points were highly correlated with Spearman rank correlations ranging from 0.55 to 0.77 (all P < 0.001). Conclusions Peristat online perimetry exhibits a reasonable ROC curve without specialized equipment and exhibited significant correlation with the conventional 24° Humphrey visual field test. Translational Relevance Low cost widely available internet-based visual fields may complement traditional office-based visual field testing.
Collapse
Affiliation(s)
- Eugene A Lowry
- Department of Ophthalmology, University of California-San Francisco, San Francisco, CA, USA
| | - Jing Hou
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China
| | - Lauren Hennein
- Department of Ophthalmology, University of California-San Francisco, San Francisco, CA, USA
| | - Robert T Chang
- Department of Ophthalmology, Stanford University, Stanford, CA, USA
| | - Shan Lin
- Department of Ophthalmology, University of California-San Francisco, San Francisco, CA, USA
| | - Jeremy Keenan
- Department of Ophthalmology, University of California-San Francisco, San Francisco, CA, USA
| | - Sean K Wang
- Department of Ophthalmology, Stanford University, Stanford, CA, USA
| | | | - Louis R Pasquale
- Department of Ophthalmology: Harvard Medical School, Boston, MA, USA ; Division of Network Medicine: Brigham and Women's Hospital, Boston, MA, USA
| | - Ying Han
- Department of Ophthalmology, University of California-San Francisco, San Francisco, CA, USA
| |
Collapse
|
23
|
Kim NR, Chin HS, Seong GJ, Kim CY. Undiagnosed Primary Open-Angle Glaucoma in Korea: The Korean National Health and Nutrition Examination Survey 2008–2009. Ophthalmic Epidemiol 2016; 23:238-47. [DOI: 10.3109/09286586.2016.1168850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Na Rae Kim
- Department of Ophthalmology and Inha Vision Science Laboratory, Inha University School of Medicine, Incheon, Korea
| | - Hee Seung Chin
- Department of Ophthalmology and Inha Vision Science Laboratory, Inha University School of Medicine, Incheon, Korea
| | - Gong Je Seong
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Yun Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | | |
Collapse
|
24
|
Choi HJ, Lee DH, Kim JH, Shin JY, Lee JH. Long Term Incidence Rate of Glaucoma after Pars Plana Vitrectomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.1.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hun Jin Choi
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Do Hyung Lee
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jin Hyoung Kim
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Joo Youn Shin
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jong Hyun Lee
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| |
Collapse
|
25
|
Opportunistic Detection of Glaucomatous Optic Discs within a Diabetic Retinopathy Screening Service. Eur J Ophthalmol 2015; 26:315-20. [DOI: 10.5301/ejo.5000722] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2015] [Indexed: 01/08/2023]
|
26
|
Yoshioka N, Wong E, Kalloniatis M, Yapp M, Hennessy MP, Agar A, Healey PR, Hayen A, Zangerl B. Influence of education and diagnostic modes on glaucoma assessment by optometrists. Ophthalmic Physiol Opt 2015; 35:682-98. [DOI: 10.1111/opo.12247] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 07/27/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Nayuta Yoshioka
- Centre for Eye Health; UNSW Australia; Sydney Australia
- School of Optometry and Vision Science; UNSW Australia; Sydney Australia
| | - Elizabeth Wong
- Centre for Eye Health; UNSW Australia; Sydney Australia
- School of Optometry and Vision Science; UNSW Australia; Sydney Australia
| | - Michael Kalloniatis
- Centre for Eye Health; UNSW Australia; Sydney Australia
- School of Optometry and Vision Science; UNSW Australia; Sydney Australia
| | - Michael Yapp
- Centre for Eye Health; UNSW Australia; Sydney Australia
- School of Optometry and Vision Science; UNSW Australia; Sydney Australia
| | - Michael P. Hennessy
- Centre for Eye Health; UNSW Australia; Sydney Australia
- Ophthalmology; Prince of Wales Hospital; Randwick Australia
| | - Ashish Agar
- Ophthalmology; Prince of Wales Hospital; Randwick Australia
| | - Paul R. Healey
- Centre for Vision Research; Westmead Millenium Institute; University of Sydney; Sydney Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine; UNSW Australia; Sydney Australia
| | - Barbara Zangerl
- Centre for Eye Health; UNSW Australia; Sydney Australia
- School of Optometry and Vision Science; UNSW Australia; Sydney Australia
| |
Collapse
|
27
|
Gracitelli CPB, Abe RY, Medeiros FA. Spectral-Domain Optical Coherence Tomography for Glaucoma Diagnosis. Open Ophthalmol J 2015; 9:68-77. [PMID: 26069519 PMCID: PMC4460228 DOI: 10.2174/1874364101509010068] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 03/30/2015] [Accepted: 03/30/2015] [Indexed: 11/26/2022] Open
Abstract
Identification of structural damage to the optic nerve and retinal nerve fiber layer (RNFL) is an essential component of diagnosis and management of glaucoma. The introduction of spectral-domain OCT (SD-OCT) has allowed objective quantification of damage to these structures with unprecedented resolution. In addition, recent attention has been directed towards imaging the macular area for quantifying loss of neural tissue caused by the disease. Many studies have evaluated and compared the diagnostic accuracies of a variety of parameters that can be obtained from imaging these areas of the ocular fundus. In this article, we critically review the existing literature evaluating the diagnostic accuracy of SD-OCT in glaucoma and we discuss issues related to how SD-OCT results should be incorporated into clinical practice.
Collapse
Affiliation(s)
- Carolina P B Gracitelli
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA ; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Ricardo Y Abe
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA ; Department of Ophthalmology, University of Campinas, Campinas, Brazil
| | - Felipe A Medeiros
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| |
Collapse
|
28
|
Ghany AFA, Botros SM, El-Raggal TM. Central retinal artery resistive index and optical coherence tomography in assessment of glaucoma progression. Int J Ophthalmol 2015; 8:305-9. [PMID: 25938045 DOI: 10.3980/j.issn.2222-3959.2015.02.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 09/06/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To assess the relation between central retinal artery (CRA) resistive index (RI) and retinal nerve fiber thickness measured by optical coherence tomography (OCT) in assessment of disease progress in cases of open angle glaucoma. METHODS Twenty-three patients with diagnosed open angle glaucoma were included in this study. They were examined by colored duplex ultrasonography of CRA with estimation of RI of CRA and ophthalmic artery (OA) with estimation of CRA/OA RI ratio as well as OCT measurement of the average retinal nerve fiber layer (RNFL) thickness in order to assess the disease progress. RESULTS There was strong inverse relation between the increased RI in CRA as well as the increased CRA/OA RI ratio and the decrease in average RNFL thickness in cases of open angle glaucoma. CONCLUSION Assessment of CRA RI can indirectly assess the vascular changes associated with glaucoma and can assess the degree of retinal atrophy helping in evaluating prognosis thus guiding the choice of treatment.
Collapse
Affiliation(s)
- Ahmed F Abdel Ghany
- Department of Radiodiagnosis, Faculty of Medicine Ain Shams University, Cairo 11591, Egypt
| | - Samer M Botros
- Department of Radiodiagnosis, Faculty of Medicine Ain Shams University, Cairo 11591, Egypt
| | - Tamer M El-Raggal
- Department of Ophthalmology, Faculty of Medicine Ain Shams University, Cairo 11591, Egypt
| |
Collapse
|
29
|
Jamous KF, Kalloniatis M, Hennessy MP, Agar A, Hayen A, Zangerl B. Clinical model assisting with the collaborative care of glaucoma patients and suspects. Clin Exp Ophthalmol 2014; 43:308-19. [PMID: 25362898 DOI: 10.1111/ceo.12466] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 10/23/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Optimizing patient management will reduce unnecessary vision loss in glaucoma through early detection. One method is the introduction of collaborative care schemes between optometrists and ophthalmologists. DESIGN We conducted a retrospective study to evaluate the impact of the Centre for Eye Health (CFEH) on glaucoma patient outcomes and management in primary optometric care. PARTICIPANTS Patients referred to CFEH by optometrists for a glaucoma assessment were eligible for this study if written consent was provided (500 participants were randomly chosen). METHODS Clinical data were classified according to disease risk and implemented patient care and analysed against the original diagnosis and patient parameters, followed by statistical analysis. MAIN OUTCOME MEASURES Two main parameters were evaluated; suitable referral of patients for glaucoma condition assessment and appropriate implementation of follow-up care. RESULTS The majority of patients referred for glaucoma assessment (86.2%) were classified as glaucoma suspects or likely to have glaucoma, indicating suitable referral of patients for a CFEH evaluation. Further, the involvement of CFEH resulted in a false positive rate of 7.8% for those patients who proceeded to ophthalmological care. However, long-term optometric patient care was not maintained for up to a third of primarily lower risk patients. CONCLUSIONS The investigated collaborative eye health-care model led to a substantial improvement in appropriate referrals of glaucoma patients to ophthalmologists and could be suitable for optimizing patient care and utilization of resources. Improvement in follow-up of patients by optometrists is required to minimize inappropriately discontinued patient care.
Collapse
Affiliation(s)
- Khalid F Jamous
- Centre for Eye Health, UNSW Australia, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, UNSW Australia, Sydney, New South Wales, Australia.,Department of Ophthalmology, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Michael Kalloniatis
- Centre for Eye Health, UNSW Australia, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, UNSW Australia, Sydney, New South Wales, Australia
| | - Michael P Hennessy
- Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Ashish Agar
- Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine, UNSW Australia, Sydney, New South Wales, Australia
| | - Barbara Zangerl
- Centre for Eye Health, UNSW Australia, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, UNSW Australia, Sydney, New South Wales, Australia
| |
Collapse
|
30
|
Roberts HW, Rughani K, Syam P, Dhingra S, Ramirez-Florez S. The Peterborough Scheme for Community Specialist Optometrists in Glaucoma: Results of 4 Years of a Two-Tiered Community-Based Assessment and Follow-up Service. Curr Eye Res 2014; 40:690-6. [DOI: 10.3109/02713683.2014.957326] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
31
|
Jamous KF, Kalloniatis M, Hayen A, Mitchell P, Stapleton FJ, Zangerl B. Application of clinical techniques relevant for glaucoma assessment by optometrists: concordance with guidelines. Ophthalmic Physiol Opt 2014; 34:580-91. [DOI: 10.1111/opo.12146] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/02/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Khalid F. Jamous
- School of Optometry and Vision Science; University of New South Wales; Sydney Australia
- Centre for Eye Health; University of New South Wales; Sydney Australia
- Department of Ophthalmology; Faculty of Medicine; King Saud University; Riyadh Saudi Arabia
| | - Michael Kalloniatis
- School of Optometry and Vision Science; University of New South Wales; Sydney Australia
- Centre for Eye Health; University of New South Wales; Sydney Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine; University of New South Wales; Sydney Australia
| | - Paul Mitchell
- Centre for Vision Research; Department of Ophthalmology and Westmead Millennium Institute; University of Sydney; Sydney Australia
| | - Fiona J. Stapleton
- School of Optometry and Vision Science; University of New South Wales; Sydney Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science; University of New South Wales; Sydney Australia
- Centre for Eye Health; University of New South Wales; Sydney Australia
| |
Collapse
|
32
|
Iwase A, Suzuki Y, Araie M. Characteristics of Undiagnosed Primary Open-Angle Glaucoma: The Tajimi Study. Ophthalmic Epidemiol 2014; 21:39-44. [DOI: 10.3109/09286586.2013.867510] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
33
|
Lu CD, Kraus MF, Potsaid B, Liu JJ, Choi W, Jayaraman V, Cable AE, Hornegger J, Duker JS, Fujimoto JG. Handheld ultrahigh speed swept source optical coherence tomography instrument using a MEMS scanning mirror. BIOMEDICAL OPTICS EXPRESS 2013; 5:293-311. [PMID: 24466495 PMCID: PMC3891340 DOI: 10.1364/boe.5.000293] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/04/2013] [Accepted: 12/12/2013] [Indexed: 05/20/2023]
Abstract
We developed an ultrahigh speed, handheld swept source optical coherence tomography (SS-OCT) ophthalmic instrument using a 2D MEMS mirror. A vertical cavity surface-emitting laser (VCSEL) operating at 1060 nm center wavelength yielded a 350 kHz axial scan rate and 10 µm axial resolution in tissue. The long coherence length of the VCSEL enabled a 3.08 mm imaging range with minimal sensitivity roll-off in tissue. Two different designs with identical optical components were tested to evaluate handheld OCT ergonomics. An iris camera aided in alignment of the OCT beam through the pupil and a manual fixation light selected the imaging region on the retina. Volumetric and high definition scans were obtained from 5 undilated normal subjects. Volumetric OCT data was acquired by scanning the 2.4 mm diameter 2D MEMS mirror sinusoidally in the fast direction and linearly in the orthogonal slow direction. A second volumetric sinusoidal scan was obtained in the orthogonal direction and the two volumes were processed with a software algorithm to generate a merged motion-corrected volume. Motion-corrected standard 6 x 6 mm(2) and wide field 10 x 10 mm(2) volumetric OCT data were generated using two volumetric scans, each obtained in 1.4 seconds. High definition 10 mm and 6 mm B-scans were obtained by averaging and registering 25 B-scans obtained over the same position in 0.57 seconds. One of the advantages of volumetric OCT data is the generation of en face OCT images with arbitrary cross sectional B-scans registered to fundus features. This technology should enable screening applications to identify early retinal disease, before irreversible vision impairment or loss occurs. Handheld OCT technology also promises to enable applications in a wide range of settings outside of the traditional ophthalmology or optometry clinics including pediatrics, intraoperative, primary care, developing countries, and military medicine.
Collapse
Affiliation(s)
- Chen D. Lu
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Martin F. Kraus
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Pattern Recognition Lab and School of Advanced Optical Technologies, University Erlangen-Nuremberg, Erlangen, Germany
| | - Benjamin Potsaid
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Advanced Imaging Group, Thorlabs, Inc., Newton, NJ, USA
| | - Jonathan J. Liu
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - WooJhon Choi
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Alex E. Cable
- Advanced Imaging Group, Thorlabs, Inc., Newton, NJ, USA
| | - Joachim Hornegger
- Pattern Recognition Lab and School of Advanced Optical Technologies, University Erlangen-Nuremberg, Erlangen, Germany
| | - Jay S. Duker
- New England Eye Center and Tufts Medical Center, Tufts University, Boston, MA, USA
| | - James G. Fujimoto
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| |
Collapse
|
34
|
Ernest PJG, Busch MJWM, Webers CAB, Beckers HJM, Hendrikse F, Prins MH, Schouten JSAG. Prevalence of end-of-life visual impairment in patients followed for glaucoma. Acta Ophthalmol 2013; 91:738-43. [PMID: 23279740 DOI: 10.1111/j.1755-3768.2012.02555.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the prevalence of end-of-life visual impairment in patients followed for glaucoma. METHODS Data of 122 patients followed for glaucoma who had died between July 2008 and July 2010 and who had visited the ophthalmology outpatient department of a large non-academic Dutch hospital were collected from the medical files. Sixty-one patients had open-angle glaucoma (OAG), and 61 patients were suspect for glaucoma or had ocular hypertension (OHT). Visual impairment was defined as a mean deviation value <-15 dB or a Snellen visual acuity <0.3 (20/60) of the better eye. We determined the number of patients with visual impairment on the last patient visit before death and investigated its main explanations. RESULTS Overall, the mean age at death was 81.8 years after a mean follow-up period of 9.2 years. Seventy-three per cent of all patients had their last visit in the year preceding death. In OAG, 16 patients (26%) had an end-of-life visual impairment. In nine patients (15%), this was caused by glaucoma. Eight of them had substantial visual loss at the initial visit. Six (10%) impaired OAG cases were mainly explained by ocular comorbidity, and there was an equal contribution of comorbidity and glaucoma in one case. Five glaucoma suspects or patients with OHT (8%) were visually impaired at death and these were all caused by ocular comorbidity. CONCLUSION The prevalence of end-of-life visual impairment is considerable in patients with OAG. Substantial visual loss at baseline is an important contributing factor. In glaucoma suspects or patients with OHT, the prevalence is lower and can be attributed to ocular comorbidity.
Collapse
Affiliation(s)
- Paul J G Ernest
- University Eye Clinic Maastricht, Maastricht, the NetherlandsDepartment of Epidemiology, Maastricht University, Maastricht, the NetherlandsCatharina Ziekenhuis Eindhoven, Department of Ophthalmology, Eindhoven, the Netherlands
| | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
INTRODUCTION Glaucoma is an optic neuropathy with characteristic progressive optic nerve degeneration. Early detection and treatment may prevent blindness; however, the value of glaucoma screening has been debated. METHODS Articles pertaining to glaucoma screening were reviewed. RESULTS In reviewing the glaucoma literature, there is a lack of a sensitive and specific screening test and concerns over cost-effectiveness. Methods of screening include population-based screening and opportunistic case finding, which both have advantages and disadvantages. CONCLUSIONS Additional research is needed to better understand glaucoma progression as well as to identify improved screening tests. Consideration must be given not only to the feasibility of performing a glaucoma screening, but also to the follow-up and long-term care for glaucoma patients.
Collapse
Affiliation(s)
- Anna C Momont
- Glaucoma Consultants Northwest, Arnold Medical Pavillion, Seattle, WA 98104, United States.
| | | |
Collapse
|
36
|
Heijl A, Bengtsson B, Oskarsdottir SE. Prevalence and severity of undetected manifest glaucoma: results from the early manifest glaucoma trial screening. Ophthalmology 2013; 120:1541-5. [PMID: 23631945 DOI: 10.1016/j.ophtha.2013.01.043] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 01/15/2013] [Accepted: 01/17/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To estimate the prevalence and severity of undetected glaucoma in the population. DESIGN Cross-sectional study. PARTICIPANTS A total of 32 918 subjects aged 55 to 79 years from Malmö, Sweden, who were screened between 1992 and 1997. All subjects in the screened age groups living in the catchment area, and for whom there were no recent records at the Malmö University Hospital Ophthalmology department, were invited. The main purpose of the screening was to recruit subjects for the Early Manifest Glaucoma Trial. METHODS We registered the age, sex, and amount of visual field loss in subjects with previously undiagnosed glaucoma identified at the screening. The disease was categorized into 5 stages based on perimetric mean deviation values. MAIN OUTCOME MEASURES Prevalence of undetected glaucoma at various disease stages in different age groups expressed as percentages. RESULTS Among the screened subjects, who were 77.5% of all invited subjects, a total of 406 subjects (1.23%) were identified with previously undetected glaucoma. Prevalence increased with age, from 0.55% at 55 to 59 years to 2.73% at 75 to 79 years. Unilateral disease accounted for 66% of all cases. Extent of visual field loss was similar in all age groups from 60 years and more. Most eyes had early (35%) or moderate (31%) glaucomatous visual field defects, but 134 subjects (33%) had advanced visual field loss in at least 1 eye. No subject was blind in both eyes, but 3.4% of the newly diagnosed patients were unilaterally blind because of glaucoma. CONCLUSIONS Prevalence of undetected glaucoma increased with age, whereas disease severity did not increase in subjects older than 60 years of age. One third of subjects with previously undetected glaucoma had advanced or later-stage disease in at least 1 eye. Unilaterally blind subjects were present in all age groups. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
Collapse
Affiliation(s)
- Anders Heijl
- Lund University, Department of Clinical Sciences Malmö, Ophthalmology, Skåne University Hospital, Malmö, Sweden.
| | | | | |
Collapse
|
37
|
Abstract
PURPOSE To describe the costs and providers of glaucoma treatment in Denmark. METHODS Analyses were based on National Register data. Glaucoma/OHT patients were identified by their first prescription for glaucoma medication (ATC-codes) in the Danish Register of Medicinal Product Statistics 2002-2007. Patients had used no glaucoma medication for 6 months. Data for 2007 were sampled cross-sectionally for a budgetary analysis of glaucoma (ICD10 code) medication and services consumed in the primary and secondary health care services. Patients were categorized according to their number of treatment changes. RESULTS The Danish annual incidence rate of glaucoma was estimated at 1.2 per 1000 adult persons. Thirty-seven per cent of patients (men 44%, mean age 68 years; women 56%, mean age 71 years) persisted with their initial treatment regimen, 21% had changed to a second regimen, and 43% had experienced ≥ 3 regimens. Treatment costs increased with the number of sequential regimens. Annual glaucoma costs (health care sector perspective) were €305 for patients under their initial regimen, increasing to €740 with ≥ 3 regimens. Drug costs accounted for 57% of total cost. CONCLUSIONS Drugs represented the major cost of glaucoma, and those costs increased, obviously, with the number of treatment changes.
Collapse
Affiliation(s)
- Jens Olsen
- Centre for Applied Health Services Research and Technology Assessment, University of Denmark, Odense C, Denmark
| | | | | |
Collapse
|
38
|
Abstract
UNLABELLED This thesis addresses several aspects of glaucoma diagnostics from both a clinical and a screening perspective. New instruments for diagnosing glaucoma have been developed over the past years, but little information is available regarding their performance as screening methods and their usefulness in ordinary clinical practice. PURPOSE OF THE RESEARCH UNDERLYING THIS THESIS: The objectives of this research were as follows: to compare the accuracy of results of analysis of the optic nerve head (ONH) achieved by computerized imaging using the Heidelberg Retina Tomograph (HRT) and by subjective assessment performed by physicians with different degrees of experience of glaucoma (paper III); to evaluate the effect of a continuous medical education (CME) lecture on subjective assessment of the ONH for diagnosis of glaucoma (paper II); to investigate subjective assessment of perimetric test results by physicians with varying knowledge of glaucoma with a trained artificial neural network (ANN) and to compare the certainty of the classifications (paper IV); and to compare the diagnostic performance of time-domain Stratus optical coherence tomography (OCT) with that of spectral-domain Cirrus OCT (paper I), frequency doubling technology (FDT) screening perimetry and scanning laser polarimetry with the GDx variable corneal compensator (VCC) in a random population-based sample and in patients with glaucoma of varying disease severity. METHODS AND RESULTS In evaluation of the ONH, use of the HRT statistical tools, Moorfields regression analysis (MRA) and the Glaucoma Probability Score (GPS) was compared with subjective assessment performed by 45 physicians. Optic nerve head images and photographs from 138 healthy and 97 glaucoma subjects were included. The sensitivity of MRA was higher (87-94%) than that of the average physician (62-82%), considerably greater than that of ophthalmologists with subspecialties other than glaucoma (53-77%) and non-significantly better than that of glaucoma experts (72-88%). Sensitivity achieved by GPS (79-93%) was also greater than that of the average physician. MRA correctly classified all eyes with advanced glaucomatous visual field defects, a result that was not achieved by GPS or even by the glaucoma experts. In eyes with small discs, MRA sensitivity (88%) was comparable with that of glaucoma experts (85%) and much better than that of GPS (50%). Also, the group comprising all physicians provided specificity (75-92%) similar to that of both MRA (69 - 86%) and GPS (72-94%) (Andersson et al. 2011a). A 1-hr CME lecture on ONH assessment led to a significant improvement in sensitivity (from 70% to 80%) and a significant decrease in uncertain assessments (from 22% to 13%), whereas specificity remained unchanged (68%) (Andersson et al. 2011b). A rise in sensitivity was seen in all subgroups of physicians, including glaucoma experts. Thirty physicians assessing standard automated perimetry (SAP) test results as Humphrey Field Analyzer single-field analysis printouts with full StatPac information from 99 patients with glaucoma and 66 healthy subjects were compared with a trained ANN regarding diagnostic performance. ANN reached significantly higher sensitivity (93%) than the average physician (83%), whereas specificity was similar for these two groups (91% and 90%, respectively). Diagnostic accuracy was similar among the different groups of physicians and seemingly rather independent of experience. Sensitivity ranged from 82% in the subgroup of other subspecialists to 87% in the glaucoma expert group, and specificity ranged from 88% among general ophthalmologists to 91% for glaucoma experts. The ANN attained certainty of classification that was in parity with that provided by the glaucoma experts and did not make any completely incorrect classifications of the visual fields (i.e. erroneous classifications were in the borderline zone) (Andersson et al. 2012). From a population-based randomly selected sample (n=308) of older subjects (aged ≥ 50 years) living in southern Sweden, 170 subjects underwent a comprehensive examination that included Stratus OCT, Cirrus OCT, an FDT screening programme and the GDx VCC. The same test protocol was applied to 138 randomized clinical patients with different stages of glaucoma. In the population-based sample, both Stratus and Cirrus OCT showed high diagnostic accuracy with area under the receiver-operating curve (aROC) values close to 1.0 (Bengtsson et al. 2012). Both OCT instruments correctly classified all of the clinical glaucoma patients with advanced disease. FDT screening showed high sensitivity (91%) but erroneously gave normal test results for some eyes with advanced disease. GDx VCC had lower sensitivity (73-92%) and also led to a large proportion of examinations with an atypical retardation pattern that is known to affect the diagnostic efficiency of this instrument. CONCLUSIONS The HRT MRA performed better than most physicians and was consistent with the glaucoma experts. These results suggest that MRA can be a valuable tool for diagnosing glaucoma in ordinary practice, particularly when only a few glaucoma experts are available. Even though MRA provided 100% sensitivity in eyes with advanced glaucoma, it probably does not offer sufficient specificity to make it suitable as a screening method. Continuing medical education on ONH analysis had a small, but positive effect on diagnostic accuracy for glaucoma. An ANN trained to classify visual fields seemed to perform at least as well as most of the participating physicians, whose performances were remarkably similar regardless of their level of experience. This indicates that available tools for interpreting SAP findings are helpful in assessments of visual field test results. However, SAP is associated with learning effects (Heijl et al. 1989) that may entail low specificity for untrained subjects, and hence, it is not an ideal screening method for glaucoma. By comparison, the screening test of FDT is rapid and easy, but it is probably less suitable for screening purpose, because some eyes with advanced glaucoma were missed in this investigation. GDx VCC images for a relatively large number of eyes could not be analysed and is thus not appropriate for screening. The OCT instruments offer both high sensitivity and high specificity, and all eyes with advanced disease were correctly classified as glaucomatous in this evaluation. However, these instruments are still expensive and require special operator skills. Additional development to obtain OCT instrument that is more compact, easier to use and less expensive might render such tomography suitable as a screening tool for glaucoma.
Collapse
Affiliation(s)
- Sabina Andersson Geimer
- Department of Clinical Sciences, Ophthalmology, Skåne University Hospital, Lund University, Malmö, Sweden.
| |
Collapse
|
39
|
Nonpopulation-Based Glaucoma Screening Exercise in an Osteoporosis Patient Organization. J Glaucoma 2012; 21:510-5. [DOI: 10.1097/ijg.0b013e3182208a48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
Lu VHJ, Lu CY, Goldberg I. Taking on glaucoma care as an interprofessional team. Can J Ophthalmol 2011; 46:465-7. [PMID: 22153630 DOI: 10.1016/j.jcjo.2011.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
41
|
Taylor H. Glaucoma screening in the real world. Ophthalmology 2011; 118:1008; author reply 1008-9, 1009-10. [PMID: 21539989 DOI: 10.1016/j.ophtha.2011.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 02/02/2011] [Indexed: 10/18/2022] Open
|
42
|
Dirani M, Crowston JG, Taylor PS, Moore PT, Rogers S, Pezzullo ML, Keeffe JE, Taylor HR. Economic impact of primary open-angle glaucoma in Australia. Clin Exp Ophthalmol 2011; 39:623-32. [DOI: 10.1111/j.1442-9071.2011.02530.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
43
|
Garas A, Kóthy P, Holló G. Accuracy of the RTVue-100 Fourier-domain optical coherence tomograph in an optic neuropathy screening trial. Int Ophthalmol 2011; 31:175-82. [DOI: 10.1007/s10792-011-9433-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 03/07/2011] [Indexed: 10/18/2022]
|
44
|
Kong YXG, Coote MA, O'Neill EC, Gurria LU, Xie J, Garway-Heath D, Medeiros FA, Crowston JG. Glaucomatous optic neuropathy evaluation project: a standardized internet system for assessing skills in optic disc examination. Clin Exp Ophthalmol 2011; 39:308-17. [PMID: 21070546 DOI: 10.1111/j.1442-9071.2010.02462.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Development of a standardized internet-based system to self-assess skills in optic disc examination for glaucoma risk assessment. DESIGN Prospective internet-based observational study. PARTICIPANTS Total of 197 participants (glaucoma subspecialists, general ophthalmologists and trainees) from 22 countries. METHODS Forty-two optic disc images demonstrating a range of features were selected from 2500 monoscopic disc photographs of normal and glaucomatous eyes. Images were presented to clinicians via website (http://www.gone-project.com). Participants were asked to assess nine topographic features and make a subjective assessment of glaucoma likelihood. MAIN OUTCOME MEASURES Inter-observer agreement using kappa (κ) or weighted kappa (κ(w) ). RESULTS There was substantial level of inter-observer agreement between glaucoma subspecialists for assessment of glaucoma likelihood (κ(w) = 0.63). Inter-observer agreement was high for haemorrhage (κ= 0.83) and substantial for disc size, disc shape, cup:disc ratio, peripapillary atrophy and cup shape (κ(w) = 0.59-0.68). Subspecialists had stronger inter-observer agreement for glaucoma likelihood and for most disc characteristics than did trainees: the greatest difference being the assessment for retinal nerve fibre layer loss. Analysis of individual disc answers from ophthalmology trainees showed that discs leading to lower agreement of glaucoma likelihood tend to produce lower agreement for the assessment of cup:disc ratio, cup shape, cup depth and retinal nerve fibre layer. Discs with features of moderate to deep cup or cup:disc ratio between 0.6 and 0.8 also lead to lower agreement in glaucoma likelihood. CONCLUSIONS This internet-based system is a readily accessible and standardized tool, for clinicians globally, that permits self-assessment and benchmarking of skills in optic disc examination.
Collapse
Affiliation(s)
- Yu Xiang G Kong
- Centre for Eye Research Australia, University of Melbourne at The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Lu CY, Lu VH, Goldberg I, Day RO. Towards integrated care: Australia's new model of care for patients with glaucoma. Med J Aust 2010; 193:200-1. [PMID: 20712538 DOI: 10.5694/j.1326-5377.2010.tb03867.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Using shared care to tackle the complexity of optimal patient management.
Collapse
|
46
|
Clinical Assessment of Stereoscopic Optic Disc Photographs for Glaucoma: The European Optic Disc Assessment Trial. Ophthalmology 2010; 117:717-23. [DOI: 10.1016/j.ophtha.2009.09.026] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 09/09/2009] [Accepted: 09/17/2009] [Indexed: 11/23/2022] Open
|
47
|
Health anxiety in a non-population-based, pre-publicised glaucoma screening exercise. Eye (Lond) 2009; 24:699-705. [DOI: 10.1038/eye.2009.131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
48
|
|
49
|
Screening for Glaucoma. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00182-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
50
|
Accuracy of Scanning Laser Polarimetry, Scanning Laser Tomography, and Their Combination in a Glaucoma Screening Trial. J Glaucoma 2008; 17:639-46. [PMID: 19092459 DOI: 10.1097/ijg.0b013e318168f01a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|