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Nakahara H, Nawata R, Matsuo R, Ohgomori T. Deterioration of postural control due to the increase of similarity between center of pressure and smooth-pursuit eye movements during standing on one leg. PLoS One 2022; 17:e0276119. [PMID: 36227896 PMCID: PMC9560487 DOI: 10.1371/journal.pone.0276119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/29/2022] [Indexed: 11/18/2022] Open
Abstract
Upright postural control is regulated by afferent and efferent/reafferent visual mechanisms. There are two types of efferent and conjugate eye movements: saccades and smooth pursuits. Although postural control is improved by saccades, the effects of smooth pursuits on postural control are still debated, because the difficulties of postural and visual tasks differ in the previous research. Additionally, the mechanisms that interfere with postural control and smooth pursuit are not fully understood. To address these issues, we examined the effects of different patterns of smooth-pursuit eye movement on the path length of the center of pressure (COP) displacement under bipedal and unipedal standing conditions. The relative frequency and amplitude of the COP displacement were remarkably increased when uniform linear visual targets were presented during unipedal standing. In addition, dynamic time warping analysis demonstrated that the similarity between the displacement of the COP and eye movements was increased by the presentation of uniform linear visual targets with orientation selectivity during unipedal standing but not during bipedal standing. In contrast, the attenuation of similarity between the displacement of the COP and eye movements significantly decreased the path length, relative frequency, and amplitude of the COP displacement. Our results indicate that postural stability is deteriorated by the increase of similarity between the displacement of the COP and smooth-pursuit eye movements under unstable conditions.
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Affiliation(s)
- Hikaru Nakahara
- Department of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka, Osaka, Japan
| | - Rukia Nawata
- Department of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka, Osaka, Japan
| | - Ryota Matsuo
- Department of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka, Osaka, Japan
| | - Tomohiro Ohgomori
- Department of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka, Osaka, Japan
- * E-mail:
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Tseng RMWW, Tham YC, Rim TH, Cheng CY. Emergence of non-artificial intelligence digital health innovations in ophthalmology: A systematic review. Clin Exp Ophthalmol 2021; 49:741-756. [PMID: 34235833 DOI: 10.1111/ceo.13971] [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: 06/30/2021] [Accepted: 07/03/2021] [Indexed: 11/30/2022]
Abstract
The prominent rise of digital health in ophthalmology is evident in the current age of Industry 4.0. Despite the many facets of digital health, there has been a greater slant in interest and focus on artificial intelligence recently. Other major elements of digital health like wearables could also substantially impact patient-focused outcomes but have been relatively less explored and discussed. In this review, we comprehensively evaluate the use of non-artificial intelligence digital health tools in ophthalmology. 53 papers were included in this systematic review - 25 papers discuss virtual or augmented reality, 14 discuss mobile applications and 14 discuss wearables. Most papers focused on the use of technologies to detect or rehabilitate visual impairment, glaucoma and age-related macular degeneration. Overall, the findings on patient-focused outcomes with the adoption of these technologies are encouraging. Further validation, large-scale studies and earlier consideration of real-world barriers are warranted to enable better real-world implementation.
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Affiliation(s)
| | - Yih-Chung Tham
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Tyler Hyungtaek Rim
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Ching-Yu Cheng
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
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Muñoz-Negrete F, Moreno-Montañés J, Rebolleda G. Perimetría en domicilio. ¿Es posible? ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2021; 96:285-287. [PMID: 34629693 PMCID: PMC8123935 DOI: 10.1016/j.oftal.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Muñoz-Negrete FJ, Moreno-Montañés J, Rebolleda G. Home perimetry. Is possible? ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:285-287. [PMID: 34092281 DOI: 10.1016/j.oftale.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/23/2021] [Indexed: 06/12/2023]
Affiliation(s)
- F J Muñoz-Negrete
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain; OFTARED, Madrid, Spain.
| | - J Moreno-Montañés
- OFTARED, Madrid, Spain; Clínica Universitaria de Navarra, Pamplona, Navarra, Spain
| | - G Rebolleda
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain; OFTARED, Madrid, Spain
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A Prospective Cohort Study of Muscular and Performance Fitness and Incident Glaucoma: The Niigata Wellness Study. J Phys Act Health 2020; 17:1171-1178. [PMID: 33055296 DOI: 10.1123/jpah.2019-0660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 07/01/2020] [Accepted: 08/30/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND To examine the association between muscular and performance fitness (MPF) and the incidence of glaucoma. METHODS A total of 27,051 glaucoma-free participants aged 20-87 years underwent physical fitness tests between April 2001 and March 2002. The MPF index was calculated using an age- and sex-specific summed z-score from grip strength, vertical jump, single-leg balance, forward bending, and whole-body reaction time. The participants were divided into quartiles according to the MPF index and each physical fitness test. Participants were followed up for the development of glaucoma, which was defined based on physician-diagnosed glaucoma at an annual health examination between April 2002 and March 2008. Hazard ratios for the incidence of glaucoma were estimated using Cox proportional hazards models. RESULTS During follow-up, 303 participants developed glaucoma. Compared with the lowest MPF index group, hazard ratio (95% confidence interval) of developing glaucoma was 0.64 (0.46-0.89) for the highest MPF index group (P for trend = .001). Vertical jump and whole-body reaction time were associated with incident glaucoma (P for trend = .01 and <.001, respectively). There were no associations between the other physical fitness tests and the incidence of glaucoma. CONCLUSION Higher MPF is associated with lower incidence of glaucoma.
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Gopalakrishnan S, Jacob CES, Kumar M, Karunakaran V, Raman R. Comparison of Visual Parameters Between Normal Individuals and People with Low Vision in a Virtual Environment. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2020; 23:171-178. [DOI: 10.1089/cyber.2019.0235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Sarika Gopalakrishnan
- Shanmugha Arts, Science, Technology & Research Academy (SASTRA) University, Thanjavur, India
- Low Vision Care Clinic, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | | | - Meenakshi Kumar
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | | | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
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Kastner A, King AJ. Advanced glaucoma at diagnosis: current perspectives. Eye (Lond) 2020; 34:116-128. [PMID: 31740802 PMCID: PMC7002722 DOI: 10.1038/s41433-019-0637-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/08/2019] [Accepted: 09/11/2019] [Indexed: 11/08/2022] Open
Abstract
Presentation with advanced glaucoma is a significant risk factor for lifetime blindness. The asymptomatic nature of glaucoma, particularly in early disease, means that substantial vision loss in one eye does not always translate into a perceptible loss of visual function. This, along with the lack of an effective screening strategy, contributes to late presentation. Those most at risk of presenting with advanced glaucoma have asymptomatic high intraocular pressure (IOP), no family history of glaucoma, are socially disadvantaged, and do not attend sight testing. Patients with glaucoma may have impaired functionality for daily activities, such as reading, walking and driving. Quality of life measures have shown this to be significantly worse in patients with more severe visual field loss, particularly if bilateral. In addition, quality of life decreases faster with further bilateral visual field loss when advanced visual field damage is present. Management of these patients requires disproportionally more resources than those with earlier disease. Both medical and surgical options are used as the initial approach to treat patients presenting with advanced glaucoma. The most recently published National Institute for Health and Care Excellence (NICE) guidelines suggest that patients presenting with advanced disease should be offered trabeculectomy as a primary intervention. However, more evidence is required to determine the best initial management. The Treatment of Advanced Glaucoma Study (TAGS) is being conducted, comparing primary medical management with primary mitomycin C-augmented trabeculectomy for people presenting with advanced open-angle glaucoma. The results of TAGS will provide robust evidence for the most appropriate initial intervention.
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Affiliation(s)
- Alan Kastner
- Nottingham University Hospital, Nottingham, England
- Pontificia Universidad Católica de Chile, Santiago, Chile
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Abstract
BACKGROUND Glaucomatous visual field loss can have far-reaching and debilitating consequences on an individual, affecting one's ability to perform many important tasks. Although assessment of glaucoma-related disability constitutes an important part of clinical care, there remains a lack of organized, detailed information on the most suitable methods to capture disability in glaucoma. PURPOSE This review details the available methods to measure glaucoma-related disability and highlights important findings from studies utilizing these various methods. METHODS The literature was reviewed to identify papers evaluating disability in glaucoma and findings were summarized by research methodology used and area of impairment. RESULTS Identified methods for capturing glaucoma-related disability included qualitative descriptions, glaucoma-specific quality of life questionnaires, vision-specific questionnaires, general health questionnaires, functional domain-specific questionnaires, evaluation of task performance, event assessment (ie, falls and motor vehicle accidents), and real-world behavior (ie, daily physical activity). Findings using these methods show a strong relationship between glaucoma and/or glaucoma severity and difficulties with reading, driving, mobility, and other tasks such as prehension and facial recognition. In addition, glaucoma has financial and psychological implications on the patient, and can affect caregivers in some cases as well. CONCLUSIONS A wide variety of research tools have been used to characterize the disability resulting from glaucoma. Together, these tools show that glaucoma affects many abilities which are important for independent living. Strengths and limitations of the various research techniques are discussed so that future studies may use the method(s) most suitable for answering the research question posed.
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Abstract
PURPOSE OF REVIEW Numerous population-based studies suggest that glaucoma is an independent risk factor for falling and motor vehicle collisions, particularly for older adults. These adverse events lead to increased healthcare expenditures and decreased quality of life. Current research priorities, therefore, include identifying factors that predispose glaucoma patients to falling and unsafe driving, and developing screening strategies and targeted rehabilitation. The purpose of this article is to review recent studies that address these priorities. RECENT FINDINGS Studies continue to support that glaucoma patients, particularly those with advanced disease, have an increased risk of falling or unsafe driving. Risk factors, however, remain variable and include severity and location of visual field defects, contrast sensitivity, and performance on divided attention tasks. Such variability is likely because of the multifactorial nature of ambulating and driving and compensatory strategies used by patients. SUMMARY Falls and unsafe driving remain a serious public health issue for older adults with glaucoma. Ambulation and driving are complex tasks and there is no consensus yet, regarding the best methods for risk stratification and targeted interventions to increase safety. Therefore, comprehensive and individualized assessments are recommended to most effectively evaluate a patient's risk for falling or unsafe driving.
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Goh RLZ, Kong YXG, McAlinden C, Liu J, Crowston JG, Skalicky SE. Objective Assessment of Activity Limitation in Glaucoma with Smartphone Virtual Reality Goggles: A Pilot Study. Transl Vis Sci Technol 2018; 7:10. [PMID: 29372112 PMCID: PMC5782825 DOI: 10.1167/tvst.7.1.10] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 10/13/2017] [Indexed: 12/04/2022] Open
Abstract
Purpose To evaluate the use of smartphone-based virtual reality to objectively assess activity limitation in glaucoma. Methods Cross-sectional study of 93 patients (54 mild, 22 moderate, 17 severe glaucoma). Sociodemographics, visual parameters, Glaucoma Activity Limitation-9 and Visual Function Questionnaire – Utility Index (VFQ-UI) were collected. Mean age was 67.4 ± 13.2 years; 52.7% were male; 65.6% were driving. A smartphone placed inside virtual reality goggles was used to administer the Virtual Reality Glaucoma Visual Function Test (VR-GVFT) to participants, consisting of three parts: stationary, moving ball, driving. Rasch analysis and classical validity tests were conducted to assess performance of VR-GVFT. Results Twenty-four of 28 stationary test items showed acceptable fit to the Rasch model (person separation 3.02, targeting 0). Eleven of 12 moving ball test items showed acceptable fit (person separation 3.05, targeting 0). No driving test items showed acceptable fit. Stationary test person scores showed good criterion validity, differentiating between glaucoma severity groups (P = 0.014); modest convergence validity, with mild to moderate correlation with VFQ-UI, better eye (BE) mean deviation, BE pattern deviation, BE central scotoma, worse eye (WE) visual acuity, and contrast sensitivity (CS) in both eyes (R = 0.243–0.381); and suboptimal divergent validity. Multivariate analysis showed that lower WE CS (P = 0.044) and greater age (P = 0.009) were associated with worse stationary test person scores. Conclusions Smartphone-based virtual reality may be a portable objective simulation test of activity limitation related to glaucomatous visual loss. Translational Relevance The use of simulated virtual environments could help better understand the activity limitations that affect patients with glaucoma.
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Affiliation(s)
- Rachel L Z Goh
- The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Yu Xiang George Kong
- The Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Centre for Eye Research Australia, The University of Melbourne, Melbourne, Australia
| | - Colm McAlinden
- Department of Ophthalmology, Glangwili Hospital, Hywel Dda University Hospital Board, Carmarthen, UK.,School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - John Liu
- Monash Medical Centre, Melbourne, Australia
| | - Jonathan G Crowston
- The Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Centre for Eye Research Australia, The University of Melbourne, Melbourne, Australia
| | - Simon E Skalicky
- The Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Discipline of Ophthalmology, The University of Sydney, Sydney, Australia.,Royal Melbourne Hospital, Department of Surgery, University of Melbourne, Melbourne, Australia
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Harrington CM, Kavanagh DO, Quinlan JF, Ryan D, Dicker P, O'Keeffe D, Traynor O, Tierney S. Development and evaluation of a trauma decision-making simulator in Oculus virtual reality. Am J Surg 2018; 215:42-47. [DOI: 10.1016/j.amjsurg.2017.02.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
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Daga FB, Diniz-Filho A, Boer ER, Gracitelli CPB, Abe RY, Medeiros FA. Fear of falling and postural reactivity in patients with glaucoma. PLoS One 2017; 12:e0187220. [PMID: 29211742 PMCID: PMC5718417 DOI: 10.1371/journal.pone.0187220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/16/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose To investigate the relationship between postural metrics obtained by dynamic visual stimulation in a virtual reality environment and the presence of fear of falling in glaucoma patients. Methods This cross-sectional study included 35 glaucoma patients and 26 controls that underwent evaluation of postural balance by a force platform during presentation of static and dynamic visual stimuli with head-mounted goggles (Oculus Rift). In dynamic condition, a peripheral translational stimulus was used to induce vection and assess postural reactivity. Standard deviations of torque moments (SDTM) were calculated as indicative of postural stability. Fear of falling was assessed by a standardized questionnaire. The relationship between a summary score of fear of falling and postural metrics was investigated using linear regression models, adjusting for potentially confounding factors. Results Subjects with glaucoma reported greater fear of falling compared to controls (-0.21 vs. 0.27; P = 0.039). In glaucoma patients, postural metrics during dynamic visual stimulus were more associated with fear of falling (R2 = 18.8%; P = 0.001) than static (R2 = 3.0%; P = 0.005) and dark field (R2 = 5.7%; P = 0.007) conditions. In the univariable model, fear of falling was not significantly associated with binocular standard perimetry mean sensitivity (P = 0.855). In the multivariable model, each 1 Nm larger SDTM in anteroposterior direction during dynamic stimulus was associated with a worsening of 0.42 units in the fear of falling questionnaire score (P = 0.001). Conclusion In glaucoma patients, postural reactivity to a dynamic visual stimulus using a virtual reality environment was more strongly associated with fear of falling than visual field testing and traditional balance assessment.
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Affiliation(s)
- Fábio B. Daga
- Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina, United States of America
- Department of Ophthalmology and Vision Science, Federal University of São Paulo, São Paulo, Brazil
- Department of Ophthalmology, University of California, San Diego, La Jolla, California, United States of America
| | - Alberto Diniz-Filho
- Department of Ophthalmology, University of California, San Diego, La Jolla, California, United States of America
| | - Erwin R. Boer
- Department of Ophthalmology, University of California, San Diego, La Jolla, California, United States of America
| | - Carolina P. B. Gracitelli
- Department of Ophthalmology and Vision Science, Federal University of São Paulo, São Paulo, Brazil
- Department of Ophthalmology, University of California, San Diego, La Jolla, California, United States of America
| | - Ricardo Y. Abe
- Department of Ophthalmology, University of California, San Diego, La Jolla, California, United States of America
| | - Felipe A. Medeiros
- Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina, United States of America
- Department of Ophthalmology, University of California, San Diego, La Jolla, California, United States of America
- * E-mail:
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Daga FB, Macagno E, Stevenson C, Elhosseiny A, Diniz-Filho A, Boer ER, Schulze J, Medeiros FA. Wayfinding and Glaucoma: A Virtual Reality Experiment. Invest Ophthalmol Vis Sci 2017; 58:3343-3349. [PMID: 28687845 PMCID: PMC5499646 DOI: 10.1167/iovs.17-21849] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Wayfinding, the process of determining and following a route between an origin and a destination, is an integral part of everyday tasks. The purpose of this study was to investigate the impact of glaucomatous visual field loss on wayfinding behavior using an immersive virtual reality (VR) environment. Methods This cross-sectional study included 31 glaucomatous patients and 20 healthy subjects without evidence of overall cognitive impairment. Wayfinding experiments were modeled after the Morris water maze navigation task and conducted in an immersive VR environment. Two rooms were built varying only in the complexity of the visual scene in order to promote allocentric-based (room A, with multiple visual cues) versus egocentric-based (room B, with single visual cue) spatial representations of the environment. Wayfinding tasks in each room consisted of revisiting previously visible targets that subsequently became invisible. Results For room A, glaucoma patients spent on average 35.0 seconds to perform the wayfinding task, whereas healthy subjects spent an average of 24.4 seconds (P = 0.001). For room B, no statistically significant difference was seen on average time to complete the task (26.2 seconds versus 23.4 seconds, respectively; P = 0.514). For room A, each 1-dB worse binocular mean sensitivity was associated with 3.4% (P = 0.001) increase in time to complete the task. Conclusions Glaucoma patients performed significantly worse on allocentric-based wayfinding tasks conducted in a VR environment, suggesting visual field loss may affect the construction of spatial cognitive maps relevant to successful wayfinding. VR environments may represent a useful approach for assessing functional vision endpoints for clinical trials of emerging therapies in ophthalmology.
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Affiliation(s)
- Fábio B Daga
- Visual Performance Laboratory, University of California San Diego, La Jolla, California, United States
| | - Eduardo Macagno
- Division of Biological Sciences, University of California San Diego, La Jolla, California, United States 3Department of Bioengineering, University of California San Diego, La Jolla, California, United States
| | - Cory Stevenson
- Division of Biological Sciences, University of California San Diego, La Jolla, California, United States 3Department of Bioengineering, University of California San Diego, La Jolla, California, United States
| | - Ahmed Elhosseiny
- Visual Performance Laboratory, University of California San Diego, La Jolla, California, United States 4California Institute for Telecommunications and Information Technology (Calit2), University of California San Diego, La Jolla, California, United States
| | - Alberto Diniz-Filho
- Visual Performance Laboratory, University of California San Diego, La Jolla, California, United States
| | - Erwin R Boer
- Visual Performance Laboratory, University of California San Diego, La Jolla, California, United States
| | - Jürgen Schulze
- California Institute for Telecommunications and Information Technology (Calit2), University of California San Diego, La Jolla, California, United States 5Department of Computer Science and Engineering, University of California San Diego, La Jolla, California, United States
| | - Felipe A Medeiros
- Visual Performance Laboratory, University of California San Diego, La Jolla, California, United States
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de Luna RA, Mihailovic A, Nguyen AM, Friedman DS, Gitlin LN, Ramulu PY. The Association of Glaucomatous Visual Field Loss and Balance. Transl Vis Sci Technol 2017; 6:8. [PMID: 28553562 PMCID: PMC5444495 DOI: 10.1167/tvst.6.3.8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 04/04/2017] [Indexed: 12/23/2022] Open
Abstract
Purpose To relate balance measures to visual field (VF) damage from glaucoma. Methods The OPAL kinematic system measured balance, as root mean square (RMS) sway, on 236 patients with suspect/diagnosed glaucoma. Balance was measured with feet shoulder width apart while standing on a firm/foam surface with eyes opened/closed (Instrumental Clinical Test of Sensory Integration and Balance [ICTSIB] conditions), and eyes open on a firm surface under feet together, semi-tandem, or tandem positions (standing balance conditions). Integrated VF (IVF) sensitivities were calculated by merging right and left eye 24-2 VF data. Results Mean age was 71 years (range, 57–93) and mean IVF sensitivity was 27.1 dB (normal = 31 dB). Lower IVF sensitivity was associated with greater RMS sway during eyes-open foam-surface testing (β = 0.23 z-score units/5 dB IVF sensitivity decrement, P = 0.001), but not during other ICTSIB conditions. Lower IVF sensitivity also was associated with greater RMS sway during feet together standing balance testing (0.10 z-score units/5 dB IVF sensitivity decrement, P = 0.049), but not during other standing balance conditions. Visual dependence of balance was lower in patients with worse IVF sensitivity (β = −21%/5 dB IVF sensitivity decrement, P < 0.001). Neither superior nor inferior IVF sensitivity consistently predicted balance measures better than measures of overall VF sensitivity. Conclusions Balance was worse in glaucoma patients with greater VF damage under foam surface testing (designed to inhibit proprioceptive contributions to balance) as well as feet-together firm-surface conditions when somatosensory inputs were available. Translational Relevance Good balance is essential to avoid unnecessary falls and patients with VF loss from glaucoma may be at higher risk of falls because of poor balance.
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Affiliation(s)
- Regina A de Luna
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | - Angeline M Nguyen
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - David S Friedman
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Laura N Gitlin
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Pradeep Y Ramulu
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Pabon S, Sunness JS, Kaleem MA. Low Vision Therapy for Glaucoma Patients. CURRENT OPHTHALMOLOGY REPORTS 2017. [DOI: 10.1007/s40135-017-0124-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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DeBuc DC. The Role of Retinal Imaging and Portable Screening Devices in Tele-ophthalmology Applications for Diabetic Retinopathy Management. Curr Diab Rep 2016; 16:132. [PMID: 27841014 DOI: 10.1007/s11892-016-0827-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In the years since its introduction, retinal imaging has transformed our capability to visualize the posterior pole of the eye. Increasing practical advances in mobile technology, regular monitoring, and population screening for diabetic retinopathy management offer the opportunity for further development of cost-effective applications through remote assessment of the diabetic eye using portable retinal cameras, smart-phone-based devices and telemedicine networks. Numerous retinal imaging methods and mobile technologies in tele-ophthalmology applications have been reported for diabetic retinopathy screening and management. They provide several advantages of automation, sensitivity, specificity, portability, and miniaturization for the development of point-of-care diagnostics for eye complications in diabetes. The aim of this paper is to review the role of retinal imaging and mobile technologies in tele-ophthalmology applications for diabetic retinopathy screening and management. At large, although improvements in current technology and telemedicine services are still needed, telemedicine has demonstrated to be a worthy tool to support health caregivers in the effective management and prevention of diabetes and its complications.
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Affiliation(s)
- Delia Cabrera DeBuc
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL, 33136, USA.
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Peer Profile: Felipe Medeiros, MD. Ophthalmology 2016; 123:2056-7. [DOI: 10.1016/j.ophtha.2016.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/13/2016] [Indexed: 11/17/2022] Open
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Weinreb RN, Leung CKS, Crowston JG, Medeiros FA, Friedman DS, Wiggs JL, Martin KR. Primary open-angle glaucoma. Nat Rev Dis Primers 2016; 2:16067. [PMID: 27654570 DOI: 10.1038/nrdp.2016.67] [Citation(s) in RCA: 276] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Glaucoma is an optic neuropathy that is characterized by the progressive degeneration of the optic nerve, leading to visual impairment. Glaucoma is the main cause of irreversible blindness worldwide, but typically remains asymptomatic until very severe. Open-angle glaucoma comprises the majority of cases in the United States and western Europe, of which, primary open-angle glaucoma (POAG) is the most common type. By contrast, in China and other Asian countries, angle-closure glaucoma is highly prevalent. These two types of glaucoma are characterized based on the anatomic configuration of the aqueous humour outflow pathway. The pathophysiology of POAG is not well understood, but it is an optic neuropathy that is thought to be associated with intraocular pressure (IOP)-related damage to the optic nerve head and resultant loss of retinal ganglion cells (RGCs). POAG is generally diagnosed during routine eye examination, which includes fundoscopic evaluation and visual field assessment (using perimetry). An increase in IOP, measured by tonometry, is not essential for diagnosis. Management of POAG includes topical drug therapies and surgery to reduce IOP, although new therapies targeting neuroprotection of RGCs and axonal regeneration are under development.
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Affiliation(s)
- Robert N Weinreb
- Shiley Eye Institute, Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, USA
| | - Christopher K S Leung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Jonathan G Crowston
- Department of Ophthalmology, Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
| | - Felipe A Medeiros
- Shiley Eye Institute, Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, USA
| | - David S Friedman
- Dana Center for Preventive Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Janey L Wiggs
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Keith R Martin
- Department of Ophthalmology and Cambridge NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
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Saunders LJ, Medeiros FA, Weinreb RN, Zangwill LM. What rates of glaucoma progression are clinically significant? EXPERT REVIEW OF OPHTHALMOLOGY 2016; 11:227-234. [PMID: 29657575 DOI: 10.1080/17469899.2016.1180246] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Clinically important rates of glaucoma progression (worsening) are ones that put a patient at risk of future functional impairment or reduction of vision-related quality of life. Rates of progression can be evaluated through measuring structural or functional changes of the optic nerve. Most treated eyes do not progress at rates that will lead to future visual impairment, but there are a significant proportion (3-17%) of eyes, that are at risk of impairment even under clinical care. While very fast rates of progression (e.g. MD progression of -1.5 dB/year) are generally problematic, much slower rates also may be deleterious for young patients, particularly those diagnosed with late disease. As a result, it is important to consider life expectancy, disease severity and vision-related quality of life based treatment targets to estimate future prognosis when evaluating whether a rate of glaucoma progression can be clinically relevant.
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