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Phu J, Tan J, Kalloniatis M. Multiple (frontloaded) visual field tests increase identification of very slow mean deviation progression in glaucoma. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:311-323. [PMID: 37652089 DOI: 10.1016/j.jcjo.2023.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/29/2023] [Accepted: 07/31/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To determine the effect of frontloading (multiple) visual field (VF) tests at the same visit for detecting mean deviation (MD) change in slowly progressive glaucoma. METHODS This was a computer simulation study. Baseline MD (range, 0 to -12 dB) and progression rate (range, 0 to -0.4 dB/year, non-inclusive) were generated for 10,000 patients. Each patient had 6 simulated "stable" baseline VF tests. Then follow-up VFs (up to 10 years) were generated by incorporating progression rate and within-visit and between-visit variability. The independent variables were number of VF tests per visit (one non-frontloaded or two frontloaded), VF reliability (100%, 85%, or 70%), repeat testing because of unreliable results (yes or no), and follow-up interval (6-monthly or yearly). The outcomes were detection of progression (MD slope that was negative and significant at p < 0.05), MD at detection, and number of years to detection. RESULTS Frontloading identified more progressors (62.7%-79.2%) compared with non-frontloading (31.0%-36.7%) at 10 years (p < 0.0001). Six-monthly follow-ups led to greater detection than yearly intervals. Progressors detected by both methods were detected by the non-frontloaded method sooner (up to 0.26 years), but this was small and not clinically significant (MD difference, 0.06 dB). An increase (less severe) in MD, an increase (slower) in progression rate, and an increase in SD of baseline VFs decreased the likelihood of detecting progression. CONCLUSIONS Frontloading VF tests at 6-monthly intervals improve detection rates of MD progression in slowly progressive glaucoma patients compared with performing 1 test per visit at yearly intervals.
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Affiliation(s)
- Jack Phu
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia; School of Medicine (Optometry), Deakin University, Waurn Ponds, Victoria, Australia; Faculty of Medicine and Health, University of Sydney, NSW, Australia; Centre for Eye Health, UNSW, Sydney, NSW, Australia.
| | - Jeremy Tan
- Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia; Department of Ophthalmology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Michael Kalloniatis
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia; School of Medicine (Optometry), Deakin University, Waurn Ponds, Victoria, Australia
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Wu JH, Moghimi S, Walker E, Nishida T, Liebmann JM, Fazio MA, Girkin CA, Zangwill LM, Weinreb RN. Time to Glaucoma Progression Detection by Optical Coherence Tomography and Visual Field in Glaucoma Individuals of African Descent. Am J Ophthalmol 2024; 269:195-204. [PMID: 39094992 DOI: 10.1016/j.ajo.2024.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/14/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE To examine the time to glaucoma progression detection by retinal nerve fiber layer thickness (RNFLT) and visual field (VF) among individuals of African descent (AD). DESIGN Retrospective cohort study. METHODS This multicenter study included eyes with glaucoma from individuals of AD from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study with ≥2 years/5 visits of optic nerve head RNFLT and 24-2 VF examinations. INTERVENTION OR OBSERVATION PROCEDURE Rates of VF mean deviation (MD) and RNFLT worsening were analyzed using linear mixed-effects models, and longitudinal data were simulated using the variability estimates. MAIN OUTCOME MEASURE The simulated time to detect trend-based glaucoma progression was assessed with assumed rates of VF MD and RNFLT change derived from the cohort (25th, 50th, and 75th percentile [as p25, median, and p75] slopes and mean slopes). Severity-stratified analyses were also performed. RESULTS We included 184 eyes from 128 subjects of AD (mean baseline age 63.4 years; VF MD -4.2 dB; RNFLT 80.2 µm). The p25, median, mean, and p75 rates of change were -0.43, -1.01, -1.15, and -1.64 µm per year for RNFLT, and 0.00, -0.21, -0.30, and -0.51 dB per year for VF MD, respectively. Compared with VF MD, RNFLT showed an overall shorter mean time to progression detection (time difference 0.4-1.7 years), with the mean rates showing the largest difference (RNFLT 5.2 years vs VF MD 6.9 years). Similarly, we found an overall shorter time to detect RNFLT progression, compared with that of VF MD progression, in eyes with mild glaucoma (≥1 year earlier) and in eyes with moderate to advanced glaucoma (∼0.5 year earlier). CONCLUSIONS Computer simulation showed a potentially shorter time to detect RNFLT progression than VF MD progression in eyes from individuals of AD. Our findings support the importance of using RNFLT to detect progressive glaucoma in individuals of AD.
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Affiliation(s)
- Jo-Hsuan Wu
- From the Hamilton Glaucoma Center (J-H.W., S.M., E.W., T.N., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Sasan Moghimi
- From the Hamilton Glaucoma Center (J-H.W., S.M., E.W., T.N., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Evan Walker
- From the Hamilton Glaucoma Center (J-H.W., S.M., E.W., T.N., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Takashi Nishida
- From the Hamilton Glaucoma Center (J-H.W., S.M., E.W., T.N., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory (J.M.L.), Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York, USA
| | - Massimo A Fazio
- Department of Ophthalmology and Vision Sciences (M.F., C.A.G.), Heersink School of Medicine, University of Alabama-Birmingham, Birmingham, Alabama, USA
| | - Christopher A Girkin
- Department of Ophthalmology and Vision Sciences (M.F., C.A.G.), Heersink School of Medicine, University of Alabama-Birmingham, Birmingham, Alabama, USA
| | - Linda M Zangwill
- From the Hamilton Glaucoma Center (J-H.W., S.M., E.W., T.N., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- From the Hamilton Glaucoma Center (J-H.W., S.M., E.W., T.N., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA.
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Kumar A, Hekmatjah N, Yu Y, Han Y, Ying GS, Oatts JT. Factors Associated With Visual Field Testing Reliability in Children With Glaucoma or Suspected Glaucoma. Am J Ophthalmol 2024; 264:187-193. [PMID: 38614194 PMCID: PMC11257782 DOI: 10.1016/j.ajo.2024.04.005] [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: 12/12/2023] [Revised: 02/26/2024] [Accepted: 04/03/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE To evaluate Humphrey Visual Field (HVF) test reliability and its associated risk factors in children with glaucoma or glaucoma suspect. DESIGN Retrospective cohort study. METHODS None. SETTING Single-center childhood glaucoma clinic. PATIENT POPULATION One hundred thirty-six patients aged ≤18 years with glaucoma/glaucoma suspect, and least 1 completed 24 to 2 HVF test between 2018 and 2023. OBSERVATION PROCEDURE Demographic and clinical characteristics including age, primary language, visual acuity (VA), and glaucoma diagnosis were extracted from electronic health records. MAIN OUTCOME MEASURES HVF 24 to 2 testing metrics, including FP, FN, and FL. Tests were defined as reliable using manufacturer guidelines of ≤33% FP, ≤33% FN, and ≤20% FL. For each patient, a reliability score was calculated as the percentage of reliable tests among all tests completed. A multivariable logistic regression model was used to determine factors associated with test-level reliability (yes/no). A multivariable linear regression model was used to determine factors associated with patient-level reliability score. RESULTS Among 634 HVFs from 136 patients (Mean ± SD age at first test 12.0 ± 3.2 years, 47.8% female), 51.3% were reliable. Older age, better baseline VA, and English as primary language were associated with greater odds of test-level reliability (P < .04). Mean ± SD patient-level reliability score was 51.7 ± 38.1%. Older age at first clinic visit, better baseline VA, and English as primary language were associated with higher reliability scores (all P < .02), and number of prior VF tests was not (P = .56). CONCLUSIONS Younger age, worse visual acuity, and non-English as primary language were associated with decreased reliability and should be considered when interpreting VF testing in children. A significant learning effect was not observed with repeated testing.
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Affiliation(s)
- Anika Kumar
- From the University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Natan Hekmatjah
- From the University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Yinxi Yu
- Scheie Eye Institute, Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ying Han
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Gui-Shuang Ying
- Scheie Eye Institute, Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julius T Oatts
- Department of Ophthalmology, University of California, San Francisco, California, USA.
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Berneshawi AR, Shue A, Chang RT. Glaucoma Home Self-Testing Using VR Visual Fields and Rebound Tonometry Versus In-Clinic Perimetry and Goldmann Applanation Tonometry: A Pilot Study. Transl Vis Sci Technol 2024; 13:7. [PMID: 39102241 PMCID: PMC11309035 DOI: 10.1167/tvst.13.8.7] [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: 09/05/2023] [Accepted: 02/22/2024] [Indexed: 08/06/2024] Open
Abstract
Purpose This pilot study aimed to assess the feasibility, accuracy, and repeatability of unsupervised, at-home, multi-day glaucoma testing using the Olleyes VisuALL Virtual Reality Platform (VRP) and the iCare HOME handheld self-tonometer. Methods Participants were trained to use two U.S. Food and Drug Administration-registered or approved devices before conducting self-tests at home over 3 consecutive days. The iCare HOME intraocular pressure (IOP) measurements were collected four times daily per eye, and VRP visual field tests were performed once daily. The results were compared with one in-clinic Humphrey Field Analyzer (HFA) visual field test performed on the day of device training, iCare HOME measurements by the trainer, and the last five Goldmann applanation tonometer (GAT) results. Results Of 15 enrolled participants, nine of them (60%) completed the study. The six excluded participants could not self-measure using iCare HOME. There was significant correlation between the average mean deviation (MD) values of the at-home VRP tests and in-clinic HFA test (r2 = 0.8793, P < 0.001). Additionally, the average of the sensitivities in five of six Garway-Heath sectors were significantly correlated. VRP test duration was also shorter than in-clinic HFA testing (P < 0.001). Finally, at-home tonometry yielded statistically similar values compared to trainer-obtained iCare HOME values. The mean and range of at-home tonometry were also statistically similar to those for in-clinic GAT, but at-home tonometry demonstrated higher maximum IOP values (P = 0.0429). Conclusions Unsupervised, at-home, multi-day glaucoma testing using two devices resulted in the capture of higher maximum IOPs than in the clinic and good MD correlation of VRP with HFA. However, 40% of participants could not self-measure IOP using iCare HOME. Translational Relevance The study findings suggest that at-home remote glaucoma monitoring correlates with in-office testing and could provide additional information for glaucoma management, although patients had more difficulty with the iCare HOME than the VRP.
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Affiliation(s)
- Andrew R. Berneshawi
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ann Shue
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
| | - Robert T. Chang
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
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Dave S, Rathore M, Campbell P, Edgar DF, Crabb DP, Callaghan T, Jones PR. Views and opinions of patients with glaucoma and age-related macular degeneration on vision home-monitoring: a UK-based focus group study. BMJ Open 2024; 14:e080619. [PMID: 39002965 PMCID: PMC11253750 DOI: 10.1136/bmjopen-2023-080619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/16/2024] [Indexed: 07/15/2024] Open
Abstract
OBJECTIVE To investigate the views, hopes and concerns of patients living with glaucoma and age-related macular degeneration (AMD) regarding vision home-monitoring. DESIGN Qualitative study using focus groups and questionnaires. Participants were given three disease-relevant home-monitoring tests to try. The tests consisted of three visual field tests for the glaucoma groups (Melbourne Rapid Fields, Eyecatcher, Visual Fields Fast) and three acuity and/or contrast-sensitivity tests for AMD groups (Alleye, PopCSF, SpotChecks). Focus group data were thematically analysed. SETTING University meeting rooms in London, UK. PARTICIPANTS Eight people with glaucoma (five women, median age 74) and seven people with AMD (four women, median age 77) volunteered through two UK-based charities. Participants were excluded if they did not self-report a diagnosis of glaucoma or AMD or if they lived further than a 1-hour travel distance from the university (to ensure minimal travel burden on participants). RESULTS Six themes emerged from focus groups, the two most frequently referenced being: 'concerns about home-monitoring' and 'patient and practitioner access to results'. Overall, participants believed home-monitoring could provide patients with a greater sense of control, but also expressed concerns, including: the possibility of home-monitoring replacing face-to-face appointments; the burden placed on clinicians by the need to process additional data; struggles to keep up with requisite technologies; and potential anxiety from seeing worrying results. Most devices were scored highly for usability, though several practical improvements were suggested. CONCLUSION Patients with mild-to-moderate glaucoma/AMD expect vision home-monitoring to be beneficial, but have significant concerns about its potential implementation.
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Affiliation(s)
- Sonali Dave
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Mehal Rathore
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Peter Campbell
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, UK
| | - David F Edgar
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, UK
| | - David P Crabb
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Tamsin Callaghan
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, UK
- Royal Free Clinical Research Facility, Royal Free London NHS Foundation Trust, London, UK
| | - Pete R Jones
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, UK
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Meyerov J, Chen Y, Busija L, Green C, Skalicky SE. Repeatability of Online Circular Contrast Perimetry Compared to Standard Automated Perimetry. J Glaucoma 2024; 33:505-515. [PMID: 38595156 DOI: 10.1097/ijg.0000000000002384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/16/2024] [Indexed: 04/11/2024]
Abstract
PRCIS Online circular contrast perimetry provides visual field assessment on any computer or tablet with no extra hardware. It has good test repeatability and reliability that is comparable with standard automated perimetry. It holds promise for use in disease screening and surveillance to expand the provision of glaucoma care. PURPOSE To evaluate the repeatability of online circular contrast perimetry (OCCP) compared to standard automated perimetry (SAP) in normal participants and patients with stable glaucoma over 18 weeks. METHODS Thirty-six participants (13 normal controls and 23 patients with open angle glaucoma) were recruited. OCCP and SAP perimetry tests were performed twice at baseline, then at 6, 12, and 18 weeks. Global perimetric indices were compared between perimetry types and analyzed for short-term and intermediate-term repeatability. RESULTS There were no statistically significant changes over time for both OCCP and SAP across all groups for mean deviation (MD), pattern standard deviation, and visual index/visual field index ( P >0.05). Test-retest intraclass correlation coefficients (ICCs) for OCCP MD were excellent at baseline (0.98, 95% CI: 0.89-0.99) and good at 18 weeks (0.88, 95% CI: 0.51-0.98). SAP test-retest ICCs were excellent at baseline (0.94, 95% CI: 0.70-0.99) and 18 weeks (0.97, 95% CI: 0.84-0.99). Inter-test ICCs were good, ranging from 0.84 to 0.87. OCCP testing time was shorter than SAP (5:29 ± 1:24 vs. 6:00 ± 1:05, P <0.001). OCCP had similar false-positive (3.84 ± 3.32 vs. 3.66 ± 4.53, P =0.48) but lower false-negative (0.73 ± 1.52 vs. 4.48 ± 5.00, P <0.001) and fixation loss responses (0.91 ± 1.32 vs. 2.02 ± 2.17, P <0.001). CONCLUSIONS OCCP allows visual field assessment on any computer screen with no additional hardware. It demonstrated good repeatability and reliability with similar performance indices to SAP in both the short term and intermediate term. OCCP has the potential to be utilized as a glaucoma screening and surveillance tool for in-clinic and at-home testing, expanding the provision of care.
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Affiliation(s)
- Joshua Meyerov
- Department of Ophthalmology, The Alfred Hospital, Alfred Health
| | - Yang Chen
- Department of Surgery Ophthalmology, University of Melbourne
| | - Lazar Busija
- Department of Surgery Ophthalmology, University of Melbourne
- Glaucoma Investigation and Research Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Catherine Green
- Department of Surgery Ophthalmology, University of Melbourne
- Glaucoma Investigation and Research Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Simon E Skalicky
- Department of Surgery Ophthalmology, University of Melbourne
- Glaucoma Investigation and Research Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
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Häner NU, Chen HY, Lincke JB, Shang X, Zinkernagel MS, Unterlauft JD. [Virtual reality perimetry and home perimetry]. DIE OPHTHALMOLOGIE 2024; 121:586-591. [PMID: 38871972 DOI: 10.1007/s00347-024-02058-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 04/14/2024] [Accepted: 05/22/2024] [Indexed: 06/15/2024]
Abstract
In this article virtual reality (VR)-based procedures for home perimetry (HP) are described and an overview is given of which procedures can already be used today.
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Affiliation(s)
- Nathanael Urs Häner
- Inselspital, Universitäts-Augenklinik Bern, Freiburgstr., 3010, Bern, Schweiz
| | - Hsin-Yang Chen
- Inselspital, Universitäts-Augenklinik Bern, Freiburgstr., 3010, Bern, Schweiz
| | | | - Xiao Shang
- Inselspital, Universitäts-Augenklinik Bern, Freiburgstr., 3010, Bern, Schweiz
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Leidy L, Dickinson A, Ramulu P, Ehrlich J, Kaleem MA. Clinical outcome measures in vision and eye care. Surv Ophthalmol 2024; 69:632-637. [PMID: 38484982 DOI: 10.1016/j.survophthal.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Abstract
Traditionally, clinical outcome assessments have focused on the patient's perspective through patient-reported outcome assessments; however, given the complexity, integration, and interactions of various participants within the clinical ophthalmology setting, we propose that additional diverse clinical perspectives should be explored in order to appreciate fully the value of care provided to patients. In this review we introduce a framework by which clinical outcome assessments (COAs) can be organized. Our COA framework is composed of five outcome measurements that encompass the perspectives of each player in a patient's care: clinical data-reported outcomes, patient-reported outcomes, clinician-reported outcomes, observer-reported outcomes, and reviewer-reported outcomes. By establishing a standard for evaluating patient care, we hope to address gaps in expectations of patient care and encourage more thoughtful patient-clinician relationships.
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Affiliation(s)
- Luke Leidy
- Eastern Virginia Medical School, Norfolk, VA, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna Dickinson
- Eastern Virginia Medical School, Norfolk, VA, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pradeep Ramulu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Faculty of Medicine, Baltimore, MD, USA
| | - Joshua Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Mona A Kaleem
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Faculty of Medicine, Baltimore, MD, USA.
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Venkata Srinivasan V, Carter-Dawson L, Patel NB. Retinal Ganglion Cell Content Underlying Standard Automated Perimetry Size I to V Visual Sensitivities in the Non-Human Primate Experimental Glaucoma Model. Invest Ophthalmol Vis Sci 2024; 65:22. [PMID: 38995114 PMCID: PMC11246096 DOI: 10.1167/iovs.65.8.22] [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] [Indexed: 07/13/2024] Open
Abstract
Purpose To determine the relationship between visual sensitivities from white-on-white Goldmann size I to V stimuli and the underlying retinal ganglion cell (RGC) content in the non-human primate (NHP) experimental glaucoma model. Methods Normative data were collected from 13 NHPs. Unilateral experimental glaucoma was induced in seven animals with the least variable fields who were monitored using optical coherence tomography and 30-2 full-threshold standard automated perimetry (SAP). At varying endpoints, animals were euthanized followed by perfusion fixation, and 1-mm retinal punches were obtained from 34 corresponding SAP locations. RGCs were immunolabeled with an antibody against an RNA-binding protein (RBPMS) marker and imaged using confocal microscopy. RGC counts from each location were then related to visual sensitivities for each stimulus size, after accounting for ocular magnification. Results At the endpoint, the circumpapillary retinal nerve fiber layer thickness for experimental glaucoma eyes ranged from 47 to 113 µm. RGC density in control eyes was greatest for the 4.24° sample (18,024 ± 6869 cells/mm2) and decreased with eccentricity. Visual sensitivity at each tested location followed that predicted by spatial summation, with the critical area increasing with eccentricity (slope = 0.0036, R2 = 0.44). The relationship between RGC counts and visual sensitivity was described using a two-line fit, where the intercept of the first segment and hinge points were dependent on eccentricity. Conclusions In NHPs, SAP visual thresholds are related to the underlying RGCs. The resulting spatial summation based structure-function model can be used to estimate RGC content from any standard white-on-white stimulus size.
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Affiliation(s)
| | | | - Nimesh B Patel
- University of Houston College of Optometry, Houston, Texas, United States
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Medeiros FA, Malek DA, Tseng H, Swaminathan SS, Boland MV, Friedman DS, Jammal AA. Short-term Detection of Fast Progressors in Glaucoma: The Fast Progression Assessment through Clustered Evaluation (Fast-PACE) Study. Ophthalmology 2024; 131:645-657. [PMID: 38160883 DOI: 10.1016/j.ophtha.2023.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/19/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE To evaluate the performance of an intensive, clustered testing approach in identifying eyes with rapid glaucoma progression over 6 months in the Fast Progression Assessment through Clustered Evaluation (Fast-PACE) Study. DESIGN Prospective cohort study. PARTICIPANTS A total of 125 eyes from 65 primary open-angle glaucoma (POAG) subjects. METHODS Subjects underwent 2 sets of 5 weekly visits (clusters) separated by an average of 6 months and then were followed with single visits every 6 months for an overall mean follow-up of 25 months (mean of 17 tests). Each visit consisted of testing with standard automated perimetry (SAP) 24-2 and 10-2, and spectral-domain OCT (SD-OCT). Progression was assessed using trend analyses of SAP mean deviation (MD) and retinal nerve fiber layer (RNFL) thickness. Generalized estimating equations were applied to adjust for correlations between eyes for confidence interval (CI) estimation and hypothesis testing. MAIN OUTCOME MEASURES Diagnostic accuracy of the 6-month clustering period to identify progression detected during the overall follow-up. RESULTS A total of 19 of 125 eyes (15%, CI, 9%-24%) progressed based on SAP 24-2 MD over the 6-month clustering period. A total of 14 eyes (11%, CI, 6%-20%) progressed on SAP 10-2 MD, and 16 eyes (13%, CI, 8%-21%) progressed by RNFL thickness, with 30 of 125 eyes (24%, CI, 16%-34%) progressing by function, structure, or both. Of the 35 eyes progressing during the overall follow-up, 25 had progressed during the 6-month clustering period, for a sensitivity of 71% (CI, 53%-85%). Of the 90 eyes that did not progress during the overall follow-up, 85 also did not progress during the 6-month period, for a specificity of 94% (CI, 88%-98%). Of the 14 eyes considered fast progressors by SAP 24-2, SAP 10-2, or SD-OCT during the overall follow-up, 13 were identified as progressing during the 6-month cluster period, for a sensitivity of 93% (CI, 66%-100%) for identifying fast progression with a specificity of 85% (CI, 77%-90%). CONCLUSIONS Clustered testing in the Fast-PACE Study detected fast-progressing glaucoma eyes over 6 months. The methodology could be applied in clinical trials investigating interventions to slow glaucoma progression and may be of value for short-term assessment of high-risk subjects. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Felipe A Medeiros
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida; Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina.
| | - Davina A Malek
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Henry Tseng
- Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina
| | | | - Michael V Boland
- Mass Eye and Ear and Harvard Medical School, Boston, Massachusetts
| | - David S Friedman
- Mass Eye and Ear and Harvard Medical School, Boston, Massachusetts
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Swaminathan SS, Berchuck SI, Rao JS, Medeiros FA. Performance of Linear Mixed Models in Estimating Structural Rates of Glaucoma Progression Using Varied Random Effect Distributions. OPHTHALMOLOGY SCIENCE 2024; 4:100454. [PMID: 38317870 PMCID: PMC10838913 DOI: 10.1016/j.xops.2023.100454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/03/2023] [Accepted: 11/21/2023] [Indexed: 02/07/2024]
Abstract
Purpose To compare how linear mixed models (LMMs) using Gaussian, Student t, and log-gamma (LG) random effect distributions estimate rates of structural loss in a glaucomatous population using OCT and to compare model performance to ordinary least squares (OLS) regression. Design Retrospective cohort study. Subjects Patients in the Bascom Palmer Glaucoma Repository (BPGR). Methods Eyes with ≥ 5 reliable peripapillary retinal nerve fiber layer (RNFL) OCT tests over ≥ 2 years were identified from the BPGR. Retinal nerve fiber layer thickness values from each reliable test (signal strength ≥ 7/10) and associated time points were collected. Data were modeled using OLS regression as well as LMMs using different random effect distributions. Predictive modeling involved constructing LMMs with (n - 1) tests to predict the RNFL thickness of subsequent tests. A total of 1200 simulated eyes of different baseline RNFL thickness values and progression rates were developed to evaluate the likelihood of declared progression and predicted rates. Main Outcome Measures Model fit assessed by Watanabe-Akaike information criterion (WAIC) and mean absolute error (MAE) when predicting future RNFL thickness values; log-rank test and median time to progression with simulated eyes. Results A total of 35 862 OCT scans from 5766 eyes of 3491 subjects were included. The mean follow-up period was 7.0 ± 2.3 years, with an average of 6.2 ± 1.4 tests per eye. The Student t model produced the lowest WAIC. In predictive models, all LMMs demonstrated a significant reduction in MAE when estimating future RNFL thickness values compared with OLS (P < 0.001). Gaussian and Student t models were similar and significantly better than the LG model in estimating future RNFL thickness values (P < 0.001). Simulated eyes confirmed LMM performance in declaring progression sooner than OLS regression among moderate and fast progressors (P < 0.01). Conclusions LMMs outperformed conventional approaches for estimating rates of OCT RNFL thickness loss in a glaucomatous population. The Student t model provides the best model fit for estimating rates of change in RNFL thickness, although the use of the Gaussian or Student t distribution in models led to similar improvements in accurately estimating RNFL loss. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Swarup S. Swaminathan
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Samuel I. Berchuck
- Department of Biostatistics & Bioinformatics, Statistical Science, Duke University, Durham, North Carolina
| | - J. Sunil Rao
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Felipe A. Medeiros
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Besharati S, Su E, Mohammadzadeh V, Mohammadi M, Caprioli J, Weiss RE, Nouri-Mahdavi K. Detecting Fast Progressors: Comparing a Bayesian Longitudinal Model to Linear Regression for Detecting Structural Changes in Glaucoma. Am J Ophthalmol 2024; 261:85-94. [PMID: 38281568 DOI: 10.1016/j.ajo.2024.01.024] [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: 08/20/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE Demonstrate that a novel Bayesian hierarchical spatial longitudinal (HSL) model identifies macular superpixels with rapidly deteriorating ganglion cell complex (GCC) thickness more efficiently than simple linear regression (SLR). DESIGN Prospective cohort study. SETTING Tertiary Glaucoma Center. SUBJECTS One hundred eleven eyes (111 patients) with moderate to severe glaucoma at baseline and ≥4 macular optical coherence tomography scans and ≥2 years of follow-up. OBSERVATION PROCEDURE Superpixel-patient-specific GCC slopes and their posterior variances in 49 superpixels were derived from our latest Bayesian HSL model and Bayesian SLR. A simulation cohort was created with known intercepts, slopes, and residual variances in individual superpixels. MAIN OUTCOME MEASURES We compared HSL and SLR in the fastest progressing deciles on (1) proportion of superpixels identified as significantly progressing in the simulation study and compared to SLR slopes in cohort data; (2) root mean square error (RMSE), and SLR/HSL RMSE ratios. RESULTS Cohort- In the fastest decile of slopes per SLR, 77% and 80% of superpixels progressed significantly according to SLR and HSL, respectively. The SLR/HSL posterior SD ratio had a median of 1.83, with 90% of ratios favoring HSL. Simulation- HSL identified 89% significant negative slopes in the fastest progressing decile vs 64% for SLR. SLR/HSL RMSE ratio was 1.36 for the fastest decile of slopes, with 83% of RMSE ratios favoring HSL. CONCLUSION The Bayesian HSL model improves the estimation efficiency of local GCC rates of change regardless of underlying true rates of change, particularly in fast progressors.
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Affiliation(s)
- Sajad Besharati
- From the Glaucoma Division (S.B., V.M., M.M., J.C., K.N-M.), Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Erica Su
- Department of Biostatistics (R.E.W.), Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Vahid Mohammadzadeh
- From the Glaucoma Division (S.B., V.M., M.M., J.C., K.N-M.), Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Massood Mohammadi
- From the Glaucoma Division (S.B., V.M., M.M., J.C., K.N-M.), Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Joseph Caprioli
- From the Glaucoma Division (S.B., V.M., M.M., J.C., K.N-M.), Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Robert E Weiss
- Department of Biostatistics (R.E.W.), Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Kouros Nouri-Mahdavi
- From the Glaucoma Division (S.B., V.M., M.M., J.C., K.N-M.), Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
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Madu CT, Lee TF, Sohn A, Hu J, Matayev R, Paranjpe V, Fam J, Wronka A, Kim ET, Zambrano R, Wollstein G, Schuman JS. Disparities in Visual Field Testing Frequency Among Subjects With Glaucoma. Transl Vis Sci Technol 2024; 13:2. [PMID: 38564202 PMCID: PMC10996970 DOI: 10.1167/tvst.13.4.2] [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: 06/30/2023] [Accepted: 01/23/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Prior evidence suggests racial disparities in the utilization of visual field testing (VFT) for the diagnosis and monitoring of glaucoma. In this study, we considered the effect of baseline glaucoma severity and socioeconomic disadvantage along with other potential confounders such as test reliability, ancillary tests, and glaucoma surgeries on racial disparity in the frequency of VFT. Methods The records of all subjects with a diagnosis of glaucoma who received VFT at an academic, tertiary care facility from January 2018 to December 2021 were accessed. Analysis was performed to compare VFT frequency, the total number of office visits (DoS), and the ratio of VFT frequency to DoS (VFT/DoS) across self-reported races while controlling for sex, age, socioeconomic disadvantage (Area Deprivation Index), VF reliability indicators and baseline mean deviation, optical coherence tomography frequency, and glaucoma surgeries. Results Among the 2654 subjects (1515 White, 782 Black, and 357 Asian) included in this study, Black subjects had the worst socioeconomic status and disease severity at baseline. They also experienced a 3% lower VFT/DoS ratio compared to White subjects (P = 0.031). Asian subjects had a 5% lower VFT/DoS ratio compared to White subjects (P = 0.015). Discussion We identified racial disparity in performing VFT in subjects with glaucoma even when multiple confounders were considered. Further investigation is necessary to identify other race-associated factors to work toward reducing racial disparities in VFT. Translational Relevance Black and Asian subjects with glaucoma receive fewer VFT per visit compared to White subjects even when considering socioeconomic disadvantage and disease severity.
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Affiliation(s)
- Chisom T Madu
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Ting-Fang Lee
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Ashley Sohn
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Jiyuan Hu
- Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Rachel Matayev
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Vikram Paranjpe
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Jonathan Fam
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Andrew Wronka
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Eleanore T Kim
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | | | - Gadi Wollstein
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Joel S Schuman
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
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Wu JH, Moghimi S, Walker E, Nishida T, Brye N, Mahmoudinezhad G, Liebmann JM, Fazio M, Girkin CA, Zangwill LM, Weinreb RN. Time to Glaucoma Progression Detection by Optical Coherence Tomography in Individuals of African and European Descents. Am J Ophthalmol 2024; 260:60-69. [PMID: 38061585 DOI: 10.1016/j.ajo.2023.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/14/2024]
Abstract
PURPOSE To examine the time to detectable retinal nerve fiber layer thickness (RNFLT) progression by optical coherence tomography (OCT) among glaucoma patients of African descent (AD) and European descent (ED). DESIGN Retrospective cohort study. METHODS AD and ED glaucoma eyes from the Diagnostic Innovations in Glaucoma Study (DIGS)/African Descent and Glaucoma Evaluation Study (ADAGES) with ≥2 years/4 visits of optic nerve head RNFLT measurements were included after homogenization on age, diagnosis, and baseline visual field (VF) measurement. RNFLT variability estimates based on linear mixed-effects models were used to simulate longitudinal RNFLT data for both races. Times to trend-based RNFLT progression detection were calculated under standardized scenarios (same RNFLT baseline/thinning rates for both races) and real-world scenarios (AD and ED cohort-specific RNFLT baseline/thinning rates). RESULTS We included 332 and 542 eyes (216 and 317 participants) of AD and ED, respectively. In standardized scenarios, the time to detect RNFLT progression appeared to be similar (difference, <0.2 years) for AD and ED across different assumed RNFLT thinning rates/baseline. In real-world scenarios, compared to ED, AD had a faster RNFLT thinning rate (-0.8 vs -0.6 µm/y) and thicker baseline RNFLT (84.6 vs 81.8 µm). With a faster thinning rate, the mean (SD) time to progression detection was shorter in AD (4.8 [2.0] vs ED: 5.4 [2.4] years), and the 5-year progression rate appeared to be higher (AD: 59% vs ED: 47%). CONCLUSIONS Time to progression detection was similar for both races when assuming identical RNFLT baseline/thinning rates, and shorter in AD eyes under real-world simulation when AD had faster RNFLT thinning. In contrast to prior results on VF, which detected progression later in AD eyes than in ED eyes, OCT may detect progression more consistently across these races.
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Affiliation(s)
- Jo-Hsuan Wu
- From the Hamilton Glaucoma Center (J.-H.W., S.M., E.W., T.N., N.B., G.M., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Sasan Moghimi
- From the Hamilton Glaucoma Center (J.-H.W., S.M., E.W., T.N., N.B., G.M., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Evan Walker
- From the Hamilton Glaucoma Center (J.-H.W., S.M., E.W., T.N., N.B., G.M., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Takashi Nishida
- From the Hamilton Glaucoma Center (J.-H.W., S.M., E.W., T.N., N.B., G.M., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Nicole Brye
- From the Hamilton Glaucoma Center (J.-H.W., S.M., E.W., T.N., N.B., G.M., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Golnoush Mahmoudinezhad
- From the Hamilton Glaucoma Center (J.-H.W., S.M., E.W., T.N., N.B., G.M., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory (J.M.L.), Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York, USA
| | - Massimo Fazio
- Department of Ophthalmology and Vision Sciences (M.F., C.A.G.), Heersink School of Medicine, University of Alabama-Birmingham, Birmingham, Alabama, USA
| | - Christopher A Girkin
- Department of Ophthalmology and Vision Sciences (M.F., C.A.G.), Heersink School of Medicine, University of Alabama-Birmingham, Birmingham, Alabama, USA
| | - Linda M Zangwill
- From the Hamilton Glaucoma Center (J.-H.W., S.M., E.W., T.N., N.B., G.M., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- From the Hamilton Glaucoma Center (J.-H.W., S.M., E.W., T.N., N.B., G.M., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA.
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15
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Chen DF, Wang C, Si Y, Lu X, Zhou W, Huang Q, Zuo J, Cheng G, Leung DYL, Wang N, Friedman DS, Liang Y. Natural History and Risk Factors for Glaucoma Progression in Chinese Patients With Normal-Tension Glaucoma. Invest Ophthalmol Vis Sci 2024; 65:28. [PMID: 38506850 PMCID: PMC10959195 DOI: 10.1167/iovs.65.3.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/27/2024] [Indexed: 03/21/2024] Open
Abstract
Purpose To characterize the natural history of normal-tension glaucoma (NTG) in Chinese patients. Methods The prospective observational cohort study included patients with untreated NTG with a minimum follow-up of 2 years. Functional progression was defined by visual field (VF) deterioration, while structural progression was characterized by thinning of the retinal nerve fiber layer (RNFL) or ganglion cell inner plexiform layer (GCIPL). Results Among 84 participants (mean age, 60.5 years; mean deviation, -5.01 decibels [dB]) with newly diagnosed NTG followed for an average of 69.7 months, 63.1% progressed during the observation period. Specifically, 29.8% progressed by VF, and 48.8% progressed by either RNFL or GCIPL. In Cox proportional hazards analysis, disc hemorrhage (hazard ratio [HR], 2.82; 95% confidence interval [CI], 1.48-5.35), female gender (HR, 1.98; 95% CI, 1.08-3.62), and mean IOP during the follow-up period (HR, 1.14 per mm Hg; 95% CI, 1.00-1.31) were significant predictors of glaucomatous progression. Additionally, longer axial length (AL; HR, 0.57 per millimeter; 95% CI, 0.35-0.94) was protective against VF progression faster than -0.50 dB/y, and higher minimum diastolic blood pressure (DBP; HR, 0.96 per mm Hg; 95% CI, 0.92-1.00) was protective against structural progression. Conclusions Nearly two-thirds of untreated Chinese patients with NTG progressed over an average follow-up of 70 months by VF, RNFL, or GCIPL. Disc hemorrhage, female gender, higher mean IOP, shorter AL, and lower minimum DBP were significant predictors for disease progression.
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Affiliation(s)
- De-Fu Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Glaucoma Research Institute, Wenzhou Medical University, Wenzhou, China
| | - Chenmin Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Glaucoma Research Institute, Wenzhou Medical University, Wenzhou, China
| | - Yuqing Si
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Glaucoma Research Institute, Wenzhou Medical University, Wenzhou, China
| | - Xiaonan Lu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Glaucoma Research Institute, Wenzhou Medical University, Wenzhou, China
| | - Weihe Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qiangjie Huang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jingjing Zuo
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Glaucoma Research Institute, Wenzhou Medical University, Wenzhou, China
| | - Gangwei Cheng
- Key Laboratory of Ocular Fundus Diseases, Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dexter Y. L. Leung
- Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Science Key Lab, Beijing, China
| | - David S. Friedman
- Glaucoma Center of Excellence, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Yuanbo Liang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Glaucoma Research Institute, Wenzhou Medical University, Wenzhou, China
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Chia ZK, Kong AW, Turner ML, Saifee M, Damato BE, Backus BT, Blaha JJ, Schuman JS, Deiner MS, Ou Y. Assessment of Remote Training, At-Home Testing, and Test-Retest Variability of a Novel Test for Clustered Virtual Reality Perimetry. Ophthalmol Glaucoma 2024; 7:139-147. [PMID: 37619815 DOI: 10.1016/j.ogla.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 07/08/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To assess the feasibility of remotely training glaucoma patients to take a 10-session clustered virtual reality (VR) visual field (VF) test (Vivid Vision Perimetry [VVP-10]) at home, analyze results for test-retest variability, and assess correspondence with conventional perimetry. DESIGN Cross-sectional study. SUBJECTS Twenty-one subjects with glaucoma were enrolled and included in the feasibility assessment of remote training. Thirty-six eyes were used for test-retest analysis and determination of concordance with the Humphrey Field Analyzer (HFA). METHODS Subjects were provided with a mobile VR headset containing the VVP-10 test software and trained remotely via video conferencing. Subjects were instructed to complete 10 sessions over a 14-day period. MAIN OUTCOME MEASURES Feasibility was determined by the number of subjects who were able to independently complete VVP-10 over the 14-day period after 1 remote training session. The intraclass correlation coefficient (ICC) for average fraction seen across 10 sessions and the standard error (SE) of the mean were primary outcome measures for assessing test-retest variability. Correlation with HFA mean sensitivity (MS) across eyes, was a secondary outcome measure. RESULTS Twenty subjects (95%) successfully completed the VVP-10 test series after 1 training session. The ICC for VVP-10 was 0.95 (95% confidence interval [CI], 0.92-0.97). The mean SE in units of fraction seen was 0.012. The Spearman correlations between VVP-10 average fraction seen and HFA MS were 0.87 (95% CI, 0.66-0.98) for moderate-to-advanced glaucoma eyes, and decreased to 0.67 (95% CI, 0.28-0.94) when all eyes were included. CONCLUSIONS Remote training of patients at home is feasible, and subsequent remote clustered VF testing using VVP-10 by patients on their own, without any further interactions with caregivers or study staff, was possible. At-home VVP-10 results demonstrated low test-retest variability. Future studies must be conducted to determine if VVP-10, taken at home as convenient for the patient, may be a viable supplement to provide equivalent or complementary results to that of standard in-clinic assessment of visual function in glaucoma. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Zer Keen Chia
- Department of Ophthalmology, UCSF School of Medicine, San Francisco, California
| | - Alan W Kong
- Department of Ophthalmology, UCSF School of Medicine, San Francisco, California
| | - Marcus L Turner
- Department of Ophthalmology, UCSF School of Medicine, San Francisco, California
| | - Murtaza Saifee
- Department of Ophthalmology, UCSF School of Medicine, San Francisco, California
| | - Bertil E Damato
- Department of Ophthalmology, UCSF School of Medicine, San Francisco, California
| | | | | | - Joel S Schuman
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania; Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania; Department of Ophthalmology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael S Deiner
- Department of Ophthalmology, UCSF School of Medicine, San Francisco, California
| | - Yvonne Ou
- Department of Ophthalmology, UCSF School of Medicine, San Francisco, California.
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Christopher M, Gonzalez R, Huynh J, Walker E, Radha Saseendrakumar B, Bowd C, Belghith A, Goldbaum MH, Fazio MA, Girkin CA, De Moraes CG, Liebmann JM, Weinreb RN, Baxter SL, Zangwill LM. Proactive Decision Support for Glaucoma Treatment: Predicting Surgical Interventions with Clinically Available Data. Bioengineering (Basel) 2024; 11:140. [PMID: 38391627 PMCID: PMC10886033 DOI: 10.3390/bioengineering11020140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/06/2024] [Accepted: 01/27/2024] [Indexed: 02/24/2024] Open
Abstract
A longitudinal ophthalmic dataset was used to investigate multi-modal machine learning (ML) models incorporating patient demographics and history, clinical measurements, optical coherence tomography (OCT), and visual field (VF) testing in predicting glaucoma surgical interventions. The cohort included 369 patients who underwent glaucoma surgery and 592 patients who did not undergo surgery. The data types used for prediction included patient demographics, history of systemic conditions, medication history, ophthalmic measurements, 24-2 VF results, and thickness measurements from OCT imaging. The ML models were trained to predict surgical interventions and evaluated on independent data collected at a separate study site. The models were evaluated based on their ability to predict surgeries at varying lengths of time prior to surgical intervention. The highest performing predictions achieved an AUC of 0.93, 0.92, and 0.93 in predicting surgical intervention at 1 year, 2 years, and 3 years, respectively. The models were also able to achieve high sensitivity (0.89, 0.77, 0.86 at 1, 2, and 3 years, respectively) and specificity (0.85, 0.90, and 0.91 at 1, 2, and 3 years, respectively) at an 0.80 level of precision. The multi-modal models trained on a combination of data types predicted surgical interventions with high accuracy up to three years prior to surgery and could provide an important tool to predict the need for glaucoma intervention.
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Affiliation(s)
- Mark Christopher
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Ruben Gonzalez
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Justin Huynh
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Evan Walker
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Bharanidharan Radha Saseendrakumar
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Christopher Bowd
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Akram Belghith
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Michael H Goldbaum
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Massimo A Fazio
- Department of Ophthalmology and Vision Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Christopher A Girkin
- Department of Ophthalmology and Vision Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Carlos Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY 10032, USA
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY 10032, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Sally L Baxter
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Linda M Zangwill
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
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18
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Swaminathan SS, Jammal AA, Rao JS, Medeiros FA. Improved Prediction of Perimetric Loss in Glaucomatous Eyes Using Latent Class Mixed Modeling. Ophthalmol Glaucoma 2023; 6:642-650. [PMID: 37178874 PMCID: PMC10640664 DOI: 10.1016/j.ogla.2023.05.003] [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: 11/26/2022] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE To evaluate whether the identification of distinct classes within a population of glaucoma patients improves estimates of future perimetric loss. DESIGN Longitudinal cohort study. PARTICIPANTS A total of 6558 eyes of 3981 subjects from the Duke Ophthalmic Registry with ≥ 5 reliable standard automated perimetry (SAP) tests and ≥ 2 years of follow-up. METHODS Standard automated perimetry mean deviation (MD) values were extracted with associated timepoints. Latent class mixed models (LCMMs) were used to identify distinct subgroups (classes) of eyes according to rates of perimetric change over time. Rates for individual eyes were then estimated by considering both individual eye data and the most probable class membership for that eye. Data were split into training (80%) and test sets (20%), and test set mean squared prediction errors (MSPEs) were estimated using LCMM and ordinary least squares (OLS) regression. MAIN OUTCOME MEASURES Rates of change in SAP MD in each class and MSPE. RESULTS The dataset contained 52 900 SAP tests with an average of 8.1 ± 3.7 tests per eye. The best-fitting LCMM contained 5 classes with rates of -0.06, -0.21, -0.87, -2.15, and +1.28dB/year (80.0%, 10.2%, 7.5%, 1.3%, and 1.0% of the population, respectively) labeled as slow, moderate, fast, catastrophic progressors, and "improvers" respectively. Fast and catastrophic progressors were older (64.1 ± 13.7 and 63.5 ± 16.9 vs. 57.8 ± 15.8, P < 0.001) and had generally mild-moderate disease at baseline (65.7% and 71% vs. 52%, P < 0.001) than slow progressors. The MSPE was significantly lower for LCMM compared to OLS, regardless of the number of tests used to obtain the rate of change (5.1 ± 0.6 vs. 60.2 ± 37.9, 4.9 ± 0.5 vs. 13.4 ± 3.2, 5.6 ± 0.8 vs. 8.1 ± 1.1, 3.4 ± 0.3 vs. 5.5 ± 1.1 when predicting the fourth, fifth, sixth, and seventh visual fields (VFs) respectively; P < 0.001 for all comparisons). MSPE of fast and catastrophic progressors was significantly lower with LCMM versus OLS (17.7 ± 6.9 vs. 48.1 ± 19.7, 27.1 ± 8.4 vs. 81.3 ± 27.1, 49.0 ± 14.7 vs. 183.9 ± 55.2, 46.6 ± 16.0 vs. 232.4 ± 78.0 when predicting the fourth, fifth, sixth, and seventh VFs respectively; P < 0.001 for all comparisons). CONCLUSIONS Latent class mixed model successfully identified distinct classes of progressors within a large glaucoma population that seemed to reflect subgroups observed in clinical practice. Latent class mixed models were superior to OLS regression in predicting future VF observations. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosuremay be found after the references.
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Affiliation(s)
- Swarup S Swaminathan
- Vision, Imaging & Performance (VIP) Laboratory, Duke Eye Center, Duke University, Durham, North Carolina; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Alessandro A Jammal
- Vision, Imaging & Performance (VIP) Laboratory, Duke Eye Center, Duke University, Durham, North Carolina
| | - J Sunil Rao
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Felipe A Medeiros
- Vision, Imaging & Performance (VIP) Laboratory, Duke Eye Center, Duke University, Durham, North Carolina.
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Stagg BC, Tullis B, Asare A, Stein JD, Medeiros FA, Weir C, Borbolla D, Hess R, Kawamoto K. Systematic User-centered Design of a Prototype Clinical Decision Support System for Glaucoma. OPHTHALMOLOGY SCIENCE 2023; 3:100279. [PMID: 36970116 PMCID: PMC10033738 DOI: 10.1016/j.xops.2023.100279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/05/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
Purpose To rigorously develop a prototype clinical decision support (CDS) system to help clinicians determine the appropriate timing for follow-up visual field testing for patients with glaucoma and to identify themes regarding the context of use for glaucoma CDS systems, design requirements, and design solutions to meet these requirements. Design Semistructured qualitative interviews and iterative design cycles. Participants Clinicians who care for patients with glaucoma, purposefully sampled to ensure a representation of a range of clinical specialties (glaucoma specialist, general ophthalmologist, optometrist) and years in clinical practice. Methods Using the established User-Centered Design Process framework, we conducted semistructured interviews with 5 clinicians that addressed the context of use and design requirements for a glaucoma CDS system. We analyzed the interviews using inductive thematic analysis and grounded theory to generate themes regarding the context of use and design requirements. We created design solutions to address these requirements and used iterative design cycles with the clinicians to refine the CDS prototype. Main Outcome Measures Themes regarding decision support for determining the timing of visual field testing for patients with glaucoma, CDS design requirements, and CDS design features. Results We identified 9 themes that addressed the context of use for the CDS system, 9 design requirements for the prototype CDS system, and 9 design features intended to address these design requirements. Key design requirements included the preservation of clinician autonomy, incorporation of currently used heuristics, compilation of data, and increasing and communicating the level of certainty regarding the decision. After completing 3 iterative design cycles using this preliminary CDS system design solution, the design was satisfactory to the clinicians and was accepted as our prototype glaucoma CDS system. Conclusions We used a systematic design process based on the established User-Centered Design Process to rigorously develop a prototype glaucoma CDS system, which will be used as a starting point for a future, large-scale iterative refinement and implementation process. Clinicians who care for patients with glaucoma need CDS systems that preserve clinician autonomy, compile and present data, incorporate currently used heuristics, and increase and communicate the level of certainty regarding the decision. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Brian C. Stagg
- Department of Ophthalmology and Visual Sciences, John Moran Eye Center, University of Utah, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Benton Tullis
- School of Medicine, University of Utah, Salt Lake City, Utah
| | - Afua Asare
- Department of Ophthalmology and Visual Sciences, John Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Joshua D. Stein
- Department of Ophthalmology and Visual Sciences, Center for Eye Policy & Innovation, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan
| | | | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah
| | - Damian Borbolla
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah
- Clinical Effectiveness, Wolters Kluwer Health, Salt Lake City, Utah
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah
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Melchior B, De Moraes CG, Paula JS, Cioffi GA, Gordon MO, Kass MA, Liebmann JM. What is the Optimal Frequency of Visual Field Testing to Detect Rapid Progression Among Hypertensive Eyes? J Glaucoma 2023; 32:721-724. [PMID: 37343189 DOI: 10.1097/ijg.0000000000002260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
PRCIS We evaluated 16,351 visual field (VF) tests from Ocular Hypertension Treatment Study (OHTS) database and showed that more frequent testing resulted in a shorter time to detect glaucoma progression, with the best trade-off being the 6-month intervals for high-risk and 12 months for low-risk patients. PURPOSE To investigate the effect of different testing intervals on time to detect visual field progression in eyes with ocular hypertension. METHODS A total of 16,351 reliable 30-2 VF tests from 1575 eyes of the OHTS-1 observation arm with a mean (95% CI) follow-up of 4.8 (4.7-4.8) years were analyzed. Computer simulations (n = 10,000 eyes) based on mean deviation values and the residuals of risk groups (according to their baseline 5 y risk of developing primary open angle glaucoma: low, medium, and high risk) were performed to estimate time to detect progression with testing intervals of 4, 6, 12, and 24 months using linear regression. The time to detect VF progression ( P < 5%) at 80% power was calculated based on the mean deviation slope of -0.42 dB/year. We assessed the time to detect a -3 dB loss as an estimate of clinically meaningful perimetric loss. RESULTS At 80% power, based on the progression of -0.42 dB/year, the best trade-off to detect significant rates of VF change to clinically meaningful perimetric loss in high, medium, and low-risk patients was 6, 6, and 12-month intervals, respectively. CONCLUSION Given the importance of not missing the conversion to glaucoma, the frequency of testing used in OHTS (6 mo) was optimal for the detection of progression in high-risk patients. Low-risk patients could potentially be tested every 12 months to optimize resource utilization.
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Affiliation(s)
- Bruna Melchior
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - C Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center
| | - Jayter S Paula
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - George A Cioffi
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center
| | - Mae O Gordon
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
| | - Michael A Kass
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center
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21
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Mahmoudinezhad G, Salazar D, Morales E, Tran P, Lee J, Hubschman JP, Nouri-Mahdavi K, Caprioli J. Risk factors for microcystic macular oedema in glaucoma. Br J Ophthalmol 2023; 107:505-510. [PMID: 34740886 PMCID: PMC9068828 DOI: 10.1136/bjophthalmol-2021-320137] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/12/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To identify clinical characteristics and factors associated with microcystic macular edema (MME) in patients with primary open-angle glaucoma (POAG). METHODS We included 315 POAG eyes between 2010 and 2019 with good-quality macular volume scans that had reliable visual fields (VF) available within 6 months in this observational retrospective cohort study. Eyes with retinal pathologies except for epiretinal membrane (ERM) were excluded. The inner nuclear layer was qualitatively assessed for the presence of MME. Global mean deviation (MD) and Visual Field Index (VFI) decay rates, superior and inferior MD rates and pointwise total deviation rates of change were estimated with linear regression. Logistic regression was performed to identify baseline factors associated with the presence of MME and to determine whether MME is associated with progressive VF loss. RESULTS 25 out of 315 eyes (7.9%) demonstrated MME. The average (±SD) age and MD in eyes with and without MME was 57.2 (±8.7) versus 62.0 (±9.9) years (p=0.02) and -9.8 (±5.7) versus -4.9 (±5.3) dB (p<0.001), respectively. Worse global MD at baseline (p=0.001) and younger age (p=0.02) were associated with presence of MME. ERM was not associated with the presence of MME (p=0.84) in this cohort. MME was not associated with MD and VFI decay rates (p>0.49). CONCLUSIONS More severe glaucoma and younger age were associated with MME. MME was not associated with faster global VF decay in this cohort. MME may confound monitoring of glaucoma with full macular thickness.
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Affiliation(s)
| | - Diana Salazar
- Ophthalmology, Glaucoma, University of California Los Angeles, Los Angeles, CA, USA
| | - Esteban Morales
- Ophthalmology, Glaucoma, University of California Los Angeles, Los Angeles, CA, USA
| | - Peter Tran
- Ophthalmology, Glaucoma, University of California Los Angeles, Los Angeles, CA, USA
| | - Janet Lee
- Ophthalmology, Retina, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Kouros Nouri-Mahdavi
- Ophthalmology, Glaucoma, University of California Los Angeles, Los Angeles, CA, USA
| | - Joseph Caprioli
- Ophthalmology, Glaucoma, University of California Los Angeles, Los Angeles, CA, USA
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22
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Detecting disease progression in mild, moderate and severe glaucoma. Curr Opin Ophthalmol 2023; 34:168-175. [PMID: 36730773 DOI: 10.1097/icu.0000000000000925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine contemporary techniques for detecting the progression of glaucoma. We provide a general overview of detection principles and review evidence-based diagnostic strategies and specific considerations for detecting glaucomatous progression in patients with mild, moderate and severe disease. RECENT FINDINGS Diagnostic techniques and technologies for glaucoma have dramatically evolved in recent years, affording clinicians an expansive toolkit with which to detect glaucoma progression. Each stage of glaucoma, however, presents unique diagnostic challenges. In mild disease, either structural or functional changes can develop first in disease progression. In moderate disease, structural or functional changes can occur either in tandem or in isolation. In severe disease, standard techniques may fail to detect further disease progression, but such detection can still be measured using other modalities. SUMMARY Detecting disease progression is central to the management of glaucoma. Glaucomatous progression has both structural and functional elements, both of which must be carefully monitored at all disease stages to determine when interventions are warranted.
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23
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A deep learning model incorporating spatial and temporal information successfully detects visual field worsening using a consensus based approach. Sci Rep 2023; 13:1041. [PMID: 36658309 PMCID: PMC9852268 DOI: 10.1038/s41598-023-28003-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
Glaucoma is a leading cause of irreversible blindness, and its worsening is most often monitored with visual field (VF) testing. Deep learning models (DLM) may help identify VF worsening consistently and reproducibly. In this study, we developed and investigated the performance of a DLM on a large population of glaucoma patients. We included 5099 patients (8705 eyes) seen at one institute from June 1990 to June 2020 that had VF testing as well as clinician assessment of VF worsening. Since there is no gold standard to identify VF worsening, we used a consensus of six commonly used algorithmic methods which include global regressions as well as point-wise change in the VFs. We used the consensus decision as a reference standard to train/test the DLM and evaluate clinician performance. 80%, 10%, and 10% of patients were included in training, validation, and test sets, respectively. Of the 873 eyes in the test set, 309 [60.6%] were from females and the median age was 62.4; (IQR 54.8-68.9). The DLM achieved an AUC of 0.94 (95% CI 0.93-0.99). Even after removing the 6 most recent VFs, providing fewer data points to the model, the DLM successfully identified worsening with an AUC of 0.78 (95% CI 0.72-0.84). Clinician assessment of worsening (based on documentation from the health record at the time of the final VF in each eye) had an AUC of 0.64 (95% CI 0.63-0.66). Both the DLM and clinician performed worse when the initial disease was more severe. This data shows that a DLM trained on a consensus of methods to define worsening successfully identified VF worsening and could help guide clinicians during routine clinical care.
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24
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Jaumandreu L, Antón A, Pazos M, Rodriguez-Uña I, Rodriguez Agirretxe I, Martinez de la Casa JM, Ayala ME, Parrilla-Vallejo M, Dyrda A, Díez-Álvarez L, Rebolleda G, Muñoz-Negrete FJ. Glaucoma progression. Clinical practice guide. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:40-57. [PMID: 36089479 DOI: 10.1016/j.oftale.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/19/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To provide general recommendations that serve as a guide for the evaluation and management of glaucomatous progression in daily clinical practice based on the existing quality of clinical evidence. METHODS After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple Systematic Reviews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate Guideline network (SIGN) methodology. RESULTS Recommendations with their corresponding levels of evidence that may be useful in the interpretation and decision-making related to the different methods for the detection of glaucomatous progression are presented. CONCLUSIONS Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of glaucomatous progression.
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Affiliation(s)
- L Jaumandreu
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - A Antón
- Institut Català de la Retina (ICR), Barcelona, Spain; Universitat Internacional de Catalunya (UIC), Barcelona, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - M Pazos
- Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - I Rodriguez-Uña
- Instituto Oftalmológico Fernández-Vega, Universidad de Oviedo, Oviedo, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - I Rodriguez Agirretxe
- Servicio de Oftalmología, Hospital Universitario Donostia, San Sebastián, Gipuzkoa, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - J M Martinez de la Casa
- Servicio de Oftalmología, Hospital Clinico San Carlos, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IsISSC), IIORC, Universidad Complutense de Madrid, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - M E Ayala
- Institut Català de la Retina (ICR), Barcelona, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - M Parrilla-Vallejo
- Servicio de Oftalmología, Hospital Universitario Virgen Macarena, Sevilla, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - A Dyrda
- Institut Català de la Retina (ICR), Barcelona, Spain
| | - L Díez-Álvarez
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - G Rebolleda
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - F J Muñoz-Negrete
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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25
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Mahmoudinezhad G, Moghimi S, Proudfoot JA, Brye N, Nishida T, Yarmohammadi A, Kamalipour A, Zangwill LM, Weinreb RN. Effect of Testing Frequency on the Time to Detect Glaucoma Progression With Optical Coherence Tomography (OCT) and OCT Angiography. Am J Ophthalmol 2023; 245:184-192. [PMID: 36096181 DOI: 10.1016/j.ajo.2022.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine how the frequency of testing affects the time required to detect statistically significant glaucoma progression for circumpapillary retinal nerve fiber layer (cpRNFL) with optical coherence tomography (OCT) and circumpapillary capillary density (cpCD) with OCT angiography (OCTA). DESIGN Retrospective, observational cohort study. METHODS In this longitudinal study, 156 eyes of 98 patients with glaucoma followed up over an average of 3.5 years were enrolled. Participants with 4 or more OCT and OCTA tests were included to measure the longitudinal rates of cpRNFL thickness and cpCD change over time using linear regression. Estimates of variability were then used to re-create real-world cpRNFL and cpCD data by computer simulation to evaluate the time required to detect progression for various loss rates and different testing frequencies. RESULTS The time required to detect a statistically significant negative cpRNFL and cpCD slope decreased as the testing frequency increased, albeit not proportionally. cpCD detected progression slightly earlier than cpRNFL. Eighty percent of eyes with a cpCD loss of -1%/y were detected after 6.0, 4.2, and 4 years when testing was performed 1, 2, and 3 times per year, respectively. Progression in 80% of eyes with a cpRNFL loss of -1 µm/y was detected after 6.3, 5.0, and 4.2 years, respectively. CONCLUSIONS cpRNFL and cpCD are comparable in detecting progression. As there were only small changes in the time to detect progression when testing increased from 2 to 3 times per year, testing twice per year may provide sufficient information for detecting progression with either OCT or OCTA in clinical settings.
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Affiliation(s)
- Golnoush Mahmoudinezhad
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Sasan Moghimi
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - James A Proudfoot
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Nicole Brye
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Takashi Nishida
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Adeleh Yarmohammadi
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Alireza Kamalipour
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Linda M Zangwill
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA..
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Erichev VP, Antonov AA, Vitkov AA, Grigoryan LA. [Static automated perimetry in the diagnosis of glaucoma. Assessment of disease progression]. Vestn Oftalmol 2023; 139:96-104. [PMID: 37942603 DOI: 10.17116/oftalma202313905196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
There are several ways to assess glaucoma progression using standard automated perimetry. Most often, ophthalmologists evaluate the stability of visual functions manually when comparing several study protocols. The advantages of clinical assessment are ease of implementation and the ability to interpret data from any device. The main disadvantage of this method is its subjectivity. There are many available automated methods for assessing disease progression involving Humphrey Field Analyzer and Octopus perimeters. Event analysis allows determining glaucoma progression at the time of examination, with consideration of the possible physiological fluctuations in light sensitivity. Trend analysis of perimetric indices makes it possible to assess the rate of glaucoma progression and forecast the trend of changes in visual functions over the next five years. All these methods for assessing progression have certain advantages and disadvantages and cannot be considered ideal. Pointwise and cluster trend analysis are more sensitive in early glaucoma and are being actively researched and developed. These methods have great potential, although they are not yet sufficiently available in clinical practice.
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Affiliation(s)
- V P Erichev
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - A A Antonov
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - A A Vitkov
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - L A Grigoryan
- MedTech Innovation - Skolkovo Research Center, Moscow, Russia
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27
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Stagg BC, Stein JD, Medeiros FA, Horns J, Hartnett ME, Kawamoto K, Hess R. The Frequency of Visual Field Testing in a US Nationwide Cohort of Individuals with Open-Angle Glaucoma. Ophthalmol Glaucoma 2022; 5:587-593. [PMID: 35605937 PMCID: PMC9675879 DOI: 10.1016/j.ogla.2022.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/04/2022] [Accepted: 05/13/2022] [Indexed: 05/16/2023]
Abstract
PURPOSE Visual field testing that is not frequent enough results in delayed identification of open-angle glaucoma (OAG) progression. Guidelines recommend at least annual testing. It is not known how frequently patients with OAG across the United States receive visual field testing and how patient characteristics and circumstances influence this frequency. If US patients with OAG do not receive visual field tests frequently enough, interventions to increase this frequency or to develop other forms of testing visual function may reduce unidentified OAG vision loss. DESIGN Retrospective cohort study. PARTICIPANTS The TruvenHealth MarketScan Commercial Claims Database (IBM) contains demographic and claims data for > 160 million individuals across the United States from 2008 to 2017. We identified enrollees in the database with a recorded diagnosis of OAG (International Classification of Diseases, Ninth Revision, Clinical Modification and International Classification of Diseases, Tenth Revision, Clinical Modification codes 356.1x and H40.1x, respectively). We excluded those aged < 40 years at the time of their first OAG diagnosis, those without at least 1 confirmatory OAG diagnosis at a subsequent visit, and those with < 4 years of follow-up data after OAG diagnosis. METHODS We calculated the number of visual field tests that each enrollee with OAG underwent per year and categorized the enrollees based on that number (0, > 0 to < 0.9, ≥ 0.9 to ≤ 1.1, > 1.1 to ≤ 2.1, and > 2.1). We used negative binomial regression to investigate the demographic or health variables that were associated with the frequency of visual field tests that enrollees with OAG received. MAIN OUTCOME MEASURES Frequency of visual field testing among enrollees with OAG. RESULTS Of the 380 029 enrollees included in the study, 33 267 (8.8%) did not receive a visual field test during the study period, 259 349 (68.2%) underwent > 0 to < 0.9 visual field tests per year, 42 129 (11.1%) underwent ≥ 0.9 to ≤ 1.1 visual field tests per year, 42 301 (11.1%) underwent > 1.1 to ≤ 2.1 visual field tests per year, and 2983 (0.8%) underwent ≥ 2.1 visual field tests per year. The median number of visual field tests per year was 0.63 (interquartile range, 0.33-0.88; mean, 0.65). CONCLUSIONS More than 75% of enrollees with OAG received < 1 visual field test per year and, thus, did not receive guideline-adherent glaucoma monitoring.
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Affiliation(s)
- Brian C Stagg
- John Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah; Department of Population Health Sciences, University of Utah, Salt Lake City, Utah.
| | - Joshua D Stein
- Center for Eye Policy & Innovation, Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan
| | | | - Joshua Horns
- Department of Surgery, Surgical Population Analysis Research Core, University of Utah Health Science Center, Salt Lake City, Utah
| | - M Elizabeth Hartnett
- John Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah; Department of Internal Medicine, University of Utah, Salt Lake City, Utah
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Melchior B, De Moraes CG, Paula JS, Cioffi GA, Girkin CA, Fazio MA, Weinreb RN, Zangwill LM, Liebmann JM. Frequency of Optical Coherence Tomography Testing to Detect Progression in Glaucoma. J Glaucoma 2022; 31:854-859. [PMID: 35980865 PMCID: PMC9633358 DOI: 10.1097/ijg.0000000000002101] [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: 09/06/2021] [Accepted: 08/02/2022] [Indexed: 02/04/2023]
Abstract
PRCIS With high specificity and less variability than perimetry, more frequent testing resulted in shorter time to detect progression, though a 6-month testing interval provides a reasonable trade-off for following glaucoma patients using optical coherence tomography (OCT). PURPOSE To investigate the time to detect progression in glaucomatous eyes using different OCT test intervals. MATERIALS AND METHODS Participants with manifest glaucoma from the African Descent and Glaucoma Evaluation Study (ADAGES), a multicenter, prospective, observational cohort study, were included. A total of 2699 OCT tests from 171 glaucomatous and 149 normal eyes of 182 participants, with at least 5 tests and 2 years of follow-up, were analyzed. Computer simulations (n=10,000 eyes) were performed to estimate time to detect progression of global circumpapillary retinal nerve fiber layer thickness (cpRNFL) measured with OCT tests. Simulations were based on different testing paradigms (every 4, 6, 12, and 24 mo) and different rates of change (µm/year). Time to detect significant progression ( P <0.05) at 80% and 90% power were calculated for each paradigm and rate of cpRNFL change. RESULTS As expected, more frequent testing resulted in shorter time to detect progression. Although there was clear disadvantage for testing at intervals of 24 versus 12 months (~22.4% time [25 mo] increase in time to progression detection) and when testing 12 versus 6 months (~22.1% time [20 mo] increase), the improved time to detect progression was less pronounced when comparing 6 versus 4 months (~11.5% time [10 mo] reduction). CONCLUSION With high specificity and less variability than perimetry, a 6-month testing interval provides a reasonable trade-off for following glaucoma patients using OCT.
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Affiliation(s)
- Bruna Melchior
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Carlos G De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | - Jayter S Paula
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - George A Cioffi
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | | | - Massimo A Fazio
- Department of Ophthalmology, University of Alabama-Birmingham, Birmingham, AL
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, and Shiley Eye Institute University of California-San Diego, La Jolla, CA
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, and Shiley Eye Institute University of California-San Diego, La Jolla, CA
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
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Stagg BC, Mariottoni EB, Berchuck SI, Jammal AA, Elam AR, Hess R, Kawamoto K, Haaland B, Medeiros FA. Longitudinal visual field variability and the ability to detect glaucoma progression in black and white individuals. Br J Ophthalmol 2022; 106:1115-1120. [PMID: 33985963 PMCID: PMC8589883 DOI: 10.1136/bjophthalmol-2020-318104] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/25/2021] [Accepted: 02/20/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To investigate racial differences in the variability of longitudinal visual field testing in a 'real-world' clinical population, evaluate how these differences are influenced by socioeconomic status, and estimate the impact of differences in variability on the time to detect visual field progression. METHODS This retrospective observational cohort study used data from 1103 eyes from 751 White individuals and 428 eyes from 317 black individuals. Linear regression was performed on the standard automated perimetry mean deviation values for each eye over time. The SD of the residuals from the trend lines was calculated and used as a measure of variability for each eye. The association of race with the SD of the residuals was evaluated using a multivariable generalised estimating equation model with an interaction between race and zip code income. Computer simulations were used to estimate the time to detect visual field progression in the two racial groups. RESULTS Black patients had larger visual field variability over time compared with white patients, even when adjusting for zip code level socioeconomic variables (SD of residuals for Black patients=1.53 dB (95% CI 1.43 to 1.64); for white patients=1.26 dB (95% CI 1.14 to 1.22); mean difference: 0.28 (95% CI 0.15 to 0.41); p<0.001). The difference in visual field variability between black and white patients was greater at lower levels of income and led to a delay in detection of glaucoma progression. CONCLUSION Black patients had larger visual field variability compared with white patients. This relationship was strongly influenced by socioeconomic status and may partially explain racial disparities in glaucoma outcomes.
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Affiliation(s)
- Brian C. Stagg
- Vision, Imaging and Performance (VIP) Laboratory, Duke Eye Center, Durham, North Carolina, USA,Moran Eye Center, University of Utah, Salt Lake City, Utah, USA,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Eduardo B. Mariottoni
- Vision, Imaging and Performance (VIP) Laboratory, Duke Eye Center, Durham, North Carolina, USA
| | - Samuel I. Berchuck
- Vision, Imaging and Performance (VIP) Laboratory, Duke Eye Center, Durham, North Carolina, USA,Department of Statistical Science and Forge, Duke University, Durham, North Carolina, USA
| | - Alessandro A. Jammal
- Vision, Imaging and Performance (VIP) Laboratory, Duke Eye Center, Durham, North Carolina, USA
| | - Angela R. Elam
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA,Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Ben Haaland
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Felipe A. Medeiros
- Vision, Imaging and Performance (VIP) Laboratory, Duke Eye Center, Durham, North Carolina, USA
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Greenfield JA, Deiner M, Nguyen A, Wollstein G, Damato B, Backus BT, Wu M, Schuman JS, Ou Y. Virtual Reality Oculokinetic Perimetry Test Reproducibility and Relationship to Conventional Perimetry and OCT. OPHTHALMOLOGY SCIENCE 2022; 2:100105. [PMID: 36276927 PMCID: PMC9562375 DOI: 10.1016/j.xops.2021.100105] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 11/27/2022]
Abstract
Purpose Vivid Vision Perimetry (VVP; Vivid Vision, Inc) is a novel method for performing in-office and home-based visual field assessment using a virtual reality platform and oculokinetic perimetry. Here we examine the reproducibility of VVP Swift and compare results with conventional standard automated perimetry (SAP) and spectral-domain (SD) OCT. Design Cross-sectional study. Participants Fourteen eyes of 7 patients with open-angle glaucoma (OAG) (average age, 64.6 years; 29% women) and 10 eyes of 5 patients with suspected glaucoma (average age, 61.8 years; 40% women) were enrolled. Methods Patients with OAG and suspected glaucoma were enrolled prospectively and underwent 2 VVP Swift examinations. Results were compared with 1 conventional SAP examination (Humphrey Visual Field [HVF]; Zeiss) and 1 SD OCT examination. Main Outcome Measures Mean sensitivity (in decibels) obtained for each eye in 2 VVP Swift test sessions and a conventional SAP examination, thickness of the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) for the SD OCT examination, and mean test durations of the VVP Swift and SAP examinations. Results The mean test duration of VVP Swift in both eyes (8.5 minutes) was significantly shorter (P < 0.001) than SAP (12.2 minutes). The average absolute difference of the mean sensitivity between the 2 VVP Swift sessions was found to be 0.73 dB (95% confidence interval [CI], 0.40–1.06). A statistically significant association was found between average mean sensitivity measurements from the VVP and mean deviation (MD) measurements obtained by the HVF with a Pearson correlation coefficient of 0.86 (95% CI, 0.70–0.94; P < 0.001). Mean visual sensitivity measurements from the VVP Swift test were significantly associated with average RNFL thickness (r = 0.66; P = 0.014) and GCC thickness (r = 0.63; P = 0.02), whereas the correlation coefficients between HVF MD and RNFL and GCC were 0.86 (P < 0.001) and 0.83 (P < 0.001), respectively. Conclusions Our results demonstrated that the VVP Swift test can generate reproducible results and is comparable with conventional SAP. This suggests that the device can be used by clinicians to assess visual function in glaucoma.
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Affiliation(s)
- Jason A. Greenfield
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York
| | - Michael Deiner
- Department of Ophthalmology and Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Anwell Nguyen
- Department of Ophthalmology and Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Gadi Wollstein
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York
- Department of Biomedical Engineering, NYU Tandon School of Engineering, New York, New York
- Department of Neural Science, NYU School of Arts and Sciences, New York, New York
| | - Bertil Damato
- Department of Ophthalmology and Proctor Foundation, University of California, San Francisco, San Francisco, California
- Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | | | - Mengfei Wu
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York
| | - Joel S. Schuman
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York
- Department of Biomedical Engineering, NYU Tandon School of Engineering, New York, New York
- Department of Neural Science, NYU School of Arts and Sciences, New York, New York
- Department of Electrical and Computer Engineering, NYU Tandon School of Engineering, New York, New York
- Department of Neuroscience and Physiology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York
| | - Yvonne Ou
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
- Correspondence: Yvonne Ou, MD, Department of Ophthalmology, University of California, San Francisco, 10 Koret Way, K141, San Francisco, CA 94143.
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Swaminathan SS, Berchuck SI, Jammal AA, Rao JS, Medeiros FA. Rates of Glaucoma Progression Derived from Linear Mixed Models Using Varied Random Effect Distributions. Transl Vis Sci Technol 2022; 11:16. [PMID: 35138343 PMCID: PMC8842468 DOI: 10.1167/tvst.11.2.16] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare the ability of linear mixed models with different random effect distributions to estimate rates of visual field loss in glaucoma patients. Methods Eyes with five or more reliable standard automated perimetry (SAP) tests were identified from the Duke Glaucoma Registry. Mean deviation (MD) values from each visual field and associated timepoints were collected. These data were modeled using ordinary least square (OLS) regression and linear mixed models using the Gaussian, Student's t, or log-gamma (LG) distributions as the prior distribution for random effects. Model fit was compared using the Watanabe–Akaike information criterion (WAIC). Simulated eyes of varying initial disease severity and rates of progression were created to assess the accuracy of each model in predicting the rate of change and likelihood of declaring progression. Results A total of 52,900 visual fields from 6558 eyes of 3981 subjects were included. Mean follow-up period was 8.7 ± 4.0 years, with an average of 8.1 ± 3.7 visual fields per eye. The LG model produced the lowest WAIC, demonstrating optimal model fit. In simulations, the LG model declared progression earlier than OLS (P < 0.001) and had the greatest accuracy in predicted slopes (P < 0.001). The Gaussian model significantly underestimated rates of progression among fast and catastrophic progressors. Conclusions Linear mixed models using the LG distribution outperformed conventional approaches for estimating rates of SAP MD loss in a population with glaucoma. Translational Relevance Use of the LG distribution in models estimating rates of change among glaucoma patients may improve their accuracy in rapidly identifying progressors at high risk for vision loss.
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Affiliation(s)
- Swarup S Swaminathan
- Vision, Imaging and Performance Laboratory, Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA.,Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Samuel I Berchuck
- Vision, Imaging and Performance Laboratory, Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA.,Department of Statistical Science and Duke Forge, Duke University, Durham, NC, USA
| | - Alessandro A Jammal
- Vision, Imaging and Performance Laboratory, Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA
| | - J Sunil Rao
- Department of Biostatistics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Felipe A Medeiros
- Vision, Imaging and Performance Laboratory, Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA
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Shon K, Sung KR, Shin JW. Can Artificial Intelligence Predict Glaucomatous Visual Field Progression? A Spatial-Ordinal Convolutional Neural Network Model. Am J Ophthalmol 2022; 233:124-134. [PMID: 34283982 DOI: 10.1016/j.ajo.2021.06.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To develop an artificial neural network model incorporating both spatial and ordinal approaches to predict glaucomatous visual field (VF) progression. DESIGN Cohort study. Methods From a cohort of primary open-angle glaucoma patients, 9212 eyes of 6047 patients who underwent regular reliable VF examinations for >4 years were included. We constructed all possible spatial-ordinal tensors by stacking 3 consecutive VF tests (VF-blocks) with at least 3 years of follow-up. Trend-based, event-based, and combined criteria were defined to determine the progression. VF-blocks were considered "progressed" if progression occurred within 3 years; the progression was further confirmed after 3 years. We constructed 6 convolutional neural network (NN) models and 2 linear models: regression on global indices and pointwise linear regression (PLR). We compared area under the receiver operating characteristic curve (AUROC) of each model for the prediction of glaucomatous VF progression. RESULTS Among 43,260 VF-blocks, 4406 (10.2%), 4376 (10.1%), and 2394 (5.5%) VF-blocks were classified as progression-based on trend-based and event-based and combined criteria. For all 3 criteria, the progression group was significantly older and had worse initial MD and VF index (VFI) than the nonprogression group (P < .001 for all). The best-performing NN model had an AUROC of 0.864 with a sensitivity of 0.42 at a specificity of 0.95. In contrast, an AUROC of 0.611 was estimated from a sensitivity of 0.28 at a specificity of 0.84 for the PLR. CONCLUSIONS The NN models incorporating spatial-ordinal characteristics demonstrated significantly better performance than the linear models in the prediction of glaucomatous VF progression.
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Affiliation(s)
- Kilhwan Shon
- From the Department of Ophthalmology (K.S.), Gangneung Asan Hospital, Gangneung, Korea
| | - Kyung Rim Sung
- Department of Ophthalmology (K.R.S., J.W.S.), College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea..
| | - Joong Won Shin
- Department of Ophthalmology (K.R.S., J.W.S.), College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
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Rothman AL, Chang R, Kolomeyer NN, Turalba A, Stein JD, Boland MV. American Glaucoma Society Position Paper: Information Sharing Using Established Standards is Essential to the Future of Glaucoma Care. Ophthalmol Glaucoma 2021; 5:375-378. [PMID: 34933142 DOI: 10.1016/j.ogla.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Adam L Rothman
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, FL, USA
| | | | | | | | - Joshua D Stein
- University of Michigan, Department of Ophthalmology and Visual Sciences, Ann Arbor, MI, USA; University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Michael V Boland
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Kim S, Jung JY, Cho GS, Lee JY, Lee HJ, Jeong J, Ha A. Trends in Utilization of Visual Field Tests for Glaucoma Patients: A Nationwide Study Using the Korean Health Insurance Review and Assessment Database. KOREAN JOURNAL OF OPHTHALMOLOGY 2021; 36:114-122. [PMID: 34823343 PMCID: PMC9013551 DOI: 10.3341/kjo.2021.0108] [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] [Received: 07/01/2021] [Accepted: 11/08/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyze 10-year trends in utilization of visual field tests for adult glaucoma or glaucoma-suspect patients using the Korean Health Insurance Review and Assessment data. Methods Health claims for the years 2010 to 2019, as recorded via Korea’s Health Insurance Review and Assessment service, were accessed. We identified glaucoma patients using the glaucoma diagnostic codes H40 (glaucoma) and H42 (glaucoma in other diseases classified elsewhere). For verification of the glaucoma diagnosis, information on any antiglaucoma medication prescriptions and ocular surgery history also was obtained. Visual field testing data was isolated using procedural codes E6690 (kinetic perimetry) and E6691 (standard automated perimetry [SAP]) performed in tertiary hospitals. Any changes in visual field test utilization were identified using regression trend analysis. Results From 2010 to 2019, the total number of SAP procedures performed in tertiary hospitals for either glaucoma or glaucoma-suspect patients increased gradually from 93,459 to 216,433. With regard to kinetic perimetry examinations, the total number decreased gradually from 6,364 to 3,792. The yearly average SAP number per patient showed a slight increase, from 1.168 to 1.248 (β = 0.008, R2 = 0.669, p = 0.004). Meanwhile, the yearly average number of kinetic perimeter examinations per patient showed a significant decrease, from 1.093 to 0.940 (β = −0.013, R2 = 0.580, p = 0.010). Conclusions Between 2010 and 2019, the yearly average number of SAP procedures performed per glaucoma or glaucoma-suspect patient increased in Korea. Meanwhile, the yearly average number of kinetic perimetry examinations per patient significantly decreased.
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Affiliation(s)
- Seongmi Kim
- Department of Ophthalmology, Jeju National University Hospital, Jeju-si, Korea.,Jeju National University, School of Medicine, Jeju-si, Korea
| | - Jung Yoon Jung
- Jeju National University, School of Medicine, Jeju-si, Korea
| | - Geon Sik Cho
- Jeju National University, School of Medicine, Jeju-si, Korea
| | - Jong Young Lee
- Department of Ophthalmology, Jeju National University Hospital, Jeju-si, Korea.,Jeju National University, School of Medicine, Jeju-si, Korea
| | - Hye Jin Lee
- Department of Ophthalmology, Jeju National University Hospital, Jeju-si, Korea.,Jeju National University, School of Medicine, Jeju-si, Korea
| | - Jinho Jeong
- Department of Ophthalmology, Jeju National University Hospital, Jeju-si, Korea.,Jeju National University, School of Medicine, Jeju-si, Korea
| | - Ahnul Ha
- Department of Ophthalmology, Jeju National University Hospital, Jeju-si, Korea.,Jeju National University, School of Medicine, Jeju-si, Korea
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Phu J, Kalloniatis M. The Frontloading Fields Study (FFS): Detecting Changes in Mean Deviation in Glaucoma Using Multiple Visual Field Tests Per Clinical Visit. Transl Vis Sci Technol 2021; 10:21. [PMID: 34779836 PMCID: PMC8606810 DOI: 10.1167/tvst.10.13.21] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine the impact of different numbers of visual field tests per visit for detecting mean deviation changes over time in patients with early glaucoma or suspected glaucoma and to identify a practical approach to maximize change detection. Methods Intrasession (n = 322) and intersession (n = 323) visual field results for patients with glaucoma or suspected glaucoma were used to model mean deviation change in 10,000 progressing and 10,000 non-progressing computer-simulated patients over time. Variables assessed in the model included follow-up intervals (0.5, 1, or 2 years), reliability rates (70%, 85%, or 100%) and number of visual field tests performed at each visit (one to four). Results Two visual field tests per session compared with one provided higher case detection rates at 2 years (99%–99.8% vs. 34.7%–76.3%, respectively), reduced time to detection (three or four visits vs. six to 10, respectively), and more positive mean deviation score (−4 dB vs. −10 dB, respectively) at the point of mean deviation change identification, especially in the context of unreliable results. Performing two tests per visit offered similar advantages compared with more tests. False positive change detection rates (<2.5%), were similar across all conditions. Patients followed up 6 monthly had less severe mean deviation loss at follow-up compared to 1-year and 2-year follow-up intervals. Conclusions Performing two tests per clinical visit at 6 months is practical using SITA-Faster and provides higher detection rates of mean deviation change in comparison with only one test performed per visit and more spaced-out intervals. Translational Relevance This model provides guidance for selecting the number of tests per visit to detect mean deviation change.
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Affiliation(s)
- Jack Phu
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
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Muthusamy V, Turpin A, Nguyen BN, Denniss J, McKendrick AM. Patients' Views of Visual Field Testing and Priorities for Research Development and Translation into Practice. Ophthalmol Glaucoma 2021; 5:313-324. [PMID: 34655797 DOI: 10.1016/j.ogla.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Information regarding the views of patients, on visual field testing is limited, and no information exists regarding their preferences for test developments. This study aimed to increase knowledge of patients' experiences of visual field assessment and to explore their opinions and priorities regarding current areas of research and development. DESIGN Online questionnaire with purposive sampling design. PARTICIPANTS Adults who regularly undergo visual field tests in Australia who report having glaucoma or being at glaucomatous risk. METHODS An anonymous survey, implemented using the Qualtrics webtool, with both closed- and-open ended questions designed to explore opinions regarding visual field testing, visit attendance for perimetry, as well as priorities for developments. MAIN OUTCOME MEASURES The survey assessed 3 domains: (1) opinions regarding test duration and visit frequency, (2) subjective experience, and (3) perspectives on future developments. RESULTS One hundred fifty-two complete survey responses were obtained. The median age of participants was 66 years (interquartile range [IQR], 60-72 years). Most participants (70%) had experience of undergoing more than 11 visual field tests. Participants recalled that they completed visual field tests in median of 6 minutes (IQR, 5-8 minutes) and were willing to accept additional time (median, 5 minutes; IQR, 3-6 minutes) to obtain more information. Participants were prepared to increase both the number of visual field tests per eye and the frequency of visual field tests (median, 3 visits per year; IQR, 2-4 visits per year) to gain more information about their visual status. Regarding future developments, the most preferred option was "similar test times but an increase in the level of information about my visual field," which ranked significantly higher than all other options, including "shorter test times that maintain the currently available level of information about my visual field." CONCLUSIONS Our study confirms, in a different population and health care system, previous research reporting patient perspectives on visual field assessment. We further revealed that health care consumers show a strong preference for accurate information about their vision and report being prepared to undergo longer visual field tests or more visual field tests to achieve that outcome.
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Affiliation(s)
- Vasanth Muthusamy
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Andrew Turpin
- School of Computing and Information Systems, The University of Melbourne, Melbourne, Australia
| | - Bao N Nguyen
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Jonathan Denniss
- School of Optometry and Vision Science, University of Bradford, Bradford, United Kingdom
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia.
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Pham AT, Ramulu PY, Boland MV, Yohannan J. The Effect of Transitioning from SITA Standard to SITA Faster on Visual Field Performance. Ophthalmology 2021; 128:1417-1425. [PMID: 33798655 PMCID: PMC8463413 DOI: 10.1016/j.ophtha.2021.03.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To determine the effect of transitioning from Swedish Interactive Thresholding Algorithm (SITA) Standard to SITA Faster on visual field (VF) performance in glaucomatous eyes with a broad spectrum of disease severity undergoing longitudinal VF testing in a real-world clinical setting. DESIGN Retrospective, longitudinal study. PARTICIPANTS A total of 421 patients (766 eyes) with manifest or suspect glaucoma followed at a single institution. METHODS Each included eye received the following sequence of VF examinations during routine clinical care: (1) SITA Standard, (2) SITA Standard, and (3) SITA Faster (mean time between tests = 13.9 months). Intra-eye comparisons were made between the first 2 VFs (Standard-Standard sequence) and the last 2 VFs (Standard-Faster sequence). The primary dependent variable was the difference in mean deviation (MD) between the second and first VF of the sequence (ΔMD, calculated as MDVF2 - MDVF1). The primary independent variable was the VF sequence (Standard-Standard or Standard-Faster). Linear mixed-effects models were used to study the effect of testing sequence on ΔMD, adjusting for confounders including time between VFs and change in false-positive (FP) errors. Results were stratified to understand the effect of glaucoma severity on the relationship between testing sequence and ΔMD. MAIN OUTCOME MEASURES The difference in ΔMD between Standard-Standard and Standard-Faster sequence by mild, moderate, and advanced disease severity. RESULTS In eyes with mild or suspect glaucoma, there was no significant difference in ΔMD between Standard-Faster and Standard-Standard sequences (-0.23 decibels [dB]; 95% confidence interval [CI], -0.60 to 0.15 dB). However, the Standard-Faster sequence was associated with a 0.87 dB (95% CI, 0.18-1.57 dB) improvement in ΔMD compared with the Standard-Standard sequence in eyes with moderate glaucoma and a 1.49 dB (95% CI, 0.79-2.19 dB) improvement in ΔMD in eyes with advanced glaucoma. CONCLUSIONS Converting to SITA Faster in eyes that were previously followed with SITA Standard led to similar VF performance in mild glaucoma but resulted in higher MD values in moderate and advanced glaucoma. For patients with moderate or severe glaucoma, this may conceal disease progression when transitioning testing strategies.
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Affiliation(s)
- Alex T Pham
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pradeep Y Ramulu
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael V Boland
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Jithin Yohannan
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Loughman J, Loskutova E, Butler JS, Siah WF, O’Brien C. Macular Pigment Response to Lutein, Zeaxanthin, and Meso-zeaxanthin Supplementation in Open-Angle Glaucoma. OPHTHALMOLOGY SCIENCE 2021; 1:100039. [PMID: 36247822 PMCID: PMC9562333 DOI: 10.1016/j.xops.2021.100039] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 01/30/2023]
Abstract
Purpose To evaluate macular pigment response to carotenoid supplementation in glaucomatous eyes. Design Double-masked, randomized, placebo-controlled clinical trial, the European Nutrition in Glaucoma Management Study (ClinicalTrials.gov identifier, NCT04460365). Participants Sixty-two participants (38 men, 24 women) with a diagnosis of open-angle glaucoma were enrolled. Forty-two were randomized to receive the active supplement, 20 participants were allocated to placebo. Methods Macular pigment optical density (MPOD) was measured by autofluorescence using the Heidelberg Spectralis scanning laser ophthalmoscope. Macular pigment optical density volume within the central 6° of retinal eccentricity as well as MPOD at 0.23°, 0.51°, 0.74°, and 1.02° were recorded at baseline and at 6-month intervals over 18 months. Visual function was assessed using visual acuity, mesopic and photopic contrast sensitivity under glare conditions, photo stress recovery time, microperimetry, and Glaucoma Activities Limitation 9 questionnaire. Advanced glaucoma module scans of retinal nerve fiber layer thickness and ganglion cell complex thickness over the central 6° of retinal eccentricity also were completed at each study visit. Main Outcome Measures Change in MPOD after supplementation with 10 mg lutein, 2 mg zeaxanthin, and 10 mg meso-zeaxanthin or placebo over 18 months. Results A mixed-model repeated measures analysis of variance revealed a statistically significant increase in MPOD volume (significant time effect: F(3,111) = 89.31, mean square error (MSE) = 1656.9; P < 0.01). Post hoc t tests revealed a significant difference in MPOD volume at each study visit for the treatment group (P < 0.01 for all), but no change in the placebo group (P > 0.05 for all). A statistically significant increase in mesopic contrast sensitivity under glare conditions was noted at 18 months in the treatment group, but not placebo. No other structural or functional changes were observed. No serious adverse events were noted during the trial. Conclusions Macular pigment can be augmented in glaucomatous eyes by supplementation with a formulation containing the carotenoids lutein, zeaxanthin, and meso-zeaxanthin. The greatest relative benefit was observed in those with the lowest baseline levels, but increases were noted across all participants and each retinal eccentricity. The potential benefits of MP augmentation for macular health in glaucoma merit further long-term evaluation.
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Swaminathan SS, Jammal AA, Berchuck SI, Medeiros FA. Rapid initial OCT RNFL thinning is predictive of faster visual field loss during extended follow-up in glaucoma. Am J Ophthalmol 2021; 229:100-107. [PMID: 33775658 DOI: 10.1016/j.ajo.2021.03.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the relationship between the rate of retinal nerve fiber layer (RNFL) loss during initial follow-up and the magnitude of associated visual field loss during an extended follow-up period. DESIGN Retrospective cohort study. METHODS A total of 1,150 eyes of 839 glaucoma patients extracted from the Duke Glaucoma Registry. Rates of RNFL loss were obtained from global RNFL thickness values of the first 5 optical coherence tomography (OCT) scans. Rates of visual field loss were assessed using standard automated perimetry mean deviation (SAP MD) during the entire follow-up period. Joint longitudinal mixed effects models were used to estimate rates of change. Eyes were categorized as fast, moderate or slow progressors based on rates of RNFL loss, with cutoffs of ≤-2 µm/year, -2 to -1 µm/year and ≥-1 µm/year, respectively. Univariable and multivariable regressions were completed to identify significant predictors of SAP MD loss. RESULTS The rate of RNFL change was -0.76±0.85 µm/y during initial follow-up, which occurred over 3.7±1.5 years. 765 (66%) eyes were slow, 328 (29%) moderate, and 57 (5%) fast progressors, with rates of RNFL thinning of -0.36±0.54 µm/year, -1.34±0.25 µm/year, and -2.87±1.39 µm/year respectively. The rates of SAP MD loss among slow, moderate, and fast OCT progressors were -0.16±0.35 dB/y, -0.32±0.43 dB/y, and -0.71±0.65 dB/y respectively over the extended follow-up period of 6.1±1.9 years (P<0.001). Age, OCT progressor group, and concurrent SAP rate were all significantly associated with the overall rate of SAP MD loss in a multivariable model (all P<0.001). CONCLUSION Rapid RNFL thinning during an initial follow-up period was predictive of concurrent and subsequent rates of visual field decline over an extended period.
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Orbach A, Ang GS, Camp AS, Welsbie DS, Medeiros FA, Girkin CA, Fazio MA, Oh WH, Weinreb RN, Zangwill LM, Wu Z. Qualitative Evaluation of the 10-2 and 24-2 Visual Field Tests for Detecting Central Visual Field Abnormalities in Glaucoma. Am J Ophthalmol 2021; 229:26-33. [PMID: 33626360 DOI: 10.1016/j.ajo.2021.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To examine whether glaucomatous central visual field abnormalities can be more effectively detected using a qualitative, expert evaluation of the 10-2 test compared with the topographically corresponding central 12 locations of the 24-2 test (C24-2). DESIGN Cross-sectional study. METHODS Eyes with a glaucomatous optic nerve appearance or ocular hypertension (n = 523) and healthy eyes (n = 107) were included as cases and control subjects, respectively. The 10-2 and C24-2 visual field results of all eyes were graded by 4 glaucoma specialists for the probability that central visual field abnormalities were present. RESULTS The sensitivity of the 10-2 and C24-2 tests for detecting the cases at 95% specificity were not significantly different (e.g., 32.2% and 31.4%, respectively, for grader 1, P = .87; all graders P ≥ .25). At 95% specificity, the pattern standard deviation values from these tests had a similar sensitivity to the qualitative evaluation for the C24-2 test for all graders (P ≥ .083), but it had a significantly higher sensitivity than the qualitative evaluation for the 10-2 test for 3 graders (P ≤ .016). CONCLUSIONS The similarity in performance of the 10-2 and C24-2 test suggests that the increased sampling density of the former does not significantly improve the detection of central visual field abnormalities, even when based on expert assessment. These findings should not be taken to mean that the 10-2 test is not useful, but it underscores the need for its utility to be clearly established before incorporating it as routine glaucoma standard of care.
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Poleon S, Racette L, Fifolt M, Schoenberger-Godwin YM, Abu SL, Twa MD. Patient and Provider Perspectives on Glaucoma Treatment Adherence: A Delphi Study in Urban Alabama. Optom Vis Sci 2021; 98:1085-1093. [PMID: 34524213 PMCID: PMC8505131 DOI: 10.1097/opx.0000000000001776] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/30/2021] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Patients with glaucoma and providers recognized perceived treatment efficacy, patient-provider relationship, psychological stress, instillation skill, good quality of life, and forgetfulness as key determinants of glaucoma adherence. This shared insight could help shape the development of clinical and behavioral interventions for addressing treatment barriers and improving adherence. PURPOSE Despite their impact on adherence in glaucoma, sociobehavioral factors may not be adequately explored during clinical consultations. We aimed to elicit consensus between patients and providers around key determinants of adherence and hypothesized that patients would place greater emphasis on sociobehavioral factors compared with providers. METHODS A two-round Delphi survey was used to assess treatment beliefs, barriers, facilitators, motivators, and needs among 18 patients with glaucoma and providers. In round 1, agreement with 46 statements was scored on a 5-point Likert scale (strongly disagree to strongly agree). Statements with which 80% or more of panelists agreed reached consensus and advanced to round 2, where participants were asked to prioritize them based on their importance to treatment. RESULTS There was consensus regarding the influence of perceived treatment efficacy, good provider relationship, good quality of life, psychological stress, glaucoma knowledge, instillation skill, and forgetfulness on glaucoma adherence. For statements that failed to reach consensus, the Bonferroni-corrected Mann-Whitney U test revealed that the greatest differences between patients and providers pertained to regimen complexity (provider median, 4 [interquartile range {IQR}, 1]; patient median, 1.5 [IQR, 1]; P = .002), instillation skill (providers, 4 [IQR, 0.5]; patients, 2 [IQR, 1]; P = .001), and low motivation (providers, 3 [IQR, 2.25]; patients, 1 [IQR, 0]; P = .003). CONCLUSIONS Although patients and providers prioritized sociobehavioral factors as key determinants of adherence, disagreement between these groups was observed in other areas. Continued juxtaposition of patient and provider perspectives could spotlight underexplored areas and guide the development of successful interventions for improving adherence.
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Affiliation(s)
- Shervonne Poleon
- Department of Optometry and Vision Science, University of Alabama at Birmingham School of Optometry, Birmingham, Alabama
| | - Lyne Racette
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Matthew Fifolt
- Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama
| | - Yu-Mei Schoenberger-Godwin
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Sampson Listowell Abu
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Michael D. Twa
- University of Houston College of Optometry, Houston, Texas
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Optical coherence tomographic angiography study of perfusion recovery after surgical lowering of intraocular pressure. Sci Rep 2021; 11:17251. [PMID: 34446739 PMCID: PMC8390670 DOI: 10.1038/s41598-021-96225-7] [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] [Received: 02/16/2021] [Accepted: 08/06/2021] [Indexed: 02/03/2023] Open
Abstract
We investigated the time and location of retinal perfusion recovery after surgical intraocular pressure (IOP) lowering in glaucoma by using optical coherent tomography angiography (OCTA). Seventeen patients were analyzed. The 4.5 × 4.5-mm OCTA scans centered on the disc were performed preoperatively and postoperatively at 6 weeks, 3 months, and 6 months. The peripapillary retinal nerve fiber layer (NFL) thickness, NFL plexus capillary density (NFLP-CD) and visual field (VF) were measured overall and in 8 corresponding sectors. The low-perfusion area (LPA) was used to assess the cumulative area where local NFLP-CD was significantly below normal. At 6 months, the average IOP decreased 5.3 mmHg (P = 0.004), LPA decreased by 15% (P = 0.005), and NFLP-CD improved by 12% (P < 0.001). The NFL thickness and VF mean deviation didn’t change significantly at any time point. Among the sectors with significant preoperative NFLP-CD loss, the recovery at 6 months was greatest in sectors with minimal preoperative NFL thinning (P < 0.001). In conclusion, surgical IOP lowering may improve NFLP capillary perfusion after 6 months. The perfusion recovery tended to occur in areas with minimal NFL thinning at baseline. OCTA parameters may have potential usefulness as pharmacodynamic biomarkers for glaucoma therapy.
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Phu J, Kalloniatis M. Patient and technician perspectives following the introduction of frontloaded visual field testing in glaucoma assessment. Clin Exp Optom 2021; 105:617-623. [PMID: 34402753 DOI: 10.1080/08164622.2021.1965461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CLINICAL RELEVANCE Frontloaded visual field testing (twice per eye per session) is well-tolerated by patients and technicians, representing a viable strategy that can be implemented in routine clinical practice to capture enough clinical perimetry data for effective disease diagnosis, surveillance and management. BACKGROUND To determine the experiences of patients and technicians following the implementation of frontloaded visual field testing (multiple tests per eye within the same session) in a glaucoma service. METHODS This was a retrospective, cross-sectional study. A written questionnaire was administered to patients (three questions) attending the glaucoma service at the Centre for Eye Health for glaucoma assessment and to their administering perimetry technicians (two questions). The questionnaire was administered after static automated perimetry (24-2 SITA-Faster on the Humphrey Field Analyzer) was performed twice for each eye (frontloaded) within the same session. Respondents were asked to provide a 1-5 Likert scale response to questions that targeted operational issues for frontloaded visual field testing. Responses were correlated against to demographic (age, gender, ethnicity) and clinical (diagnosis, refractive error, visual field indices, test duration) parameters. RESULTS Approximately 90% of patient respondents agreed that frontloaded visual field testing was clearly explained to them, that they were comfortable during the test, and would prefer completing the tests at a single visit rather than returning to repeat the test. Most technician respondents were also able to keep their patients comfortable. 13% of technician respondents felt they ran late during the session, but on average, the total test duration for four visual field tests was 13 minutes, including breaks. There was no correlation found between demographic and clinical factors, and the responses. CONCLUSIONS Frontloaded visual field testing was well-tolerated by patients and technicians. Strategies that may be helpful for other clinics to adopt this new paradigm are described.
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Affiliation(s)
- Jack Phu
- Centre For Eye Health, University of New South Wales, Kensington, NSW, Australia
| | - Michael Kalloniatis
- Centre For Eye Health, University of New South Wales, Kensington, NSW, Australia
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Giammaria S, Vianna JR, Ohno Y, Iwase A, Chauhan BC. Nomograms for Converting Perimetric Sensitivity From Full Threshold and SITA Fast to SITA Standard in Patients With Glaucoma and Healthy Subjects. Transl Vis Sci Technol 2021; 10:2. [PMID: 34342610 PMCID: PMC8340673 DOI: 10.1167/tvst.10.9.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/22/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose The purpose of this study was to develop nomograms for converting Full Threshold (FT) and Swedish Interactive Threshold Algorithm (SITA) Fast (SF) tests to SITA Standard (SS) tests with the Humphrey Field Analyzer in patients with glaucoma and healthy subjects. Methods One eye each of 49 patients with glaucoma and 50 healthy subjects was tested in 4 and 2 sessions (each containing the 3 strategies), respectively, over 4 weeks. The difference between pointwise Best Available Estimate (BAE; mean of all FT tests) and SS sensitivity at each session was used to derive four nomograms. Nomogram accuracy was assessed by: (1) comparing the converted FT to actual SS sensitivity (omitting the test session used to derive the nomogram) and (2) comparing the distribution of the differences between the converted and actual SS sensitivity to the actual SS test-retest differences. The process was repeated for SF and healthy subjects. Results In patients with glaucoma, 39.85% and 59.69% of the conversion differences from FT were within 1 dB and 2 dB of the mean, respectively. The respective figures for SF were 45.69% and 65.04%, and in healthy subjects, they were 54.34% and 76.48% for FT and 61.17% and 82.66% for SF. The difference in the mean conversion and test-retest differences was <0.5 dB for all comparisons, with an overlap in distributions ranging from 78.75% to 85.24. There was no association between conversion differences and BAE for either FT or SF in either subject group. Conclusions Nomograms to convert FT and SF tests to SS tests yield accuracies that are negligibly different from test-retest differences with SS. Translational Relevance Nomograms allow direct comparisons between different perimetric strategies for a more comprehensive assessment of visual field change.
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Affiliation(s)
- Sara Giammaria
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
- DSCMT, University of Rome Tor Vergata, Rome, Italy
| | - Jayme R. Vianna
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Yuko Ohno
- Division of Health Sciences, Osaka University, Suita, Osaka, Japan
| | - Aiko Iwase
- Department of Ophthalmology, Tajimi Iwase Eye Clinic, Gifu, Tajimi, Japan
| | - Balwantray C. Chauhan
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
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Proudfoot JA, Zangwill LM, Moghimi S, Bowd C, Saunders LJ, Hou H, Belghith A, Medeiros FA, Williams-Steppe E, Acera T, Dirkes K, Weinreb R. Estimated Utility of the Short-term Assessment of Glaucoma Progression Model in Clinical Practice. JAMA Ophthalmol 2021; 139:839-846. [PMID: 34110362 PMCID: PMC8193543 DOI: 10.1001/jamaophthalmol.2021.1812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/19/2021] [Indexed: 01/10/2023]
Abstract
IMPORTANCE Clinical trials of glaucoma therapies focused on protecting the optic nerve have required large sample sizes and lengthy follow-up to detect clinically relevant change due to its slow rate of progression. Whether shorter trials may be possible with more frequent testing and use of rate of change as the end point warrants further investigation. OBJECTIVE To describe the design for the Short-term Assessment of Glaucoma Progression (STAGE) model and provide guidance on sample size and power calculations for shorter clinical trials. DESIGN, SETTING, AND PARTICIPANTS A cohort study of patients with mild, moderate, or advanced open-angle glaucoma recruited from the Diagnostic Innovations in Glaucoma Study at the University of California, San Diego. Enrollment began in May 2012 with follow-up for every 3 months for 2 years after baseline examination. Follow-up was concluded in September 2016. Data were analyzed from July 2019 to January 2021. Visual fields (VF) and optic coherence tomography (OCT) scans were obtained at baseline and for 2 years with visits every 3 months. EXPOSURES Glaucoma was defined as glaucomatous appearing optic discs classified by disc photographs in at least 1 eye and/or repeatable VF damage at baseline. MAIN OUTCOMES AND MEASURES Longitudinal rates of change in retinal nerve fiber layer (RNFL) thickness and VF mean deviation (MD) are estimated in study designs of varying length and observation frequency. Power calculations as functions of study length, observation frequency, and sample size were performed. RESULTS In a total referred sample of 97 patients with mild, moderate, or advanced glaucoma (mean [SD] age, 69 [11.4] years; 50 [51.5%] were female; 19 [19.6%]), over the 2-year follow-up, the mean VF 24-2 MD slope was -0.32 dB/y (95% CI, -0.43 to -0.21 dB/y) and the mean RNFL thickness slope was -0.54 μm/y (95% CI, -0.75 to -0.32 μm/y). Sufficient power (80%) to detect similar group differences in the rate of change in both outcomes was attained with total follow-up between 18 months and 2 years and fewer than 300 total participants. CONCLUSIONS AND RELEVANCE In this cohort study, results from the STAGE model with reduction of the rate of progression as the end point, frequent testing, and a moderate effect size, suggest that clinical trials to test efficacy of glaucoma therapy can be completed within 18 months of follow-up and with fewer than 300 participants.
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Affiliation(s)
- James A Proudfoot
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Christopher Bowd
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Luke J Saunders
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Huiyuan Hou
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Akram Belghith
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Felipe A Medeiros
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
- Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Eunice Williams-Steppe
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Tess Acera
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Keri Dirkes
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Robert Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
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Jones L, Callaghan T, Campbell P, Jones PR, Taylor DJ, Asfaw DS, Edgar DF, Crabb DP. Acceptability of a home-based visual field test (Eyecatcher) for glaucoma home monitoring: a qualitative study of patients' views and experiences. BMJ Open 2021; 11:e043130. [PMID: 33820785 PMCID: PMC8030466 DOI: 10.1136/bmjopen-2020-043130] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To explore the acceptability of home visual field (VF) testing using Eyecatcher among people with glaucoma participating in a 6-month home monitoring pilot study. DESIGN Qualitative study using face-to-face semistructured interviews. Transcripts were analysed using thematic analysis. SETTING Participants were recruited in the UK through an advertisement in the International Glaucoma Association (now Glaucoma UK) newsletter. PARTICIPANTS Twenty adults (10 women; median age: 71 years) with a diagnosis of glaucoma were recruited (including open angle and normal tension glaucoma; mean deviation=2.5 to -29.9 dB). RESULTS All participants could successfully perform VF testing at home. Interview data were coded into four overarching themes regarding experiences of undertaking VF home monitoring and attitudes towards its wider implementation in healthcare: (1) comparisons between Eyecatcher and Humphrey Field Analyser (HFA); (2) capability using Eyecatcher; (3) practicalities for effective wider scale implementation; (4) motivations for home monitoring. CONCLUSIONS Participants identified a broad range of benefits to VF home monitoring and discussed areas for service improvement. Eyecatcher was compared positively with conventional VF testing using HFA. Home monitoring may be acceptable to at least a subset of people with glaucoma.
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Affiliation(s)
- Lee Jones
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Tamsin Callaghan
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Peter Campbell
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
- Department of Ophthalmology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Pete R Jones
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Deanna J Taylor
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Daniel S Asfaw
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David F Edgar
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David P Crabb
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
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Jones PR, Campbell P, Callaghan T, Jones L, Asfaw DS, Edgar DF, Crabb DP. Glaucoma Home Monitoring Using a Tablet-Based Visual Field Test (Eyecatcher): An Assessment of Accuracy and Adherence Over 6 Months. Am J Ophthalmol 2021; 223:42-52. [PMID: 32882222 PMCID: PMC7462567 DOI: 10.1016/j.ajo.2020.08.039] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 01/14/2023]
Abstract
Purpose To assess accuracy and adherence of visual field (VF) home monitoring in a pilot sample of patients with glaucoma. Design Prospective longitudinal feasibility and reliability study. Methods Twenty adults (median 71 years) with an established diagnosis of glaucoma were issued a tablet perimeter (Eyecatcher) and were asked to perform 1 VF home assessment per eye, per month, for 6 months (12 tests total). Before and after home monitoring, 2 VF assessments were performed in clinic using standard automated perimetry (4 tests total, per eye). Results All 20 participants could perform monthly home monitoring, though 1 participant stopped after 4 months (adherence: 98% of tests). There was good concordance between VFs measured at home and in the clinic (r = 0.94, P < .001). In 21 of 236 tests (9%), mean deviation deviated by more than ±3 dB from the median. Many of these anomalous tests could be identified by applying machine learning techniques to recordings from the tablets' front-facing camera (area under the receiver operating characteristic curve = 0.78). Adding home-monitoring data to 2 standard automated perimetry tests made 6 months apart reduced measurement error (between-test measurement variability) in 97% of eyes, with mean absolute error more than halving in 90% of eyes. Median test duration was 4.5 minutes (quartiles: 3.9-5.2 minutes). Substantial variations in ambient illumination had no observable effect on VF measurements (r = 0.07, P = .320). Conclusions Home monitoring of VFs is viable for some patients and may provide clinically useful data.
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Affiliation(s)
- Pete R Jones
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Peter Campbell
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK; Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Tamsin Callaghan
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Lee Jones
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Daniel S Asfaw
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David F Edgar
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David P Crabb
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
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Abstract
PURPOSE OF REVIEW Perimetry remains important for the diagnosis and management of glaucoma despite advances in imaging technology. The purpose of this review is to describe advances in the acquisition and analysis of visual field data and highlight novel techniques for performing perimetry. RECENT FINDINGS Studies have focused on improving the detection of patients at highest risk of severe vision loss and the development of innovative testing strategies that allow for more frequent testing. Artificial intelligence has been utilized in research settings to improve detection and characterization of glaucomatous field damage. Furthermore, tablet-based strategies and virtual reality headsets show promise for glaucoma screening and remote monitoring of patients with glaucoma. SUMMARY New testing strategies and research findings have improved our ability to identify patients with both paracentral and mid-peripheral visual field progression. New strategies have the potential to make visual field testing more efficient, reliable and accessible for patients with glaucoma.
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Razeghinejad R, Gonzalez-Garcia A, Myers JS, Katz LJ. Preliminary Report on a Novel Virtual Reality Perimeter Compared With Standard Automated Perimetry. J Glaucoma 2021; 30:17-23. [PMID: 32941320 DOI: 10.1097/ijg.0000000000001670] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/22/2020] [Indexed: 11/26/2022]
Abstract
PRECIS The VisuALL head-mounted perimetry in normal subjects and glaucoma patients had a moderate to strong correlation with the Humphrey Field Analyzer (HFA). PURPOSE Visual field testing has a vital role in diagnosing and managing glaucoma. The current clinical practice relies on large, table-based testing units. This study investigated the performance of a novel virtual reality head-mounted visual perimetry device (VisuALL), in normal and glaucoma patients. METHODS This prospective observational study was conducted on 50 eyes of 25 healthy subjects (normal group) and 52 eyes of 26 patients with a controlled mild or moderate stage of glaucoma (glaucoma group). All participants had visual field testing with VisuALL and the HFA (24-2, Swedish Interactive Threshold Algorithm). The mean sensitivity of the whole visual field and each quadrant were compared between both machines and the receiver operating characteristic was used to compare the diagnostic abilities and the Bland-Altman plot to evaluate the agreement of the 2 perimeters. RESULTS The global mean sensitivity of the VisuALL and the HFA correlated significantly in both normal (r=0.5, P=0.001) and glaucoma (r=0.8, P<0.001) groups. The mean sensitivity of all quadrants also correlated significantly in both groups. The VisuALL mean sensitivity had a greater (0.98) receiver operating characteristic curve than HFA (0.93) mean sensitivity (P=0.06) in discriminating normal versus glaucoma. CONCLUSION There was an excellent correlation between the VisuALL and the Standard Automated Perimetry in normal and glaucoma patients and VisuALL showing high diagnostic performance.
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Affiliation(s)
| | | | | | - L Jay Katz
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA
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Lee J, Kim YW, Ha A, Kim YK, Park KH, Choi HJ, Jeoung JW. Estimating visual field loss from monoscopic optic disc photography using deep learning model. Sci Rep 2020; 10:21052. [PMID: 33273643 PMCID: PMC7712913 DOI: 10.1038/s41598-020-78144-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 11/19/2020] [Indexed: 11/09/2022] Open
Abstract
AbstractVisual field assessment is recognized as the important criterion of glaucomatous damage judgement; however, it can show large test–retest variability. We developed a deep learning (DL) algorithm that quantitatively predicts mean deviation (MD) of standard automated perimetry (SAP) from monoscopic optic disc photographs (ODPs). A total of 1200 image pairs (ODPs and SAP results) for 563 eyes of 327 participants were enrolled. A DL model was built by combining a pre-trained DL network and subsequently trained fully connected layers. The correlation coefficient and mean absolute error (MAE) between the predicted and measured MDs were calculated. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the detection ability for glaucomatous visual field (VF) loss. The data were split into training/validation (1000 images) and testing (200 images) sets to evaluate the performance of the algorithm. The predicted MD showed a strong correlation and good agreement with the actual MD (correlation coefficient = 0.755; R2 = 57.0%; MAE = 1.94 dB). The model also accurately predicted the presence of glaucomatous VF loss (AUC 0.953). The DL algorithm showed great feasibility for prediction of MD and detection of glaucomatous functional loss from ODPs.
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