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Lee JH, Yoo K, Lung K, Apolo G, Toy B, Sanvicente C, Xu B. Patterns and Disparities in Recorded Gonioscopy During Initial Glaucoma Evaluations in the United States. Am J Ophthalmol 2024; 264:90-98. [PMID: 38423202 DOI: 10.1016/j.ajo.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To assess patterns in gonioscopy during initial glaucoma evaluations in the United States. DESIGN Retrospective, case-control study. METHODS Patients undergoing initial glaucoma evaluation between 2009-2020 were identified in the Optum Clinformatics DataMart. Initial evaluation was defined as follows: (1) glaucoma suspect, anatomical narrow angle (ANA), or primary/secondary glaucoma diagnosed by an ophthalmologist; (2) continuously observable during a 36-month lookback period; (3) no history of glaucoma medications, laser, or surgical procedures; and (4) optical coherence tomography (OCT) or visual field performed within 6 months of initial diagnosis. Logistic regression models were developed to identify factors associated with no record of gonioscopy based on Current Procedural Terminology (CPT) codes. RESULTS Among 198,995 patients, 20.4% and 29.5% had recorded gonioscopy on the day of diagnosis or within 6 months, respectively. On multivariable analysis, odds of recorded gonioscopy within 6 months of initial evaluation was lower (P < .001) among non-Hispanic Whites (OR=0.84) but similar for Blacks (OR=1.02) and Hispanics (OR=0.96) compared with Asians. Age ≥60 years (OR<0.82), pseudophakia/aphakia (OR=0.58), or residence outside of the Northeast region (OR=0.66-0.84) conferred lower odds of recorded gonioscopy (P < .001). Angle closure glaucoma (OR=0.85), secondary glaucoma (OR=0.31), or open angle glaucoma/suspect (OR=0.12/0.24, respectively) patients were less likely to have recorded gonioscopy compared to ANA patients (P < .01). CONCLUSIONS More than 70% patients undergoing initial glaucoma evaluation in the United States do not have a record of gonioscopy, especially elderly, non-Hispanic White, and pseudophakic patients in non-Northeast regions. This pattern does not conform to current practice guidelines and could contribute to misdiagnosed disease and suboptimal outcomes.
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Affiliation(s)
- Jun Hui Lee
- From the Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California (J.H.L., G.A., B.T., B.X.), Los Angeles, California
| | - Kristy Yoo
- Keck School of Medicine at the University of Southern California (K.Y.), Los Angeles, California
| | - Khristina Lung
- Schaeffer Center for Health Policy and Economics, University of Southern California (K.I.), Los Angeles, California
| | - Galo Apolo
- From the Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California (J.H.L., G.A., B.T., B.X.), Los Angeles, California
| | - Brian Toy
- From the Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California (J.H.L., G.A., B.T., B.X.), Los Angeles, California
| | - Carina Sanvicente
- Harvey & Bernice Jones Eye Institute, University of Arkansas for Medical Sciences (C.S.), Little Rock, Arkansas, USA
| | - Benjamin Xu
- From the Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California (J.H.L., G.A., B.T., B.X.), Los Angeles, California.
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Alwazae M, Alhumud A, Alsarhan S, Ali Aljasim L. Acceptance of Selective Laser Trabeculoplasty as a First-Line Treatment for Primary Open-Angle Glaucoma in Saudi Arabia. Cureus 2024; 16:e52360. [PMID: 38361705 PMCID: PMC10868151 DOI: 10.7759/cureus.52360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Glaucoma is the second leading cause of blindness worldwide. Early detection and timely treatment are crucial to reducing disease progression. Selective laser trabeculoplasty (SLT) has proven efficacious as a primary treatment for primary open-angle glaucoma. This study aims to evaluate the acceptance among Saudi ophthalmologists of using SLT as a primary treatment for glaucoma. METHODS This cross-sectional study enrolled 128 ophthalmologists practicing in Saudi Arabia. Data collection was conducted using a structured online questionnaire, which evaluated sociodemographic data, current glaucoma practice, the technology acceptance model (TAM), and potential barriers to incorporating SLT as the primary treatment for glaucoma. RESULTS The mean age of the participants was 40 ± 9.6 years, with 65.6% being male. Almost one-third were glaucoma specialists, and 89% followed the American Academy of Ophthalmology recommendations for managing glaucoma patients. The majority (96.1%) used medical treatment as the initial therapy, 72.7% agreed that SLT is safe, and 59.4% agreed that it rapidly controls intraocular pressure. Nearly half of the participants were willing to use SLT as the primary treatment, yet only 42.2% considered themselves experienced enough to do so. The most reported barriers were inadequate training (47.7%), non-availability of SLT equipment (41.4%), and low efficacy as reported by 27.3% of participants. CONCLUSION Despite the good overall acceptance of SLT as a first-line treatment for glaucoma, most participants still preferred medical therapy as the primary treatment. To overcome the barriers to incorporating SLT, Saudi ophthalmologists require more training and access to equipment to effectively implement this modality in their practices.
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Affiliation(s)
- Manal Alwazae
- Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, SAU
| | | | - Shrouq Alsarhan
- General Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
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Shouchane-Blum K, Zahavi A, Geffen N, Nahum Y, Livny E, Rosenblatt I, Sella R, Bahar I, Sternfeld A, Gaton D. Long-Term Evaluation of Pseudoexfoliation Syndrome Post-Cataract Extraction. J Pers Med 2023; 13:jpm13050818. [PMID: 37240988 DOI: 10.3390/jpm13050818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/02/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
The study aimed to examine the effect of cataract extraction on ophthalmologists' ability to detect pseudoexfoliation (PXF) syndrome. A total of 31 patients admitted for elective cataract surgery were enrolled in this prospective comparative study. Prior to surgery, patients underwent slit-lamp examination and gonioscopy conducted by experienced glaucoma specialists. Subsequently, patients were re-examined by a different glaucoma specialist and comprehensive ophthalmologists. Pre-operatively, 12 patients were diagnosed with PXF on the basis of a Sampaolesi line (100%), anterior capsular deposits (83%), and pupillary ruff deposits (50%). The remaining 19 patients acted as controls. All patients were re-examined 10-46 months post-operatively. Of the 12 patients with PXF, 10 (83%) were correctly diagnosed post-operatively by glaucoma specialists and 8 (66%) by comprehensive ophthalmologists. There was no statistically significant difference in PXF diagnosis. However, detection of anterior capsular deposits (p = 0.02), Sampaolesi lines (p = 0.04), and pupillary ruff deposits (p = 0.01) were significantly lower post-operatively. Diagnosis of PXF is challenging in pseudophakic patients as the anterior capsule is removed during cataract extraction. Therefore, PXF diagnosis in pseudophakic patients relies mainly on the presence of deposits at other anatomical sites, and careful attention to these signs is required. Glaucoma specialists may be more likely than comprehensive ophthalmologists to detect PXF in pseudophakic patients.
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Affiliation(s)
- Karny Shouchane-Blum
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Alon Zahavi
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Noa Geffen
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yoav Nahum
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eitan Livny
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Irit Rosenblatt
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ruti Sella
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Irit Bahar
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Amir Sternfeld
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dan Gaton
- Ophthalmology Department and Laboratory of Eye Research Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Zhou S, Pardeshi AA, Burkemper B, Apolo G, Cho A, Jiang X, Torres M, McKean-Cowdin R, Varma R, Xu BY. Refractive Error and Anterior Chamber Depth as Risk Factors in Primary Angle Closure Disease: The Chinese American Eye Study. J Glaucoma 2023; 32:257-264. [PMID: 36847699 PMCID: PMC10065888 DOI: 10.1097/ijg.0000000000002154] [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: 02/07/2022] [Accepted: 10/06/2022] [Indexed: 03/01/2023]
Abstract
PRCIS The risk of primary angle closure disease (PACD) rises rapidly with greater hyperopia while remaining relatively low for all degrees of myopia. Refractive error (RE) is useful for angle closure risk stratification in the absence of biometric data. PURPOSE To assess the role of RE and anterior chamber depth (ACD) as risk factors in PACD. METHODS Chinese American Eye Study participants received complete eye examinations including refraction, gonioscopy, amplitude-scan biometry, and anterior segment ocular coherence tomography imaging. PACD included primary angle closure suspect (≥3 quadrants of angle closure on gonioscopy) and primary angle closure/primary angle closure glaucoma (peripheral anterior synechiae or intraocular pressure >21 mm Hg). Logistic regression models were developed to assess associations between PACD and RE and/or ACD adjusted for sex and age. Locally weighted scatterplot smoothing curves were plotted to assess continuous relationships between variables. RESULTS Three thousand nine hundred seventy eyes (3403 open angle and 567 PACD) were included. The risk of PACD increased with greater hyperopia [odds ratio (OR) = 1.41 per diopter (D); P < 0.001] and shallower ACD (OR = 1.75 per 0.1 mm; P < 0.001). Hyperopia (≥ + 0.5 D; OR = 5.03) and emmetropia (-0.5 D to +0.5 D; OR = 2.78) conferred a significantly higher risk of PACD compared with myopia (≤0.5 D). ACD (standardized regression coefficient = -0.54) was a 2.5-fold stronger predictor of PACD risk compared with RE (standardized regression coefficient = 0.22) when both variables were included in one multivariable model. The sensitivity and specificity of a 2.6 mm ACD cutoff for PACD were 77.5% and 83.2% and of a +2.0 D RE cutoff were 22.3% and 89.1%. CONCLUSION The risk of PACD rises rapidly with greater hyperopia while remaining relatively low for all degrees of myopia. Although RE is a weaker predictor of PACD than ACD, it remains a useful metric to identify patients who would benefit from gonioscopy in the absence of biometric data.
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Affiliation(s)
- Sarah Zhou
- Keck School of Medicine at the University of Southern California
| | | | | | - Galo Apolo
- Department of Ophthalmology, Roski Eye Institute
| | - Austin Cho
- Keck School of Medicine at the University of Southern California
| | - Xuejuan Jiang
- Department of Ophthalmology, Roski Eye Institute
- Department of Population and Public Health Sciences, Keck School of Medicine at the University of Southern California
| | - Mina Torres
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, CA
| | - Roberta McKean-Cowdin
- Keck School of Medicine at the University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine at the University of Southern California
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, CA
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Randhawa J, Chiang M, Porporato N, Pardeshi AA, Dredge J, Apolo Aroca G, Tun TA, Quah JH, Tan M, Higashita R, Aung T, Varma R, Xu BY. Generalisability and performance of an OCT-based deep learning classifier for community-based and hospital-based detection of gonioscopic angle closure. Br J Ophthalmol 2023; 107:511-517. [PMID: 34670749 PMCID: PMC9018872 DOI: 10.1136/bjophthalmol-2021-319470] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 10/02/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE To assess the generalisability and performance of a deep learning classifier for automated detection of gonioscopic angle closure in anterior segment optical coherence tomography (AS-OCT) images. METHODS A convolutional neural network (CNN) model developed using data from the Chinese American Eye Study (CHES) was used to detect gonioscopic angle closure in AS-OCT images with reference gonioscopy grades provided by trained ophthalmologists. Independent test data were derived from the population-based CHES, a community-based clinic in Singapore, and a hospital-based clinic at the University of Southern California (USC). Classifier performance was evaluated with receiver operating characteristic curve and area under the receiver operating characteristic curve (AUC) metrics. Interexaminer agreement between the classifier and two human examiners at USC was calculated using Cohen's kappa coefficients. RESULTS The classifier was tested using 640 images (311 open and 329 closed) from 127 Chinese Americans, 10 165 images (9595 open and 570 closed) from 1318 predominantly Chinese Singaporeans and 300 images (234 open and 66 closed) from 40 multiethnic USC patients. The classifier achieved similar performance in the CHES (AUC=0.917), Singapore (AUC=0.894) and USC (AUC=0.922) cohorts. Standardising the distribution of gonioscopy grades across cohorts produced similar AUC metrics (range 0.890-0.932). The agreement between the CNN classifier and two human examiners (Ҡ=0.700 and 0.704) approximated interexaminer agreement (Ҡ=0.693) in the USC cohort. CONCLUSION An OCT-based deep learning classifier demonstrated consistent performance detecting gonioscopic angle closure across three independent patient populations. This automated method could aid ophthalmologists in the assessment of angle status in diverse patient populations.
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Affiliation(s)
- Jasmeen Randhawa
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Michael Chiang
- Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Natalia Porporato
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Anmol A Pardeshi
- Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Justin Dredge
- Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Galo Apolo Aroca
- Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Tin A Tun
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | | | - Marcus Tan
- Ophthalmology, National University of Singapore, Singapore
| | | | - Tin Aung
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
- Ophthalmology, National University of Singapore, Singapore
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California, USA
| | - Benjamin Y Xu
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Laroche D, Rickford K, Sinon J, Brown A, Ng C, Sakkari S. Preventing blindness from glaucoma with patient education, the NIDEK GS-1 Gonioscope, lensectomy and microinvasive glaucoma surgery. J Natl Med Assoc 2023; 115:175-185. [PMID: 36841683 DOI: 10.1016/j.jnma.2023.01.014] [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: 02/18/2022] [Accepted: 01/25/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVES The purpose of this report is to demonstrate the patient education ability and benefits in treating glaucoma and preventing blindness with the NIDEK GS-1 Gonioscope and earlier surgical intervention with cataract surgery/lensectomy and microinvasive glaucoma surgery (MIGS). METHODS This data was collected using a NIDEK GS-1 Gonioscope. Informed consent was obtained from all participants following explanation of possible risks. RESULTS AND DISCUSSION NIDEK GS-1 automated gonioscopy offers many advantages, including (1) the ability to capture high quality, 360-degree chromatic documentation of the iridocorneal angle and trabecular meshwork, (2) improved patient education on the condition at hand through images; and (3) visualization of the change in the angle and trabecular meshwork before and after surgical intervention in patients with glaucoma. CONCLUSION AND IMPLICATIONS Gonioscopic imaging is helpful in educating patients on the anatomy of the angle and how its anatomical configuration can contribute to glaucoma. It also gives clinicians a supplementary tool to document features of the ICA; to evaluate anatomical changes before and after surgical treatment of glaucoma and cataracts; and to demonstrate to patients how a specific surgical device or technique is controlling their intraocular pressure (IOP).
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Affiliation(s)
- Daniel Laroche
- New York Eye and Ear Infirmary, Icahn School of Medicine of Mount Sinai, 49 W 127th Street; Advanced Eyecare of New York, New York, USA.
| | - Kara Rickford
- School of Medicine, New York Medical College, Valhalla, USA
| | - José Sinon
- SUNY Downstate Health Sciences University, Brooklyn, USA
| | - Aaron Brown
- New York Eye and Ear Infirmary, Icahn School of Medicine of Mount Sinai, 49 W 127th Street
| | - Chester Ng
- Advanced Eyecare of New York, New York, USA
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Mispositioned Hydrus Microstents: A Case Series Imaged with NIDEK GS-1 Gonioscope. J Ophthalmol 2022; 2022:1605195. [PMID: 36119138 PMCID: PMC9477617 DOI: 10.1155/2022/1605195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction. The Hydrus microstent has become a common procedure in glaucoma surgery intended to improve outcomes of cataract surgery to lower intraocular pressure. Despite proper placement, this device can subsequently be noted to not be in the proper position. In this case series, we report mispositioned Hydrus microstents in five different patients and use NIDEK GS-1 gonioscopy. Case Report. We report five different patients who had cataract surgery and who were subsequently noted to have mispositioned Hydrus stents. No stents needed to be removed. All patients had improved vision and stable visual fields, and none required secondary surgery. Management and Outcome. In each case of mispositioned stents, vision was significantly improved and there was no inflammation or other complications noted. Discussion. Hydrus stents can be noted to be mispositioned during the post-operative period after successful insertion. This can often be well tolerated requiring no further intervention.
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Apolo G, Bohner A, Pardeshi A, Lung K, Toy B, Wong B, Song B, Camp A, Xu B. Racial and Sociodemographic Disparities in the Detection of Narrow Angles before Detection of Primary Angle-Closure Glaucoma in the United States. Ophthalmol Glaucoma 2022; 5:388-395. [PMID: 35085828 PMCID: PMC9309181 DOI: 10.1016/j.ogla.2022.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/15/2022] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE To assess the proportion of newly diagnosed cases of primary angle-closure glaucoma (PACG) with and without prior diagnosis of anatomical narrow angle (ANA) and to identify sociodemographic risk factors for late detection (PACG without prior ANA diagnosis). DESIGN Retrospective cohort study. METHODS One hundred two thousand six hundred seventeen patients with PACG were identified from the Optum Clinformatics Data Mart Database (2007-2019). Patients with newly diagnosed PACG met the following criteria: (1) diagnosis made by an ophthalmologist, (2) disease observable for at least 12 months before diagnosis, and (3) no history of treatment before diagnosis unless preceded by a diagnosis of ANA. Multivariate logistic regression modeling was performed to identify sociodemographic risk factors for late detection. MAIN OUTCOME MEASURES Proportion of patients with newly diagnosed PACG without prior ANA diagnosis and sociodemographic factors associated with late detection. RESULTS Thirty-one thousand forty-four patients were eligible. More than 70% of PACG cases were detected without prior ANA diagnosis, regardless of patient age, sex, or race. The odds of late detection were significantly higher (P < 0.001) among men (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.25-1.40), Black patients (OR, 1.25; 95% CI, 1.15-1.37), and patients 80 years of age or older (OR, 1.28; 95% CI, 1.11-1.47) or living in Southern (OR, 1.30; 95% CI, 1.22-1.40) or Pacific (OR, 1.27; 95% CI, 1.16-1.36) regions. Findings were similar for patients with PACG with a record of gonioscopy and treatment or with a 24-month lookback period. CONCLUSIONS Most patients who receive a new diagnosis of PACG in the United States do not have a prior diagnosis of ANA. The elderly, men, and Black patients are at higher risk of late detection. A need exists for increased disease awareness among providers and more accessible tools to detect patients at risk of developing PACG.
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Affiliation(s)
- Galo Apolo
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Austin Bohner
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California; Department of Internal Medicine, University of Washington-Boise, Boise, Idaho
| | - Anmol Pardeshi
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Khristina Lung
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California
| | - Brian Toy
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Brandon Wong
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Brian Song
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Andrew Camp
- Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Benjamin Xu
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California.
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Efficacy and Safety of Micropulse Transscleral Cyclophotocoagulation. J Clin Med 2022; 11:jcm11123447. [PMID: 35743514 PMCID: PMC9224545 DOI: 10.3390/jcm11123447] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Early studies have shown that micropulse transscleral cyclophotocoagulation (MP-TSCPC) might be an effective and safe treatment option for lowering intraocular pressure (IOP). These studies were, however, somewhat limited, in particular by their retrospective nature and the length of follow-up. Therefore, we assessed the efficacy and safety of this novel treatment in a large cohort for up to 4 years. Methods: We performed a prospective cohort study, including all patients who were treated with MP-TSCPC since November 2017. The primary outcome was a reduction of IOP and the number of IOP-lowering medications. Results: The mean ± standard deviation baseline IOP and number of IOP-lowering medications were 26.6 ± 10.8 mmHg and 3.3 ± 1.3. IOP was reduced by 8.2 ± 7.9 (31.8% reduction), 6.9 ± 8.7 (28.1% reduction), and 7.1 ± 8.4 (30.2% reduction) mmHg after 6, 12, and 24 months, respectively (p < 0.001). The mean postoperative number of IOP-lowering medications was significantly reduced after 6 months by 0.6 ± 1.5 (p = 0.002) but was not significantly different after 12 or 24 months. Oral acetazolamide was significantly reduced from 28 (29%) eyes before treatment, to 9 (9%) at the last follow-up visit (p < 0.001). No major complications were observed after treatment. Conclusions: MP-TSCPC is a safe and effective treatment option for lowering IOP, but only reduced IOP-lowering medications in the first 6 months after treatment. However, MP-TSCPC is especially effective in getting patients off oral IOP-lowering drugs.
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Widen the Applicability of a Convolutional Neural-Network-Assisted Glaucoma Detection Algorithm of Limited Training Images across Different Datasets. Biomedicines 2022; 10:biomedicines10061314. [PMID: 35740336 PMCID: PMC9219722 DOI: 10.3390/biomedicines10061314] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/22/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023] Open
Abstract
Automated glaucoma detection using deep learning may increase the diagnostic rate of glaucoma to prevent blindness, but generalizable models are currently unavailable despite the use of huge training datasets. This study aims to evaluate the performance of a convolutional neural network (CNN) classifier trained with a limited number of high-quality fundus images in detecting glaucoma and methods to improve its performance across different datasets. A CNN classifier was constructed using EfficientNet B3 and 944 images collected from one medical center (core model) and externally validated using three datasets. The performance of the core model was compared with (1) the integrated model constructed by using all training images from the four datasets and (2) the dataset-specific model built by fine-tuning the core model with training images from the external datasets. The diagnostic accuracy of the core model was 95.62% but dropped to ranges of 52.5–80.0% on the external datasets. Dataset-specific models exhibited superior diagnostic performance on the external datasets compared to other models, with a diagnostic accuracy of 87.50–92.5%. The findings suggest that dataset-specific tuning of the core CNN classifier effectively improves its applicability across different datasets when increasing training images fails to achieve generalization.
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11
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Wu AM, Stein JD, Shah M. Potentially Missed Opportunities in Prevention of Acute Angle-Closure Crisis. JAMA Ophthalmol 2022; 140:598-603. [PMID: 35554487 PMCID: PMC9100468 DOI: 10.1001/jamaophthalmol.2022.1231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance If an anatomic narrow angle is not appropriately diagnosed and treated, it can result in acute angle-closure crisis (AACC) and lead to substantial vision loss. Objective To identify patients who presented with AACC and assess for factors that may have been associated with risk of developing it. Design, Setting, and Participants This population-based retrospective cohort study conducted from January 1, 2001, to December 31, 2015, included a 20% nationwide sample of 1179 Medicare beneficiaries. Patients aged 40 years or older with AACC were identified with billing codes. A 2-year lookback period from the date of initial presentation of AACC was used to identify patients who had at least 1 eye care visit, received a diagnosis of open-angle glaucoma (OAG) or suspected OAG, or received at least 1 medication associated with risk of AACC. Of the patients who had at least 1 eye care visit, those who underwent gonioscopy, received a diagnosis of an anatomic narrow angle before developing AACC, or both were identified. Main Outcomes and Measures Proportions of patients who had at least 1 eye care visit, had OAG or suspected OAG, received at least 1 medication associated with risk of AACC, underwent gonioscopy, or received a diagnosis of an anatomic narrow angle before development of AACC. Results A total of 1179 patients had a confirmed diagnosis of AACC. The mean (SD) age of patients with AACC was 66.7 (11.8) years (range, 40-96 years), 766 were women (65.0%), 57 were Asian (4.8%), 109 were Black (9.2%), 126 were Latino (10.7%), 791 were White (67.1%), and 96 were other race and ethnicity (8.1%). Of these patients, only 796 (67.5%) consulted an optometrist or ophthalmologist at least once during the 2-year lookback period. A total of 464 individuals (39.4%) had OAG or suspected OAG, and 414 (35.1%) had received at least 1 medication associated with increased risk of AACC before developing it. Of the 796 patients who consulted an optometrist or ophthalmologist in the lookback period, less than one-third underwent gonioscopy in the 2 years before developing AACC (n = 264 [33.2%]), and less than one-half of all patients undergoing gonioscopy received a diagnosis of an anatomic narrow angle (n = 113 [42.8%]). Most patients underwent gonioscopy in the 1 to 4 weeks preceding the AACC. Conclusions and Relevance In this group of Medicare patients, there appear to have been multiple opportunities for interventions that may have averted AACC. Interventions aimed at addressing risk factors associated with AACC and improving performance of gonioscopy might be associated with reduced risk for ocular morbidity.
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Affiliation(s)
- Annie M Wu
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor
| | - Joshua D Stein
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor.,Center for Eye Policy and Innovation, University of Michigan, Ann Arbor.,Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
| | - Manjool Shah
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor
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12
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Skuta GL, Ding K, Lum F, Coleman AL. An IRIS® Registry-Based Assessment of Primary Open-Angle Glaucoma Practice Patterns in Academic versus Non-Academic Settings. Am J Ophthalmol 2022; 242:228-242. [PMID: 35469787 DOI: 10.1016/j.ajo.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare patient demographic data; level of severity; and clinical, diagnostic, and surgical practice patterns in patients with primary open-angle glaucoma (POAG) in an academic setting (AS) versus non-academic setting (NAS) using the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight). METHODS A retrospective cohort study of IRIS® Registry data that included patients with POAG who were seen between January 2016 and December 2019 and had at least one year of follow-up. RESULTS Of 3,707,084 distinct eyes with POAG, 3% (109,920) were included in the academic subcohort and 97% (3,597,164) were included in the non-academic subcohort. Among the findings of greatest note (P < .0001 for all comparisons) were a higher proportion of eyes of Black patients, a higher proportion of eyes with level 3 severity, and a higher mean cup-to-disc ratio in eyes in the AS. The relative frequency of gonioscopy, pachymetry, and visual field testing in conjunction with new patient visits was also notably higher in the AS. For glaucoma surgical procedures, the greatest proportional differences in relative frequency were seen for tube shunt procedures (2.55-fold higher in the AS), iStent and Hydrus procedures (2.52-fold higher in the NAS), and endoscopic cyclophotocoagulation (5.80-fold higher in the NAS). CONCLUSIONS Based on IRIS® Registry data, notable differences appear to exist with regard to ethno-racial groups, glaucoma severity, and diagnostic and surgical practice patterns in AS versus NAS. By understanding these differences, potential opportunities exist in the development of educational programs related to clinical and surgical glaucoma care.
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13
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Matsuo M, Kozuki N, Inomata Y, Kumagai Y, Shiba R, Hamaguchi K, Tanito M. Automated Focal Plane Merging From a Stack of Gonioscopic Photographs Using a Focus-Stacking Algorithm. Transl Vis Sci Technol 2022; 11:22. [PMID: 35452095 PMCID: PMC9055566 DOI: 10.1167/tvst.11.4.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to investigate the utility of automated focal plane merging with the collection of gonio-photographs with different depths of field (DOF) using an established focus-stacking algorithm. Methods A cross-sectional study was conducted at Shimane University Hospital, Izumo, Japan. Sixteen eyes from 16 subjects from the glaucoma clinic were included in this study. Image processing was performed for the images of 16 eyes from 16 angle sector following the successful gonio-photography. The 256 sets of focus-stacked and best-focused images were prepared in random order and were compared for the DOF and informativeness to diagnose angle pathology by masked observers in each set as the subjective assessments. Moreover, the energy of the Laplacian (average |ΔI|), which is an indicator of image sharpness between the photographs with and without the focus-stacking processing was also analyzed with the Laplacian filter as the objective assessment. Results The automated image processing was successfully performed in all stacks of images. The significant deepening of DOF and improvement of informativeness achieved in 255 (99.6%) and 216 (84.4%) images (P < 0.0001 for both, sign test) and the energy of the Laplacian also significantly increased in 243 (94.9%) images (P < 0.0001, sign test). Conclusions Focal plane merging by the automated algorithm can make the gonio-images deeper focus compared with the paired best-focused images subjectively and objectively, which would be useful for angle pathological assessment in clinical practice. Translational Relevance Focal plane merging algorithm for the automated gonio-photography can facilitate the angle assessment by providing informative deep-focus image, which would be useful for glaucoma care.
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Affiliation(s)
- Masato Matsuo
- Department of Ophthalmology, Shimane University Faculty of Medicine (Matsuo, Kozuki, Inomata, Tanito), Izumo, Japan; NIDEK CO., LTD., Gamagori, Japan (Kumagai, Shiba, Hamaguchi)
| | - Nana Kozuki
- Department of Ophthalmology, Shimane University Faculty of Medicine (Matsuo, Kozuki, Inomata, Tanito), Izumo, Japan; NIDEK CO., LTD., Gamagori, Japan (Kumagai, Shiba, Hamaguchi)
| | - Yuina Inomata
- Department of Ophthalmology, Shimane University Faculty of Medicine (Matsuo, Kozuki, Inomata, Tanito), Izumo, Japan; NIDEK CO., LTD., Gamagori, Japan (Kumagai, Shiba, Hamaguchi)
| | - Yoshiki Kumagai
- Department of Ophthalmology, Shimane University Faculty of Medicine (Matsuo, Kozuki, Inomata, Tanito), Izumo, Japan; NIDEK CO., LTD., Gamagori, Japan (Kumagai, Shiba, Hamaguchi)
| | - Ryosuke Shiba
- Department of Ophthalmology, Shimane University Faculty of Medicine (Matsuo, Kozuki, Inomata, Tanito), Izumo, Japan; NIDEK CO., LTD., Gamagori, Japan (Kumagai, Shiba, Hamaguchi)
| | - Koji Hamaguchi
- Department of Ophthalmology, Shimane University Faculty of Medicine (Matsuo, Kozuki, Inomata, Tanito), Izumo, Japan; NIDEK CO., LTD., Gamagori, Japan (Kumagai, Shiba, Hamaguchi)
| | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine (Matsuo, Kozuki, Inomata, Tanito), Izumo, Japan; NIDEK CO., LTD., Gamagori, Japan (Kumagai, Shiba, Hamaguchi)
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Laroche D, Scheive M. How to Stop People from Going Blind from Glaucoma Using Early Cataract Surgery/Refractive Lensectomy and Microinvasive Glaucoma Surgery. Clin Ophthalmol 2022; 16:815-821. [PMID: 35313477 PMCID: PMC8934161 DOI: 10.2147/opth.s354338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/14/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Daniel Laroche
- Department of Ophthalmology, New York Eye and Ear Infirmary, Icahn School of Medicine of Mount Sinai, New York, NY, USA
- Advanced Eyecare of New York, New York, NY, USA
- Correspondence: Daniel Laroche, Department of Ophthalmology, New York Eye and Ear Infirmary and Advanced Eyecare of New York, 49 West 127th Street, New York, NY, 10027, USA, Tel +1 212663-0473, Email
| | - Melanie Scheive
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
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15
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Gedde SJ, Feuer WJ, Crane AM, Shi W. Factors Influencing Career Decisions and Satisfaction Among Newly Practicing Ophthalmologists. Am J Ophthalmol 2022; 234:285-326. [PMID: 34157277 DOI: 10.1016/j.ajo.2021.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/12/2021] [Accepted: 06/12/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To describe the career choices of newly practicing ophthalmologists and explore factors influencing career decisions and satisfaction. METHODS A cross-sectional study was conducted using data from an electronic survey of ophthalmologists who completed training within the prior 5 years. The survey included questions about demographic information, medical education, current practice, factors affecting career choices, and career satisfaction. Statistical comparisons were made based on gender, type of practice, subspecialty training, and practice area. RESULTS Surveys were completed by 696 (32%) newly practicing ophthalmologists, including 276 (40%) women, 179 (29%) academicians, and 465 (67%) subspecialists. A higher proportion of female respondents entered academics than male respondents (36% vs 26%, P = .009). Female and male respondents pursued fellowship training with similar frequency (64% vs 68%, P = .32), but men were more likely to seek vitreoretinal fellowships (30% vs 11%, P < .001) and women were more likely to undertake fellowships in pediatric ophthalmology (21% vs 8%, P < .001), uveitis (10% vs 2%, P = .002), and neuro-ophthalmology (6% vs 2%, P = .042). A total of 514 (83%) respondents reported being happy with work life. CONCLUSIONS The career choices of newly practicing ophthalmologists differ based on gender, type of practice, subspecialty training, and practice area. Many factors affect career decisions, and they have varying influence on subgroups within ophthalmology. Ophthalmologists have high levels of career satisfaction. This information may prove useful when developing workforce strategies to meet future eye care needs. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Toomey M, Ho KC, Gyawali R, Stapleton F, Wiles L, Hibbert P, Keay L, Jalbert I. The appropriateness of and barriers to glaucoma care delivery by Australian optometrists. Clin Exp Optom 2022; 105:593-601. [PMID: 35037600 DOI: 10.1080/08164622.2021.2004861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CLINICAL RELEVANCE Establishing the level of appropriateness and barriers to glaucoma care delivery by Australian optometrists are important first steps in developing tailored interventions aimed at improving glaucoma care delivery. BACKGROUND To determine the appropriateness of and barriers to glaucoma care by optometrists. METHODS A mixed method study was conducted. Phase I was a retrospective cross-sectional medical record audit that assessed glaucoma care appropriateness against 37 clinical indicators from a nationally representative sample of 42 optometry practices. In Phase II, focus groups and interviews involving 31 optometrists explored audit findings to identify barriers to appropriate glaucoma care. Barriers were analysed by deductive and inductive qualitative analysis. Saliency analysis was used to identify key domains that influence glaucoma care. RESULTS Appropriate glaucoma care was delivered for 63% (95% CI 61%, 64%) of the 420 patient encounters audited. Appropriate care was delivered above 80% for most (57%) indicators, while 14 (38%) indicators were delivered below 60% appropriateness. Good compliance to appropriate care was noted for key indicators of intraocular pressure measurement (90%, 95% CI 87%, 93%) and optic nerve head/retinal nerve fibre layer imaging (78%, 95% CI 74%, 82%). Important barriers identified were beliefs about expected outcomes, lack of perceived relevancy, time constraints, poor organisational culture, knowledge gaps, focusing on some aspects of glaucoma care to the detriment of others, the complexity of glaucoma care, information recall, and social norms. CONCLUSION Glaucoma care was appropriate in most patient encounters, with opportunity to improve some aspects of history taking and physical examinations. Barriers to glaucoma care were diverse, existing at both the practitioner and organisational levels. These findings provide direction for the development of a tailored improvement intervention.
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Affiliation(s)
- Melinda Toomey
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Kam Chun Ho
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Population Health Research Unit, Singapore Eye Research Institute, Singapore, Singapore
| | - Rajendra Gyawali
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Louise Wiles
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,Iimpact in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Peter Hibbert
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,Iimpact in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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18
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Poelman HJ, Pals J, Rostamzad P, Bramer WM, Wolfs RCW, Ramdas WD. Efficacy of the XEN-Implant in Glaucoma and a Meta-Analysis of the Literature. J Clin Med 2021; 10:jcm10051118. [PMID: 33800112 PMCID: PMC7962186 DOI: 10.3390/jcm10051118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022] Open
Abstract
Background: To assess the efficacy of XEN-implant surgery in patients with glaucoma, and to perform a meta-analysis of previously published results and compare these to our data. Methods: Prospective case-control study, in which all eyes that underwent XEN-implant surgery were included from 2015 onwards. Sub-analyses were performed for eyes that underwent XEN-implant as standalone procedure and as cataract-combined procedure. To compare our results, a systematic review was performed using the Embase, PubMed, Web of Science, and Cochrane database. Meta-analyses were performed by combining data (intraocular pressure (IOP), IOP-lowering medication, and complications) from the retrieved studies. Results: A total of 221 eyes underwent XEN-implant surgery (124 standalone and 97 cataract-combined). The mean ± standard deviation IOP declined from 18.8 ± 6.5 to 13.5 ± 4.3 mmHg at the last follow-up (p < 0.001; 28.9%). Postoperative, no significant differences in IOP or IOP-lowering medication were found between patients with and without combined procedure. Secondary surgeries were performed in 20.8% of eyes, most of them (63.0%) within six months. A meta-analysis of 19 studies retrieved from the systematic review showed a two-years postoperative pooled mean (weighted mean difference) of 14.5 (7.3) mmHg and 1.0 (1.6) for IOP and IOP-lowering medications, respectively (compared to 13.5 (5.3) mmHg and 3.2 (2.4) in the current study). Conclusion: XEN-implant surgery was effective and safe in lowering IOP and the number of IOP-lowering medications. There were no differences between standalone and combined procedures.
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Affiliation(s)
- Huub J. Poelman
- Department of Ophthalmology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands; (H.J.P.); (J.P.); (P.R.); (R.C.W.W.)
| | - Jan Pals
- Department of Ophthalmology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands; (H.J.P.); (J.P.); (P.R.); (R.C.W.W.)
| | - Parinaz Rostamzad
- Department of Ophthalmology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands; (H.J.P.); (J.P.); (P.R.); (R.C.W.W.)
| | - Wichor M. Bramer
- Medical Library, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands;
| | - Roger C. W. Wolfs
- Department of Ophthalmology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands; (H.J.P.); (J.P.); (P.R.); (R.C.W.W.)
| | - Wishal D. Ramdas
- Department of Ophthalmology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands; (H.J.P.); (J.P.); (P.R.); (R.C.W.W.)
- Correspondence: ; Tel.: +31-10-7033691
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19
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Lee CS, Lee ML, Yanagihara RT, Lee AY. Predictors of narrow angle detection rate-a longitudinal study of Massachusetts residents over 1.7 million person years. Eye (Lond) 2021; 35:952-958. [PMID: 32494044 PMCID: PMC8027027 DOI: 10.1038/s41433-020-1003-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/14/2020] [Accepted: 05/21/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES To determine the predictors of narrow angle detection in a United States population-based cohort. MATERIALS AND METHODS This was a retrospective cohort study using the Massachusetts All-Payer Claims Database. Demographic information of all patients and eye care provider information during the years 2011-2015 were extracted from Massachusetts All Payers Claims Data. All payers who received eye care during 1/1/2012-12/31/2015 without any previous eye visit during 2011 were included in the analyses. Laser peripheral iridotomy was identified by Current Procedural Terminology code 66761. Narrow angle detection was defined as the diagnosis of narrow angles by diagnosis code followed by a laser peripheral iridotomy procedure. Different predictors of narrow angle detection were evaluated using Kaplan-Meier curves with the log rank and Cox regression modeling. RESULTS A total of 1,082,144 patients were included. The hazard ratio of narrow angle detection increased with age compared to the reference group of 0-10 years: 21-30 years of age (hazard ratio = 4.5), 31-40 (10.5), 41-50 (27.9), 51-60 (46.1), 61-70 (68.4), 71-80 (56.8) (all p < 0.0002), was 1.47 times higher in women and 1.85 times higher if evaluated by ophthalmologists compared to optometrists, after controlling for provider × time interaction. CONCLUSION Older age and female sex are associated with narrow angles. The rate of narrow angle detection was significantly higher if patients are seen by ophthalmologists compared to optometrists only. Evaluation with an ophthalmologist may be important for patients at high risks for developing primary angle closure glaucoma.
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Affiliation(s)
- Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA.
| | - Michael L Lee
- Department of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Ryan T Yanagihara
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
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20
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Poelman HJ, Wolfs RCW, Ramdas WD. The Baerveldt Glaucoma Drainage Device: Efficacy, Safety, and Place in Therapy. Clin Ophthalmol 2020; 14:2789-2797. [PMID: 33061263 PMCID: PMC7522304 DOI: 10.2147/opth.s219271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/27/2020] [Indexed: 12/25/2022] Open
Abstract
Objective This review summarizes published findings concerning the Baerveldt-350 glaucoma drainage device (GDD). Most studies focus on the comparison between different treatments; in this review, the primary focus is efficacy, safety, and place in therapy for the Baerveldt implant. Methods A systematic review was performed using the PubMed database for literature on March 13th, 2020. Efficacy was estimated by performing multiple meta-analyses to calculate the weighted mean difference in intraocular pressure (IOP) and IOP-lowering medication after surgery. In order to get an indication of the safety of the Baerveldt implant, all recorded peri- and postoperative complication were summarized. Results A total of 21 studies, including 12 randomized controlled trials, were included with a follow-up up to 5 years, covering a mix of glaucoma types. At the last follow-up point, at 5 years postoperative, the mean (95% confidence interval) reduction in IOP was 15.57 mmHg (14.43-16.71) and the mean (95% confidence interval) reduction in IOP-lowering medication after surgery was 1.81 (1.61-2.01). Most frequently observed postoperative complications were corneal edema (2-34%) and tube complications (4-33%). Rates of required re-intervention ranged from 0% to 51% across all included studies. Conclusion The efficacy of the Baerveldt implant is a significant reduction in IOP in the long term. The safety profile of the Baerveldt implant in terms of complication incidence is similar to those reported for other GDD's. For treatment of secondary glaucoma, we suggest the Baerveldt (or any other similar GDD) as the choice of treatment in patients where highest IOP reduction is desired.
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Affiliation(s)
- Huub J Poelman
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Roger C W Wolfs
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Wishal D Ramdas
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands
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21
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Gandara-Loe J, Souza BE, Missyul A, Giraldo G, Tan JC, Silvestre-Albero J. MOF-Based Polymeric Nanocomposite Films as Potential Materials for Drug Delivery Devices in Ocular Therapeutics. ACS APPLIED MATERIALS & INTERFACES 2020; 12:30189-30197. [PMID: 32530261 DOI: 10.1021/acsami.0c07517] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Novel MOF-based polymer nanocomposite films were successfully prepared using Zr-based UiO-67 as a metal-organic framework (MOF) and polyurethane (PU) as a polymeric matrix. Synchrotron X-ray powder diffraction (SXRPD) analysis confirms the improved stability of the UiO-67 embedded nanocrystals, and scanning electron microscopy images confirm their homogeneous distribution (average crystal size ∼100-200 nm) within the 50 μm thick film. Accessibility to the inner porous structure of the embedded MOFs was completely suppressed for N2 at cryogenic temperatures. However, ethylene adsorption measurements at 25 °C confirm that at least 45% of the MOF crystals are fully accessible for gas-phase adsorption of nonpolar molecules. Although this partial blockage limits the adsorption performance of the embedded MOFs for ocular drugs (e.g., brimonidine tartrate) compared to the pure MOF, an almost 60-fold improvement in the adsorption capacity was observed for the PU matrix after incorporation of the UiO-67 nanocrystals. The UiO-67@PU nanocomposite exhibits a prolonged release of brimonidine (up to 14 days were quantified). Finally, the combined use of SXRPD, thermogravimetric analysis (TGA), and Fourier transform infrared (FTIR) analyses confirmed the presence of the drug in the nanocomposite film, the stability of the MOF framework and the drug upon loading, and the presence of brimonidine in an amorphous phase once adsorbed. These results open the gate toward the application of these polymeric nanocomposite films for drug delivery in ocular therapeutics, either as a component of a contact lens, in the composition of lacrimal stoppers (e.g., punctal plugs), or in subtenon inserts.
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Affiliation(s)
- J Gandara-Loe
- Laboratorio de Materiales Avanzados, Departamento de Química Inorgánica-IUMA, Universidad de Alicante, E-03690 San Vicente del Raspeig, Spain
| | - B E Souza
- Multifunctional Materials & Composites (MMC) Laboratory, Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, U.K
| | - A Missyul
- CELLS-ALBA Synchrotron, E-08290 Cerdanyola del Vallés, Spain
| | - G Giraldo
- Clínica Clofan, Carrera 48 # 19 A 40, Medellín, Colombia
| | - J-C Tan
- Multifunctional Materials & Composites (MMC) Laboratory, Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, U.K
| | - J Silvestre-Albero
- Laboratorio de Materiales Avanzados, Departamento de Química Inorgánica-IUMA, Universidad de Alicante, E-03690 San Vicente del Raspeig, Spain
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22
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Natural Ergot Alkaloids in Ocular Pharmacotherapy: Known Molecules for Novel Nanoparticle-Based Delivery Systems. Biomolecules 2020; 10:biom10070980. [PMID: 32630018 PMCID: PMC7408209 DOI: 10.3390/biom10070980] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 02/06/2023] Open
Abstract
Several pharmacological properties are attributed to ergot alkaloids as a result of their antibacterial, antiproliferative, and antioxidant effects. Although known for their biomedical applications (e.g., for the treatment of glaucoma), most ergot alkaloids exhibit high toxicological risk and may even be lethal to humans and animals. Their pharmacological profile results from the structural similarity between lysergic acid-derived compounds and noradrenalin, dopamine, and serotonin neurotransmitters. To reduce their toxicological risk, while increasing their bioavailability, improved delivery systems were proposed. This review discusses the safety aspects of using ergot alkaloids in ocular pharmacology and proposes the development of lipid and polymeric nanoparticles for the topical administration of these drugs to enhance their therapeutic efficacy for the treatment of glaucoma.
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Deep learning assisted detection of glaucomatous optic neuropathy and potential designs for a generalizable model. PLoS One 2020; 15:e0233079. [PMID: 32407355 PMCID: PMC7224540 DOI: 10.1371/journal.pone.0233079] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 04/28/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate ways to improve the generalizability of a deep learning algorithm for identifying glaucomatous optic neuropathy (GON) using a limited number of fundus photographs, as well as the key features being used for classification. Methods A total of 944 fundus images from Taipei Veterans General Hospital (TVGH) were retrospectively collected. Clinical and demographic characteristics, including structural and functional measurements of the images with GON, were recorded. Transfer learning based on VGGNet was used to construct a convolutional neural network (CNN) to identify GON. To avoid missing cases with advanced GON, an ensemble model was adopted in which a support vector machine classifier would make final classification based on cup-to-disc ratio if the CNN classifier had low-confidence score. The CNN classifier was first established using TVGH dataset, and then fine-tuned by combining the training images of TVGH and Drishti-GS datasets. Class activation map (CAM) was used to identify key features used for CNN classification. Performance of each classifier was determined through area under receiver operating characteristic curve (AUC) and compared with the ensemble model by diagnostic accuracy. Results In 187 TVGH test images, the accuracy, sensitivity, and specificity of the CNN classifier were 95.0%, 95.7%, and 94.2%, respectively, and the AUC was 0.992 compared to the 92.8% accuracy rate of the ensemble model. For the Drishti-GS test images, the accuracy of the CNN, the fine-tuned CNN and ensemble model was 33.3%, 80.3%, and 80.3%, respectively. The CNN classifier did not misclassify images with moderate to severe diseases. Class-discriminative regions revealed by CAM co-localized with known characteristics of GON. Conclusions The ensemble model or a fine-tuned CNN classifier may be potential designs to build a generalizable deep learning model for glaucoma detection when large image databases are not available.
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Porporato N, Baskaran M, Husain R, Aung T. Recent advances in anterior chamber angle imaging. Eye (Lond) 2020; 34:51-59. [PMID: 31666710 PMCID: PMC7002644 DOI: 10.1038/s41433-019-0655-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/09/2019] [Indexed: 02/06/2023] Open
Abstract
Differentiating the two main forms of primary glaucoma (open-angle and closed-angle glaucoma) depends on the correct assessment of the anterior chamber angle (ACA). This assessment will determine the management plan and prognosis for the disease. The standard method of examining the angle has been, for many years, slit-lamp gonioscopy. This method, although clinically still useful, is less robust for patient follow up and clinical research, given its low reproducibility. Several imaging technologies have been developed in recent years to improve the evaluation of the ACA and overcome the shortcomings of gonioscopy. These recent advances include three-dimensional and 360° analysis by Swept-Source OCT (SS-OCT, CASIA, Tomey, Nagoya, Japan), the introduction of deep learning algorithms for automatic imaging classification and new goniophotographic systems. SS-OCT allows for the first time the assessment of the circumferential extension of angle closure with moderate to good diagnostic performance compared with gonioscopy. Deep learning algorithms are showing promising results for the automation of imaging analysis, and may potentially save physicians' time in regards of the interpretation of the images. Lastly, goniophotograph systems have the distinct advantage of recordability of gonioscopic findings and are most closely matched to the findings of slit-lamp gonioscopy.
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Affiliation(s)
- Natalia Porporato
- Singapore Eye Research Institute/Singapore National Eye Center, Singapore, Singapore
| | - Mani Baskaran
- Singapore Eye Research Institute/Singapore National Eye Center, Singapore, Singapore
| | - Rahat Husain
- Singapore Eye Research Institute/Singapore National Eye Center, Singapore, Singapore
| | - Tin Aung
- Singapore Eye Research Institute/Singapore National Eye Center, Singapore, Singapore.
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Shi Y, Yang X, Marion KM, Francis BA, Sadda SR, Chopra V. Novel and Semiautomated 360-Degree Gonioscopic Anterior Chamber Angle Imaging in Under 60 Seconds. ACTA ACUST UNITED AC 2019; 2:215-223. [DOI: 10.1016/j.ogla.2019.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/25/2019] [Accepted: 04/01/2019] [Indexed: 11/26/2022]
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Yadav KS, Sharma S. Implantable drainage devices in glaucoma: Quo vadis? Eur J Pharm Sci 2019; 133:1-7. [DOI: 10.1016/j.ejps.2019.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/28/2019] [Accepted: 03/10/2019] [Indexed: 10/27/2022]
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Yadav KS, Rajpurohit R, Sharma S. Glaucoma: Current treatment and impact of advanced drug delivery systems. Life Sci 2019; 221:362-376. [PMID: 30797820 DOI: 10.1016/j.lfs.2019.02.029] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/04/2019] [Accepted: 02/12/2019] [Indexed: 01/02/2023]
Abstract
The human eye being a complex and a very sensitive organ makes the drug delivery task challenging. An increase in the intra-ocular pressure at the aqueous humour leads to glaucoma which is not only indecipherable but can also be the reason of blindness for many. The presently available marketed formulations using anti-glaucoma drugs have issues of either difficulty in crossing the blood- retinal barrier or lower systemic bioavailability. Hence, the drugs having lower therapeutic index would need to be administered frequently, which eventually lead to deposition of concentrated solutions at ocular site, producing toxic effects and cellular damage to the eye. To overcome these drawbacks the novel drug delivery systems like In-situ gels, liposomes, niosomes, hydrogel, dendrimers, nanoparticles, solid lipid nanoparticles, Microneedles or ocular inserts play an important role to enhance the therapeutic efficacy of the anti-glaucomic drugs. The present review briefs the current treatments in terms of drugs used and in detail the impact of utilizing the above mentioned novel drug delivery systems in the treatment of glaucoma.
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Affiliation(s)
- Khushwant S Yadav
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS Deemed to be University, Mumbai, Maharashtra, India.
| | - Rahul Rajpurohit
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS Deemed to be University, Mumbai, Maharashtra, India
| | - Sushmita Sharma
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS Deemed to be University, Mumbai, Maharashtra, India
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Teixeira F, Sousa DC, Leal I, Barata A, Neves CM, Pinto LA. Automated gonioscopy photography for iridocorneal angle grading. Eur J Ophthalmol 2018; 30:112-118. [PMID: 30360660 DOI: 10.1177/1120672118806436] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of this study is to assess the agreement between manual and automated gonioscopy for iridocorneal angle opening. METHODS The research is a cross-sectional observational study. Manual and automated gonioscopy were performed to consecutive patients in a glaucoma clinic. Iridocorneal angle opening grading was performed according to Shaffer's classification. Automated gonioscopy was performed with NGS-1 automated gonioscope (NIDEK Co., Gamagori, Japan). The automated gonio-photos were graded by two independent observers. Agreement between automated and manual gonioscopy and also among raters was ascertained by Fleiss' kappa statistic and comparison of area under curve. RESULTS In total, 88 eyes of 47 subjects were analysed. Mean age was 63 ± 10 years. Twenty eyes (22.7%) were excluded from grading due to poor quality images. Angle closure was detected in 23.4% with dynamic gonioscopy in comparison with 4.3% using automated image grading. The agreement for angle closure diagnosis between dynamic and automated gonioscopy was low (κ = 0.09 ± 0.10; p = 0.18). The area under curve for detecting eyes with angle closure showed poor accuracy between automated and manual methods (area under curve: 0.53 ± 0.05, 95% confidence interval: 0.44-0.62). There was modest inter-rater agreement for angle opening assessment of automated images with Fleiss' kappa of 0.17 (95% confidence interval: 0.035-0.238). CONCLUSION Manual and automated gonioscopy showed only slight agreement for the assessment of iridocorneal angle opening status. Further improvements of the NGS-1 automated gonioscopy and technique are desired for widespread use in a real-life setting.
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Affiliation(s)
- Filipa Teixeira
- Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.,Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - David C Sousa
- Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.,Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Centro de Estudos Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Inês Leal
- Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.,Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Centro de Estudos Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - André Barata
- Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.,Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Carlos M Neves
- Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.,Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Centro de Estudos Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Luís A Pinto
- Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.,Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Centro de Estudos Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Chansangpetch S, Rojanapongpun P, Lin SC. Anterior Segment Imaging for Angle Closure. Am J Ophthalmol 2018; 188:xvi-xxix. [PMID: 29352976 DOI: 10.1016/j.ajo.2018.01.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 01/01/2018] [Accepted: 01/05/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To summarize the role of anterior segment imaging (AS-imaging) in angle closure diagnosis and management, and the possible advantages over the current standard of gonioscopy. DESIGN Literature review and perspective. METHODS Review of the pertinent publications with interpretation and perspective in relation to the use of AS-imaging in angle closure assessment focusing on anterior segment optical coherence tomography and ultrasound biomicroscopy. RESULTS Several limitations have been encountered with the reference standard of gonioscopy for angle assessment. AS-imaging has been shown to have performance in angle closure detection compared to gonioscopy. Also, imaging has greater reproducibility and serves as better documentation for long-term follow-up than conventional gonioscopy. The qualitative and quantitative information obtained from AS-imaging enables better understanding of the underlying mechanisms of angle closure and provides useful parameters for risk assessment and possible prediction of the response to laser and surgical intervention. The latest technologies-including 3-dimensional imaging-have allowed for the assessment of the angle that simulates the gonioscopic view. These advantages suggest that AS-imaging has a potential to be a reference standard for the diagnosis and monitoring of angle closure disease in the future. CONCLUSIONS Although gonioscopy remains the primary method of angle assessment, AS-imaging has an increasing role in angle closure screening and management. The test should be integrated into clinical practice as an adjunctive tool for angle assessment. It is arguable that AS-imaging should be considered first-line screening for patients at risk for angle closure.
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Affiliation(s)
- Sunee Chansangpetch
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Department of Ophthalmology, University of California, San Francisco Medical School, San Francisco, California
| | - Prin Rojanapongpun
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Shan C Lin
- Department of Ophthalmology, University of California, San Francisco Medical School, San Francisco, California.
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Schaefer JL, Meyer AM, Rodgers CD, Rosenberg NC, Leoncavallo AJ, Lukowski ZL, Greer AB, Martorana GM, Zou B, Shuster JJ, Jay Katz L, Schuman JS, Kass MA, Sherwood MB. Comparing glaucomatous disc change using stereo disc viewing and the MatchedFlicker programme in glaucoma experts and trainees. Br J Ophthalmol 2017; 102:358-363. [PMID: 28814418 DOI: 10.1136/bjophthalmol-2017-310336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/17/2017] [Accepted: 06/19/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS The objective of this study is to evaluate the accuracy and speed of trainees and experienced glaucoma specialists using the MatchedFlicker software against the manual examination of stereoscopic disc photographs for detecting glaucomatous optic disc change. METHODS Three experienced glaucoma specialists, two resident ophthalmologists and one glaucoma fellow from multiple institutions independently evaluated the same 140 image pairs from 100 glaucomatous/ocular hypertensive eyes using a handheld stereo viewer and the MatchedFlicker programme. Fifty had progression to glaucoma as determined by the Ocular Hypertension Treatment Study (OHTS) Optic Disc Reading Group and endpoint committee, and 50 more were negative controls for progression with photos taken a few minutes apart. Twenty photo pairs from each of the two groups were duplicated for reviewer variability analysis. The initial viewing method was randomised and then alternated for each group of 70 image pairs. Reviewer accuracy and evaluation time for each method were measured. RESULTS Evaluators averaged 8.6 s faster per image pair (26%) with the MatchedFlicker programme than with the stereo viewer (p=0.0007). Evaluators correctly identified more image pairs when using the MatchedFlicker software over the stereo viewer (p=0.0003). There was no significant difference between the expert and trainee group in speed or overall accuracy for either method. Experts were significantly more consistent than trainees with the duplicate image pairs (p=0.029). Trainees appeared more reluctant to designate eyes as showing glaucoma progression than experts. CONCLUSIONS Both expert glaucoma specialists and ophthalmologists in various stages of training had greater accuracy and speed with the MatchedFlicker programme than with a handheld stereoscopic viewer.
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Affiliation(s)
- Jamie L Schaefer
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA.,Department of Ophthalmology, University at Buffalo, Ross Eye Institute, Buffalo, New York, USA
| | - Alissa M Meyer
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Cooper D Rodgers
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Nicole C Rosenberg
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | | | - Zachary L Lukowski
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Anthony B Greer
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Gina M Martorana
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Baiming Zou
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Jonathan J Shuster
- Department of Health Outcomes and Policy, University of Florida, Gainesville, Florida, USA
| | - L Jay Katz
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joel S Schuman
- Department of Ophthalmology, New York University, New York City, New York, USA
| | - Michael A Kass
- Department of Ophthalmology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mark B Sherwood
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
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Murakami Y, Wang D, Burkemper B, Lin SC, Varma R. A Population-Based Assessment of the Agreement Between Grading of Goniophotographic Images and Gonioscopy in the Chinese-American Eye Study (CHES). Invest Ophthalmol Vis Sci 2017; 57:4512-6. [PMID: 27571018 PMCID: PMC5015969 DOI: 10.1167/iovs.15-18434] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose To compare grading of goniophotographic images and gonioscopy in assessing the iridocorneal angle. Methods In a population-based, cross-sectional study, participants underwent gonioscopy and goniophotographic imaging during the same visit. The iridocorneal angle was classified as closed if the posterior trabecular meshwork could not be seen. A single masked observer graded the goniophotographic images, and each eye was classified as having angle closure based on the number of closed quadrants. Agreement between the methods was analyzed by calculating kappa (κ) and first-order agreement coefficient (AC1) statistics and comparison of area under receiver operating characteristic curves (AUC). Results A total of 4149 Chinese Americans (3994 eyes) were included in this study. The agreement for angle closure diagnosis between gonioscopy and EyeCam was moderate to excellent (κ = 0.60, AC1 0.90, AUC 0.76–0.80). Conclusions Detection of iridocorneal angle closure based on goniophotographic imaging shows moderate to very good agreement with angle closure assessment using gonioscopy.
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Affiliation(s)
- Yohko Murakami
- University of Southern California Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, United States 2University of California, San Francisco, Department of Ophthalmology, San Francisco, California, United States
| | - Dandan Wang
- University of Southern California Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Bruce Burkemper
- University of Southern California Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Shan C Lin
- University of California, San Francisco, Department of Ophthalmology, San Francisco, California, United States
| | - Rohit Varma
- University of Southern California Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
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A comparison of cup-to-disc ratio estimates by fundus biomicroscopy and stereoscopic optic disc photography in the Tema Eye Survey. Eye (Lond) 2017; 31:1184-1190. [PMID: 28387768 DOI: 10.1038/eye.2017.50] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 02/09/2017] [Indexed: 11/08/2022] Open
Abstract
PurposeTo determine if there are systematic differences in cup-to-disc ratio (CDR) grading using fundus biomicroscopy compared to stereoscopic disc photograph reading.MethodsThe vertical cup-to-disc ratio (VCDR) and horizontal cup-to-disc ratio (HCDR) of 2200 eyes (testing set) were graded by glaucoma subspecialists through fundus biomicroscopy and by a reading center using stereoscopic disc photos. For validation, the glaucoma experts also estimated VCDR and HCDR using stereoscopic disc photos in a subset of 505 eyes that they had assessed biomicroscopically. Agreement between grading methods was assessed with Bland-Altman plots.ResultsIn both sets, photo reading tended to yield small CDRs marginally larger, but read large CDRs marginally smaller than fundus biomicroscopy. The mean differences in VCDR and HCDR were 0.006±0.18 and 0.05±0.18 (testing set), and -0.053±0.23 and -0.028±0.21 (validation set), respectively. The limits of agreement were ~0.4, which is twice as large as the cutoff of clinically significant CDR difference between methods. CDR estimates differed by 0.2 or more in 33.8-48.7% between methods.ConclusionsThe differences in CDR estimates between fundus biomicroscopy and stereoscopic optic disc photo reading showed a wide variation, and reached clinically significance threshold in a large proportion of patients, suggesting a poor agreement. Thus, glaucoma should be monitored by comparing baseline and subsequent CDR estimates using the same method rather than comparing photographs to fundus biomicroscopy.
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Resident Compliance With the American Academy of Ophthalmology Preferred Practice Patterns for Primary Open-Angle Glaucoma Suspect. J Glaucoma 2016; 25:963-967. [DOI: 10.1097/ijg.0000000000000548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schaefer JL, Lukowski ZL, Meyer AM, Leoncavallo AJ, Greer A, Martorana GM, Zou B, Shuster JJ, Sherwood MB. Comparing Glaucomatous Disc Change Using Stereo Disc Viewing and the MatchedFlicker Software Program in Ophthalmologists-in-Training. Am J Ophthalmol 2016; 167:88-95. [PMID: 27038890 PMCID: PMC5697426 DOI: 10.1016/j.ajo.2016.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/21/2016] [Accepted: 03/23/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the accuracy and speed of using the computerized MatchedFlicker software program (EyeIC Inc, Narberth, Pennsylvania, USA) to evaluate glaucomatous optic disc change against the traditional gold standard of manually examining stereoscopic disc photographs. DESIGN A prospective evaluation of diagnostic technology. METHODS Two resident ophthalmologists and 1 glaucoma fellow at the University of Florida independently evaluated 140 image pairs from 100 glaucomatous/ocular hypertensive patient eyes using a handheld stereo viewer and the MatchedFlicker program. Fifty had progression to glaucoma as determined by the Ocular Hypertension Treatment Study (OHTS) Optic Disc Reading Group and the OHTS Endpoint Committee in the OHTS, and 50 more had photographs taken a few minutes apart, which were negative controls with no progression. Twenty photograph pairs from each group were duplicated to determine reviewer variability. Photographs were examined in alternating blocks of 70 photograph pairs for each method, with the starting viewing method randomized. Reviewer accuracy and time to review for each method were measured. RESULTS Using the handheld stereo viewer, the reviewers correctly identified progression or nonprogression in 76.0% of the slide pairs. Using the MatchedFlicker software, 87.6% were correctly identified (P = .011). Evaluator speed averaged 34.1 seconds per image pair with the stereo viewer vs 24.9 seconds with the MatchedFlicker program (P = .044). Overall, Flicker was significantly more specific but less sensitive than stereo slides. Trainees appeared more reluctant to identify glaucoma progression from slides than from Flicker. For the 2 less experienced trainees Flicker was significantly more accurate. CONCLUSION The MatchedFlicker software had a greater accuracy and was quicker to perform than using a handheld stereoscopic viewer.
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Affiliation(s)
- Jamie L Schaefer
- University of Florida, Department of Ophthalmology, Gainesville, Florida; Ross Eye Institute, University at Buffalo, Department of Ophthalmology, Buffalo, New York
| | - Zachary L Lukowski
- University of Florida, Department of Ophthalmology, Gainesville, Florida
| | - Alissa M Meyer
- University of Florida, Department of Ophthalmology, Gainesville, Florida
| | | | - Anthony Greer
- University of Florida, Department of Ophthalmology, Gainesville, Florida
| | - Gina M Martorana
- University of Florida, Department of Ophthalmology, Gainesville, Florida
| | - Baiming Zou
- University of Florida, Department of Ophthalmology, Gainesville, Florida
| | - Jonathan J Shuster
- University of Florida, Department of Ophthalmology, Gainesville, Florida
| | - Mark B Sherwood
- University of Florida, Department of Ophthalmology, Gainesville, Florida.
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Elam AR, Blachley TS, Stein JD. Geographic Variation in the Use of Diagnostic Testing of Patients with Newly Diagnosed Open-Angle Glaucoma. Ophthalmology 2016; 123:522-31. [DOI: 10.1016/j.ophtha.2015.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/09/2015] [Accepted: 10/09/2015] [Indexed: 11/29/2022] Open
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Fudemberg SJ, Lee B, Waisbourd M, Murphy RA, Dai Y, Leiby BE, Hark LA. Factors contributing to nonadherence to follow-up appointments in a resident glaucoma clinic versus primary eye care clinic. Patient Prefer Adherence 2016; 10:19-25. [PMID: 26811672 PMCID: PMC4712968 DOI: 10.2147/ppa.s89336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine the rate of adherence to follow-up appointment recommendations in a resident glaucoma clinic with no mechanism for reminders, compared to a resident cataract and primary eye care (CPEC) clinic in which telephone reminders were used, and to identify factors that contribute to adherence in each patient group. METHODS This retrospective cohort study included subjects in the CPEC clinic who received telephone reminders and those in the glaucoma clinic who did not. Each sample was selected to have a similar proportion of follow-up recommendations for 1, 3, and 6 months. Subjects were considered adherent if they returned within a specified timeframe. RESULTS A total of 144 subjects from the glaucoma clinic and 151 subjects from the CPEC clinic were included. There was no significant difference between follow-up adherence rates of patients who received telephone reminders and those who did not (odds ratio [OR] =1.35, 95% confidence interval [CI] 0.79-2.32, P=0.28). Patients who were on more than two ocular medications were more likely to return for follow-up (OR=3.11, 95% CI 1.53-6.35, P=0.0018). Subjects between the ages 50 and 80 years were more likely to be adherent compared to their younger and older peers (P=0.02). CONCLUSION The follow-up adherence of patients in a CPEC clinic who received telephone reminders was similar to patients in a glaucoma clinic who did not receive any intervention to increase their adherence. Younger (⩽50 years old) and elderly (⩾80 years old) subjects, as well as patients using less than two glaucoma medications, were less likely to adhere to their follow-up appointments.
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Affiliation(s)
- Scott J Fudemberg
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
- Correspondence: Scott J Fudemberg, Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 1140, Philadelphia, PA 19107, USA, Tel +1 215 928 3197, Fax +1 215 928 3285, Email
| | - Brian Lee
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | | | - Rachel A Murphy
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Yang Dai
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Benjamin E Leiby
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
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Owsley C, Rhodes LA, McGwin G, Mennemeyer ST, Bregantini M, Patel N, Wiley DM, LaRussa F, Box D, Saaddine J, Crews JE, Girkin CA. Eye Care Quality and Accessibility Improvement in the Community (EQUALITY) for adults at risk for glaucoma: study rationale and design. Int J Equity Health 2015; 14:135. [PMID: 26582103 PMCID: PMC4652429 DOI: 10.1186/s12939-015-0213-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/03/2015] [Indexed: 12/30/2022] Open
Abstract
Background Primary open angle glaucoma is a chronic, progressive eye disease that is the leading cause of blindness among African Americans. Glaucoma progresses more rapidly and appears about 10 years earlier in African Americans as compared to whites. African Americans are also less likely to receive comprehensive eye care when glaucoma could be detected before irreversible blindness. Screening and follow-up protocols for managing glaucoma recommended by eye-care professional organizations are often not followed by primary eye-care providers, both ophthalmologists and optometrists. There is a pressing need to improve both the accessibility and quality of glaucoma care for African Americans. Telemedicine may be an effective solution for improving management and diagnosis of glaucoma because it depends on ocular imaging and tests that can be electronically transmitted to remote reading centers where tertiary care specialists can examine the results. We describe the Eye Care Quality and Accessibility Improvement in the Community project (EQUALITY), set to evaluate a teleglaucoma program deployed in retail-based primary eye care practices serving communities with a large percentage of African Americans. Methods/Design We conducted an observational, 1-year prospective study based in two Walmart Vision Centers in Alabama staffed by primary care optometrists. EQUALITY focuses on new or existing adult patients who are at-risk for glaucoma or already diagnosed with glaucoma. Patients receive dilated comprehensive examinations and diagnostic testing for glaucoma, followed by the optometrist’s diagnosis and a preliminary management plan. Results are transmitted to a glaucoma reading center where ophthalmologists who completed fellowship training in glaucoma review results and provide feedback to the optometrist, who manages the care of the patient. Patients also receive eye health education about glaucoma and comprehensive eye care. Research questions include diagnostic and management agreement between providers, the impact of eye health education on patients’ knowledge and adherence to follow-up and medication, patient satisfaction, program cost-effectiveness, and EQUALITY’s impact on Walmart pharmacy prescription rates. Discussion As eye-care delivery systems in the US strive to improve quality while reducing costs, telemedicine programs including teleglaucoma initiatives such as EQUALITY could contribute toward reaching this goal, particularly among underserved populations at-risk for chronic blinding diseases.
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Affiliation(s)
- Cynthia Owsley
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, 700 S. 18th St, Birmingham, AL, 35294-0009, USA.
| | - Lindsay A Rhodes
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, 700 S. 18th St, Birmingham, AL, 35294-0009, USA.
| | - Gerald McGwin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, 700 S. 18th St, Birmingham, AL, 35294-0009, USA. .,Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1655 University Blvd, Birmingham, AL, 35294-0022, USA.
| | - Stephen T Mennemeyer
- Department of Health Care Organization and Policy, School of Public Health, 1655 University Blvd, Birmingham, 35294-0022, USA.
| | - Mary Bregantini
- Prevent Blindness, 211 West Wacker Drive, Suite 1700, Chicago, Il, 60606, USA.
| | - Nita Patel
- Prevent Blindness, 211 West Wacker Drive, Suite 1700, Chicago, Il, 60606, USA.
| | - Demond M Wiley
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, 700 S. 18th St, Birmingham, AL, 35294-0009, USA.
| | - Frank LaRussa
- Walmart Vision Center #1481, Birmingham, AL, 35209, USA.
| | - Dan Box
- Walmart Vision Center #715 and Global Eye Care PC, Tuscaloosa, AL, 35405, USA.
| | - Jinan Saaddine
- Vision Health Initiative, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, 30341-3727, USA.
| | - John E Crews
- Vision Health Initiative, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, 30341-3727, USA.
| | - Christopher A Girkin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, 700 S. 18th St, Birmingham, AL, 35294-0009, USA.
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Zebardast N, Solus JF, Quigley HA, Srikumaran D, Ramulu PY. Comparison of resident and glaucoma faculty practice patterns in the care of open-angle glaucoma. BMC Ophthalmol 2015; 15:41. [PMID: 25879212 PMCID: PMC4403911 DOI: 10.1186/s12886-015-0027-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 03/30/2015] [Indexed: 11/29/2022] Open
Abstract
Background Previous studies suggest there are large variations in adherence of ophthalmologists with the American Academy of Ophthalmology’s Preferred Practice Patterns (PPPs). The purpose of this study was to compare rates of compliance with glaucoma care guidelines between resident and glaucoma faculty physicians at a single institution. Methods Charts of resident continuity clinic or glaucoma faculty patients with primary open angle glaucoma (POAG), ocular hypertension (OHTN), or suspicion of glaucoma were reviewed during the 2005–6 academic year. Performance within care measures specified by the 2005 PPP guidelines was compared between resident and faculty physicians using univariate and multivariable logistic regression models. Results 112 resident and 100 faculty charts were reviewed. The mean compliance rate for all 7 care measures for resident physicians was significantly lower than that of faculty physicians (78% vs. 96%, p < 0.001). As compared to glaucoma faculty, resident physicians were less likely to have documented 6 of the 7 individual care measures (p ≤ 0.001 for all); the exception was optic nerve (ON) description. In multivariable analyses, resident patients were more likely to have at least one undocumented care measure than faculty patients (OR = 10.1, 95% CI = 5.1 to 20.0, p < 0.001). Among resident patients, undocumented care measures were more common among patients with poorer visual acuity (VA) in the better eye. Conclusions Though unmeasured differences in clinic structure and patient characteristics may have partially contributed to poorer resident performance, residents were more likely than faculty to omit PPP care measures and significantly underperformed faculty in global assessment of glaucoma care. Resident education should focus on integration of PPPs into residency training and monitoring of resident compliance with evidence-based guidelines.
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Affiliation(s)
- Nazlee Zebardast
- Wilmer Eye Institute Johns Hopkins University, 600 North Wolfe St. Maumenee B-110, Baltimore, MD, 21287, USA.
| | - Jason F Solus
- Wilmer Eye Institute Johns Hopkins University, 600 North Wolfe St. Maumenee B-110, Baltimore, MD, 21287, USA.
| | - Harry A Quigley
- Wilmer Eye Institute Johns Hopkins University, 600 North Wolfe St. Maumenee B-110, Baltimore, MD, 21287, USA.
| | - Divya Srikumaran
- Wilmer Eye Institute Johns Hopkins University, 600 North Wolfe St. Maumenee B-110, Baltimore, MD, 21287, USA.
| | - Pradeep Y Ramulu
- Wilmer Eye Institute Johns Hopkins University, 600 North Wolfe St. Maumenee B-110, Baltimore, MD, 21287, USA.
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Susanna R, De Moraes CG, Cioffi GA, Ritch R. Why Do People (Still) Go Blind from Glaucoma? Transl Vis Sci Technol 2015; 4:1. [PMID: 25767744 DOI: 10.1167/tvst.4.2.1] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 01/18/2015] [Indexed: 02/03/2023] Open
Affiliation(s)
- Remo Susanna
- Department of Ophthalmology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil
| | | | - George A Cioffi
- Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye & Ear Infirmary of Mount Sinai, New York, NY, USA
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Crabb DP, Russell RA, Malik R, Anand N, Baker H, Boodhna T, Bronze C, Fung SSM, Garway-Heath DF, Glen FC, Hernández R, Kirwan JF, Lemer C, McNaught AI, Viswanathan AC. Frequency of visual field testing when monitoring patients newly diagnosed with glaucoma: mixed methods and modelling. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02270] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundVisual field (VF) tests are the benchmark for detecting and monitoring the eye disease glaucoma. Measurements from VF tests are variable, which means that frequent monitoring, perhaps over a long period of time, is required to accurately detect true glaucomatous progression. In 2009, guidelines for the diagnosis and management of glaucoma issued by the National Institute for Health and Care Excellence revealed an absence of research evidence about the clinical effectiveness and cost-effectiveness of using different monitoring intervals to detect disease progression. However, the European Glaucoma Society (EGS) guidelines on patient examination recommend that newly diagnosed glaucoma patients should undergo VF testing three times per year in the first 2 years after initial diagnosis.ObjectivesThe primary objective of this project was to explore the clinical effectiveness and cost-effectiveness of using different monitoring intervals to detect VF progression in newly diagnosed glaucoma patients. Other objectives sought to (1) explore glaucoma patients’ views and experiences of monitoring using focus groups; and (2) establish glaucoma subspecialists’ attitudes regarding frequency of VF testing using a five-item questionnaire.DesignThese questions were investigated using a multicentre audit of current practice and existing NHS data (VF records from almost 90,000 patients). New research knowledge was provided through statistical and health economic modelling of these and additional published data.ResultsThe multicentre audit showed that VF monitoring is, on average, carried out annually. Patient focus groups indicated that, although patients do not like VF testing, they accept it as a critical part of their care. Patients raised concerns regarding distracting testing environments, quality of instructions, explanation of results and excessive waiting times. Questionnaires revealed that clinicians’ attitudes towards the frequency of VF testing varied considerably, and many glaucoma specialists believed that current recommendations are impractical. Statistical modelling suggested that EGS recommendations could be clinically effective as progression can be identified sooner than is possible with annual testing. Health economic modelling suggested that increased VF monitoring may also be cost-effective [incremental cost-effectiveness ratio (ICER) was equal to £21,679].ConclusionsStatistical modelling of VF data suggests there is strong rationale for following EGS recommendations with the primary benefit of providing better information about fast-progressing patients. Our health economic model suggested that increasing VF testingmaybe cost-effective (ICER was equal to £21,679), especially when accounting for gains to society. Nevertheless, many clinicians consider increased VF testing of patients impossible with current resources. In addition, patient focus groups raised concerns about the practicalities of delivery of VF tests.Future workResults from this study could inform the design of a prospective randomised comparative trial of different VF monitoring intervals in glaucoma linked to stratifying patients according to risk factors for progression. The statistical model for VF data can be further developed to be used as a practical tool for optimising individualised follow-up. The views of clinicians and patients indicate that service delivery of VF testing is an important issue and worthy of further investigation. Ensuring the confidence and co-operation of the patient should be at the centre of future research into the most efficient strategies for glaucoma monitoring.FundingThis work was funded by the National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- David P Crabb
- Division of Optometry and Visual Science, School of Health Sciences, City University London, London, UK
| | - Richard A Russell
- Division of Optometry and Visual Science, School of Health Sciences, City University London, London, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Rizwan Malik
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Nitin Anand
- Department of Ophthalmology, Calderdale and Huddersfield NHS Trust, Calderdale and Huddersfield Royal Infirmaries, Halifax and Huddersfield, UK
| | - Helen Baker
- Division of Optometry and Visual Science, School of Health Sciences, City University London, London, UK
| | - Trishal Boodhna
- Division of Optometry and Visual Science, School of Health Sciences, City University London, London, UK
| | | | - Simon SM Fung
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - David F Garway-Heath
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Fiona C Glen
- Division of Optometry and Visual Science, School of Health Sciences, City University London, London, UK
| | - Rodolfo Hernández
- Health Services Research Unit, University of Aberdeen and Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - James F Kirwan
- Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, UK
| | | | - Andrew I McNaught
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, and Cranfield University, Bedford, UK
| | - Ananth C Viswanathan
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Campbell RJ, Bell CM, Gill SS, Whitehead M, Campbell EDLP, Xu K, El-Defrawy SR. Clinic-based glaucoma care in the era of surgical subspecialization. Am J Ophthalmol 2014; 157:631-9.e1-2. [PMID: 24321471 DOI: 10.1016/j.ajo.2013.11.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 11/14/2013] [Accepted: 11/22/2013] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the impact of surgeon practice profile on clinic-based glaucoma care. DESIGN Population-based study of glaucoma care patterns in Ontario, Canada from 2000-2010. METHODS Using comprehensive physician services data from the Ontario Health Insurance Plan database, ophthalmologists were divided into 5 surgical practice subgroups. The role of each subgroup in the provision of glaucoma care was evaluated. Consultations and office visits were used to assess nonsurgical care, while laser trabeculoplasty procedures were used to assess clinic-based procedural care. RESULTS Between 2000 and 2010, the population rate of glaucoma consultations and follow-up visits provided by ophthalmologists who do not perform incisional glaucoma surgery increased at average annual rates of 1.6% (P < .0002) and 3.3% (P < .0001), respectively. In contrast, no significant growth in the rate of glaucoma consultations or follow-up visits provided by glaucoma surgeons was observed (0.8%/year [P = .2] for consultations; 0.2%/year [P = .6] for follow-up visits). Between 2000 and 2010, the rate of laser trabeculoplasty procedures provided by ophthalmologists who do not perform incisional glaucoma surgery increased 19.3% annually (P < .0001), while growth among glaucoma surgeons was more modest (annual growth of 9.2% [P = .0002]). CONCLUSIONS While subspecialization is a growing reality in most areas of medicine, we found that the provision of clinic-based glaucoma care remains dependent on ophthalmologists who do not perform incisional glaucoma surgery. With increasing focus on integrated care, these findings will have important implications for residency education programs and their accrediting bodies and will inform decisions of health care policymakers, hospitals, and academic departments.
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Affiliation(s)
- Robert J Campbell
- Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada; Department of Ophthalmology, Hotel Dieu and Kingston General Hospitals, Kingston, Ontario, Canada; Institute for Clinical Evaluative Sciences - Queen's University Site, Queen's University, Kingston, Ontario, Canada.
| | - Chaim M Bell
- Institute for Clinical Evaluative Sciences - Sunnybrook Site, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Sudeep S Gill
- Division of Geriatric Medicine, Queen's University, Kingston, Ontario, Canada; Institute for Clinical Evaluative Sciences - Queen's University Site, Queen's University, Kingston, Ontario, Canada; Division of Geriatric Medicine, St. Mary's of the Lake Hospital, Kingston, Ontario, Canada
| | - Marlo Whitehead
- Institute for Clinical Evaluative Sciences - Queen's University Site, Queen's University, Kingston, Ontario, Canada; Queen's University, Kingston, Ontario, Canada
| | - Erica de L P Campbell
- Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada; Department of Ophthalmology, Hotel Dieu and Kingston General Hospitals, Kingston, Ontario, Canada
| | - Kunyong Xu
- Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada; Department of Ophthalmology, Hotel Dieu and Kingston General Hospitals, Kingston, Ontario, Canada
| | - Sherif R El-Defrawy
- Department of Ophthalmology, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, Kensington Eye Institute, Toronto, Ontario, Canada
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Ong SS, Sanka K, Mettu PS, Brosnan TM, Stinnett SS, Lee PP, Challa P. Resident compliance with the american academy of ophthalmology preferred practice pattern guidelines for primary open-angle glaucoma. Ophthalmology 2013; 120:2462-2469. [PMID: 23916487 DOI: 10.1016/j.ophtha.2013.05.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 05/17/2013] [Accepted: 05/21/2013] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To examine resident adherence to preferred practice pattern (PPP) guidelines set up by the American Academy of Ophthalmology for follow-up care of primary open-angle glaucoma (POAG) patients. DESIGN Retrospective chart review. PARTICIPANTS One hundred three charts were selected for analysis from all patients with an International Classification of Diseases, Ninth Revision, code of open-angle glaucoma or its related entities who underwent a follow-up evaluation between July 2, 2003, and December 15, 2004, at the resident ophthalmology clinic in the Durham Veteran Affairs Medical Center. METHODS Follow-up visits of POAG patients were evaluated for documentation of 19 elements in accordance to PPP guidelines. MAIN OUTCOME MEASURES Compliance rates for the 19 elements of PPP guidelines first were averaged in all charts, and then were averaged per resident and were compared among 8 residents between their first and second years of residency. RESULTS The overall mean compliance rate for all 19 elements was 82.6% for all charts (n = 103), 78.8% for first-year residents, and 81.7% for second-year residents. The increase from first to second year of residency was not significant (P>0.05). Documentation rates were high (>90%) for 14 elements, including all components of the physical examination and follow-up as well as most components of the examination history and management plan. Residents documented adjusting target intraocular pressure downward, local or systemic problems with medications, and impact of visual function on daily living approximately 50% to 80% of the time. Documentation rates for components of patient education were the lowest, between 5% and 16% in all charts. CONCLUSIONS Residents' compliance with PPP guidelines for a POAG follow-up visit was very high for most elements, but documentation rates for components of patient education were poor. Adherence rates to PPP guidelines can be used as a tool to evaluate and improve resident performance during training. However, further studies are needed to establish the advantages of using PPP guidelines for resident education and to determine if such assessments can lead to improved patient care.
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Affiliation(s)
- Sally S Ong
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina; Duke-NUS Graduate Medical School, Singapore, Republic of Singapore
| | - Krishna Sanka
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina; Eye Centers of Racine and Kenosha, Racine, Wisconsin
| | - Priyatham S Mettu
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | | | - Sandra S Stinnett
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Paul P Lee
- W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Pratap Challa
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina.
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Development of a Resident Training Module for Systematic Optic Disc Evaluation in Glaucoma. J Glaucoma 2012; 21:601-7. [DOI: 10.1097/ijg.0b013e31821db3c7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Swamy L, Smith S, Radcliffe NM. Optic nerve complex imaging in glaucoma Medicare beneficiaries. Ophthalmic Epidemiol 2012; 19:249-55. [PMID: 22775282 DOI: 10.3109/09286586.2012.691601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess the frequency of fundus photography and scanning computerized ophthalmic diagnostic imaging (SCODI) on patients receiving glaucoma care under Medicare. METHODS In this retrospective, observational, Medicare claims-based study, we used a 5% random sample, from 2006-2008, of Medicare beneficiaries, selected for International Classification of Diseases, 9th Revision (ICD-9) diagnoses of glaucoma or glaucoma suspect, who had greater than one year of follow up (N = 143,374). The proportion of patients with an ICD-9 diagnosis of glaucoma or glaucoma suspect who received fundus photography (Physicians' Current Procedural Terminology, CPT 99250) or scanning computerized ophthalmic diagnostic imaging (SCODI; CPT 92135) was determined. RESULTS A total of 48% of patients did not have any form of imaging during the study period. Among those who were imaged, 27% were imaged only once. The use of fundus photography was significantly lower than the use of SCODI (p < 0.00005). A total of 75% of those imaged once received SCODI while only 25% were photographed. Analysis of optic nerve complex imaging over time revealed that 20% received SCODI and 6% were photographed in the first quarter of appearance of the glaucoma or suspect diagnosis code in the dataset, with a decline thereafter. CONCLUSIONS Optic disc imaging in patients diagnosed with glaucoma or glaucoma suspect may not meet guidelines set by the American Academy of Ophthalmology. While both modalities are underused, optic disc photos are performed less often and repeated less frequently when compared to SCODI. Underuse of imaging may negatively impact detection of disease progression over time in glaucoma patients.
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Affiliation(s)
- Lakshmi Swamy
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY 10021, USA
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Kass MA, Gordon MO, Gao F, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JK, Miller JP, Parrish RK, Wilson MR. Delaying treatment of ocular hypertension: the ocular hypertension treatment study. ACTA ACUST UNITED AC 2010; 128:276-87. [PMID: 20212196 DOI: 10.1001/archophthalmol.2010.20] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To compare the safety and efficacy of earlier vs later treatment in preventing primary open-angle glaucoma (POAG) in individuals with ocular hypertension. METHODS One thousand six hundred thirty-six individuals with intraocular pressure (IOP) from 24 to 32 mm Hg in 1 eye and 21 to 32 mm Hg in the fellow eye were randomized to observation or to topical ocular hypotensive medication. Median time of treatment in the medication group was 13.0 years. After a median of 7.5 years without treatment, the observation group received medication for a median of 5.5 years. To determine if there is a penalty for delaying treatment, we compared the cumulative proportions of participants who developed POAG at a median follow-up of 13 years in the original observation group and in the original medication group. MAIN OUTCOME MEASURES Cumulative proportion of participants who developed POAG. RESULTS The cumulative proportion of participants in the original observation group who developed POAG at 13 years was 0.22 (95% confidence interval [CI], 0.19-0.25), vs 0.16 (95% CI, 0.13-0.19) in the original medication group (P = .009). Among participants at the highest third of baseline risk of developing POAG, the cumulative proportion who developed POAG was 0.40 (95% CI, 0.33-0.46) in the original observation group and 0.28 (95% CI, 0.22-0.34) in the original medication group. There was little evidence of increased adverse events associated with medication. APPLICATION TO CLINICAL PRACTICE Absolute reduction was greatest among participants at the highest baseline risk of developing POAG. Individuals at high risk of developing POAG may benefit from more frequent examinations and early preventive treatment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00000125.
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Affiliation(s)
- Michael A Kass
- Ocular Hypertension Treatment Study Coordinating Center, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Box 8203, 660 S Euclid Ave, St Louis, MO 63110, USA
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Niemiec ES, Anderson KL, Scott IU, Greenberg PB. Evidence-based management of resident-performed cataract surgery: an investigation of compliance with a preferred practice pattern. Ophthalmology 2009; 116:678-84. [PMID: 19268367 DOI: 10.1016/j.ophtha.2008.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 11/14/2008] [Accepted: 11/14/2008] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate compliance with the American Academy of Ophthalmology (AAO) Cataract in the Adult Eye Preferred Practice Pattern (PPP) in a resident ophthalmology clinic. DESIGN Retrospective chart review. PARTICIPANTS All patients undergoing first-eye cataract surgery by ophthalmology residents with attending supervision at a Veterans Affairs Medical Center between January 1, 2006, and July 31, 2007. METHODS Electronic medical records (EMRs) were reviewed for compliance with the AAO Cataract in the Adult Eye PPP. MAIN OUTCOME MEASURES Frequency of resident compliance with all 39 elements of the AAO Cataract in the Adult Eye PPP. RESULTS A total of 129 patients met the inclusion criteria. The mean compliance with the PPP was 81%, with 62% of the elements having 90% or greater compliance. Compliance was below the mean for those PPP elements requiring patient input or assessment, including 0% for considering patient preference in the determination of anesthesia management, 73% for patient assessment of preoperative functional status, and 66% for patient assessment of postoperative vision. CONCLUSIONS Compliance with the AAO Cataract in the Adult Eye PPP in this resident ophthalmology clinic can be improved by increasing the documentation of patient input about their visual function both preoperatively and postoperatively. Further study of compliance with evidence-based guidelines is needed in ophthalmology, particularly in teaching hospitals where new providers are developing their approach to care.
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Affiliation(s)
- Elizabeth S Niemiec
- Ophthalmology Section, VA Medical Center, Providence, Rhode Island 02908-4799, USA
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Pablo LE, Ferreras A, Fogagnolo P, Figus M, Pajarin AB. Optic nerve head changes in early glaucoma: a comparison between stereophotography and Heidelberg retina tomography. Eye (Lond) 2009; 24:123-30. [PMID: 19218992 DOI: 10.1038/eye.2009.14] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To evaluate and compare the diagnostic accuracy of the Heidelberg retina tomograph (HRT) version 3 with that of glaucoma specialists using stereophotography in discriminating between normal eyes and patients with early glaucomatous visual field loss. METHODS A total of 105 eyes of 105 individuals were prospectively and consecutively recruited. The sample comprised 51 normal and 54 early glaucomatous eyes, as defined by intraocular pressure and standard automated perimetry results, regardless of optic disc appearance. Receiver operating characteristic (ROC) curves were plotted for the HRT3 parameters and a linear discriminant function (LDF) developed in our hospital. Best sensitivity-specificity pairs were compared between the HRT3 parameters, with the highest areas under the ROC curve (AUCs) and evaluation of optic disc stereophotographs. Agreement between methods for measuring vertical cup-to-disc ratio was evaluated with the Bland-Altman plot. RESULTS The average visual field mean deviation was -2.90 dB. The HRT3 parameters with the largest AUCs were our LDF (0.900), rim volume (0.883), and vertical cup/disk ratio (0.880), with no significant differences between these parameters. Sensitivity-specificity pairs were 79.6-100% (clinical evaluation), 83.3-86.3% (our LDF), 64.8-96.1% (final glaucoma probability score), and 68.5-90.2% (global Moorfields regression analysis). CONCLUSIONS The diagnostic accuracy for differentiating normal eyes from those with early visual field defects was similar between clinical evaluation of the optic disc and evaluation with the HRT3. The use of our LDF increased the sensitivity-specificity balance with respect to the HRT-provided parameters. The diagnostic accuracy of the HRT classifications was comparable to that of an experienced glaucoma specialist.
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Affiliation(s)
- L E Pablo
- Department of Ophthalmology, Miguel Servet University Hospital, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
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