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Schlatter A, Rauchegger T, Schmid E, Teuchner B. Effects of glaucoma surgery on visual field progression in open-angle glaucoma considering the floor effect. Acta Ophthalmol 2022; 100:e1127-e1134. [PMID: 34708544 PMCID: PMC9544081 DOI: 10.1111/aos.15048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 10/01/2021] [Accepted: 10/06/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this retrospective analysis was to investigate whether trabeculectomy (TRAB) and XEN® Gel Stent implantation (XEN) - both filtrating surgery techniques - can slow down the deterioration of visual field (VF) parameters considering the floor effect, which could lead to a misestimation of pre- and postoperative VF rate of progression (ROP). METHODS Included in this study were patients with open-angle glaucoma, who underwent either TRAB or XEN® gel stent implantation and who had at least three VF tests before and after surgery, over an observation period of 13 years. The annual ROP of the mean defect (MD) and the square root of loss variance (sLV) were calculated with two different censoring thresholds: by censored regression and by ordinary least squares regression (OLSR). In addition, the diagnostic range of sLV was calculated. RESULTS 48 eyes of 39 glaucoma patients were included in the study. The annual rate of MD progression was significantly reduced by filtering surgery when calculating the yearly ROP using OLSR (p = 0.006) and by censoring values exceeding a precalculated cut-off of 14.20 dB (p = 0.041) and a cut-off from the literature of 15.00 dB (p = 0.028). On average, the MD was impacted by a significant floor effect of 14.20 dB (95% CI: 12.83-15.56), corresponding to 17.7/59 absolute defects or 29.9% of the whole VF. When applying both OLSR and censored regression, the annual rate of sLV progression did not show a significant difference. The sLV showed a diagnostic boundary at a MD of 15.78 dB. CONCLUSION This study shows that filtering surgery can reduce the progression of VF in patients with open-angle glaucoma, especially those whose disease develops aggressively. This is valid even if the floor effect in advanced cases is compensated by censored regression. On average, the ROP of MD is affected by a significant floor effect at about 29.9% absolute loss of the whole VF.
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Affiliation(s)
- Andreas Schlatter
- Department of Ophthalmology and OptometryMedical University of InnsbruckAnichstrasse 35Innsbruck6020Austria
| | - Teresa Rauchegger
- Department of Ophthalmology and OptometryMedical University of InnsbruckAnichstrasse 35Innsbruck6020Austria
| | - Eduard Schmid
- Department of Ophthalmology and OptometryMedical University of InnsbruckAnichstrasse 35Innsbruck6020Austria
| | - Barbara Teuchner
- Department of Ophthalmology and OptometryMedical University of InnsbruckAnichstrasse 35Innsbruck6020Austria
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Scuderi L, Gattazzo I, de Paula A, Iodice CM, Di Tizio F, Perdicchi A. Understanding the role of microperimetry in glaucoma. Int Ophthalmol 2022; 42:2289-2301. [DOI: 10.1007/s10792-021-02203-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
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Long-term effects of trabeculectomy in primary open-angle glaucoma on segmented macular ganglion cell complex alterations. Int Ophthalmol 2021; 41:2249-2263. [PMID: 33880684 DOI: 10.1007/s10792-021-01840-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study is to compare, using optical coherence tomography (OCT), the changes in the thickness of the macular nerve fiber layer (mNFL), macular ganglion cell layer (mGCL), macular inner plexiform layer (mIPL) and peripapillary global retinal nerve fiber layer (gRNFL) (in a span of 3 years) in surgically treated eyes with primary open-angle glaucoma (POAG). METHODS The medical records of 32 consecutive POAG patients who underwent trabeculectomy with mitomycin-C, between January 2013 and December 2014, were retrospectively reviewed. Pre- and postoperative measurements of IOP and OCT were analyzed 1, 2 and 3 years after the operation. RESULTS Among all patients, no significant changes in the thickness of the mNFL, mGCL or mIPL were found, with a significant reduction observed only in the IOP values and peripapillary gRNFL thickness during the 3-year postoperative period. In a subgroup analysis based on the preoperative peak IOPs (median value:41 mmHg), the thickness of the mNFL, mGCL and mIPL in the 3-year postoperative period increased significantly in the lower preoperative peak IOP group (IOP < 41 mmHg), whereas the macular OCT parameters in the 3-year postoperative period decreased in the higher preoperative peak IOP group. CONCLUSIONS Eyes exhibiting lesser preoperative peak IOP demonstrated greater preservation of the layer-by-layer segmented macular ganglion cell complex thickness as compared to eyes exhibiting greater preoperative peak IOP; also when the IOPs determined for the two groups in the period of follow-up were quite comparable.
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Pfau M, Jolly JK, Wu Z, Denniss J, Lad EM, Guymer RH, Fleckenstein M, Holz FG, Schmitz-Valckenberg S. Fundus-controlled perimetry (microperimetry): Application as outcome measure in clinical trials. Prog Retin Eye Res 2020; 82:100907. [PMID: 33022378 DOI: 10.1016/j.preteyeres.2020.100907] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/20/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Abstract
Fundus-controlled perimetry (FCP, also called 'microperimetry') allows for spatially-resolved mapping of visual sensitivity and measurement of fixation stability, both in clinical practice as well as research. The accurate spatial characterization of visual function enabled by FCP can provide insightful information about disease severity and progression not reflected by best-corrected visual acuity in a large range of disorders. This is especially important for monitoring of retinal diseases that initially spare the central retina in earlier disease stages. Improved intra- and inter-session retest-variability through fundus-tracking and precise point-wise follow-up examinations even in patients with unstable fixation represent key advantages of these technique. The design of disease-specific test patterns and protocols reduces the burden of extensive and time-consuming FCP testing, permitting a more meaningful and focused application. Recent developments also allow for photoreceptor-specific testing through implementation of dark-adapted chromatic and photopic testing. A detailed understanding of the variety of available devices and test settings is a key prerequisite for the design and optimization of FCP protocols in future natural history studies and clinical trials. Accordingly, this review describes the theoretical and technical background of FCP, its prior application in clinical and research settings, data that qualify the application of FCP as an outcome measure in clinical trials as well as ongoing and future developments.
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Affiliation(s)
- Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Department of Biomedical Data Science, Stanford University, Stanford, USA
| | - Jasleen Kaur Jolly
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Zhichao Wu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Eleonora M Lad
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany; John A. Moran Eye Center, University of Utah, USA.
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Wang M, Shen LQ, Pasquale LR, Boland MV, Wellik SR, De Moraes CG, Myers JS, Nguyen TD, Ritch R, Ramulu P, Wang H, Tichelaar J, Li D, Bex PJ, Elze T. Artificial Intelligence Classification of Central Visual Field Patterns in Glaucoma. Ophthalmology 2020; 127:731-738. [PMID: 32081491 PMCID: PMC7246163 DOI: 10.1016/j.ophtha.2019.12.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To quantify the central visual field (VF) loss patterns in glaucoma using artificial intelligence. DESIGN Retrospective study. PARTICIPANTS VFs of 8712 patients with 13 951 Humphrey 10-2 test results from 13 951 eyes for cross-sectional analyses, and 824 patients with at least 5 reliable 10-2 test results at 6-month intervals or more from 1191 eyes for longitudinal analyses. METHODS Total deviation values were used to determine the central VF patterns using the most recent 10-2 test results. A 24-2 VF within a 3-month window of the 10-2 tests was used to stage eyes into mild, moderate, or severe functional loss using the Hodapp-Anderson-Parrish scale at baseline. Archetypal analysis was applied to determine the central VF patterns. Cross-validation was performed to determine the optimal number of patterns. Stepwise regression was applied to select the optimal feature combination of global indices, average baseline decomposition coefficients from central VFs archetypes, and other factors to predict central VF mean deviation (MD) slope based on the Bayesian information criterion (BIC). MAIN OUTCOME MEASURES The central VF patterns stratified by severity stage based on 24-2 test results and a model to predict the central VF MD change over time using baseline test results. RESULTS From cross-sectional analysis, 17 distinct central VF patterns were determined for the 13 951 eyes across the spectrum of disease severity. These central VF patterns could be divided into isolated superior loss, isolated inferior loss, diffuse loss, and other loss patterns. Notably, 4 of the 5 patterns of diffuse VF loss preserved the less vulnerable inferotemporal zone, whereas they lost most of the remaining more vulnerable zone described by the Hood model. Inclusion of coefficients from central VF archetypical patterns strongly improved the prediction of central VF MD slope (BIC decrease, 35; BIC decrease of >6 indicating strong prediction improvement) than using only the global indices of 2 baseline VF results. Eyes with baseline VF results with more superonasal and inferonasal loss were more likely to show worsening MD over time. CONCLUSIONS We quantified central VF patterns in glaucoma, which were used to improve the prediction of central VF worsening compared with using only global indices.
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Affiliation(s)
- Mengyu Wang
- Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts
| | - Lucy Q Shen
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Louis R Pasquale
- Eye and Vision Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael V Boland
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah R Wellik
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida
| | | | - Jonathan S Myers
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Thao D Nguyen
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Pradeep Ramulu
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hui Wang
- Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts; Institute for Psychology and Behavior, Jilin University of Finance and Economics, Changchun, China
| | - Jorryt Tichelaar
- Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts
| | - Dian Li
- Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts
| | - Peter J Bex
- Department of Psychology, Northeastern University, Boston, Massachusetts
| | - Tobias Elze
- Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts; Complex Structures in Biology and Cognition, Max Planck Institute for Mathematics in the Sciences, Leipzig, Germany.
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Traber GL, Della Volpe-Waizel M, Maloca P, Schmidt-Erfurth U, Rubin G, Roska B, Cordeiro MF, Otto T, Weleber R, Lesmes LA, Arleo A, Scholl HPN. New Technologies for Outcome Measures in Glaucoma: Review by the European Vision Institute Special Interest Focus Group. Ophthalmic Res 2020; 63:88-96. [PMID: 31935739 DOI: 10.1159/000504892] [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: 07/18/2019] [Accepted: 11/19/2019] [Indexed: 11/19/2022]
Abstract
Glaucoma is the leading cause of irreversible blindness worldwide, with an increasing prevalence. The complexity of the disease has been a major challenge in moving the field forward with regard to both pathophysiological insight and treatment. In this context, discussing possible outcome measures in glaucoma trials is of utmost importance and clinical relevance. A recent meeting of the European Vision Institute (EVI) special interest focus group was held on "New Technologies for Outcome Measures in Retina and Glaucoma," addressing both functional and structural outcomes, as well as translational hot topics in glaucoma and retina research. In conjunction with the published literature, this review summarizes the meeting focusing on glaucoma.
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Affiliation(s)
- Ghislaine L Traber
- Department of Ophthalmology, University Hospital Basel, University of Basel, Basel, Switzerland.,Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
| | - Maria Della Volpe-Waizel
- Department of Ophthalmology, University Hospital Basel, University of Basel, Basel, Switzerland.,Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
| | - Peter Maloca
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
| | | | - Gary Rubin
- Institute of Ophthalmology, UCL University College London, London, United Kingdom
| | - Botond Roska
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
| | - M Francesca Cordeiro
- Institute of Ophthalmology, UCL University College London, London, United Kingdom.,Western Eye Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.,Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, United Kingdom
| | - Tilman Otto
- Heidelberg Engineering GmbH, Heidelberg, Germany
| | - Richard Weleber
- Casey Eye Institute, Departments of Ophthalmology and Molecular and Medical Genetics, University of Oregon Health & Science University, Portland, Oregon, USA
| | | | - Angelo Arleo
- Institut de la Vision, CNRS, INSERM, Sorbonne Université, Paris, France
| | - Hendrik P N Scholl
- Department of Ophthalmology, University Hospital Basel, University of Basel, Basel, Switzerland, .,Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland,
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