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Einollahi N, Doozandeh A, Sharifipour F, Hassanpour K, Rezaei J, Radmehr H, Yazdani S. Failed Ahmed glaucoma valves: trabeculectomy versus repeat shunt surgery. BMC Ophthalmol 2024; 24:367. [PMID: 39179983 PMCID: PMC11342670 DOI: 10.1186/s12886-024-03610-7] [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: 04/07/2024] [Accepted: 08/02/2024] [Indexed: 08/26/2024] Open
Abstract
INTRODUCTION To investigate the outcomes of trabeculectomy (TRAB) versus repeat Ahmed glaucoma valve (re-AGV) implantation in eyes with Ahmed glaucoma valve (AGV) failure. METHODS This quasi-experimental study includes patients with failed AGV implants requiring additional surgical intervention between 2018 and 2022. Patients in the TRAB group underwent a fornix-based procedure with mitomycin C 0.01% injection (0.1 mL). Eyes in the re-AGV group underwent repeat shunt surgery. The choice of the procedure was based on conjunctival condition. The primary outcome measure was surgical success rate based on various intraocular pressure (IOP) targets and percentages of IOP reduction from baseline: IOP ≤ 21 mmHg and 20% reduction (conventional criteria), IOP ≤ 18 and > 20% reduction (criterion A), IOP ≤ 15 and > 25% reduction (criterion B), and IOP ≤ 12 and > 30% reduction (criterion C). RESULTS Forty-eight eyes of 48 patients were operated and reported herein, consisting of 22 eyes of 22 patients undergoing TRAB and 26 eyes of 26 subjects undergoing re-AGV. No significant difference was observed between the study groups in terms of initial diagnoses, baseline IOP or the number of prior surgeries. The cumulative probability of survival at one year was significantly higher in the trabeculectomy group using the three stricter success definitions. In both study groups, IOP was significantly reduced from baseline at all postoperative visits, and was significantly lower in the TRAB group at all time points beyond one month. At 12 months, 5% of TRAB versus 48% of re-AGV eyes required glaucoma medications (P < 0.001). The rate of complications was comparable between the study groups (P = 0.76) but there was a trend toward a greater need for repeat surgery in the re-AGV group (4 eyes versus nil, P = 0.07). CONCLUSIONS Trabeculectomy can be considered a safe and effective surgical option in eyes with failed AGV leading to significantly lower IOP levels and more favorable success rates than re-AGV in selected patients.
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Affiliation(s)
- Neda Einollahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Paydarfard St. Boostan 9 St., Pasdaran Ave., Tehran, 16666-94516, Iran
| | - Azadeh Doozandeh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Paydarfard St. Boostan 9 St., Pasdaran Ave., Tehran, 16666-94516, Iran
| | - Farideh Sharifipour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Paydarfard St. Boostan 9 St., Pasdaran Ave., Tehran, 16666-94516, Iran
| | - Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Paydarfard St. Boostan 9 St., Pasdaran Ave., Tehran, 16666-94516, Iran
| | - Javad Rezaei
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Paydarfard St. Boostan 9 St., Pasdaran Ave., Tehran, 16666-94516, Iran
| | - Hamed Radmehr
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Paydarfard St. Boostan 9 St., Pasdaran Ave., Tehran, 16666-94516, Iran
| | - Shahin Yazdani
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Paydarfard St. Boostan 9 St., Pasdaran Ave., Tehran, 16666-94516, Iran.
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Un Y, Imamoglu S. Clinical outcomes of Ahmed glaucoma valve implantation in primary open-angle glaucoma and pseudoexfoliative glaucoma. Int Ophthalmol 2024; 44:25. [PMID: 38326580 DOI: 10.1007/s10792-024-02918-z] [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: 03/27/2023] [Accepted: 12/24/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE To investigate the clinical outcomes of Ahmed glaucoma valve (AGV) implantation in primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG). METHODS The patients who underwent AGV implantation for POAG and PEXG between January 2015 and December 2021 in a single tertiary center eye clinic were reviewed retrospectively. Thirty-one eyes with the diagnosis of POAG constituted Group 1 and 40 eyes with the diagnosis of PEXG constituted Group 2. The primary outcome measures were intraocular pressure (IOP) changes after AGV implantation and surgical success at the last visit. We evaluated complete and qualified surgical success using the following three criteria: (1) IOP ≤ 21mmH g, (2) IOP ≤ 18 mmHg, and (3) IOP ≤ 15 mmHg, as well as the absence of any serious complications, such as light perception loss and phthisis bulbi, and additional de novo glaucoma surgery. RESULTS The mean follow-up times were 25.2 (± 21.4) months and 27.6 (± 19.8) months for Groups 1 and 2, respectively (p > 0.05). In Groups 1 and 2, the mean preoperative IOPs were 31.9 ± 9.4 mmHg and 32.3 ± 8.4 mmHg, respectively, which significantly reduced to 14.5 ± 0.7 mmHg and 11.6 ± 0.6 mmHg, respectively at the last postoperative visit (p < 0.001 for both). The mean IOP value at the last visit was statistically significantly lower in Group 2 (p = 0.006). At the last visit, the number of eyes with qualified success according to criteria 1, 2, and 3 was 26 (83.9%), 25 (80.6%), and 18 (58.1%), respectively, in Group 1 and 39 (97.5%), 39 (97.5%), and 32 (80%), respectively, in Group 2. The comparison of the qualified success rates showed statistically significantly higher rates in Group 2 for criterion 2 (p = 0.038). CONCLUSION AGV implantation had high success rates in both POAG and PEXG, but at the final visit, lower IOP levels were reached in the latter.
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Affiliation(s)
- Yasemin Un
- Department of Ophthalmology, Istanbul Haydarpasa Numune Training and Research Hospital, 34668, Uskudar, Istanbul, Turkey.
| | - Serhat Imamoglu
- Department of Ophthalmology, Istanbul Haydarpasa Numune Training and Research Hospital, 34668, Uskudar, Istanbul, Turkey
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Lestak J, Fus M, Pitrova S. Peripapillary retinal nerve fiber layer following vessel density correction at different IOP values. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024. [PMID: 38230508 DOI: 10.5507/bp.2024.001] [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: 01/18/2024] Open
Abstract
PURPOSE The aim of this study was to define the thickness of the retinal nerve fiber layer (RNFL) in the peripapillary region of the retina after adjusting for the effect of vessel density (VD) in patients with pathological intraocular pressure (IOP). PATIENTS AND METHODS 69 patients (122 eyes) with IOP >21 mmHg (range 21-36 mmHg, mean 23.65±2.70 mmHg). 32 were men (average age 55±13 years) and 37 were women (average age 52±14 years). IOP was measured using the Ocular Response Analyser (ORA). VD and RNFL were measured peripapillary by OCT (Avanti RTVue XR) in eight segments: Inferior Temporal - IT (1); Temporal Inferior - TI (2); Temporal Superior -TS (3); Superior Temporal - ST (4); Superior Nasal - SN (5); Nasal Superior - NS (6); Nasal Inferior - NI (7) and Inferior Nasal - IN (8). The VD value was subtracted from the total RNFL value. RESULTS A corrected value for the RNFLc nerve fiber layer thickness (RNFLc) was introduced to account for VD across the RNFL volume in each segment. Person's correlation coefficient (r) was used to assess the correlation between IOP and RNFLc. The strongest correlations in RNFLc were in segments 5 (r=-0.32, P=0.002) and 8 (r=-0.21, P=0.037). CONCLUSION The greatest changes in RNFLc (RNFL minus VD) were in eyes with pathological IOP in segments 5 and 8, the location of the retinal ganglion cell magnocellular fibers. That is, when the thickness of the nerve fiber layer was reduced by correcting for vessel density, there was a significant correlation in segments 5 (r =-0.32, p<0.05) and 8 (r =-0.21, P<0.05) with intraocular pressure. The results suggest use of a corrected RNFL from VD value as more appropriate for detecting early changes in glaucoma.
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Affiliation(s)
- Jan Lestak
- Department of Natural Sciences, Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno 2, Czech Republic
| | - Martin Fus
- Department of Natural Sciences, Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno 2, Czech Republic
| | - Sarka Pitrova
- Department of Natural Sciences, Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno 2, Czech Republic
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Mandal S, Vishvakarma P, Bhumika K. Developments in Emerging Topical Drug Delivery Systems for Ocular Disorders. Curr Drug Res Rev 2024; 16:251-267. [PMID: 38158868 DOI: 10.2174/0125899775266634231213044704] [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: 07/12/2023] [Revised: 10/23/2023] [Accepted: 11/10/2023] [Indexed: 01/03/2024]
Abstract
According to the current information, using nano gels in the eyes have therapeutic benefits. Industry growth in the pharmaceutical and healthcare sectors has been filled by nanotechnology. Traditional ocular preparations have a short retention duration and restricted drug bioavailability because of the eye's architectural and physiological barriers, a big issue for physicians, patients, and chemists. In contrast, nano gels can encapsulate drugs within threedimensional cross-linked polymeric networks. Because of their distinctive structural designs and preparation methods, they can deliver loaded medications in a controlled and sustained manner, enhancing patient compliance and therapeutic efficacy. Due to their excellent drugloading capacity and biocompatibility, nano-gels outperform other nano-carriers. This study focuses on using nano gels to treat eye diseases and provides a brief overview of their creation and response to stimuli. Our understanding of topical drug administration will be advanced using nano gel developments to treat common ocular diseases such as glaucoma, cataracts, dry eye syndrome, bacterial keratitis, and linked medication-loaded contact lenses and natural active ingredients.
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Affiliation(s)
- Suraj Mandal
- Department of Pharmacy, IIMT College of Medical Sciences, IIMT University, O-Pocket, Ganganagar, Meerut, 250001, U.P., India
| | - Prabhakar Vishvakarma
- Department of Pharmacy, IIMT College of Medical Sciences, IIMT University, O-Pocket, Ganganagar, Meerut, 250001, U.P., India
| | - Km Bhumika
- Department of Pharmacy, IIMT College of Medical Sciences, IIMT University, O-Pocket, Ganganagar, Meerut, 250001, U.P., India
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Mazumder AG, Julé AM, Sun D. Astrocytes of the optic nerve exhibit a region-specific and temporally distinct response to elevated intraocular pressure. Mol Neurodegener 2023; 18:68. [PMID: 37759301 PMCID: PMC10523752 DOI: 10.1186/s13024-023-00658-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The optic nerve is an important tissue in glaucoma and the unmyelinated nerve head region remains an important site of many early neurodegenerative changes. In both humans and mice, astrocytes constitute the major glial cell type in the region, and in glaucoma they become reactive, influencing the optic nerve head (ONH) microenvironment and disease outcome. Despite recognizing their importance in the progression of the disease, the reactive response of optic nerve head astrocytes remains poorly understood. METHODS To determine the global reactive response of ONH astrocytes in glaucoma we studied their transcriptional response to an elevation in IOP induced by the microbead occlusion model. To specifically isolate astrocyte mRNA in vivo from complex tissues, we used the ribotag method to genetically tag ribosomes in astrocytes, restricting analysis to astrocytes and enabling purification of astrocyte-associated mRNA throughout the entire cell, including the fine processes, for bulk RNA-sequencing. We also assessed the response of astrocytes in the more distal myelinated optic nerve proper (ONP) as glaucomatous changes manifest differently between the two regions. RESULTS Astrocytes of the optic nerve exhibited a region-specific and temporally distinct response. Surprisingly, ONH astrocytes showed very few early transcriptional changes and ONP astrocytes demonstrated substantially larger changes over the course of the experimental period. Energy metabolism, particularly oxidative phosphorylation and mitochondrial protein translation emerged as highly upregulated processes in both ONH and ONP astrocytes, with the former showing additional upregulation in antioxidative capacity and proteolysis. Interestingly, optic nerve astrocytes demonstrated a limited neuroinflammatory response, even when challenged with a more severe elevation in IOP. Lastly, there were a greater number of downregulated processes in both astrocyte populations compared to upregulated processes. CONCLUSION Our findings demonstrate an essential role for energy metabolism in the response of optic nerve astrocytes to elevated IOP, and contrary to expectations, neuroinflammation had a limited overall role. The transcriptional response profile is supportive of the notion that optic nerve astrocytes have a beneficial role in glaucoma. These previously uncharacterized transcriptional response of optic nerve astrocytes to injury reveal their functional diversity and a greater heterogeneity than previously appreciated.
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Affiliation(s)
- Arpan G Mazumder
- Department of Ophthalmology, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, 02114, USA
| | - Amélie M Julé
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Daniel Sun
- Department of Ophthalmology, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, 02114, USA.
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Li S, Chen L, Fu Y. Nanotechnology-based ocular drug delivery systems: recent advances and future prospects. J Nanobiotechnology 2023; 21:232. [PMID: 37480102 PMCID: PMC10362606 DOI: 10.1186/s12951-023-01992-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/09/2023] [Indexed: 07/23/2023] Open
Abstract
Ocular drug delivery has constantly challenged ophthalmologists and drug delivery scientists due to various anatomical and physiological barriers. Static and dynamic ocular barriers prevent the entry of exogenous substances and impede therapeutic agents' active absorption. This review elaborates on the anatomy of the eye and the associated constraints. Followed by an illustration of some common ocular diseases, including glaucoma and their current clinical therapies, emphasizing the significance of drug therapy in treating ocular diseases. Subsequently, advances in ocular drug delivery modalities, especially nanotechnology-based ocular drug delivery systems, are recommended, and some typical research is highlighted. Based on the related research, systematic and comprehensive characterizations of the nanocarriers are summarized, hoping to assist with future research. Besides, we summarize the nanotechnology-based ophthalmic drugs currently on the market or still in clinical trials and the recent patents of nanocarriers. Finally, inspired by current trends and therapeutic concepts, we provide an insight into the challenges faced by novel ocular drug delivery systems and further put forward directions for future research. We hope this review can provide inspiration and motivation for better design and development of novel ophthalmic formulations.
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Affiliation(s)
- Shiding Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, 200011, China
| | - Liangbo Chen
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, 200011, China
| | - Yao Fu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, 200011, China.
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Lawrence ECN, Guo M, Schwartz TD, Wu J, Lu J, Nikonov S, Sterling JK, Cui QN. Topical and systemic GLP-1R agonist administration both rescue retinal ganglion cells in hypertensive glaucoma. Front Cell Neurosci 2023; 17:1156829. [PMID: 37362000 PMCID: PMC10288152 DOI: 10.3389/fncel.2023.1156829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/05/2023] [Indexed: 06/28/2023] Open
Abstract
Glaucomatous neurodegeneration, a blinding disease affecting millions worldwide, has a need for the exploration of new and effective therapies. Previously, the glucagon-like peptide-1 receptor (GLP-1R) agonist NLY01 was shown to reduce microglia/macrophage activation, rescuing retinal ganglion cells after IOP elevation in an animal model of glaucoma. GLP-1R agonist use is also associated with a reduced risk for glaucoma in patients with diabetes. In this study, we demonstrate that several commercially available GLP-1R agonists, administered either systemically or topically, hold protective potential in a mouse model of hypertensive glaucoma. Further, the resulting neuroprotection likely occurs through the same pathways previously shown for NLY01. This work contributes to a growing body of evidence suggesting that GLP-1R agonists represent a viable therapeutic option for glaucoma.
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Affiliation(s)
| | | | | | | | | | | | | | - Qi N. Cui
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, United States
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Ren X, Zhou Y, Lu F, Zhai L, Wu H, Chen Z, Wang C, Zhu X, Xie Y, Cai P, Xu J, Tang X, Li J, Yao J, Jiang Q, Hu B. Contact Lens Sensor with Anti-jamming Capability and High Sensitivity for Intraocular Pressure Monitoring. ACS Sens 2023. [PMID: 37262351 DOI: 10.1021/acssensors.3c00542] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Contact lens sensors provide a noninvasive approach for intraocular pressure (IOP) monitoring in patients with glaucoma. Accurate measurement of this imperceptible pressure variation requires highly sensitive sensors in the absence of simultaneously amplifying IOP signal and blinking-induced noise. However, current noise-reduction methods rely on external filter circuits, which thicken contact lenses and reduce signal quality. Here, we introduce a contact lens strain sensor with an anti-jamming ability by utilizing a self-lubricating layer to reduce the coefficient of friction (COF) to remove the interference from the tangential force. The sensor achieves exceptionally high sensitivity due to the strain concentration layout and the confined occurrence of sympatric microcracks. The animal tests prove our lens can accurately detect IOP safely and reliably.
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Affiliation(s)
- Xueyang Ren
- Department of Neuro-Psychiatric Institute, the Affiliated Brain Hospital with Nanjing Medical University, Nanjing 210029, China
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 211166, China
- State Key Laboratory of Bioelectronics and Jiangsu Key Laboratory of Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
| | - Yunfan Zhou
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 211166, China
- The Affiliated Eye Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Fangzhou Lu
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 211166, China
| | - Leili Zhai
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 211166, China
| | - Hao Wu
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 211166, China
| | - Zhongda Chen
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 211166, China
| | - Changxian Wang
- Innovative Center for Flexible Devices (iFLEX), Max Planck-NTU Joint Lab for Artificial Senses, School of Materials Science and Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Xuefei Zhu
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 211166, China
- The Affiliated Eye Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yandong Xie
- Department of Neuro-Psychiatric Institute, the Affiliated Brain Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Pingqiang Cai
- Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing 210093, China
| | - Juan Xu
- Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing 210093, China
| | - Xianglong Tang
- Department of Neuro-Psychiatric Institute, the Affiliated Brain Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Jianqing Li
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 211166, China
- School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China
| | - Jin Yao
- The Affiliated Eye Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Qin Jiang
- The Affiliated Eye Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Benhui Hu
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 211166, China
- State Key Laboratory of Bioelectronics and Jiangsu Key Laboratory of Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
- The Affiliated Eye Hospital of Nanjing Medical University, Nanjing 210029, China
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Klabe K, Rüfer F. [Minimally invasive glaucoma surgery-Comparison of angle based procedures]. DIE OPHTHALMOLOGIE 2023; 120:358-371. [PMID: 37010578 DOI: 10.1007/s00347-023-01844-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 04/04/2023]
Abstract
Surgical procedures are playing an increasing role in the care of patients with glaucoma. Within the last decade, new surgical procedures have been established, which are summarized under the term minimally invasive glaucoma surgery (MIGS). A wide variety of different procedures are aimed at the structures in the angle of the anterior chamber, such as the trabecular meshwork and Schlemm's canal, to improve the physiological outflow or to improve the alternative uveoscleral outflow. The implementation of the treatment goal differs in the individual procedures, as does the maximum pressure reduction that can be achieved. Compared to trabeculectomy with the use of cytostatic agents, the achievable pressure reduction is usually significantly lower. In contrast, the significantly lower intraoperative and postoperative complication rates are emphasized as an advantage of these procedures. With increasing clinical experience and the growth of sufficient data on these new surgical procedures, a well-founded classification in the treatment algorithm of glaucoma surgery becomes easier; nevertheless, due to the small differences with respect to efficacy and safety profile, the final decision for an individual procedure often remains dependent on the surgeon's personal preferences.
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Affiliation(s)
- Karsten Klabe
- Breyer Kaymak Klabe Augenchirurgie, Martin-Luther-Platz 22, 40212, Düsseldorf, Deutschland.
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Ong AY, McCann P, Perera SA, Lim F, Ng SM, Friedman DS, Chang D. Lens extraction versus laser peripheral iridotomy for acute primary angle closure. Cochrane Database Syst Rev 2023; 3:CD015116. [PMID: 36884304 PMCID: PMC9994579 DOI: 10.1002/14651858.cd015116.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Acute primary angle closure (APAC) is a potentially blinding condition. It is one of the few ophthalmic emergencies and carries high rates of visual morbidity in the absence of timely intervention. Laser peripheral iridotomy (LPI) has been the standard of care thus far. However, LPI does not eliminate the long-term risk of chronic angle closure glaucoma and other associated sequelae. There has been increasing interest in lens extraction as the primary treatment for the spectrum of primary angle closure disease, and it is as yet unclear whether these results can be extrapolated to APAC, and whether lens extraction provides better long-term outcomes. We therefore sought to evaluate the effectiveness of lens extraction in APAC to help inform the decision-making process. OBJECTIVES: To assess the effect of lens extraction compared to LPI in the treatment of APAC. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2022, Issue 1), Ovid MEDLINE, Ovid MEDLINE E-pub Ahead of Print, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily (January 1946 to 10 January 2022), Embase (January 1947 to 10 January 2022), PubMed (1946 to 10 January 2022), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to 10 January 2022), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search. We last searched the electronic databases on 10 January 2022. SELECTION CRITERIA We included randomized controlled clinical trials comparing lens extraction against LPI in adult participants ( ≥ 35 years) with APAC in one or both eyes. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology and assessed the certainty of the body of evidence for prespecified outcomes using the GRADE approach. MAIN RESULTS We included two studies conducted in Hong Kong and Singapore, comprising 99 eyes (99 participants) of predominantly Chinese origin. The two studies compared LPI with phacoemulsification performed by experienced surgeons. We assessed that both studies were at high risk of bias. There were no studies evaluating other types of lens extraction procedures. Phacoemulsification may result in an increased proportion of participants with intraocular pressure (IOP) control compared with LPI at 18 to 24 months (risk ratio (RR) 1.66, 95% confidence interval (CI) 1.28 to 2.15; 2 studies, n = 97; low certainty evidence) and may reduce the need for further IOP-lowering surgery within 24 months (RR 0.07, 96% CI 0.01 to 0.51; 2 studies, n = 99; very low certainty evidence). Phacoemulsification may result in a lower mean IOP at 12 months compared to LPI (mean difference (MD) -3.20, 95% CI -4.79 to -1.61; 1 study, n = 62; low certainty evidence) and a slightly lower mean number of IOP-lowering medications at 18 months (MD -0.87, 95% CI -1.28 to -0.46; 1 study, n = 60; low certainty evidence), but this may not be clinically significant. Phacoemulsification may have little to no effect on the proportion of participants with one or more recurrent APAC episodes in the same eye (RR 0.32, 95% CI 0.01 to 7.30; 1 study, n = 37; very low certainty evidence). Phacoemulsification may result in a wider iridocorneal angle assessed by Shaffer grading at six months (MD 1.15, 95% CI 0.83 to 1.47; 1 study, n = 62; very low certainty evidence). Phacoemulsification may have little to no effect on logMAR best-corrected visual acuity (BCVA) at six months (MD -0.09, 95% CI -0.20 to 0.02; 2 studies, n = 94; very low certainty evidence). There was no evidence of a difference in the extent of peripheral anterior synechiae (PAS) (clock hours) between intervention arms at 6 months (MD -1.86, 95% CI -7.03 to 3.32; 2 studies, n = 94; very low certainty evidence), although the phacoemulsification group may have less PAS (degrees) at 12 months (MD -94.20, 95% CI -140.37 to -48.03; 1 study, n = 62) and 18 months (MD -127.30, 95% CI -168.91 to -85.69; 1 study, n = 60). In one study, there were 26 adverse events in the phacoemulsification group: intraoperative corneal edema (n = 12), posterior capsular rupture (n = 1), intraoperative bleeding from iris root (n = 1), postoperative fibrinous anterior chamber reaction (n = 7), and visually significant posterior capsular opacification (n = 5), and no cases of suprachoroidal hemorrhage or endophthalmitis. There were four adverse events in the LPI group: closed iridotomy (n = 1) and small iridotomies that required supplementary laser (n = 3). In the other study, there was one adverse event in the phacoemulsification group (IOP > 30 mmHg on day 1 postoperatively (n = 1)), and no intraoperative complications. There were five adverse events in the LPI group: transient hemorrhage (n = 1), corneal burn (n = 1), and repeated LPI because of non-patency (n = 3). Neither study reported health- or vision-related quality of life measures. AUTHORS' CONCLUSIONS Low certainty evidence suggests that early lens extraction may produce more favorable outcomes compared to initial LPI in terms of IOP control. Evidence for other outcomes is less clear. Future high-quality and longer-term studies evaluating the effects of either intervention on the development of glaucomatous damage and visual field changes as well as health-related quality of life measures would be helpful.
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Affiliation(s)
- Ariel Yuhan Ong
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Paul McCann
- Department of Ophthalmology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shamira A Perera
- Glaucoma Service, Department of Ophthalmology, Singapore National Eye Centre, Singapore, Singapore
| | - Fiona Lim
- Glaucoma Service, Department of Ophthalmology, Singapore National Eye Centre, Singapore, Singapore
| | - Sueko M Ng
- Department of Ophthalmology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Dolly Chang
- Genentech Inc, South San Francisco, California, USA
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
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11
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Sterling J, Hua P, Dunaief JL, Cui QN, VanderBeek BL. Glucagon-like peptide 1 receptor agonist use is associated with reduced risk for glaucoma. Br J Ophthalmol 2023; 107:215-220. [PMID: 34413054 PMCID: PMC8857286 DOI: 10.1136/bjophthalmol-2021-319232] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/06/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND/AIMS Glucagon-like peptide-1 receptor (GLP-1R) agonists regulate blood glucose and are commonly used to treat type 2 diabetes mellitus. Recent work showed that treatment with the GLP-1R agonist NLY01 decreased retinal neuroinflammation and glial activation to rescue retinal ganglion cells in a mouse model of glaucoma. In this study, we used an insurance claims database (Clinformatics Data Mart) to examine whether GLP-1R agonist exposure impacts glaucoma risk. METHODS A retrospective cohort of patients who initiated a new GLP-1R agonist was 1:3 age, gender, race, classes of active diabetes medications and year of index date matched to patients who initiated a different class of oral diabetic medication. Inverse probability of treatment weighting (IPTW) was used within a multivariable Cox proportional hazard regression model to test the association between GLP-1R agonist exposure and a new diagnosis of primary open-angle glaucoma, glaucoma suspect or low-tension glaucoma. RESULTS Cohorts were comprised of 1961 new users of GLP-1R agonists matched to 4371 unexposed controls. After IPTW, all variables were balanced (standard mean deviation <|0.1|) between cohorts. Ten (0.51%) new diagnoses of glaucoma were present in the GLP-1R agonist cohort compared with 58 (1.33%) in the unexposed controls. After adjustment, GLP-1R exposure conferred a reduced hazard of 0.56 (95% CI: 0.36 to 0.89, p=0.01), suggesting that GLP-1R agonists decrease the risk for glaucoma. CONCLUSIONS GLP-1R agonist use was associated with a statistically significant hazard reduction for a new diagnosis of glaucoma. Our findings support further investigations into the use of GLP-1R agonists in glaucoma prevention.
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Affiliation(s)
- Jacob Sterling
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Medical Scientist Training Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Peiying Hua
- Center for Preventative Ophthalmology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joshua L Dunaief
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Qi N Cui
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian L VanderBeek
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics & Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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12
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Buehne KL, Rosdahl JA, Hein AM, Woolson S, Olsen M, Kirshner M, Sexton M, Bosworth HB, Muir KW. How Medication Adherence Affects Disease Management in Veterans with Glaucoma: Lessons Learned from a Clinical Trial. Ophthalmic Res 2023; 66:489-495. [PMID: 36603568 DOI: 10.1159/000528857] [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: 04/21/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION We conducted a secondary, real-world clinical assessment of a randomized controlled trial to determine how a glaucoma medication adherence intervention impacted the clinical outcomes of participants at 12 months post-randomization. Participants included veterans at a VA eye clinic with medically treated glaucoma who reported poor adherence and their companions, if applicable. METHODS The treatment group received a glaucoma education session with drop administration instruction and virtual reminders from a "smart bottle" (AdhereTech) for their eye drops. The control group received a general eye health class and the smart bottle with the reminder function turned off. Medical chart extraction determined if participants in each group experienced visual field progression, additional glaucoma medications, or a recommendation for surgery or laser due to inadequate intraocular pressure control over the 12 months following randomization. The main outcome measure was disease progression, defined as visual field progression or escalation of glaucoma therapy, in the 12 months following randomization. RESULTS Thirty-six versus 32% of the intervention (n = 100) versus control (n = 100) groups, respectively, experienced disease intensification. There was no difference between the intervention and control groups in terms of intensification (intervention vs. control group odds ratio: 1.20; 95% confidence interval: [0.67, 2.15]), including when age, race, and disease severity were accounted for in the logistic regression model. Those whose study dates included time during the COVID-19 pandemic were evenly distributed between groups. CONCLUSIONS A multifaceted intervention that improved medication adherence for glaucoma for 6 months did not affect the clinical outcomes measured at 12 months post-randomization. Twelve months may not be long enough to see the clinical effect of this intervention or more than 6 months of intervention are needed.
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Affiliation(s)
- Kristen L Buehne
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA,
| | - Jullia A Rosdahl
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Aaron M Hein
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sandra Woolson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Maren Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Miriam Kirshner
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Malina Sexton
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hayden B Bosworth
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Kelly W Muir
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
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13
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Luebke J, Böhringer D, Evers C, Daniel MC, Reinhard T, Lang SJ. Glaucoma Treatment in German Hospitals in 2019. Klin Monbl Augenheilkd 2023; 240:86-91. [PMID: 35320870 DOI: 10.1055/a-1725-8605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgical procedures in ophthalmology are subject to fluctuations in their application and are dependent on new developments, availability, and success rates. In the field of glaucoma surgery in particular, numerous new procedures have been introduced over the last few years. So far, hardly any analyses have been done on the current application of these newer procedures. In this paper, we present the extent to which different glaucoma surgery procedures were used in German hospitals in 2019. METHODS The quality reports of German hospitals from 2019 were evaluated regarding all glaucoma-specific procedure codes. In particular, laser procedures, "classic" glaucoma procedures, and "modern" procedures such as MIGS (minimally invasive glaucoma surgery) are compared below. RESULTS In 2019, 49,031 glaucoma procedures were performed in German hospitals. Numerically, cyclodestructive procedures were used most frequently. MIGS accounted for approximately 10% of procedures according to the available data. Among filtering procedures, about 40% were implant-assisted. DISCUSSION AND CONCLUSION On the one hand, the data analyzed show a mixed expansion of the spectrum with newer procedures such as the MIGS and implants; on the other hand, classic procedures such as cyclodestruction are still used. It can be assumed that further shifts in surgical methods will be seen in the coming years.
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Affiliation(s)
- Jan Luebke
- Klinik für Augenheilkunde, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Universitätsklinikum Freiburg, Deutschland
| | - Daniel Böhringer
- Klinik für Augenheilkunde, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Universitätsklinikum Freiburg, Deutschland
| | - Charlotte Evers
- Klinik für Augenheilkunde, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Universitätsklinikum Freiburg, Deutschland
| | - Moritz Claudius Daniel
- Klinik für Augenheilkunde, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Universitätsklinikum Freiburg, Deutschland
| | - Thomas Reinhard
- Klinik für Augenheilkunde, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Universitätsklinikum Freiburg, Deutschland
| | - Stefan J Lang
- Klinik für Augenheilkunde, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Universitätsklinikum Freiburg, Deutschland
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14
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Astakhov SY, Nechiporenko PA, Novikov DP, Frolov OA, Pokrovskiy AS. [Comparison of the effectiveness and safety of glaucoma drugs in the therapy of primary open-angle glaucoma]. Vestn Oftalmol 2023; 139:101-108. [PMID: 38235636 DOI: 10.17116/oftalma2023139061101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
The rise in the number of glaucoma drugs complicates the choice that the ophthalmologists have to do. PURPOSE The study compares the effectiveness, safety and usability of the Russian latanoprost drug Trilaktan and the drug Xalatan in monotherapy for patients with primary open-angle glaucoma (POAG) and ocular hypertension (OH). MATERIAL AND METHODS This is a multicenter observational study of the effectiveness and safety of eye drops Trilaktan (Groteks, Russia) and Xalatan (Pfizer MFG. Belgium N.V., Belgium) in monotherapy for patients with POAG of early and moderate stages or OH. The maximum duration of the regimen for the studied drugs was 87 days. The study included 76 patients: 56 (74%) women and 20 (26%) men aged 50-84 years (mean age 66.3±1.3 years). The groups were homogeneous in demographic, anthropometric and vital indicators. Effectiveness was assessed by the trends in intraocular pressure (IOP) changes, safety - by analyzing the adverse events, usability and ease of use - by the questionnaires the study patients filled. RESULTS Both drugs investigated in this study decrease IOP by a mean of 6-8 mm Hg depending on tonometry method, with difference not exceeding 0.55 mm Hg. The proportion of patients with IOP decreased by 30% and more from the baseline level was 89.5% in both groups. The differences between the indicators of drug usability (by McMonnies conjunctival hyperemia scale, tear break-up time (TBUT), punctate keratopathy, OSDI questionnaire results) were insignificant, and the observed changes did not decrease the tolerability of the studied drugs. The patients using Trilaktan also commended the usability of the included eye drops dispenser. CONCLUSIONS The results of this study allow a conclusion that the effectiveness and safety of Trilaktan (Groteks, Russia) eye drops are equal to those of Xalatan (Pfizer MFG. Belgium N.V., Belgium) eye drops in patients with POAG of early and moderate stages or OH. Trilaktan is easy to use thanks to the included eye drops dispenser.
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Affiliation(s)
- S Yu Astakhov
- Academician I.P. Pavlov First St. Petersburg State Medical University, Saint Petersburg, Russia
| | - P A Nechiporenko
- Academician I.P. Pavlov First St. Petersburg State Medical University, Saint Petersburg, Russia
| | - D P Novikov
- Eye Diagnostic Center No. 7 for Adults and Children, Saint Petersburg, Russia
| | - O A Frolov
- Eye Diagnostic Center No. 7 for Adults and Children, Saint Petersburg, Russia
| | - A S Pokrovskiy
- Eye Diagnostic Center No. 7 for Adults and Children, Saint Petersburg, Russia
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15
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Sun MT, Singh K, Wang SY. Real-World Outcomes of Glaucoma Filtration Surgery Using Electronic Health Records: An Informatics Study. J Glaucoma 2022; 31:847-853. [PMID: 36223316 PMCID: PMC9633387 DOI: 10.1097/ijg.0000000000002122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/25/2022] [Indexed: 11/06/2022]
Abstract
PRCIS Utilizing an automated pipeline for data extraction from electronic health records provides real-world information on the success of various glaucoma procedures, with tube shunt implantation associated with increased failure rates compared with trabeculectomy. BACKGROUND We aimed to evaluate the long-term survival of glaucoma surgeries using an automated pipeline for extraction of outcomes from electronic health records. METHODS A retrospective observational study from a single academic center. Patients undergoing trabeculectomy, Ex-PRESS shunt, Baerveldt, and Ahmed tube shunt insertion from 2009 to 2018 were identified from electronic health record procedure codes. Patient characteristics were identified from structured and unstructured fields using a previously validated natural language processing pipeline. RESULTS Five hundred twelve patients underwent 711 glaucoma surgeries: 287 trabeculectomies, 47 Ex-PRESS shunts, 274 Baerveldt and 103 Ahmed tube implantations. The Median follow-up was 359 days. The mean baseline IOP was 24.4 mm Hg (SD 10.9), and 73.1% were on ≥3 medications. Compared with trabeculectomy, tube shunt surgery had a higher risk of failure (Baerveldt: Hazard Ratio (HR) 1.44, 95% CI 1.02 to 2.02; Ahmed: HR 2.01, 95% CI 1.28 to 3.17). Previous glaucoma surgery was associated with increased failure (≥2 previous surgeries: HR 2.74, 95% CI 1.62 to 4.64), as were fewer baseline medications (<3 medications: HR 2.96, 95% CI 2.12 to 4.13) and male sex (HR 1.40, 95% CI 1.03 to 1.90). At 1 year, tube shunt patients had a 2.53 mm Hg ( P =0.002) higher IOP compared with trabeculectomy patients. CONCLUSIONS Baerveldt and Ahmed tube shunt implantation was associated with increased failure compared with trabeculectomy. Fewer baseline medications, previous glaucoma surgeries, and male sex were also risk factors for failure. These results demonstrate the utility of applying an informatics pipeline to electronic health records to investigate key clinical questions using real-world evidence.
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16
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Zhu H, Yang H, Zhan L, Chen Y, Wang J, Xu F. Hydrogel-Based Smart Contact Lens for Highly Sensitive Wireless Intraocular Pressure Monitoring. ACS Sens 2022; 7:3014-3022. [PMID: 36260093 DOI: 10.1021/acssensors.2c01299] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Real-time intraocular pressure (IOP) monitoring plays a crucial role in glaucoma diagnosis and treatment. The wireless smart contact lens based on a flexible inductor-capacitor-resistor (LCR) sensor is chip-free and battery-free, demonstrating excellent application potential for physiological signal monitoring. To promote the use of LCR contact lenses for clinical IOP monitoring, reliable, comfortable contact lens materials should be used and excellent sensitivity needs to be realized. Here, we propose a method for producing hydrogel-based smart contact lenses for wireless IOP monitoring that uses the conformal stacking technique, solving the problems of swelling of the hydrogel and spherical integration of the pyramid-microstructured dielectric elastomer. The IOP of the in vitro porcine eye is successfully monitored owing to the high sensitivity of the spherical pyramid-microstructured capacitive pressure sensor and the hydrogel substrate. In addition, a glasses-integrated impedance-matching tunable reader for remote signal measurement is realized by enhancing the signal amplitude and increasing the reading distance, improving the portability of the signal measurement equipment. With the above improved designs, the wireless contact lens system has application potential for clinical IOP monitoring and shows substantial promise for next-generation daily ocular health management.
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Affiliation(s)
- Hengtian Zhu
- College of Engineering and Applied Sciences and Collaborative Innovation Center of Advanced Microstructures, Nanjing University, Nanjing210023, China
| | - Huan Yang
- College of Engineering and Applied Sciences and Collaborative Innovation Center of Advanced Microstructures, Nanjing University, Nanjing210023, China
| | - Liuwei Zhan
- College of Engineering and Applied Sciences and Collaborative Innovation Center of Advanced Microstructures, Nanjing University, Nanjing210023, China
| | - Ye Chen
- College of Engineering and Applied Sciences and Collaborative Innovation Center of Advanced Microstructures, Nanjing University, Nanjing210023, China
| | - Junming Wang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan430030, China
| | - Fei Xu
- College of Engineering and Applied Sciences and Collaborative Innovation Center of Advanced Microstructures, Nanjing University, Nanjing210023, China
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17
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Ittoop SM, Jaccard N, Lanouette G, Kahook MY. The Role of Artificial Intelligence in the Diagnosis and Management of Glaucoma. J Glaucoma 2022; 31:137-146. [PMID: 34930873 DOI: 10.1097/ijg.0000000000001972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 12/10/2021] [Indexed: 11/26/2022]
Abstract
Glaucomatous optic neuropathy is the leading cause of irreversible blindness worldwide. Diagnosis and monitoring of disease involves integrating information from the clinical examination with subjective data from visual field testing and objective biometric data that includes pachymetry, corneal hysteresis, and optic nerve and retinal imaging. This intricate process is further complicated by the lack of clear definitions for the presence and progression of glaucomatous optic neuropathy, which makes it vulnerable to clinician interpretation error. Artificial intelligence (AI) and AI-enabled workflows have been proposed as a plausible solution. Applications derived from this field of computer science can improve the quality and robustness of insights obtained from clinical data that can enhance the clinician's approach to patient care. This review clarifies key terms and concepts used in AI literature, discusses the current advances of AI in glaucoma, elucidates the clinical advantages and challenges to implementing this technology, and highlights potential future applications.
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Affiliation(s)
- Sabita M Ittoop
- The George Washington University Medical Faculty Associates, Washington, DC
| | | | | | - Malik Y Kahook
- Sue Anschutz-Rodgers Eye Center, The University of Colorado School of Medicine, Aurora, CO
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18
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Leung DYL, Tham CC. Normal-tension glaucoma: Current concepts and approaches-A review. Clin Exp Ophthalmol 2022; 50:247-259. [PMID: 35040248 DOI: 10.1111/ceo.14043] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 12/19/2022]
Abstract
Normal tension glaucoma (NTG) has remained a challenging disease. We review, from an epidemiological perspective, why we should redefine normality, act earlier at lower pre-treatment intraocular pressure (IOP) level, and the role of ocular perfusion pressures, noting that perfusion is affected by defective vascular bed autoregulation and endothelial dysfunction. The correlation of silent cerebral infarcts (SCI) and NTG may indicate that NTG belongs to a wider spectrum of small vessel diseases (SVD), with its main pathology being also on vascular endothelium. Epidemiological studies also suggested that vascular geometry, such as fractal dimension, may affect perfusion efficiency, occurrence of SCI, SVD and glaucoma. Artificial intelligence with deep learning, may help predicting NTG progression from vascular geometry. Finally, we review latest evidence on the role of minimally-invasive glaucoma surgery, lasers, and newer drugs. We conclude that IOP is not the only modifiable risk factors as, many vascular risk factors are readily modifiable.
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Affiliation(s)
- Dexter Y L Leung
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong SAR, China
- Department of Ophthalmology, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong SAR, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China
- Lam Kin Chung . Jet King-Shing Ho Glaucoma Treatment and Research Centre, The Chinese University of Hong Kong, Hong Kong SAR, China
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19
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Detecting glaucoma with only OCT: Implications for the clinic, research, screening, and AI development. Prog Retin Eye Res 2022; 90:101052. [PMID: 35216894 DOI: 10.1016/j.preteyeres.2022.101052] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/21/2022] [Accepted: 02/01/2022] [Indexed: 12/25/2022]
Abstract
A method for detecting glaucoma based only on optical coherence tomography (OCT) is of potential value for routine clinical decisions, for inclusion criteria for research studies and trials, for large-scale clinical screening, as well as for the development of artificial intelligence (AI) decision models. Recent work suggests that the OCT probability (p-) maps, also known as deviation maps, can play a key role in an OCT-based method. However, artifacts seen on the p-maps of healthy control eyes can resemble patterns of damage due to glaucoma. We document in section 2 that these glaucoma-like artifacts are relatively common and are probably due to normal anatomical variations in healthy eyes. We also introduce a simple anatomical artifact model based upon known anatomical variations to help distinguish these artifacts from actual glaucomatous damage. In section 3, we apply this model to an OCT-based method for detecting glaucoma that starts with an examination of the retinal nerve fiber layer (RNFL) p-map. While this method requires a judgment by the clinician, sections 4 and 5 describe automated methods that do not. In section 4, the simple model helps explain the relatively poor performance of commonly employed summary statistics, including circumpapillary RNFL thickness. In section 5, the model helps account for the success of an AI deep learning model, which in turn validates our focus on the RNFL p-map. Finally, in section 6 we consider the implications of OCT-based methods for the clinic, research, screening, and the development of AI models.
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20
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Mouhammad ZA, Vohra R, Horwitz A, Thein AS, Rovelt J, Cvenkel B, Williams PA, Azuara-Blanco A, Kolko M. Glucagon-Like Peptide 1 Receptor Agonists – Potential Game Changers in the Treatment of Glaucoma? Front Neurosci 2022; 16:824054. [PMID: 35264926 PMCID: PMC8899005 DOI: 10.3389/fnins.2022.824054] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/10/2022] [Indexed: 12/22/2022] Open
Abstract
Glaucoma is a common ocular neurodegenerative disease characterized by the progressive loss of retinal ganglion cells and their axons. It is the most common cause of irreversible blindness. With an increasing number of glaucoma patients and disease progression despite treatment, it is paramount to develop new and effective therapeutics. Emerging new candidates are the receptor agonists of the incretin hormone glucagon-like-peptide-1 (GLP-1), originally used for the treatment of diabetes. GLP-1 receptor (GLP-1R) agonists have shown neuroprotective effects in preclinical and clinical studies on neurodegenerative diseases in both the brain (e.g., Alzheimer’s disease, Parkinson’s disease, stroke and diabetic neuropathy) and the eye (e.g., diabetic retinopathy and AMD). However, there are currently very few studies investigating the protective effects of GLP-1R agonists in the treatment of specifically glaucoma. Based on a literature search on PubMed, the Cochrane Library, and ClinicalTrials.gov, this review aims to summarize current clinical literature on GLP-1 receptor agonists in the treatment of neurodegenerative diseases to elucidate their potential in future anti-glaucomatous treatment strategies.
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Affiliation(s)
- Zaynab Ahmad Mouhammad
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Rupali Vohra
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anna Horwitz
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Anna-Sophie Thein
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Jens Rovelt
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Barbara Cvenkel
- Department of Ophthalmology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Pete A. Williams
- Division of Eye and Vision, Department of Clinical Neuroscience, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
- *Correspondence: Miriam Kolko,
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Dikmetas O, Sadigh SL, Şekerler C, Kocabeyoğlu S, Karahan S, Cankaya AB. Optic nerve head microvascular characteristics in patients with unilateral pseudoexfoliation syndrome: an optical coherence tomography angiography study. Int Ophthalmol 2022; 42:2397-2405. [DOI: 10.1007/s10792-022-02239-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
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22
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Rodríguez-Agirretxe I, Loizate E, Astorkiza B, Onaindia A, Galdos-Olasagasti L, Basasoro A. Validation of the SITA faster strategy for the management of glaucoma. Int Ophthalmol 2022; 42:2347-2354. [DOI: 10.1007/s10792-022-02232-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
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23
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Sarossy M, Crowston J, Kumar D, Wu Z. Empirical mode decomposition denoising of the electroretinogram to enhance measurement of the photopic negative response. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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24
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Wang J, Li B, Huang D, Norat P, Grannonico M, Cooper RC, Gui Q, Chow WN, Liu X, Yang H. Nano-in-Nano Dendrimer Gel Particles for Efficient Topical Delivery of Antiglaucoma Drugs into the Eye. CHEMICAL ENGINEERING JOURNAL (LAUSANNE, SWITZERLAND : 1996) 2021; 425:130498. [PMID: 34121919 PMCID: PMC8194049 DOI: 10.1016/j.cej.2021.130498] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Low bioavailability of topically applied drugs remains a significant challenge for long-term glaucoma therapy. To enhance drug delivery efficiency, we developed dendrimer gel particles that collectively exhibit structural benefits of dendrimer, hydrogel, and particles, using the inverse emulsion method coupled with the highly efficient aza-Michael addition reaction (IEaMA). This hierarchical approach would maximize the utility of the structural features of existing ocular drug delivery systems. We have tested the delivery efficiency and efficacy of two first-line antiglaucoma drugs, brimonidine tartrate (BT) and timolol maleate (TM), which were loaded into dendrimer gel particles of various sizes, i.e., nDHP (nano-in-nano dendrimer hydrogel particles, ~200 nm), μDHP3 (3 μm), and μDHP10 (9 μm). We found that nDHP was superior to μDHP3 and μDHP10 in terms of cytocompatibility, degradability, drug release kinetics, and corneal permeability. The nDHPs increased drug corneal permeability by 17-fold compared to plain drug solution and enabled zero-order prolonged drug release kinetics. The nDHP-based formulation demonstrated pronounced IOP-lowering effects in both single-dose test and 7-day chronic daily dosing test in both Brown Norway rats and glaucoma mice. Taken together, we have developed nano-in-nano dendrimer gel particles for precise dosing and enabling sustained and synergistic efficacy of antiglaucoma drugs, which could be clinically impactful for improving glaucoma treatment.
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Affiliation(s)
- Juan Wang
- College of Biomedical Engineering, Sichuan University, Chengdu, Sichuan 610065, China
| | - Boxuan Li
- Tianjin Key Laboratory of Biomedical Materials, Key Laboratory of Biomaterials and Nanotechnology for Cancer Immunotherapy, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, China
| | - Da Huang
- Linda and Bipin Doshi Department of Chemical and Biochemical Engineering, Missouri University of Science and Technology, Rolla, Missouri 65409, United States
| | - Pedro Norat
- Department of Biology, University of Virginia, Charlottesville, Virginia 22904, United States
| | - Marta Grannonico
- Department of Biology, University of Virginia, Charlottesville, Virginia 22904, United States
| | - Remy C. Cooper
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia 23298, United States
| | - Qin Gui
- Department of Chemical and Life Science Engineering, Virginia Commonwealth University, Richmond, Virginia 23219, United States
| | - Woon Nam Chow
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia 23298, United States
- Department of Ophthalmology, Virginia Commonwealth University, Richmond, Virginia 23298, United States
| | - Xiaorong Liu
- Department of Biology, University of Virginia, Charlottesville, Virginia 22904, United States
- Department of Psychology, University of Virginia, Charlottesville, Virginia 22904, United States
- Corresponding authors: (XL), (HY)
| | - Hu Yang
- Linda and Bipin Doshi Department of Chemical and Biochemical Engineering, Missouri University of Science and Technology, Rolla, Missouri 65409, United States
- Corresponding authors: (XL), (HY)
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25
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Katsanos A, Riva I, Bozkurt B, Holló G, Quaranta L, Oddone F, Irkec M, Dutton GN, Konstas AG. A new look at the safety and tolerability of prostaglandin analogue eyedrops in glaucoma and ocular hypertension. Expert Opin Drug Saf 2021; 21:525-539. [PMID: 34666576 DOI: 10.1080/14740338.2022.1996560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION In the last 25 years, topical prostaglandin analogues (PGAs) have emerged to become first line and first choice therapeutic options in the management of glaucoma and ocular hypertension (OHT). Although the short-term efficacy and safety of PGAs has been extensively investigated, less is known about their long term safety and tolerability. This gap in current knowledge is clinically relevant, because treatment-related adverse events and long-term tolerability issues are key determinants of the overall success of long-term therapy and the final outcome of a lifelong, symptomless disease like glaucoma. AREAS COVERED We include selected evidence pertaining to the safety and tolerability of available and emerging PGA formulations. We also outline PGA formulations with different concentrations of the active ingredient, different preservatives, and preservative-free (PF) options. EXPERT OPINION Undoubtedly PGAs will continue to play a major role in the medical therapy of glaucoma and OHT. Despite extensive literature and prolonged clinical experience with these agents worldwide, a number of areas that warrant further research have been identified in the present review. Recently launched novel PGAs, or those still in development offer new opportunities and future challenges.
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Affiliation(s)
- Andreas Katsanos
- Ophthalmology Department, University of Ioannina, Ioannina, Greece
| | - Ivano Riva
- Istituto Clinico Sant'Anna, Brescia, Italy
| | - Banu Bozkurt
- Department of Ophthalmology, Selcuk University School of Medicine, Konya, Turkey
| | - Gábor Holló
- Tutkimusz Ltd, Solymar, Hungary.,Eye Center, Prima Medica Health Centers, Budapest, Hungary
| | - Luciano Quaranta
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia, Irccs Fondazione Policlinico San Matteo, Pavia, Italy
| | | | - Murat Irkec
- Faculty of Medicine, Department of Ophthalmology, Hacettepe University, Ankara, Turkey
| | - Gordon N Dutton
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Anastasios G Konstas
- 1st and 3rd University Departments of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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26
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Mofidfar M, Abdi B, Ahadian S, Mostafavi E, Desai TA, Abbasi F, Sun Y, Manche EE, Ta CN, Flowers CW. Drug delivery to the anterior segment of the eye: A review of current and future treatment strategies. Int J Pharm 2021; 607:120924. [PMID: 34324989 PMCID: PMC8579814 DOI: 10.1016/j.ijpharm.2021.120924] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 01/03/2023]
Abstract
Research in the development of ophthalmic drug formulations and innovative technologies over the past few decades has been directed at improving the penetration of medications delivered to the eye. Currently, approximately 90% of all ophthalmic drug formulations (e.g. liposomes, micelles) are applied as eye drops. The major challenge of topical eye drops is low bioavailability, need for frequent instillation due to the short half-life, poor drug solubility, and potential side effects. Recent research has been focused on improving topical drug delivery devices by increasing ocular residence time, overcoming physiological and anatomical barriers, and developing medical devices and drug formulations to increase the duration of action of the active drugs. Researchers have developed innovative technologies and formulations ranging from sub-micron to macroscopic size such as prodrugs, enhancers, mucus-penetrating particles (MPPs), therapeutic contact lenses, and collagen corneal shields. Another approach towards the development of effective topical drug delivery is embedding therapeutic formulations in microdevices designed for sustained release of the active drugs. The goal is to optimize the delivery of ophthalmic medications by achieving high drug concentration with prolonged duration of action that is convenient for patients to administer.
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Affiliation(s)
| | - Behnam Abdi
- Institute of Polymeric Materials (IPM), Sahand University of Technology, New Town of Sahand, Tabriz, Iran; Faculty of Polymer Engineering, Sahand University of Technology, New Town of Sahand, Tabriz, Iran
| | - Samad Ahadian
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA, USA
| | - Ebrahim Mostafavi
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University, CA, USA
| | - Tejal A Desai
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
| | - Farhang Abbasi
- Institute of Polymeric Materials (IPM), Sahand University of Technology, New Town of Sahand, Tabriz, Iran; Faculty of Polymer Engineering, Sahand University of Technology, New Town of Sahand, Tabriz, Iran
| | - Yang Sun
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Edward E Manche
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Christopher N Ta
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Charles W Flowers
- USC Roski Eye Institute, University of Southern California, Los Angeles, CA, USA.
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27
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Luebke J, Boehringer D, Anton A, Daniel M, Reinhard T, Lang S. Trends in Surgical Glaucoma Treatment in Germany Between 2006 and 2018. Clin Epidemiol 2021; 13:581-592. [PMID: 34285592 PMCID: PMC8286102 DOI: 10.2147/clep.s310542] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/13/2021] [Indexed: 01/09/2023] Open
Abstract
Background/Aims Surgical procedures in ophthalmology underlie variations over different time periods and are strongly dependent on the technical process and the invention of innovative surgical techniques. Especially, in glaucoma surgery a lot of surgical devices and techniques have been introduced during the last years. Until now, the use of these newer techniques has not been shown on a robust data basis. We herein present the numbers of different types of glaucoma surgeries performed at German hospitals between 2006 and 2018. Methods and Design The quality reports of hospitals in Germany from 2006 to 2018 were analyzed concerning all procedural codes for glaucoma surgery and intervention. Especially, the change in usage of "classical" and "modern" surgical techniques (MIGS: "minimally invasive glaucoma surgery") or devices was compared. Results The number of glaucoma procedures performed increased by 75% from 27,811 in 2006 to 48,794 in 2018. Absolute numbers of trabeculectomies, goniotomies, ab externo trabeculotomies and to a certain level cyclodestructive procedures decreased during the examined years while use of MIGS has increased in absolute and relative numbers since 2012. From 2015 a strong increase in the usage of XEN implants could be seen. Drainage implants (such as Baerveldt/Ahmed) showed stable absolute numbers over the time period covered. Absolute numbers of laser trabeculoplasty peaked in 2014 and decreased afterwards. Iridotomies and iridectomies increased by 120%/248% over the whole period. Conclusion Our data show a trend towards the modern surgical options and especially MIGS during the recent years. Classical procedures showed a decrease in total numbers emphasized from 2013. These numbers confirm the assumption that modern glaucoma surgery is becoming more and more popular and established in German hospitals.
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Affiliation(s)
- Jan Luebke
- Eye Center, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Boehringer
- Eye Center, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Moritz Daniel
- Eye Center, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Reinhard
- Eye Center, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Lang
- Eye Center, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
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28
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Cen LP, Ng TK, Liang JJ, Xu C, Zhuang X, Liu YF, Chen SL, Xu Y, Yang Q, Yuan XL, Qin YJ, Chan SO, Chen H, Zhang M, Schally AV, Pang CP. Agonist of growth hormone-releasing hormone enhances retinal ganglion cell protection induced by macrophages after optic nerve injury. Proc Natl Acad Sci U S A 2021; 118:e1920834118. [PMID: 34244423 PMCID: PMC8285901 DOI: 10.1073/pnas.1920834118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Optic neuropathies are leading causes of irreversible visual impairment and blindness, currently affecting more than 100 million people worldwide. Glaucoma is a group of optic neuropathies attributed to progressive degeneration of retinal ganglion cells (RGCs). We have previously demonstrated an increase in survival of RGCs by the activation of macrophages, whereas the inhibition of macrophages was involved in the alleviation on endotoxin-induced inflammation by antagonist of growth hormone-releasing hormone (GHRH). Herein, we hypothesized that GHRH receptor (GHRH-R) signaling could be involved in the survival of RGCs mediated by inflammation. We found the expression of GHRH-R in RGCs of adult rat retina. After optic nerve crush, subcutaneous application of GHRH agonist MR-409 or antagonist MIA-602 promoted the survival of RGCs. Both the GHRH agonist and antagonist increased the phosphorylation of Akt in the retina, but only agonist MR-409 promoted microglia activation in the retina. The antagonist MIA-602 reduced significantly the expression of inflammation-related genes Il1b, Il6, and Tnf Moreover, agonist MR-409 further enhanced the promotion of RGC survival by lens injury or zymosan-induced macrophage activation, whereas antagonist MIA-602 attenuated the enhancement in RGC survival. Our findings reveal the protective effect of agonistic analogs of GHRH on RGCs in rats after optic nerve injury and its additive effect to macrophage activation, indicating a therapeutic potential of GHRH agonists for the protection of RGCs against optic neuropathies especially in glaucoma.
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Affiliation(s)
- Ling-Ping Cen
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, 515041 Shantou, China
| | - Tsz Kin Ng
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, 515041 Shantou, China
- Shantou University Medical College, 515041 Shantou, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Jia-Jian Liang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, 515041 Shantou, China
| | - Ciyan Xu
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, 515041 Shantou, China
| | - Xi Zhuang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, 515041 Shantou, China
| | - Yu-Fen Liu
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, 515041 Shantou, China
- Shantou University Medical College, 515041 Shantou, China
| | - Shao-Lang Chen
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, 515041 Shantou, China
| | - Yanxuan Xu
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, 515041 Shantou, China
| | - Qichen Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Xiang-Ling Yuan
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, 515041 Shantou, China
- Shantou University Medical College, 515041 Shantou, China
| | - Yong Jie Qin
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, 510080 Guangzhou, China
| | - Sun On Chan
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Haoyu Chen
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, 515041 Shantou, China
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, 515041 Shantou, China
| | - Andrew V Schally
- Department of Pathology, Miller School of Medicine, University of Miami, Miami, FL 33136;
- Division of Medical Oncology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL 33136
- Division of Endocrinology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL 33136
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 33136
- Cancer Institute, Veterans Affairs Medical Center, Miami, FL 33125
| | - Chi Pui Pang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, 515041 Shantou, China;
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
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Pantalon A, Feraru C, Tarcoveanu F, Chiselita D. Success of Primary Trabeculectomy in Advanced Open Angle Glaucoma. Clin Ophthalmol 2021; 15:2219-2229. [PMID: 34079219 PMCID: PMC8166817 DOI: 10.2147/opth.s308228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/21/2021] [Indexed: 12/15/2022] Open
Abstract
Aim The study assesed trabeculectomy survival in advanced open angle glaucoma (OAG). Methods This is a retrospective longitudinal study in advanced OAG undergoing primary trabeculectomy. Clinical and demographic parameters were recorded. Surgical survival (qualified/complete) was calculated by Kaplan–Meier analysis for multiple upper limits of intraocular pressure (IOP) with/without medication (≤21 mmHg, ≤18 mmHg, ≤15 mmHg, ≤12 mmHg); Cox hazard ratio analysis identified parameters influencing survival. Results We included 165 eyes from 165 OAG patients: primary forms (POAG) – 86 eyes and secondary (pseudoexfoliative, SOAG) – 79 eyes; mean follow-up interval was 36.21 ± 13.49 months. Clinical parameters were comparable between sub-groups at baseline, except a higher IOP in SOAG vs POAG (36.6 ± 13.2 vs 32.7 ± 11.1 mmHg, p = 0.04); IOP reduction was similar (SOAG vs POAG) 53.93% vs 56.19%, p = 0.45, yet longer hospitalization (8.47 ± 4.39 (SOAG) vs 6.69 ± 3.01 days (POAG), p=0.03) and more medications (0.65 ± 0.24 vs 0.36 ± 0.16, p = 0.05) were needed to achieve comparable final IOP (16.0 ± 9.1 vs 15.1 ± 7.8 mmHg, p = 0.45). Kaplan Meier survival analysis applied for IOP ≤21 mmHg, ≤18 mmHg, ≤15 mmHg and ≤12 mmHg, revealed complete success in 26.2%, 27.3%, 34.5% and 54.6% eyes, respectively; qualified success was found in 45.7%, 48.6%, 77% and 88.6% eyes, respectively. Multiple medications at baseline diminished survival in all tested models (hazard ratio HR > 1, p<0.05), while 5FU+needling improved survival, mostly if combined with lower IOP regime: HR = 0.15, 95% CI = [0.07 −1.12], p = 0.06, if IOP ≤15 mmHg and HR = 0.09, 95% CI = [0.02–1.25], p = 0.06, if IOP ≤12 mmHg. Conclusion Trabeculectomy in advanced OAG reached very good survival rates (77% and 88.6%) at 36 months postoperative, if IOP could be maintained ≤15 mmHg, respectively ≤12 mmHg with medication and additional needling+5FU maneuvers. Specific factors influencing survival were identified for each success definition.
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Affiliation(s)
- Anca Pantalon
- Ophthalmology Clinic, St. Spiridon Emergency University Hospital, Iași, Romania
| | - Crenguta Feraru
- Ophthalmology Department, Gr. T. Popa University of Medicine and Pharmacy, Iași, Romania
| | - Filip Tarcoveanu
- Ophthalmology Department, Gr. T. Popa University of Medicine and Pharmacy, Iași, Romania.,Ophthalmology Department, Countess of Chester Hospital NHS Trust, Chester, UK
| | - Dorin Chiselita
- Ophthalmology Clinic, St. Spiridon Emergency University Hospital, Iași, Romania.,Ophthalmology Department, Gr. T. Popa University of Medicine and Pharmacy, Iași, Romania
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30
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Tseng RMWW, Gunasekeran DV, Tan SSH, Rim TH, Lum E, Tan GSW, Wong TY, Tham YC. Considerations for Artificial Intelligence Real-World Implementation in Ophthalmology: Providers' and Patients' Perspectives. Asia Pac J Ophthalmol (Phila) 2021; 10:299-306. [PMID: 34383721 DOI: 10.1097/apo.0000000000000400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Artificial Intelligence (AI), in particular deep learning, has made waves in the health care industry, with several prominent examples shown in ophthalmology. Despite the burgeoning reports on the development of new AI algorithms for detection and management of various eye diseases, few have reached the stage of regulatory approval for real-world implementation. To better enable real-world translation of AI systems, it is important to understand the demands, needs, and concerns of both health care professionals and patients, as providers and recipients of clinical care are impacted by these solutions. This review outlines the advantages and concerns of incorporating AI in ophthalmology care delivery, from both the providers' and patients' perspectives, and the key enablers for seamless transition to real-world implementation.
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Affiliation(s)
| | - Dinesh Visva Gunasekeran
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | | | - Tyler Hyungtaek Rim
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, Singapore
| | | | - Gavin S W Tan
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, Singapore
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31
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What Is New in Glaucoma: From Treatment to Biological Perspectives. J Ophthalmol 2021; 2021:5013529. [PMID: 33936807 PMCID: PMC8060111 DOI: 10.1155/2021/5013529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/24/2021] [Accepted: 03/24/2021] [Indexed: 11/30/2022] Open
Abstract
Glaucoma is a chronic silent disease and an irreversible cause of blindness worldwide. Research has made many efforts to improve disease control and especially to anticipate both early diagnosis and treatment of advanced stages of glaucoma. In terms of prevention, networking between professionals and nonprofessionals is an important goal to disseminate information and help diagnose the disease early. On the other hand, the most recent approaches to treat glaucoma outcomes in its advanced stages include electrical stimulation, stem cells, exosomes, extracellular vesicles, and growth factors. Finally, neuronal plasticity-based rehabilitation methods are being studied to reeducate patients in order to stimulate their residual visual capacity. This review provides an overview of new approaches to future possible glaucoma treatment modalities and gives insight into the perspectives available nowadays in this field.
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32
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Shin H, Seo H, Chung WG, Joo BJ, Jang J, Park JU. Recent progress on wearable point-of-care devices for ocular systems. LAB ON A CHIP 2021; 21:1269-1286. [PMID: 33704299 DOI: 10.1039/d0lc01317j] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The eye is a complex sensory organ that contains abundant information for specific diseases and pathological responses. It has emerged as a facile biological interface for wearable healthcare platforms because of its excellent accessibility. Recent advances in electronic devices have led to the extensive research of point-of-care (POC) systems for diagnosing and monitoring diseases by detecting the biomarkers within the eye. Among these systems, contact lenses, which make direct contact with the ocular surfaces, have been utilized as one of the promising candidates for non-invasive POC testing of various diseases. The continuous and long-term measurement from the sensor allows the patients to manage their symptoms in an effective and convenient way. Herein, we review the progress of contact lens sensors in terms of the materials, methodologies, device designs, and target biomarkers. The anatomical structure and biological mechanisms of the eye are also discussed to provide a comprehensive understanding of the principles of contact lens sensors. Intraocular pressure and glucose, which are the representative biomarkers found in the eyes, can be measured with the biosensors integrated with contact lenses for the diagnosis of glaucoma and diabetes. Furthermore, contact lens sensors for various general pathologies as well as other ocular diseases are also considered, thereby providing the prospects for further developments of smart contact lenses as a future POC system.
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Affiliation(s)
- Haein Shin
- Nano Science Technology Institute, Department of Materials Science and Engineering, Yonsei University, Seoul, 03722, Republic of Korea.
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33
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Jones PR, Campbell P, Callaghan T, Jones L, Asfaw DS, Edgar DF, Crabb DP. Glaucoma Home Monitoring Using a Tablet-Based Visual Field Test (Eyecatcher): An Assessment of Accuracy and Adherence Over 6 Months. Am J Ophthalmol 2021; 223:42-52. [PMID: 32882222 PMCID: PMC7462567 DOI: 10.1016/j.ajo.2020.08.039] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 01/14/2023]
Abstract
Purpose To assess accuracy and adherence of visual field (VF) home monitoring in a pilot sample of patients with glaucoma. Design Prospective longitudinal feasibility and reliability study. Methods Twenty adults (median 71 years) with an established diagnosis of glaucoma were issued a tablet perimeter (Eyecatcher) and were asked to perform 1 VF home assessment per eye, per month, for 6 months (12 tests total). Before and after home monitoring, 2 VF assessments were performed in clinic using standard automated perimetry (4 tests total, per eye). Results All 20 participants could perform monthly home monitoring, though 1 participant stopped after 4 months (adherence: 98% of tests). There was good concordance between VFs measured at home and in the clinic (r = 0.94, P < .001). In 21 of 236 tests (9%), mean deviation deviated by more than ±3 dB from the median. Many of these anomalous tests could be identified by applying machine learning techniques to recordings from the tablets' front-facing camera (area under the receiver operating characteristic curve = 0.78). Adding home-monitoring data to 2 standard automated perimetry tests made 6 months apart reduced measurement error (between-test measurement variability) in 97% of eyes, with mean absolute error more than halving in 90% of eyes. Median test duration was 4.5 minutes (quartiles: 3.9-5.2 minutes). Substantial variations in ambient illumination had no observable effect on VF measurements (r = 0.07, P = .320). Conclusions Home monitoring of VFs is viable for some patients and may provide clinically useful data.
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Affiliation(s)
- Pete R Jones
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Peter Campbell
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK; Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Tamsin Callaghan
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Lee Jones
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Daniel S Asfaw
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David F Edgar
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David P Crabb
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
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Kesav NP, Young CEC, Ertel MK, Seibold LK, Kahook MY. Sustained-release drug delivery systems for the treatment of glaucoma. Int J Ophthalmol 2021; 14:148-159. [PMID: 33469497 PMCID: PMC7790669 DOI: 10.18240/ijo.2021.01.21] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/17/2020] [Indexed: 12/27/2022] Open
Abstract
Glaucoma, a leading cause of irreversible blindness, affects more than 64 million people worldwide and is expected to grow in number due to the aging global population and enhanced methods of detection. Although topical therapies are often effective when used as prescribed, the drawbacks of current medical management methods include poor patient adherence, local and systemic side effects, and in some cases, limited therapeutic efficacy. Novel ocular drug delivery platforms promise to deliver differentiated drug formulations with targeted delivery leveraging patient-independent administration. Several platforms are in various stages of development with promising pre-clinical and clinical data. The Bimatoprost Sustained Release (SR) intracameral implant was approved in the United States in March of 2020, making it the first long-term injectable therapy available for the treatment of glaucoma. This review aims to provide an update on novel sustained release drug delivery systems that are available today as well as those that might be commercialized in coming years.
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Affiliation(s)
- Natasha P. Kesav
- Department of Ophthalmology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | | | - Monica K. Ertel
- Department of Ophthalmology, University of Colorado School of Medicine, CO 80045, USA
| | - Leonard K. Seibold
- Department of Ophthalmology, University of Colorado School of Medicine, CO 80045, USA
| | - Malik Y. Kahook
- Department of Ophthalmology, University of Colorado School of Medicine, CO 80045, USA
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Sterling JK, Adetunji MO, Guttha S, Bargoud AR, Uyhazi KE, Ross AG, Dunaief JL, Cui QN. GLP-1 Receptor Agonist NLY01 Reduces Retinal Inflammation and Neuron Death Secondary to Ocular Hypertension. Cell Rep 2020; 33:108271. [PMID: 33147455 PMCID: PMC7660987 DOI: 10.1016/j.celrep.2020.108271] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/03/2020] [Accepted: 09/23/2020] [Indexed: 12/16/2022] Open
Abstract
Glaucoma is the leading cause of irreversible blindness and is characterized by the death of retinal ganglion cells (RGCs). Recent studies have implicated pro-inflammatory microglia, macrophages, and A1 astrocytes in the pathogenesis of neurodegenerative diseases. The role of pro-inflammatory, neurotoxic A1 astrocytes in glaucoma is just beginning to be explored. Using a mouse model of glaucoma, we demonstrate that ocular hypertension is sufficient to trigger production of C1q, interleukin-1α (IL-1α), and tumor necrosis factor α (TNF-α), three cytokines necessary and sufficient to drive the formation of A1 astrocytes. Upregulation of these cytokines occurs first in CD11b+ CD11c+ cells followed by CD11b+ CD11c- cells. Ablation of this pathway, by either genetic deletions of C1qa, IL-1α, and TNF-α, or treatment with glucagon-like peptide-1 receptor agonist NLY01, reduces A1 astrocyte transformation and RGC death. Together, these results highlight a neuroinflammatory mechanism of glaucomatous neurodegeneration that can be therapeutically targeted by NLY01 administration.
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Affiliation(s)
- Jacob K Sterling
- FM Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; Medical Scientist Training Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Modupe O Adetunji
- FM Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Samyuktha Guttha
- FM Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Albert R Bargoud
- FM Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Katherine E Uyhazi
- FM Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Ahmara G Ross
- FM Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Joshua L Dunaief
- FM Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Qi N Cui
- FM Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA.
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Konstas AG, Schmetterer L, Costa VP, Holló G, Katsanos A, Denis P, Quaranta L, Irkec M, Castejón MA, Teus MA, Robin AL. Current and emerging fixed combination therapies in glaucoma: a safety and tolerability review. Expert Opin Drug Saf 2020; 19:1445-1460. [DOI: 10.1080/14740338.2020.1826928] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Anastasios G. Konstas
- 1st and 3rd University Departments of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore; Academic Clinical Program, Duke-NUS Medical School, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore; Department of Clinical Pharmacology, Medical University of Vienna, Austria; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria; Institute of Clinical and Molecular Ophthalmology,
| | - Vital P. Costa
- Department of Ophthalmology, Universidade Estadual De Campinas, Campinas, Brazil
| | - Gábor Holló
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Andreas Katsanos
- Department of Ophthalmology, University of Ioannina, Ioannina, Greece
| | - Philippe Denis
- Department of Ophthalmology, Croix-Rousse University Hospital, Lyon, France
| | - Luciano Quaranta
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia-IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Murat Irkec
- Department of Ophthalmology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Miguel A. Castejón
- Ophthalmology Department, University Hospital “Príncipe De Asturias”, Alcalá De Henares, Spain
| | - Miguel A. Teus
- Ophthalmology Department, University of Alcala, Madrid, Spain
| | - Alan L. Robin
- Wilmer Eye Institute and Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, USA; Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
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Sunaric Megevand G, Bron AM. Personalising surgical treatments for glaucoma patients. Prog Retin Eye Res 2020; 81:100879. [PMID: 32562883 DOI: 10.1016/j.preteyeres.2020.100879] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023]
Abstract
Surgical treatments for glaucoma have relied for decades on traditional filtering surgery such as trabeculectomy and, in more challenging cases, tubes. Antifibrotics were introduced to improve surgical success in patients at increased risk of failure but have been shown to be linked to a greater incidence of complications, some being potentially vision-threatening. As our understanding of glaucoma and its early diagnosis have improved, a more individualised management has been suggested. Recently the term "precision medicine" has emerged as a new concept of an individualised approach to disease management incorporating a wide range of individual data in the choice of therapeutic modalities. For glaucoma surgery, this involves evaluation of the right timing, individual risk factors, targeting the correct anatomical and functional outflow pathways and appropriate prevention of scarring. As a consequence, there is an obvious need for better knowledge of anatomical and functional pathways and for more individualised surgical approaches with new, less invasive and safer techniques allowing for earlier intervention. With the recent advent of minimally invasive glaucoma surgery (MIGS) a large number of novel devices have been introduced targeting potential new sites of the outflow pathway for lowering intraocular pressure (IOP). Their popularity is growing in view of the relative surgical simplicity and apparent lack of serious side effects. However, these new surgical techniques are still in an era of early experiences, short follow-up and lack of evidence of their superiority in safety and cost-effectiveness over the traditional methods. Each year several new devices are introduced while others are withdrawn from the market. Glaucoma continues to be the primary cause of irreversible blindness worldwide and access to safe and efficacious treatment is a serious problem, particularly in the emerging world where the burden of glaucoma-related blindness is important and concerning. Early diagnosis, individualised treatment and, very importantly, safe surgical management should be the hallmarks of glaucoma treatment. However, there is still need for a better understanding of the disease, its onset and progression, the functional and structural elements of the outflow pathways in relation to the new devices as well as their long-term IOP-lowering efficacy and safety. This review discusses current knowledge and the future need for personalised glaucoma surgery.
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Affiliation(s)
- Gordana Sunaric Megevand
- Clinical Eye Research Centre Memorial Adolphe de Rothschild, Geneva, Switzerland; Centre Ophtalmologique de Florissant, Geneva, Switzerland.
| | - Alain M Bron
- Department of Ophthalmology, University Hospital, Dijon, France; Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, F-21000, Dijon, France
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Aguilar-Rivera M, Erudaitius DT, Wu VM, Tantiongloc JC, Kang DY, Coleman TP, Baxter SL, Weinreb RN. Smart Electronic Eyedrop Bottle for Unobtrusive Monitoring of Glaucoma Medication Adherence. SENSORS 2020; 20:s20092570. [PMID: 32366013 PMCID: PMC7248824 DOI: 10.3390/s20092570] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 11/16/2022]
Abstract
Glaucoma, the leading cause of irreversible blindness, affects >70 million people worldwide. Lowering intraocular pressure via topical administration of eye drops is the most common first-line therapy for glaucoma. This treatment paradigm has notoriously high non-adherence rates: ranging from 30% to 80%. The advent of smart phone enabled technologies creates promise for improving eyedrop adherence. However, previous eyedrop electronic monitoring solutions had awkward medication bottle adjuncts and crude software for monitoring the administration of a drop that adversely affected their ability to foster sustainable improvements in adherence. The current work begins to address this unmet need for wireless technology by creating a “smart drop” bottle. This medication bottle is instrumented with sensing electronics that enable detection of each eyedrop administered while maintaining the shape and size of the bottle. This is achieved by a thin electronic force sensor wrapped around the bottle and underneath the label, interfaced with a thin electronic circuit underneath the bottle that allows for detection and wireless transmission to a smart-phone application. We demonstrate 100% success rate of wireless communication over 75 feet with <1% false positive and false negative rates of single drop deliveries, thus providing a viable solution for eyedrop monitoring for glaucoma patients.
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Affiliation(s)
- Marcelo Aguilar-Rivera
- Department of Bioengineering, University of California San Diego, La Jolla, San Diego, CA 92093, USA; (M.A.-R.); (D.T.E.); (V.M.W.); (D.Y.K.); (T.P.C.)
| | - Dieanira T. Erudaitius
- Department of Bioengineering, University of California San Diego, La Jolla, San Diego, CA 92093, USA; (M.A.-R.); (D.T.E.); (V.M.W.); (D.Y.K.); (T.P.C.)
| | - Vincent M. Wu
- Department of Bioengineering, University of California San Diego, La Jolla, San Diego, CA 92093, USA; (M.A.-R.); (D.T.E.); (V.M.W.); (D.Y.K.); (T.P.C.)
| | - Justin C. Tantiongloc
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, San Diego, CA 92093, USA;
| | - Dae Y. Kang
- Department of Bioengineering, University of California San Diego, La Jolla, San Diego, CA 92093, USA; (M.A.-R.); (D.T.E.); (V.M.W.); (D.Y.K.); (T.P.C.)
| | - Todd P. Coleman
- Department of Bioengineering, University of California San Diego, La Jolla, San Diego, CA 92093, USA; (M.A.-R.); (D.T.E.); (V.M.W.); (D.Y.K.); (T.P.C.)
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, San Diego, CA 92093, USA;
| | - Sally L. Baxter
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, San Diego, CA 92093, USA;
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, San Diego, CA 92093, USA
| | - Robert N. Weinreb
- Department of Bioengineering, University of California San Diego, La Jolla, San Diego, CA 92093, USA; (M.A.-R.); (D.T.E.); (V.M.W.); (D.Y.K.); (T.P.C.)
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, San Diego, CA 92093, USA;
- Correspondence: ; Tel./Fax: +1-858-534-8824
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Endothelin-1 Mediated Decrease in Mitochondrial Gene Expression and Bioenergetics Contribute to Neurodegeneration of Retinal Ganglion Cells. Sci Rep 2020; 10:3571. [PMID: 32107448 PMCID: PMC7046667 DOI: 10.1038/s41598-020-60558-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 02/07/2020] [Indexed: 11/09/2022] Open
Abstract
Endothelin-1 (ET-1) is a vasoactive peptide that is elevated in aqueous humor as well as circulation of primary open angle glaucoma (POAG) patients. ET-1 has been shown to promote degeneration of optic nerve axons and apoptosis of retinal ganglion cells (RGCs), however, the precise mechanisms are still largely unknown. In this study, RNA-seq analysis was used to assess changes in ET-1 mediated gene expression in primary RGCs, which revealed that 23 out of 156 differentially expressed genes (DEGs) had known or predicted mitochondrial function, of which oxidative phosphorylation emerged as the top-most enriched pathway. ET-1 treatment significantly decreased protein expression of key mitochondrial genes including cytochrome C oxidase copper chaperone (COX17) and ATP Synthase, H+ transporting, Mitochondrial Fo Complex (ATP5H) in primary RGCs and in vivo following intravitreal ET-1 injection in rats. A Seahorse ATP rate assay revealed a significant decrease in the rate of mitochondrial ATP production following ET-1 treatment. IOP elevation in Brown Norway rats showed a trend towards decreased expression of ATP5H. Our results demonstrate that ET-1 produced a decrease in expression of vital components of mitochondrial electron transport chain, which compromise bioenergetics and suggest a mechanism by which ET-1 promotes neurodegeneration of RGCs in glaucoma.
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Yadav KS, Sharma S, Londhe VY. Bio-tactics for neuroprotection of retinal ganglion cells in the treatment of glaucoma. Life Sci 2020; 243:117303. [DOI: 10.1016/j.lfs.2020.117303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/03/2020] [Accepted: 01/12/2020] [Indexed: 01/01/2023]
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Baxter SL, Marks C, Kuo TT, Ohno-Machado L, Weinreb RN. Machine Learning-Based Predictive Modeling of Surgical Intervention in Glaucoma Using Systemic Data From Electronic Health Records. Am J Ophthalmol 2019; 208:30-40. [PMID: 31323204 PMCID: PMC6888922 DOI: 10.1016/j.ajo.2019.07.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE To predict the need for surgical intervention in patients with primary open-angle glaucoma (POAG) using systemic data in electronic health records (EHRs). DESIGN Development and evaluation of machine learning models. METHODS Structured EHR data of 385 POAG patients from a single academic institution were incorporated into models using multivariable logistic regression, random forests, and artificial neural networks. Leave-one-out cross-validation was performed. Mean area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, and Youden index were calculated for each model to evaluate performance. Systemic variables driving predictions were identified and interpreted. RESULTS Multivariable logistic regression was most effective at discriminating patients with progressive disease requiring surgery, with an AUC of 0.67. Higher mean systolic blood pressure was associated with significantly increased odds of needing glaucoma surgery (odds ratio [OR] = 1.09, P < .001). Ophthalmic medications (OR = 0.28, P < .001), non-opioid analgesic medications (OR = 0.21, P = .002), anti-hyperlipidemic medications (OR = 0.39, P = .004), macrolide antibiotics (OR = 0.40, P = .03), and calcium blockers (OR = 0.43, P = .03) were associated with decreased odds of needing glaucoma surgery. CONCLUSIONS Existing systemic data in the EHR has some predictive value in identifying POAG patients at risk of progression to surgical intervention, even in the absence of eye-specific data. Blood pressure-related metrics and certain medication classes emerged as predictors of glaucoma progression. This approach provides an opportunity for future development of automated risk prediction within the EHR based on systemic data to assist with clinical decision-making.
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Affiliation(s)
- Sally L Baxter
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center and Shiley Eye Institute, University of California, San Diego, La Jolla, California, USA; UCSD Health Department of Biomedical Informatics, University of California, San Diego, La Jolla, California, USA
| | - Charles Marks
- UCSD Health Department of Biomedical Informatics, University of California, San Diego, La Jolla, California, USA; Interdisciplinary Research on Substance Use Joint Doctoral Program, University of California, San Diego and San Diego State University, San Diego, California, USA
| | - Tsung-Ting Kuo
- UCSD Health Department of Biomedical Informatics, University of California, San Diego, La Jolla, California, USA
| | - Lucila Ohno-Machado
- UCSD Health Department of Biomedical Informatics, University of California, San Diego, La Jolla, California, USA; Division of Health Services Research and Development, Veterans Administration San Diego Healthcare System, La Jolla, California, USA
| | - Robert N Weinreb
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center and Shiley Eye Institute, University of California, San Diego, La Jolla, California, USA.
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Surgical Outcomes and Quality Assessment of Trabeculectomy: Leveraging Electronic Health Records for Clinical Data Visualization. J Glaucoma 2019; 28:1023-1028. [PMID: 31658225 DOI: 10.1097/ijg.0000000000001386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PRéCIS:: This electronic medical record-based study demonstrates 1 approach to monitor clinical outcomes for individual physicians performing trabeculectomy. PURPOSE The purpose of this study was to develop an interactive data visualization platform for evaluating trabeculectomy outcomes and monitoring clinical care quality. PATIENTS AND METHODS This is a retrospective electronic health record study in a glaucoma division of an academic medical center. We included 633 patients who underwent trabeculectomy between July 2016 and December 2018. Data were collected for intraocular pressure (IOP), vision loss, number of follow-up visits, and return to the operating room within the initial 3 months. Regression analyses were used to assess factors associated with these study outcomes. Risk of IOP ≤5 mm Hg was assessed using survival analysis. An interactive data visualization platform was created. RESULTS A total of 429 trabeculectomy and 204 combined surgeries were analyzed, with preoperative IOP of 21.9±9.4 and 19.4±6.9 mm Hg, respectively. Mean pressure declined by 53% and 41% (P=0.001) by 3 months. Risk of pressure ≤5 mm Hg was higher in white patients and those who underwent trabeculectomy alone. At 3 months, patients on average had 5 clinic visits; 5.5% required additional surgical procedures, and 18% experienced loss of at least 3 lines of best-recorded (not best-corrected) vision. Returning to the operating room was significantly associated with an increased number of clinic visits (coefficient=3.94) and higher odds of vision loss (odds ratio=11.12). CONCLUSIONS Over the initial 3 months after trabeculectomy, additional surgeries are rare, while a significant proportion of patients lost vision, and this was strongly associated with a need to return to the operating room. Interactive electronic health record data visualization can be a useful tool for monitoring clinical outcomes.
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Abstract
PURPOSE OF REVIEW Approximately 10% of patients become blind despite using evidence-based guidelines developed from clinical trials and epidemiology studies. Our purpose is to review opportunities to decrease glaucoma-related blindness using the emerging principles of precision medicine. RECENT FINDINGS The current review focuses on three topics: first, candidate biomarkers for angle-based surgeries, second, head-mounted display (HMD) technology for vision and testing, and third, glaucoma risk alleles discovered by genome-wide association studies. First, in angle-based surgeries, tracers injected into the anterior chamber or Schlemm's canal have allowed visualization of aqueous veins. We describe an innovative use of optical coherence tomography angiography to visualize aqueous veins in a case with 6-year successful outcome following catheter-based trabeculotomy. Second, HMD technology can augment perceived vision and can be used for perimetry testing. Third, developing genetic risk scores that characterize patients who are at highest risk for blindness is a priority. Such biomarker risk scores will integrate genome-wide association study-based risk alleles for glaucoma along with well known demographic and clinical risk factors. SUMMARY As we gain more knowledge, precision medicine will enable clinicians to decrease glaucoma-related blindness by providing more timely interventions to those patients who are at highest risk for progression to blindness. VIDEO ABSTRACT: http://links.lww.com/COOP/A29.
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