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Warjri GB, Das AV, Senthil S. Clinical profile and demographic distribution of pseudoexfoliation syndrome: An electronic medical record-driven big data analytics from an eye care network in India. Indian J Ophthalmol 2023; 71:2746-2755. [PMID: 37417115 PMCID: PMC10491057 DOI: 10.4103/ijo.ijo_2619_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 02/25/2023] [Accepted: 03/28/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose To describe the demographics and clinical profile of pseudoexfoliation syndrome (PXF or PES) in patients presenting to a multi-tier ophthalmology hospital network in India. Methods This cross-sectional hospital-based study included 3,082,727 new patients presenting between August 2010 and December 2021. Patients with a clinical diagnosis of PXF in at least one eye were included as cases. The data were collected using an electronic medical record system. Results Overall, 23,223 (0.75%) patients were diagnosed with PXF. The majority of the patients were male (67.08%) and had unilateral (60.96%) affliction. The most common age group at presentation was during the seventh decade of life with 9,495 (40.89%) patients. The overall prevalence was higher in patients from a lower socio-economic status (1.48%) presenting from the urban geography (0.84%) and in retired individuals (3.61%). The most common location of the PXF material was the pupillary margin (81.01%) followed by the iris (19.15%). The majority of the eyes had mild or no visual impairment (<20/70) in 12,962 (40.14%) eyes. PXF glaucoma was documented in 7,954 (24.63%) eyes. Krukenberg's spindle was found in 64 (0.20%) eyes, phacodonesis in 328 (1.02%) eyes, and lens subluxation in 299 (0.93%) eyes. Among the surgical interventions, cataract surgery was performed in 8,363 (25.9%) eyes, trabeculectomy was performed in 966 (2.99%) eyes, and a combined procedure in 822 (2.55%) eyes. Conclusion PXF more commonly affects males presenting during the seventh decade of life from lower socio-economic status and is predominantly unilateral. A quarter of the affected eyes are associated with glaucoma and the majority of the eyes have mild or no visual impairment.
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Affiliation(s)
- Gazella Bruce Warjri
- VST Centre for Glaucoma Services, L V Prasad Eye Institute, KallamAnji Reddy Campus, Hyderabad, Telangana, India
| | - Anthony Vipin Das
- Department of EyeSmart EMR andAEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sirisha Senthil
- VST Centre for Glaucoma Services, L V Prasad Eye Institute, KallamAnji Reddy Campus, Hyderabad, Telangana, India
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Lee JY, Sung KR, Kim YJ. Comparison of the Prevalence and Clinical Characteristics of Epiretinal Membrane in Pseudoexfoliation and Primary Open-angle Glaucoma. J Glaucoma 2021; 30:859-865. [PMID: 33899808 DOI: 10.1097/ijg.0000000000001851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/21/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to investigate and compare the prevalence and clinical characteristics of epiretinal membrane (ERM) in patients with pseudoexfoliation glaucoma (PXG) and primary open-angle glaucoma (POAG). METHODS In this retrospective observational study, 211 PXG eyes, 210 age-matched normal eyes, and 220 POAG eyes were included. The presence and staging of ERM (stage 1, 2, and 3 or greater) were independently assessed by 2 observers. Univariate and multivariate linear regression analyses were performed to assess the factors associated with visual field (VF) mean deviation (MD) in PXG eyes. RESULTS Among 211 PXG eyes, 40 (19.0%) had an ERM, while 4.1% of POAG and 2.4% of normal eyes had an ERM (P<0.001). Retinal nerve fiber layer thickness (69.4 vs. 70.4 μm, P=0.477) and VF MD (-7.7 vs. -10.4 dB, P=0.098) were not different between POAG and PXG eyes but macular thickness was greater (259.5 vs. 271.5 μm, P=0.006) in PXG eyes than in POAG. Both lower retinal nerve fiber layer thickness (β=0.337, P<0.001) and the presence of an ERM (β=-4.246, P=0.002) were independently associated with worse VF MD in PXG eyes. CONCLUSIONS The prevalence of ERM was significantly greater in PXG eyes than in age-matched normal or POAG eyes. The presence of ERM affected VF in PXG eyes.
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Affiliation(s)
- Jin Yeong Lee
- Department of Ophthalmology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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Al-Najmi Y, Kirat O, Abdalla Elsayed MEA, Albeedh M, Al-Rashed D, Al-Mohammed A. Glaucoma Diagnoses and Legal Blindness from Glaucoma among Bedouin Patients of Central Saudi Arabia: A Hospital-Based Study. Middle East Afr J Ophthalmol 2021; 28:29-35. [PMID: 34321820 PMCID: PMC8270019 DOI: 10.4103/meajo.meajo_77_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/15/2021] [Accepted: 04/11/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE: The current study aims to know the glaucoma diagnoses and legal blindness from glaucoma among a tertiary referral center in Riyadh (King Abdulaziz Medical City [KAMC]-Riyadh patients). METHODS: This is a retrospective cohort study on chart review, where all eligible glaucoma patients attending the ophthalmology clinic at KAMC-Riyadh, between 2018 and 2019; were included. RESULTS: A total of 248 patients were included in the study; 142 patients (57.3%) were females and 106 (42.7%) were males. The mean age of the patients was 62.2 ± 18 years and most of them (93.5%) did not have a family history of glaucoma. Nearly one-quarter (26.6%; n = 66) of the included patients were legally blind, out of those, 36.4% had their right eye affected, 34.8% had their left eye affected, and 28.8% had both eyes affected. Legally, blind patients (LBGs) did not show a statistically significant reduction in the intraocular pressure (IOP) in the right eye (P = 0.103), on comparing the IOP in both visits. Nevertheless, there was a statistically significant reduction in the IOP of the left eye among the LBGs in both visits (P = 0.016). Regarding the nonblind group of patients, there were highly statistically significant reductions in both eyes (P < 0.001). CONCLUSION: The present findings show a high prevalence rate of legal blindness among glaucoma patients, with IOP reduction, age, and glaucoma diagnoses being the most important predictors among the study population.
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Affiliation(s)
- Yahya Al-Najmi
- Department of Ophthalmology, Saggaf Eye Center, Jeddah, Kingdom of Saudi Arabia
| | - Omar Kirat
- Department of Ophthalmology, Prince Mohammed bin Nasser Hospital, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Maram E A Abdalla Elsayed
- Department of Ophthalmology, Jeddah Eye Hospital, Jeddah, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Albeedh
- Department of Ophthalmology, Saggaf Eye Center, Jeddah, Kingdom of Saudi Arabia
| | - Dawood Al-Rashed
- Department of Ophthalmology, Al-Safwa Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Abdulkareem Al-Mohammed
- Department of Ophthalmology, Ministry of National Guard-Health Affairs, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
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Visual impairment in pseudoexfoliation from four tertiary centres in India. PLoS One 2020; 15:e0233268. [PMID: 32469900 PMCID: PMC7259498 DOI: 10.1371/journal.pone.0233268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 05/03/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose To analyse the disease burden of pseudoexfoliation (PXF) disease stages from East and South India. Design Prospective hospital based study of patients seen at 4 tertiary centres. Subjects, participants, and/or controls Consecutive old and new patients of pseudoexfoliation with normal intraocular pressure (IOP), raised IOP (PXF with Ocular hypertension, OHT) and irreversible disc/field changes (pseudoexfoliation glaucoma, PXG) seen from April 2016-March 2017 at a tertiary centre in Odisha, East India and 3 centres in Andhra Pradesh and Telangana, South India, recruited into the prospective study were screened for baseline characteristics. Methods The clinical and demographic details including visual acuity, laterality, intraocular pressure (IOP) with details of medical/surgical therapy at presentation were collected from the hospital database at all 4 centres. Intervention or exposure The World Health Organization WHO visual criteria were used for defining visual impairment/absolute blindness in different disease stages. Outcome measures The visual impairment/blindness rates with comorbidities in the anterior/posterior segment in PXF, OHT and PXG at baseline were compared and the influence of age, IOP fluctuations and laterality was analysed using multivariate logistic regression. Results Of 6284 PXF eyes (of 3142 patients) included from all centres, OHT and PXG was seen in 2.1% and 29% respectively which included 3676 (>50%) bilateral PXF eyes. Reversible visual impairment rates caused by PXF associated co-morbidities in PXF and OHT were 33% and 26% respectively with cataract being the major cause (67% in PXF and 74% in OHT). Irreversible blindness rate was higher in bilateral PXG eyes (30.5%) compared to bilateral PXF (23.2%) or bilateral OHT (21.6%) with overall absolute blindness rates of 28.2% at presentation. Older age (p<0.001), bilaterality and higher baseline IOP were significantly associated with higher rates of blindness in PXF eyes. Conclusion and relevance Pseudoexfoliation is associated with ≥30% visual impairment across all stages and 28% absolute blindness rate which is a huge hidden burden of glaucoma. Adequate disease staging and assessment of comorbidities is required for accurate prognostication at baseline and reducing avoidable pseudoexfoliation blindness.
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Joshi RS, Singanwad SV. Frequency and surgical difficulties associated with pseudoexfoliation syndrome among Indian rural population scheduled for cataract surgery: Hospital-based data. Indian J Ophthalmol 2019; 67:221-226. [PMID: 30672474 PMCID: PMC6376804 DOI: 10.4103/ijo.ijo_931_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose: To study the frequency and intraoperative difficulties associated with pseudoexfoliation (PXF) syndrome at a tertiary eye care center in a rural central India. Methods: This study included patients scheduled for cataract surgery who were diagnosed with PXF syndrome. All patients underwent a complete ophthalmologic evaluation, including slit-lamp examination, tonometry, gonioscopy, and ophthalmoscopy before the surgery. Cataract surgeries were performed by a single surgeon who reported the intraoperative difficulties. Results: In total, 1022 phakic eyes of 1823 patients were evaluated, 226 of whom (22.1%) were diagnosed with PXF syndrome. Most eyes (n = 81, 35.8%) with PXF syndrome were ≥81 years old. Eighty-six eyes (38.1%) had bilateral involvement, whereas 70 (30.9%) had right or left eye involvement. Further, PXF material was distributed on the iris, pupil, and lens in 70 eyes (30.9%) and on the pupillary margin in 36 eyes (15.9%). The mean pupillary dilation was 5.1 (±1.4) mm in patients with PXF syndrome compared with 7.2 (±1.6) mm in those without it (P = 0.03). Grade VI cataract was observed in 93 eyes (41.2%) and hypermature cataract was the most commonly observed cataract stage. Twenty-one eyes (9.3%) had increased intraocular pressure. Intraoperative difficulties were encountered in 62 eyes (27.4%) with poor pupillary dilation being the most common problem (32 eyes, 14.2%), followed by zonular dehiscence (18 eyes, 8%). Conclusion: This hospital-based study showed that PXF syndrome is common in Indian rural population and that the intraoperative complication rate in these patients is high.
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Affiliation(s)
- Rajesh S Joshi
- Department of Ophthalmology, Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, India
| | - Sonali V Singanwad
- Department of Ophthalmology, Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, India
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FREQUENCY OF PSEUDO-EXFOLIATIVE GLAUCOMA OCCURRENCE. WORLD OF MEDICINE AND BIOLOGY 2019. [DOI: 10.26724/2079-8334-2019-3-69-10-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rao A, Padhy D, Sahay P, Pradhan A, Sarangi S, Das G, Raj N. Clinical spectrum of pseudoexfoliation syndrome-An electronic records audit. PLoS One 2017; 12:e0185373. [PMID: 29077713 PMCID: PMC5659605 DOI: 10.1371/journal.pone.0185373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 09/12/2017] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To evaluate different clinical variants of pseudoexfoliation syndrome and their risk of developing ocular hypertension (OHT) or glaucoma (PXG). DESIGN Cross sectional hospital based study. SETTING All patients seen at glaucoma services of a tertiary eye care center in east India. METHODS Electronic medical records search of hospital database including consecutive new and old cases seen during April 2013 to March 2015 was done to retrieve case sensitive words including pseudoexfoliation, PXF, PEX, PXG and pseudoexfoliative glaucoma over any part of the clinical electronic sheet of the patient. All demographic and clinical details including laterality, the pattern of deposits, need for medicines and disc damage at presentation was compared in eyes with radial pigmentary, classical or combined forms of PXF phenotypes. RESULTS Of 110313 PXF patients seen during the period of 2013-2015, a total of 2297 eyes of 1150 PXF patients were identified including 525 unilateral PXF (meaning a total of 1775 PXF eyes with 625 patients having bilateral disease, n = 1250 eyes, other clinically normal eye, n = 522) at presentation. Of 525 unilateral PXF eyes, 105 had OHT and 131 had glaucoma while bilateral cases had more >50% (675 eyes of 1250 eyes) with glaucoma. Glaucoma with significant changes in IOP with or without disc damage was seen in 32% of pigmentary and 39% of classical PXF forms with eyes with combined forms of PXF having around 50% with glaucoma at presentation compared to other forms, p<0.001. CONCLUSION Different phenotypic variants of PXF in this Indian cohort was associated with 30-50% risk of OHT or glaucoma respectively. Adequate care is required while examining the pattern of PXF in each case to prognosticate each patient/eye.
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Affiliation(s)
- Aparna Rao
- Glaucoma Service, LV Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
| | - Debananda Padhy
- Glaucoma Service, LV Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
| | - Prity Sahay
- Glaucoma Service, LV Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
| | - Amiya Pradhan
- Glaucoma Service, LV Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
| | - Sarada Sarangi
- Glaucoma Service, LV Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
| | - Gopinath Das
- Glaucoma Service, LV Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
| | - Niranjan Raj
- Glaucoma Service, LV Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
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Kang JH, Wiggs JL, Pasquale LR. Relation between time spent outdoors and exfoliation glaucoma or exfoliation glaucoma suspect. Am J Ophthalmol 2014; 158:605-14.e1. [PMID: 24857689 PMCID: PMC4138242 DOI: 10.1016/j.ajo.2014.05.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the relation between time spent outdoors at various life periods and risk of exfoliation glaucoma or exfoliation glaucoma suspect. DESIGN Retrospective cohort study in the United States. METHODS Participants (49 033 women in the Nurses Health Study and 20 066 men in the Health Professionals Follow-up Study) were 60+ years old, were free of glaucoma and cataract, reported eye examinations, and completed questions about time spent outdoors in direct sunlight at midday at 3 life periods: high school to age 24 years, age 25-35 years, and age 36-59 years (asked in 2006 in women and 2008 in men). Participants were followed biennially with mailed questionnaires from 1980 women/1986 men to 2010. Incident cases (223 women and 38 men) were confirmed with medical records. Cohort-specific multivariable-adjusted rate ratios from Cox proportional hazards models were estimated and pooled with meta-analysis. RESULTS Although no association was observed with greater time spent outdoors in the ages of 25-35 or ages 36-59 years, the pooled multivariable-adjusted rate ratios for ≥11 hours per week spent outdoors in high school to age 24 years compared with ≤5 hours per week was 2.00 (95% confidence interval = 1.30, 3.08; P for linear trend = .001). In women, this association was stronger in those who resided in the southern geographic tier in young adulthood (P for interaction = .07). CONCLUSIONS Greater time spent outdoors in young adulthood was associated with risk of exfoliation glaucoma or exfoliation glaucoma suspect, supporting an etiologic role of early exposures to climatic factors.
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Affiliation(s)
- Jae H Kang
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts.
| | - Janey L Wiggs
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Louis R Pasquale
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
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