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Shamseldin Shalaby W, Reddy R, Razeghinejad R, Jay Katz L. Contemporary Approach to Narrow Angles. J Ophthalmic Vis Res 2024; 19:88-108. [PMID: 38638634 PMCID: PMC11022020 DOI: 10.18502/jovr.v19i1.15443] [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: 10/31/2023] [Accepted: 12/12/2023] [Indexed: 04/20/2024] Open
Abstract
Glaucoma is the leading cause of irreversible blindness worldwide. Among all glaucoma types, primary angle closure glaucoma (PACG) affects approximately 23 million people worldwide, and is responsible for 50% of glaucoma-related blindness, highlighting the devastating consequences of this disease. The main mechanism of PACG is relative pupillary block. High-risk populations are female gender, Asian ethnicity, high hyperopia, short axial length, and a thick/anteriorly positioned lens. This review discusses the clinical diagnosis, classification, and management of patients with a narrow angle with and without intraocular pressure (IOP) elevation and glaucomatous optic nerve damage, including laser peripheral iridotomy (LPI), endocycloplasty (ECPL), lens extraction, and goniosynechialysis.
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Affiliation(s)
- Wesam Shamseldin Shalaby
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
- Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Rohit Reddy
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - L. Jay Katz
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
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2
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Confalonieri F, Haave H, Binder S, Bober AM, Bragadottir R, Baerland T, Faber R, Forsaa V, Gonzalez-Lopez JJ, Govetto A, Haugstad M, Ivastinovic D, Jenko NČ, Nicoară SD, Kaljurand K, Kozak I, Kvanta A, Lytvynchuk L, Nawrocka ZA, Pajic SP, Petrovič MG, Radecka L, Rehak M, Romano MR, Ruban A, Speckauskas M, Stene-Johansen I, Stranak Z, Thaler A, Thein ASA, Theocharis I, Tomic Z, Yan X, Zekolli M, Zhuri B, Znaor L, Petrovski BE, Kolko M, Lumi X, Petrovski G. Macular hole Delphi consensus statement (MHOST). Acta Ophthalmol 2023; 101:815-825. [PMID: 37493073 DOI: 10.1111/aos.15682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/21/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE To derive a Delphi method-based consensus for the surgical management of Full Thickness Macular Hole (FTMH) and Lamellar Macular Hole (LMH). METHODS 37 expert VR surgeons from 21 mainly European countries participated in Delphi method-based questionnaire for diagnosis and treatment of FTMHs and LMHs. RESULTS A total of 36 items were rated in round 1 by 37 participants, of which 10 items achieved consensus: intraoperative verification of PVD; clinical superiority of OCT-based FTMH classification; practical ineffectiveness of ocriplasmin; circular 360° ILM peeling for small macular holes; use of regular surgical technique for the size of the hole in concomitant retinal detachment; performing complete vitrectomy; SF6 gas as preferred tamponade; cataract surgery if crystalline lens is mildly/moderately opaque; removal of both ILM and LHEP in LMH surgery. In round 2, 18 items with moderate consensus (45-70% agreement) in round 1 were rated by 35 participants. Final consensus was reached in 35% of questions related to both diagnosis and surgical procedures. CONCLUSIONS This Delphi study provides valuable information about the consensus/disagreement on different scenarios encountered during FTMH and LMH management as a guide tosurgical decision-making. High rate of disagreement and/or variable approaches still exist for treating such relatively common conditions.
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Affiliation(s)
- Filippo Confalonieri
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Oslo University Hospital and University of Oslo, Oslo, Norway
- Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Hanna Haave
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Susanne Binder
- Department of Ophthalmology, Sigmund Freud University, Vienna, Austria
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York, USA
| | | | - Ragnheidur Bragadottir
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Thomas Baerland
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Rowan Faber
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Vegard Forsaa
- Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway
- Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
| | - Julio J Gonzalez-Lopez
- Surgery Department, Universidad de Alcalá School of Medicine, Madrid, Spain
- Ophthalmology Department, Hospital Universitario Ramón Y Cajal, IRYCIS, Madrid, Spain
| | - Andrea Govetto
- Ophthalmology Department, Fatebenefratelli and Ophthalmic Hospital, ASSt-Fatebenefratelli-Sacco, Milan, Italy
| | - Marta Haugstad
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | | | - Neža Čokl Jenko
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Simona Delia Nicoară
- Department of Ophthalmology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Ophthalmology, Emergency County Hospital, Cluj-Napoca, Romania
| | | | - Igor Kozak
- Moorfields Eye Hospital, Abu Dhabi, United Arab Emirates
| | - Anders Kvanta
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Lyubomyr Lytvynchuk
- Department of Ophthalmology, Justus Liebig University, University Hospital Giessen and Marburg GmbH, Giessen, Germany
- Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria
| | | | | | - Mojca Globočnik Petrovič
- Eye Hospital University Medical Centre, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Matus Rehak
- Department of Ophthalmology, University of Leipzig, Leipzig, Germany
- Department of Ophthalmology, Justus-Liebig University Giessen, Giessen, Germany
| | - Mario R Romano
- Department of Biomedical Science, Humanitas University, Milan, Italy
| | | | - Martynas Speckauskas
- Department of Ophthalmology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Zbynek Stranak
- Department of Ophthalmology for Children and Adults, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
- Department of Ophthalmology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Angela Thaler
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | | | - Zoran Tomic
- Department of Ophthalmology, University Hospital, Uppsala, Sweden
| | - Xiaohe Yan
- Shenzhen Eye Hospital, Shenzhen Eye Institute, Jinan University, Shenzhen, China
| | | | | | - Ljubo Znaor
- Department of Ophthalmology, University of Split School of Medicine, Split, Croatia
- Department of Ophthalmology, University Hospital of Split, Split, Croatia
| | | | - Miriam Kolko
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Xhevat Lumi
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Oslo University Hospital and University of Oslo, Oslo, Norway
- Department of Ophthalmology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Goran Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Oslo University Hospital and University of Oslo, Oslo, Norway
- Department of Ophthalmology, University of Split School of Medicine, Split, Croatia
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Ocansey S, Ekure E, Osuagwu UL, Ekpenyong BN, Ovenseri-Ogbomo G, Kyeremeh S, Ogbuehi KC, Agho KE, Mashige KP, Ndep AO, Naidoo KS. Profiling and factors associated with glaucoma diagnostic practice in sub-Saharan Africa-a cross sectional study of Nigerian and Ghanaian optometrists. BMC Ophthalmol 2023; 23:351. [PMID: 37553655 PMCID: PMC10410918 DOI: 10.1186/s12886-023-03083-0] [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: 11/03/2022] [Accepted: 07/14/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Ghana and Nigeria are the two countries in Africa that currently run the Doctor of Optometry (OD) program in sub-Saharan Africa (SSA). Optometrists in these countries are licensed to provide glaucoma care. Despite the clinically relevant practice guidelines for glaucoma, there is no data on the practice patterns for glaucoma eye care in SSA, a region with the highest prevalence of glaucoma. This study aimed to profile glaucoma diagnosis adherence to practice guidelines among optometrists in two neighbouring anglophone countries (Nigeria and Ghana). METHODS A web-based cross-sectional survey of practising optometrists was conducted in both countries. Each country data was weighted to reflect the total number of licensed and practising optometrists at the time of this survey. Descriptive analyses were performed against demography and practice factors using survey commands to adjust for sampling weights when estimating confidence intervals (CI) around prevalence estimates. Simple and multiple logistic regression analyses were performed to identify factors associated with glaucoma diagnosis. RESULTS A total of 493 optometrists (238, 48.3% and 255, 51.7%) from Ghana and Nigeria respectively, responded to the survey-the first to document and compare the glaucoma diagnostic criteria between optometrists in Ghana and Nigeria. More Ghanaian than Nigerian optometrists diagnosed glaucoma and over 90% in both countries reported that they frequently performed either tonometry, visual field testing, or fundus examination during glaucoma diagnosis. Ghanaian optometrists were significantly more likely to diagnose glaucoma than Nigerian optometrists (adjusted odd ratio, AOR = 6.15, 95%CI:1.63-23.15, P = .007). Optometrists who have practiced for more than 10 years (AOR = 7.04; 95%CI:1.74-28.47, P = .006) and private practice optometrists (AOR = 3.33; 95%CI:1.13-9.83, P = .03) were more likely to diagnose glaucoma. CONCLUSIONS The study provides information for evaluating glaucoma assessment for optometrists in both countries. Optometrists in both countries are reasonably well-equipped to diagnose glaucoma and are practicing at an adequate level, but with room for improvement.
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Affiliation(s)
- Stephen Ocansey
- Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Edgar Ekure
- Department of Biomedicine, Salus University, 8360 Old York Road, Elkins Park, PA, 19027, USA
| | - Uchechukwu L Osuagwu
- Bathurst Rural Clinical School (BRCS), School of Medicine, Western Sydney University, PO Box 9008, Bathurst, New South Wales, 2795, Australia.
- African Vision Research Institute, Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban, 3629, South Africa.
| | - Bernadine N Ekpenyong
- Epidemiology and Biostatistics Unit, Department of Public Health, University of Calabar, Calabar, Cross River State, Nigeria
| | - Godwin Ovenseri-Ogbomo
- Department of Optometry, Centre for Health Sciences, University of the Highlands and Islands, Inverness, IV2 3JH, UK
| | - Sylvester Kyeremeh
- Department of Optometry and Visual Science, College of Science, KNUST, Kumasi, AK-385-1973, Ghana
| | - Kelechi C Ogbuehi
- Department of Medicine, Dunedin School of Medicine, University of Otago, Otago, New Zealand
| | - Kingsley E Agho
- African Vision Research Institute, Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban, 3629, South Africa
- School of Health Science, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Khathutshelo P Mashige
- African Vision Research Institute, Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban, 3629, South Africa
| | - Antor O Ndep
- Department of Public Health, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Kovin S Naidoo
- African Vision Research Institute, Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban, 3629, South Africa
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
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Mukhopadhyay D, Patel K, Huda S. Increase in anterior chamber angle depth after topical pilocarpine measured by spectral domain optical coherence tomography: A possible additional indicator for laser peripheral iridotomy in primary angle-closure suspects in an opportunistic set-up. Indian J Ophthalmol 2022; 70:4174-4179. [PMID: 36453309 PMCID: PMC9940567 DOI: 10.4103/ijo.ijo_764_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Indication of laser peripheral iridotomy (LPI) is often conjectural due to dependency on gonioscopy and strict dichotomous classification of occludability. Indentation gonioscopy is the gold standard but is under-utilized for various reasons. The prevalence of primary angle closure disease (PACD) in eastern India is 1.5-1.9%, with a 22% five-year progression rate. Many angle closure patients may go blind without timely diagnosis and iridotomy. General ophthalmologists need alternate, validated methods for diagnoses. Pilocarpine eye drop causes miosis, and flattens the iris, producing angle changes detectable by spectral domain optical coherence tomography (SD-OCT). We hypothesized that the amount of angle change may be a suitable indicator for iridotomy. Methods Our prospective cross-sectional single-masked observational study evaluated pilocarpine-induced changes in angle parameters detected by SD-OCT. Out of 372 patients enrolled, 273 patients (539 eyes) remained, with a mean age of 48.6 years (SD = 10.36). All eyes were graded by the Van Herick (VH) method, gonioscopy, and anterior segment (AS) SD-OCT and reassessed after pilocarpine drops. Results The sensitivity and specificity of tomography measurements against gonioscopy grades were 61% and 85%, respectively. The receiver operating characteristic (ROC) curve was 0.85. Pilocarpine-induced angle widening was significant in gonioscopically narrower angles. Low Van Herick grades (217 eyes), narrow gonioscopy grades (238 eyes), and a narrow OCT angle value (165 eyes) were candidates for iridotomy. Conclusion Our study results showed that pilocarpine-induced angle widening detected by SD-OCT could be a strong objective indicator for LPI.
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Affiliation(s)
- Debdas Mukhopadhyay
- Department of Ophthalmology, MGM Medical College, Kishanganj, Bihar, India,Department of Ophthalmology, BKG Malda Eye Institute, Malda, West Bengal, India,Correspondence to: Prof. Debdas Mukhopadhyay, BKG Eye Institute, Gour Road, Mokdompur, Malda - 732 103, West Bengal, India. E-mail:
| | - Khevna Patel
- Department of Ophthalmology, MGM Medical College, Kishanganj, Bihar, India,Department of Ophthalmology, BKG Malda Eye Institute, Malda, West Bengal, India
| | - Sadaf Huda
- Department of Ophthalmology, MGM Medical College, Kishanganj, Bihar, India,Department of Ophthalmology, BKG Malda Eye Institute, Malda, West Bengal, India
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Muacevic A, Adler JR, Alotaibi NT, Mirza B, Mirza G, Bantan O. Evaluation of Compliance Issues to Anti-glaucoma Medications Before and After a Structured Interventional Program. Cureus 2022; 14:e25943. [PMID: 35844344 PMCID: PMC9282590 DOI: 10.7759/cureus.25943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 01/09/2023] Open
Abstract
Background Glaucoma is one of the most common eye diseases in the elderly and the major cause of irreversible vision loss worldwide. Adherence to life-long therapies is crucial to prevent glaucoma progression. The current study aims to assess the educational element and its impact on glaucoma medication compliance over short and long periods. Methods This was a survey-based, prospective, interventional study, conducted via interviews of all glaucoma patients presented to the Ophthalmology Center at King Abdullah Medical City (KAMC), Makkah, Saudi Arabia. To achieve the study's aim, a questionnaire with 31 items was utilized, followed by a structured program between September 2019 to June 2021. After that, a second questionnaire was used after a one month to one year to re-evaluate the intervention. Data was automatically collected in Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States) and entered into IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, New York, United States) for analysis. Results Non-compliance was detected in 15.7% of all recruited patients (n=134). However, the non-compliance percentage dropped to 10 (7.5%) after the structured program (P=0.028). Contributing factors were low educational level, bilateral eye disease, duration of treatment more than two years, and having more than two eye treatment bottles; however, the P-value was insignificant. Conclusions About one-sixth of our glaucoma patients were found to be non-compliant. However, the non-compliance reduced by more than half after the structured educational program. Treatment adherence can be improved by implementing awareness and correcting the beliefs about illness and medicines, thus potentially delaying disease development.
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Skuta GL, Ding K, Lum F, Coleman AL. An IRIS® Registry-Based Assessment of Primary Open-Angle Glaucoma Practice Patterns in Academic versus Non-Academic Settings. Am J Ophthalmol 2022; 242:228-242. [PMID: 35469787 DOI: 10.1016/j.ajo.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare patient demographic data; level of severity; and clinical, diagnostic, and surgical practice patterns in patients with primary open-angle glaucoma (POAG) in an academic setting (AS) versus non-academic setting (NAS) using the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight). METHODS A retrospective cohort study of IRIS® Registry data that included patients with POAG who were seen between January 2016 and December 2019 and had at least one year of follow-up. RESULTS Of 3,707,084 distinct eyes with POAG, 3% (109,920) were included in the academic subcohort and 97% (3,597,164) were included in the non-academic subcohort. Among the findings of greatest note (P < .0001 for all comparisons) were a higher proportion of eyes of Black patients, a higher proportion of eyes with level 3 severity, and a higher mean cup-to-disc ratio in eyes in the AS. The relative frequency of gonioscopy, pachymetry, and visual field testing in conjunction with new patient visits was also notably higher in the AS. For glaucoma surgical procedures, the greatest proportional differences in relative frequency were seen for tube shunt procedures (2.55-fold higher in the AS), iStent and Hydrus procedures (2.52-fold higher in the NAS), and endoscopic cyclophotocoagulation (5.80-fold higher in the NAS). CONCLUSIONS Based on IRIS® Registry data, notable differences appear to exist with regard to ethno-racial groups, glaucoma severity, and diagnostic and surgical practice patterns in AS versus NAS. By understanding these differences, potential opportunities exist in the development of educational programs related to clinical and surgical glaucoma care.
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Toomey M, Ho KC, Gyawali R, Stapleton F, Wiles L, Hibbert P, Keay L, Jalbert I. The appropriateness of and barriers to glaucoma care delivery by Australian optometrists. Clin Exp Optom 2022; 105:593-601. [PMID: 35037600 DOI: 10.1080/08164622.2021.2004861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CLINICAL RELEVANCE Establishing the level of appropriateness and barriers to glaucoma care delivery by Australian optometrists are important first steps in developing tailored interventions aimed at improving glaucoma care delivery. BACKGROUND To determine the appropriateness of and barriers to glaucoma care by optometrists. METHODS A mixed method study was conducted. Phase I was a retrospective cross-sectional medical record audit that assessed glaucoma care appropriateness against 37 clinical indicators from a nationally representative sample of 42 optometry practices. In Phase II, focus groups and interviews involving 31 optometrists explored audit findings to identify barriers to appropriate glaucoma care. Barriers were analysed by deductive and inductive qualitative analysis. Saliency analysis was used to identify key domains that influence glaucoma care. RESULTS Appropriate glaucoma care was delivered for 63% (95% CI 61%, 64%) of the 420 patient encounters audited. Appropriate care was delivered above 80% for most (57%) indicators, while 14 (38%) indicators were delivered below 60% appropriateness. Good compliance to appropriate care was noted for key indicators of intraocular pressure measurement (90%, 95% CI 87%, 93%) and optic nerve head/retinal nerve fibre layer imaging (78%, 95% CI 74%, 82%). Important barriers identified were beliefs about expected outcomes, lack of perceived relevancy, time constraints, poor organisational culture, knowledge gaps, focusing on some aspects of glaucoma care to the detriment of others, the complexity of glaucoma care, information recall, and social norms. CONCLUSION Glaucoma care was appropriate in most patient encounters, with opportunity to improve some aspects of history taking and physical examinations. Barriers to glaucoma care were diverse, existing at both the practitioner and organisational levels. These findings provide direction for the development of a tailored improvement intervention.
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Affiliation(s)
- Melinda Toomey
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Kam Chun Ho
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Population Health Research Unit, Singapore Eye Research Institute, Singapore, Singapore
| | - Rajendra Gyawali
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Louise Wiles
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,Iimpact in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Peter Hibbert
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,Iimpact in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Phu J, Masselos K, Sullivan-Mee M, Kalloniatis M. Glaucoma Suspects: The Impact of Risk Factor-Driven Review Periods on Clinical Load, Diagnoses, and Healthcare Costs. Transl Vis Sci Technol 2022; 11:37. [PMID: 35089311 PMCID: PMC8802015 DOI: 10.1167/tvst.11.1.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To model the healthcare impact (clinical attendance time and financial cost) and clinical outcomes (glaucoma diagnoses) of different risk factor–driven review frequencies for glaucoma suspect patients up until the point of discharge or diagnosis. Methods Medical records of 494 glaucoma suspects were examined to extract the clinical diagnosis. Two criteria for review periods were defined, based on contrasting stringency from established clinical guidelines: American Academy of Ophthalmology (AAO), more stringent/less frequent; and the Australian National Health and Medical Research Council (NHMRC), less stringent/more frequent. We used these data to model patient outcomes and healthcare costs using a Markov model. Results The less stringent/more frequent criterion resulted in more high-risk glaucoma suspects requiring more frequent review compared with the more stringent/less frequent criterion. Across the 15 Markov cycles (7.5 years), the less stringent/more frequent review criterion resulted in 6.6% more diagnoses and fewer overall clinical visits (14.7%) and reduced cost per diagnosis by 12% to 32% (P < 0.0001). The number of glaucoma diagnoses made using each criterion converged at 2.5 to 3 years. Conclusions The stringency of risk assessments for glaucoma suspects impacts review periods and therefore clinical load, healthcare costs, and diagnosis rates. Using current testing methods, more frequent review periods appear advantageous for diagnostic efficiency, with both lower clinic load and lower cost up until the point of discharge or glaucoma diagnosis. Translational Relevance A less stringent criterion for assessing the risk of developing glaucoma potentially offers a more cost-effective method for reviewing glaucoma suspects, especially within the first 2.5 years.
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Affiliation(s)
- Jack Phu
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Katherine Masselos
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,Prince of Wales Hospital Ophthalmology Department, Randwick, NSW, Australia
| | | | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
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Qian CX, Chen Q, Cun Q, Tao YJ, Yang WY, Yang Y, Hu ZY, Zhu YT, Zhong H. Comparison of the SITA Faster-a new visual field strategy with SITA Fast strategy. Int J Ophthalmol 2021; 14:1185-1191. [PMID: 34414082 DOI: 10.18240/ijo.2021.08.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 03/05/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To compare visual field defects using the Swedish Interactive Thresholding Algorithm (SITA) Fast strategy with SITA Faster strategy, a newly developed time-saving threshold visual field strategy. METHODS Ninety-three participants (60 glaucoma patients and 33 normal controls) were enrolled. One eye from each participant was selected randomly for the study. SITA Fast and SITA Faster were performed using the 24-2 default mode for each test. The differences of visual field defects between the two strategies were compared using the test duration, false-positive response errors, mean deviation (MD), visual field index (VFI) and the numbers of depressed test points at the significant levels of P<5%, <2%, <1%, and <0.5% in probability plots. The correlation between strategies was analyzed. The agreement between strategies was acquired by Bland-Altman analysis. RESULTS Mean test durations were 246.0±60.9s for SITA Fast, and 156.3±46.3s for SITA Faster (P<0.001). The test duration of SITA Faster was 36.5% shorter than SITA Fast. The MD, VFI and numbers of depressed points at P<5%, <2%, <1%, and <0.5% in probability plots showed no statistically significant difference between two strategies (P>0.05). Correlation analysis showed a high correlation for MD (r=0.986, P<0.001) and VFI (r=0.986, P<0.001) between the two strategies. Bland-Altman analysis showed great agreement between the two strategies. CONCLUSION SITA Faster, which saves considerable test time, has a great test quality comparing to SITA Fast, but may be not directly interchangeable.
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Affiliation(s)
- Chao-Xu Qian
- The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Qin Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
| | - Qing Cun
- The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Yi-Jin Tao
- The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Wen-Yan Yang
- The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Yue Yang
- The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Zhong-Yin Hu
- The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Ying-Ting Zhu
- Tissue Tech, Inc., 7300 Corporate Center Drive, Suite B, Miami, FL 33126, USA
| | - Hua Zhong
- The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
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Toomey M, Jalbert I. Knowledge translation for the everyday optometrist. Clin Exp Optom 2021; 104:744-755. [PMID: 33831335 DOI: 10.1080/08164622.2021.1898275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
A gap exists between best evidence and actual clinical care provided to patients. The advent of evidence-based practice was meant to address this gap by providing practitioners with a method to search, evaluate and incorporate evidence into practice. However, the gap continues to exist. The health research fields of knowledge translation and implementation science have evolved over the last few decades to assist practitioners in embedding research findings and best evidence into routine practice. Knowledge translation seeks to improve public health outcomes by facilitating the movement of best evidence from the bench to clinical practice. Implementation science is the study of methods to integrate research findings and evidence-based practice into routine practice. This literature review aims to revisit the concepts of evidence-based practice and to introduce knowledge translation and implementation science by exploring their roles and influences in the delivery of appropriate glaucoma care by optometrists.
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Affiliation(s)
- Melinda Toomey
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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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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