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Van Eijgen J, Schuhmann V, Fingerroos EL, Renier M, Burchert H, Kröpfl JM, Van Craenenbroeck A, Cornelissen V, Gugleta K, Stalmans I, Hanssen H. High-intensity interval training in patients with glaucoma (HIT-GLAUCOMA): protocol for a multicenter randomized controlled exercise trial. Front Physiol 2024; 15:1349313. [PMID: 38818519 PMCID: PMC11137214 DOI: 10.3389/fphys.2024.1349313] [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: 12/04/2023] [Accepted: 04/04/2024] [Indexed: 06/01/2024] Open
Abstract
Background Glaucoma stands as a prominent global cause of irreversible blindness and the primary treatment approach involves reducing intraocular pressure (IOP). However, around one-third of patients exhibit disease progression despite effective IOP reduction. Microvascular endothelial function, chronic inflammation, and oxidative stress are known to affect retinal neuronal networks and have been associated with disease severity and progression. Exercise training has the potential to counteract these mechanisms as add-on treatment to usual care. Aims The HIT-GLAUCOMA study will investigate the effects of a 6-month high-intensity interval training (HIIT) on intermediate endpoints such as local retinal microvascular and systemic large artery function, inflammation, and oxidative stress as well as clinical endpoints such as visual field indices, optic nerve rim assessment, retinal nerve fiber layer thickness, IOP, number of eye drops, vision-related quality of life and ocular surface disease symptomatology. Methods The study is a multi-center randomized controlled clinical trial in patients with both normal tension and high-tension primary open angle glaucoma. Across two study centers, 128 patients will be enrolled and randomized on a 1:1 basis into an exercise intervention group and a usual care control group. The primary microvascular endpoints are retinal arteriolar and venular flicker light-induced dilation at 6 months. The primary endpoint in the systemic circulation is brachial artery flow-mediated dilation at 6 months. Anticipated results We hypothesize that exercise therapy will improve retinal microvascular function and thus ocular blood flow in patients with glaucoma. As clinical outcomes, we will investigate the effect of exercise on visual field indices, optic nerve rim assessment, retinal nerve fiber layer thickness, IOP, number of eye drops, vision-related quality of life and ocular surface disease symptomatology. Discussion HIT-GLAUCOMA is a blueprint trial design to study the effect of exercise training on neurodegenerative and cardiovascular diseases. Importantly, patients are also expected to benefit from improvements in general health and cardiovascular co-morbidities. If proven effective, exercise may offer a new add-on treatment strategy to slow glaucoma progression. Clinical Trial Registration Number The trial is registered at Clinicaltrials.gov under the identifier NCT06058598 and is currently in the recruitment stage.
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Affiliation(s)
- Jan Van Eijgen
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Research Group Ophthalmology, Department of Neurosciences, Leuven, Belgium
| | - Valentin Schuhmann
- Department of Sports, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Emma-Liina Fingerroos
- Department of Sports, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Marie Renier
- Research Group of Rehabilitation of Internal Disorders, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven, Belgium
| | - Holger Burchert
- Department of Sports, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Julia Maria Kröpfl
- Department of Sports, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Amaryllis Van Craenenbroeck
- Division of Nephrology, University Hospitals UZ Leuven, Leuven, Belgium
- Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology, and Transplantation, Leuven, Belgium
| | - Véronique Cornelissen
- Research Group of Rehabilitation of Internal Disorders, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven, Belgium
| | | | - Ingeborg Stalmans
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Research Group Ophthalmology, Department of Neurosciences, Leuven, Belgium
| | - Henner Hanssen
- Department of Sports, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
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Mishra A, Agrawal M, Tripathi A, Bhirud A, Kumar LCR, Vinod K BB. A Comparative Study on Efficacy of Intraocular Pressure Lowering of Two Fixed-Dose Antiglaucoma Drug Combination Brinzolamide-Brimonidine Versus Latanoprost-Timolol in Primary Open-Angle Glaucoma and Ocular Hypertension. J Ocul Pharmacol Ther 2024; 40:240-245. [PMID: 38598266 DOI: 10.1089/jop.2023.0186] [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: 04/11/2024] Open
Abstract
Purpose: To compare the efficacy of Brinzolamide-Brimonidine (BB) (1%+0.2%) with the gold standard Latanoprost-Timolol (LT) (0.005%+0.5%) in treating primary open-angle glaucoma (POAG) and ocular hypertension (OHT). Methods: A 1-year prospective study, spanning from May 2022 to May 2023, conducted at a tertiary eye-care hospital. Participants, aged 40-60, with a baseline intraocular pressure (IOP) >21 mm Hg, requiring a >30% reduction, were enrolled. Group A (n = 100) received BB, and Group B (n = 100) received LT. Outcomes were assessed at 1 month (IOP difference from baseline), 3 and 6 months (mean diurnal variations). Results: The mean age at presentation was 55.5 ± 4.5 years in Group A and 54.7 ± 4.2 years in Group B. At 1 month, Group A exhibited a mean IOP of 18.7 mm Hg, while Group B had 17.6 mm Hg, with no statistically significant difference (P = 0.53). No significant diurnal variation was observed in either group (P = 0.07). Target pressure was achieved in 88% of patients in Group A and slightly higher at 92% in Group B. Moreover, no serious side effects were reported, and compliance was higher in Group B (98%) compared to Group A (96%). Conclusion: Although LT showed slightly better and sustained IOP reduction, the difference was not statistically significant. Both BB and LT demonstrated comparable outcomes for managing POAG and OHT.
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Affiliation(s)
- Avinash Mishra
- Department of Ophthalmology, Military Hospital, Jalandhar, India
| | - Mohini Agrawal
- Department of Ophthalmology, Military Hospital, Jalandhar, India
| | - Anchal Tripathi
- Department of Ophthalmology, Military Hospital, Jammu, India
| | - Atul Bhirud
- Department of Ophthalmology, Military Hospital, Jalandhar, India
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Kim M, Kim JY, Rhim WK, Cimaglia G, Want A, Morgan JE, Williams PA, Park CG, Han DK, Rho S. Extracellular vesicle encapsulated nicotinamide delivered via a trans-scleral route provides retinal ganglion cell neuroprotection. Acta Neuropathol Commun 2024; 12:65. [PMID: 38649962 PMCID: PMC11036688 DOI: 10.1186/s40478-024-01777-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
The progressive and irreversible degeneration of retinal ganglion cells (RGCs) and their axons is the major characteristic of glaucoma, a leading cause of irreversible blindness worldwide. Nicotinamide adenine dinucleotide (NAD) is a cofactor and metabolite of redox reaction critical for neuronal survival. Supplementation with nicotinamide (NAM), a precursor of NAD, can confer neuroprotective effects against glaucomatous damage caused by an age-related decline of NAD or mitochondrial dysfunction, reflecting the high metabolic activity of RGCs. However, oral supplementation of drug is relatively less efficient in terms of transmissibility to RGCs compared to direct delivery methods such as intraocular injection or delivery using subconjunctival depots. Neither method is ideal, given the risks of infection and subconjunctival scarring without novel techniques. By contrast, extracellular vesicles (EVs) have advantages as a drug delivery system with low immunogeneity and tissue interactions. We have evaluated the EV delivery of NAM as an RGC protective agent using a quantitative assessment of dendritic integrity using DiOlistics, which is confirmed to be a more sensitive measure of neuronal health in our mouse glaucoma model than the evaluation of somatic loss via the immunostaining method. NAM or NAM-loaded EVs showed a significant neuroprotective effect in the mouse retinal explant model. Furthermore, NAM-loaded EVs can penetrate the sclera once deployed in the subconjunctival space. These results confirm the feasibility of using subconjunctival injection of EVs to deliver NAM to intraocular targets.
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Affiliation(s)
- Myungjin Kim
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea
| | - Jun Yong Kim
- Department of Biomedical Science, CHA University, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
- Department of Biomedical Engineering and Intelligent Precision of Healthcare Convergence, SKKU Institute for Convergence, Sungkyunkwan University (SKKU), Jangan-gu, Suwon-Si, Gyeonggi-do, Republic of Korea
| | - Won-Kyu Rhim
- Department of Biomedical Science, CHA University, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Gloria Cimaglia
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - Andrew Want
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - James E Morgan
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- School of Medicine, Cardiff University, Cardiff, UK
| | - Pete A Williams
- Division of Eye and Vision, Department of Clinical Neuroscience, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Chun Gwon Park
- Department of Biomedical Engineering and Intelligent Precision of Healthcare Convergence, SKKU Institute for Convergence, Sungkyunkwan University (SKKU), Jangan-gu, Suwon-Si, Gyeonggi-do, Republic of Korea
| | - Dong Keun Han
- Department of Biomedical Science, CHA University, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Seungsoo Rho
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea.
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Karapapak M, Olgun A. Comparison of GATT versus micropulse transscleral diode laser cyclophotocoagulation combined with GATT in patients with advanced glaucoma. Eur J Ophthalmol 2024:11206721241247440. [PMID: 38602018 DOI: 10.1177/11206721241247440] [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: 04/12/2024]
Abstract
PURPOSE To compare the efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) versus micropulse transscleral diode laser cyclophotocoagulation(MP-TDLC) combined with GATT in the treatment of advanced glaucoma. METHODS This retrospective comparative study study included 82 patients (82 eyes) with a diagnosis of advanced glaucoma: 36 patients underwent GATT, and 46 underwent GATT + MP-TDLC. Intraocular pressure (IOP) changes in patients who underwent GATT and GATT MP-TDLC were analyzed retrospectively at regular intervals during the 6-month follow-up period. RESULTS For the 82 patients included in this study, the mean ± SD IOPs before the procedures were 27.2 ± 8.5 mmHg in the GATT group and 26.6 ± 6.9 mmHg in the GATT + MP-TDLC group (p = 0.866), and the numbers of glaucoma medications used were 3.41 ± 0.5 in the GATT group and 3.36 ± 0.4 in the GATT + MP-TDLC group (p = 0.605). The mean IOP after GATT was 13.6 ± 3.9 mmHg at day 1, 13.9 ± 3.7 mmHg at week 1, 14.6 ± 4.0 mmHg at month 1, 15.3 ± 4.3 mmHg at month 3, and 14.7 ± 3.3 mmHg at month 6. In the GATT + MP-TDLC group, the postoperative day 1, week 1, month 1, month 3, and month 6 IOP values were 12.4 ± 2.5, 11.8 ± 1.8, 12.1 ± 2.0, 11.8 ± 1.09, and 11.8 ± 1.5 mmHg, respectively. CONCLUSION GATT was found to be effective in the treatment of patients with advanced glaucoma, and results closer to the targeted low teens IOP values were obtained with GATT + MP-TDLC.
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Affiliation(s)
- Murat Karapapak
- Department of Ophthalmology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ali Olgun
- Department of Ophthalmology, West Eye Hospital, Erbil, Iraq
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Bengtsson B, Villalba C, Peters D, Aspberg J. Comparison of disease severity in glaucoma patients identified by screening in the 1990s and in routine clinical care in the 2010s in Sweden. Acta Ophthalmol 2024; 102:238-245. [PMID: 37786298 DOI: 10.1111/aos.15777] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND AND PURPOSE In a previous study comparing the amount of visual field damage at presentation in patients having open-angle glaucoma (OAG) identified through screening and in patients diagnosed in routine clinical practice in the 1990s, the damage was considerably worse in the clinically diagnosed patients. In the present study we compare visual field damage at presentation in the same 402 screened patients with that seen in 281 newly detected previously untreated patients clinically diagnosed in the 2010s. METHODS The perimetric visual field index mean deviation (MD) was compared in the two groups of patients. RESULTS In the clinical patients diagnosed with bilateral visual field damage the median MD was -5.1 dB in the better eye and -13.0 dB in the worse eye. In the screened patients the median MD in the better eye was -6.5 dB and -11.5 dB in the worse eye. The differences between the clinical and screened patients were non-significant, p = 0.28 and p = 0.67 respectively. More clinical patients had severe visual field loss, defined as MD less than -20 dB, in the worse eye than in the screened patients, 18.5% versus 12.7% respectively, p = 0.037. CONCLUSION The visual field damage at presentation in clinically diagnosed OAG patients has improved in the past 20 years, but the proportion of patients with severe visual field loss in at least one eye, almost 20%, is still unacceptably high considering that severe visual field damage at presentation is the most important risk factor for later development of glaucoma blindness.
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Affiliation(s)
- B Bengtsson
- Department of Clinical Sciences, Ophthalmology in Malmö, Lund University, Lund, Sweden
| | - C Villalba
- Department of Clinical Sciences, Ophthalmology in Malmö, Lund University, Lund, Sweden
| | - D Peters
- Department of Clinical Sciences, Ophthalmology in Malmö, Lund University, Lund, Sweden
- Department of Ophthalmology, Skåne University Hospital, Lund, Sweden
| | - J Aspberg
- Department of Clinical Sciences, Ophthalmology in Malmö, Lund University, Lund, Sweden
- Department of Ophthalmology, Skåne University Hospital, Lund, Sweden
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Zhang X, Jiang J, Kong K, Li F, Chen S, Wang P, Song Y, Lin F, Lin TPH, Zangwill LM, Ohno-Matsui K, Jonas JB, Weinreb RN, Lam DSC. Optic neuropathy in high myopia: Glaucoma or high myopia or both? Prog Retin Eye Res 2024; 99:101246. [PMID: 38262557 DOI: 10.1016/j.preteyeres.2024.101246] [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: 10/12/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 01/25/2024]
Abstract
Due to the increasing prevalence of high myopia around the world, structural and functional damages to the optic nerve in high myopia has recently attracted much attention. Evidence has shown that high myopia is related to the development of glaucomatous or glaucoma-like optic neuropathy, and that both have many common features. These similarities often pose a diagnostic challenge that will affect the future management of glaucoma suspects in high myopia. In this review, we summarize similarities and differences in optic neuropathy arising from non-pathologic high myopia and glaucoma by considering their respective structural and functional characteristics on fundus photography, optical coherence tomography scanning, and visual field tests. These features may also help to distinguish the underlying mechanisms of the optic neuropathies and to determine management strategies for patients with high myopia and glaucoma.
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Affiliation(s)
- Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Jingwen Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Kangjie Kong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Fei Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Shida Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Peiyuan Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Yunhe Song
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Fengbin Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Timothy P H Lin
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA.
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland.
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA.
| | - Dennis S C Lam
- The International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China; The C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China.
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King AJ, Hudson J, Azuara-Blanco A, Kirwan JF, Goyal S, Lim KS, Maclennan G. Effects of socioeconomic status on baseline values and outcomes at 24 months in the Treatment of Advanced Glaucoma Study randomised controlled Trial. Br J Ophthalmol 2024; 108:203-210. [PMID: 36596663 DOI: 10.1136/bjo-2022-321922] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND/AIMS Socioeconomic status (SES) is associated with late disease presentation and poorer outcomes. We evaluate the effect of SES on treatment outcomes and report the correlation between SES and baseline characteristics of participants in the Treatment of Advanced Glaucoma Study. METHODS Pragmatic multicentre randomised controlled trial. Four hundred and fifty-three patients presenting with advanced open-angle glaucoma in at least one eye (Hodapp-Parrish-Anderson classification). Participants were randomised to either glaucoma drops (medical arm) or trabeculectomy (surgery arm). Clinical characteristics, Quality of life measurement (QoL) and SES defined by the Index of Multiple Deprivation are reported. Subgroup analysis explored treatment effect modifications of SES at 24 months. Correlation between SES and baseline characteristics was tested with the χ2 test of association for dichotomous variables and pairwise Pearson's correlation for continuous variables. RESULTS The mean visual field mean deviation was -17.2 (6.7)dB for the most deprived quintile of participants and -13.0 (5.5) for the least deprived quintile in the index eye. At diagnosis, there was a strong correlation between SES and ethnicity, age, extent of visual field loss and number of visits to opticians prior to diagnosis. At 24 months, there was no evidence that the treatment effect was moderated by SES. CONCLUSIONS In patients presenting with advanced glaucoma. SES at baseline is correlated with poorer visual function, poorer Visual Function Questionnaire-25 QoL, ethnicity, age and number visits to an optician in the years preceding diagnosis. SES at baseline does not have an effect of the success of treatment at 24 months. TRIAL REGISTRATION NUMBER ISRCTN56878850.
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Affiliation(s)
- Anthony J King
- Departament of Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jemma Hudson
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - James F Kirwan
- Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, UK
| | - Saurabh Goyal
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kin Sheng Lim
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Graeme Maclennan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Nagstrup AH. The use of benzalkonium chloride in topical glaucoma treatment: An investigation of the efficacy and safety of benzalkonium chloride-preserved intraocular pressure-lowering eye drops and their effect on conjunctival goblet cells. Acta Ophthalmol 2023; 101 Suppl 278:3-21. [PMID: 38037546 DOI: 10.1111/aos.15808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
ENGLISH SUMMARY Glaucoma is a leading cause of the global prevalence of irreversible blindness. The pathogenesis of glaucoma is not entirely known, but the major risk factors include advancing age, genetic predisposition, and increased intraocular pressure (IOP). The only evidence-based treatment is a lowering of IOP through the use of eye drops, laser procedures, or surgical interventions. Although laser treatment is gaining recognition as a first-choice treatment option, the most common approach for managing glaucoma is IOP-lowering eye drops. A major challenge in the treatment is the occurrence of adverse events and poor adherence. In this context, the ocular surface is an area of great concern, as most glaucoma patients have dry eye disease (DED), which is largely caused by eye drops. Preservation with benzalkonium chloride (BAK) is a controversial topic due to its potential role as a significant cause of DED. A systematic review and meta-analyses investigate potential differences in efficacy and safety between BAK-preserved and BAK-free anti-glaucomatous eye drops (I). Many of the included studies report on ocular surface damage caused by the application of BAK-preserved eye drops. However, the meta-analyses addressing hyperemia, number of ocular adverse events, and tear break-up time did not identify any significant differences. The latter is likely due to varying measurement methods, different endpoints, and study durations. It is, therefore, possible that the large variations between the studies conceal differences in the safety profiles. The efficacy meta-analysis finds that there are no differences in the IOP-lowering effect between BAK-preserved and BAK-free eye drops, indicating that BAK is not necessary for the effectiveness of eye drops. To promote more homogeneous choices of endpoints and methods when evaluating BAK-preserved and BAK-free glaucoma treatments, a Delphi consensus statement was performed. In this study, glaucoma experts and ocular surface disease experts reached consensus on the key factors to consider when designing such studies (II). The hope is to have more studies with comparable endpoints that can systematically show the potentially adverse effects of BAK. The preclinical studies in the current Ph.D. research focus on conjunctival goblet cells (GCs). GCs are important for the ocular surface because they release the mucin MUC5AC, which is an essential component of the inner layer of the tear film. BAK preservation may damage the GCs and result in a low GC density, leading to an unstable tear film and DED. The most commonly used IOP-lowering drugs are prostaglandin analogs (PGAs). Thus, the conducted studies investigate the effect of PGAs preserved in different ways on GCs. BAK-preserved latanoprost is cytotoxic to primary cultured human conjunctival GCs and results in a scattered expression of MUC5AC, in contrast to negative controls, where MUC5AC is localized around the cell nucleus (III). Preservative-free (PF) latanoprost is not cytotoxic and does not affect the MUC5AC expression pattern. Furthermore, BAK-preserved travoprost is found to be cytotoxic in a time-dependent manner, while Polyquad®-preserved travoprost does not affect GC survival at any measured time point (IV). Both Polyquad and BAK induce scattered expression of MUC5AC. The cytotoxicity of BAK-preserved PGA eye drops is higher compared to the safer profile of PF and Polyquad-preserved PGA eye drops (V). Additionally, PF latanoprost does not increase the release of the inflammatory markers interleukin (IL)-6 and IL-8, unlike BAK-preserved latanoprost. A review highlights the active and inactive components of IOP-lowering eye drops (VI). Several preclinical and clinical studies have identified adverse effects of BAK. Although other components, such as the active drug and phosphates, can also cause adverse events, the review clearly states that BAK alone is a major source of decreased tolerability. The conclusion of this thesis is that BAK preservation is unnecessary and harmful to the ocular surface. The preclinical studies demonstrate that GCs die when exposed to BAK. Furthermore, they find that BAK induces a pro-inflammatory response. The review included in the thesis concludes that BAK should be phased out of eye drops for chronic use. Overall, the inclusion of BAK poses a risk of developing DED and poor adherence, which can ultimately lead to disease progression and blindness.
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Affiliation(s)
- Anne Hedengran Nagstrup
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Karg MM, Lu YR, Refaian N, Cameron J, Hoffmann E, Hoppe C, Shirahama S, Shah M, Krasniqi D, Krishnan A, Shrestha M, Guo Y, Cermak JM, Walthier M, Broniowska K, Rosenzweig-Lipson S, Gregory-Ksander M, Sinclair DA, Ksander BR. Sustained Vision Recovery by OSK Gene Therapy in a Mouse Model of Glaucoma. Cell Reprogram 2023; 25:288-299. [PMID: 38060815 PMCID: PMC10739681 DOI: 10.1089/cell.2023.0074] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Glaucoma, a chronic neurodegenerative disease, is a leading cause of age-related blindness worldwide and characterized by the progressive loss of retinal ganglion cells (RGCs) and their axons. Previously, we developed a novel epigenetic rejuvenation therapy, based on the expression of the three transcription factors Oct4, Sox2, and Klf4 (OSK), which safely rejuvenates RGCs without altering cell identity in glaucomatous and old mice after 1 month of treatment. In the current year-long study, mice with continuous or cyclic OSK expression induced after glaucoma-induced vision damage had occurred were tracked for efficacy, duration, and safety. Surprisingly, only 2 months of OSK fully restored impaired vision, with a restoration of vision for 11 months with prolonged expression. In RGCs, transcription from the doxycycline (DOX)-inducible Tet-On AAV system, returned to baseline 4 weeks after DOX withdrawal. Significant vision improvements remained for 1 month post switching off OSK, after which the vision benefit gradually diminished but remained better than baseline. Notably, no adverse effects on retinal structure or body weight were observed in glaucomatous mice with OSK continuously expressed for 21 months providing compelling evidence of efficacy and safety. This work highlights the tremendous therapeutic potential of rejuvenating gene therapies using OSK, not only for glaucoma but also for other ocular and systemic injuries and age-related diseases.
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Affiliation(s)
- Margarete M. Karg
- Schepens Eye Research Institute of Mass Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Yuancheng Ryan Lu
- Paul F. Glenn Center for Biology of Aging Research, Department of Genetics, Blavatnik Institute, Harvard Medical School, Boston, Massachusetts, USA
- Whitehead Institute for Biomedical Research, Department of Biology, MIT, Cambridge, Massachusetts, USA
| | - Nasrin Refaian
- Schepens Eye Research Institute of Mass Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - James Cameron
- Whitehead Institute for Biomedical Research, Department of Biology, MIT, Cambridge, Massachusetts, USA
| | - Emma Hoffmann
- Schepens Eye Research Institute of Mass Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Cindy Hoppe
- Schepens Eye Research Institute of Mass Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Shintaro Shirahama
- Schepens Eye Research Institute of Mass Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Madhura Shah
- Schepens Eye Research Institute of Mass Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Drenushe Krasniqi
- Schepens Eye Research Institute of Mass Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Anitha Krishnan
- Schepens Eye Research Institute of Mass Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Maleeka Shrestha
- Schepens Eye Research Institute of Mass Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Yinjie Guo
- Schepens Eye Research Institute of Mass Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Meredith Gregory-Ksander
- Schepens Eye Research Institute of Mass Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - David A. Sinclair
- Paul F. Glenn Center for Biology of Aging Research, Department of Genetics, Blavatnik Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Bruce R. Ksander
- Schepens Eye Research Institute of Mass Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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10
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Hedengran A, Kolko M. The molecular aspect of anti-glaucomatous eye drops - are we harming our patients? Mol Aspects Med 2023; 93:101195. [PMID: 37459821 DOI: 10.1016/j.mam.2023.101195] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 08/14/2023]
Abstract
Glaucoma is one of the leading causes of irreversible blindness. Progression is halted with a reduction in intraocular pressure (IOP), which is most often achieved with eye drops. A major challenge in the topical treatment of glaucoma patients is the many side effects and the resulting reduced adherence. Side effects may of course be due to the molecular properties of the active pharmaceutical ingredients (APIs). There are currently six different APIs available: prostaglandin analogues, β-adrenergic inhibitors, α-adrenergic agonists, carbonic anhydrase inhibitors, rho-kinase inhibitors and muscarinic 3 agonists. But the additives used in eye drops are also known to cause damage to the ocular surface and to some extent also to the deeper tissues. Said additives are considered inactive molecular components and are added to secure for instance viscosity and pH value, and to prevent contamination. There has been an increasing focus on the harmful effects of preservatives, with the most commonly used preservative benzalkonium chloride (BAK) being particularly controversial. BAK has long been recognized as a toxin that increases the risk of ocular discomfort. This can affect the adherence and ultimately result in lack of disease control. Other issues include the addition of certain buffers, such as phosphates, and varying pH values. This review will address the different molecular components of the IOP-lowering eye drops and what to be aware of when prescribing topical glaucoma treatment.
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Affiliation(s)
- Anne Hedengran
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2200, Copenhagen N, Denmark; Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark.
| | - Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2200, Copenhagen N, Denmark; Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark.
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11
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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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12
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Mamidipaka A, Di Rosa I, Lee R, Zhu Y, Chen Y, Salowe R, Addis V, Sankar P, Daniel E, Ying GS, O’Brien JM. Factors Associated with Large Cup-to-Disc Ratio and Blindness in the Primary Open-Angle African American Glaucoma Genetics (POAAGG) Study. Genes (Basel) 2023; 14:1809. [PMID: 37761949 PMCID: PMC10530848 DOI: 10.3390/genes14091809] [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: 08/11/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND/AIMS Primary open-angle glaucoma (POAG) disproportionately affects individuals of African ancestry. In these patients' eyes, a large cup-to-disc ratio (LCDR > 0.90) suggests greater retinal ganglion cell loss, though these patients often display varied visual ability. This study investigated the prevalence and risk factors associated with LCDR in African ancestry individuals with POAG and explored the differences between blind (>20/200) and not blind (≤20/200) LCDR eyes. METHODS A case-control methodology was used to investigate the demographic, optic disc, and genetic risk factors of subjects in the Primary Open-Angle African American Glaucoma Genetics Study. Risk factors were analyzed using univariable and multivariable logistic regression models with inter-eye correlation adjusted using generalized estimating equations. RESULTS Out of 5605 eyes with POAG, 1440 eyes (25.7%) had LCDR. In the multivariable analysis, LCDR was associated with previous glaucoma surgery (OR = 1.72), increased intraocular pressure (OR = 1.04), decreased mean deviation (OR = 1.08), increased pattern standard deviation (OR = 1.06), thinner retinal nerve fiber layer (OR = 1.05), nasalization of vessels (OR = 2.67), bayonetting of vessels (OR = 1.98), visible pores in the lamina cribrosa (OR = 1.68), and a bean-shaped cup (OR = 2.11). Of LCDR eyes, 30.1% were classified as blind (≤20/200). In the multivariable analysis, the statistically significant risk factors of blindness in LCDR eyes were previous glaucoma surgery (OR = 1.72), increased intraocular pressure (OR = 1.05), decreased mean deviation (OR = 1.04), and decreased pattern standard deviation (OR = 0.90). CONCLUSIONS These findings underscore the importance of close monitoring of intraocular pressure and visual function in African ancestry POAG patients, particularly those with LCDR, to preserve visual function.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Joan M. O’Brien
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.M.); (I.D.R.); (R.L.); (Y.Z.); (Y.C.); (R.S.); (V.A.); (P.S.); (E.D.); (G.-S.Y.)
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13
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Tokumo K, Okada N, Onoe H, Komatsu K, Masuda S, Okumichi H, Hirooka K, Asaoka R, Kiuchi Y. Ex-PRESS Implantation versus Trabeculectomy for Long-Term Maintenance in Patients with Open-Angle Glaucoma. Clin Ophthalmol 2023; 17:2525-2537. [PMID: 37662650 PMCID: PMC10473402 DOI: 10.2147/opth.s419765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/10/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose To compare the efficacy of Ex-PRESS implantation (EXP) with that of trabeculectomy (TLE) with mitomycin C for maintaining low target intraocular pressure (IOP) in patients with open-angle glaucoma. Patients and Methods Patients were randomly assigned to receive EXP or TLE. Surgical success was defined according to three target mean IOP ranges (5 mmHg ≤ IOP ≤ 18 mmHg [criterion A], 5 mmHg ≤ IOP ≤ 15 mmHg [criterion B], and 5 mmHg ≤ IOP ≤ 12 mmHg [criterion C]) representing reductions of at least 20% below the baseline on two consecutive follow-up visits 3 months post-surgery, with or without antiglaucoma medication and without further glaucoma surgery. Participants were divided into three subgroups based on baseline mean deviation (MD) values: early (MD ≥ -6 dB), moderate (-6 dB > MD ≥ -12 dB), and advanced (-12 dB > MD). Survival rates were calculated by subgroup. Results A total of 73 patients, including 30 in the EXP group and 43 in the TLE group, were included in the study. No significant differences in baseline ocular or demographic characteristics were found between the two groups. No significant difference in IOP was noted every 6 months. After the 3-year follow-up, success rates were A) 60.0% and 60.2%, B) 45.7% and 58.1%, and C) 31.5% and 40.5% for the EXP and TLE groups, respectively. Moreover, there was no difference in success rate based on glaucoma level. Many glaucoma medications administered before surgery were associated with a higher failure rate in the TLE group but not in the EXP group. Conclusion Both procedures resulted in similar IOP reductions and success rates for a low target IOP. The number of preoperative glaucoma medications was a risk factor for TLE failure.
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Affiliation(s)
- Kana Tokumo
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Naoki Okada
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Hiromitsu Onoe
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kaori Komatsu
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Shun Masuda
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Hideaki Okumichi
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kazuyuki Hirooka
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Ryo Asaoka
- Seirei Hamamatsu General Hospital Department of Ophthalmology, Shizuoka, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
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14
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Heijl A, Peters D, Bengtsson B. Long-term Impact of Immediate Versus Delayed Treatment of Early Glaucoma: Results From the Early Manifest Glaucoma Trial. Am J Ophthalmol 2023; 252:286-294. [PMID: 37142174 DOI: 10.1016/j.ajo.2023.04.010] [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: 12/31/2022] [Revised: 04/14/2023] [Accepted: 04/15/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To compare long-term visual outcomes in the 2 arms of the Early Manifest Glaucoma Trial (EMGT) and determine if delayed treatment was associated with a penalty in terms of visual function. DESIGN Long-term follow-up of a prospective, randomized controlled clinical trial. METHODS EMGT was carried out at 2 centers in Sweden; 255 subjects with newly detected, untreated glaucoma were randomized to immediate treatment with topical betaxolol and argon laser trabeculoplasty or to no initial treatment as long as no progression was detected. Subjects were followed prospectively with standard automated perimetry, visual acuity measurements, and tonometry for up to 21 years. Outcomes included vision impairment (VI), the perimetric mean deviation (MD) index and rate of progression, and visual acuity. RESULTS At study end, percentages of eyes with VI or blindness were slightly higher in the treated group than in the untreated control group, 12.1% vs 11.0%, and 9.4.% vs 6.1% respectively, as were subjects with VI in at least one eye, 19.5% vs 18.7%. The differences were not statistically significant, nor were cumulative incidences of VI in at least one eye. The control group had more field loss than the treatment group, with median MD in the worse eye of -14.73 dB vs -12.85 dB, and rate of progression of -0.74 vs -0.60 dB/y, which was not statistically significant. Differences in visual acuity were minimal. CONCLUSIONS Delaying treatment did not result in serious penalties. VI occurred at similar proportions in both treatment arms with a slight preponderance in the treatment group, whereas visual field damage was slightly higher in the control group.
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Affiliation(s)
- Anders Heijl
- From the Department of Clinical Sciences, Ophthalmology, Lund University (A.H., D.P., B.B.); Department of Ophthalmology, Skåne University Hospital (A.H., D.P.), Malmö, Sweden..
| | - Dorothea Peters
- From the Department of Clinical Sciences, Ophthalmology, Lund University (A.H., D.P., B.B.); Department of Ophthalmology, Skåne University Hospital (A.H., D.P.), Malmö, Sweden
| | - Boel Bengtsson
- From the Department of Clinical Sciences, Ophthalmology, Lund University (A.H., D.P., B.B.)
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15
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Tribble JR, Hui F, Quintero H, El Hajji S, Bell K, Di Polo A, Williams PA. Neuroprotection in glaucoma: Mechanisms beyond intraocular pressure lowering. Mol Aspects Med 2023; 92:101193. [PMID: 37331129 DOI: 10.1016/j.mam.2023.101193] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/25/2023] [Accepted: 06/04/2023] [Indexed: 06/20/2023]
Abstract
Glaucoma is a common, complex, multifactorial neurodegenerative disease characterized by progressive dysfunction and then loss of retinal ganglion cells, the output neurons of the retina. Glaucoma is the most common cause of irreversible blindness and affects ∼80 million people worldwide with many more undiagnosed. The major risk factors for glaucoma are genetics, age, and elevated intraocular pressure. Current strategies only target intraocular pressure management and do not directly target the neurodegenerative processes occurring at the level of the retinal ganglion cell. Despite strategies to manage intraocular pressure, as many as 40% of glaucoma patients progress to blindness in at least one eye during their lifetime. As such, neuroprotective strategies that target the retinal ganglion cell and these neurodegenerative processes directly are of great therapeutic need. This review will cover the recent advances from basic biology to on-going clinical trials for neuroprotection in glaucoma covering degenerative mechanisms, metabolism, insulin signaling, mTOR, axon transport, apoptosis, autophagy, and neuroinflammation. With an increased understanding of both the basic and clinical mechanisms of the disease, we are closer than ever to a neuroprotective strategy for glaucoma.
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Affiliation(s)
- James R Tribble
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Flora Hui
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Department of Optometry & Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Heberto Quintero
- Department of Neuroscience, University of Montreal, Montreal, Canada; Neuroscience Division, Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Sana El Hajji
- Department of Neuroscience, University of Montreal, Montreal, Canada; Neuroscience Division, Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Katharina Bell
- NHMRC Clinical Trials Centre, University of Sydney, Australia; Eye ACP Duke-NUS, Singapore
| | - Adriana Di Polo
- Department of Neuroscience, University of Montreal, Montreal, Canada; Neuroscience Division, Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Pete A Williams
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden.
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16
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Kiuchi Y, Inoue T, Shoji N, Nakamura M, Tanito M. The Japan Glaucoma Society guidelines for glaucoma 5th edition. Jpn J Ophthalmol 2023; 67:189-254. [PMID: 36780040 DOI: 10.1007/s10384-022-00970-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 02/14/2023]
Abstract
We are pleased to bring you the 5th edition of the Glaucoma Clinical Practice Guidelines. Clinical practice guidelines are based on evidence (scientific grounds). It is a document that presents the treatment that is the most appropriate for the patient. "Glaucoma Clinical Guidelines" was first published in 2003. This was the first guideline for glaucoma treatment in Japan. The principle of glaucoma treatment is to lower intraocular pressure. Means for lowering intraocular pressure includes drugs, lasers, and surgery; Glaucoma is a disease that should be considered as a complex syndrome rather than a single condition. Therefore, the actual medical treatment is not as simple as one word. This time we set the Clinical Questionnaire with a focus on glaucoma treatment. We hope that you will take advantage of the 5th edition.
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Affiliation(s)
- Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-31 Kasumi, Minami-ku, Hiroshima, Japan.
| | - Toshihiro Inoue
- Department of Ophthalmology, Faculty of Life Science, Kumamoto University, Kumamoto, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Makoto Nakamura
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan
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17
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Díez-Álvarez L, Beltrán-Agullo L, Loscos J, Pazos M, Ponte-Zúñiga B, Pinazo-Durán MD, Giménez-Gómez R, Ussa F, Pinilla LM, Jaumandreu L, Rebolleda G, Muñoz-Negrete FJ. Advanced glaucoma. Clinical practice guideline. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:18-39. [PMID: 36088247 DOI: 10.1016/j.oftale.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/24/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To present an update clinical practice guideline that serve as a guide for the detection, evaluation and treatment of adults patients with advanced glaucoma. METHODS After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple systematic Rewiews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate methodology. Guideline Network (SIGN). RESULTS Recommendations with their corresponding levels of evidence that may be useful in the diagnosis, monitoring and treatment of adults patients with advanced glaucoma. CONCLUSIONS Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of advanced glaucoma.
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Affiliation(s)
- L Díez-Álvarez
- Departamento de Oftalmología, Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain.
| | | | - J Loscos
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Servicio de Oftalmología, Hospital Universitari Germans Trias i Pujol, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - M Pazos
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - B Ponte-Zúñiga
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Servicio de Oftalmología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M D Pinazo-Durán
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Unidad Investigación Oftalmológica Santiago Grisolía/FISABIO; Unidad de Oftalmobiología Celular y Molecular, Universidad de Valencia, Valencia, Spain
| | - R Giménez-Gómez
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Servicio de Oftalmología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - F Ussa
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain; Department of Ophthalmology, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - L M Pinilla
- Institut Català de la Retina (ICR), Barcelona, Spain
| | - L Jaumandreu
- Departamento de Oftalmología, Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Department of Ophthalmology, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - G Rebolleda
- Departamento de Oftalmología, Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain
| | - F J Muñoz-Negrete
- Departamento de Oftalmología, Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain
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18
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Hedengran A, Freiberg JC, Hansen PM, Jacobsen J, Larsen SW, Harloff‐Helleberg S, Freude K, Boix‐Lemonche G, Petrovski G, Heegaard S, Kolko M. Generic benzalkonium chloride-preserved travoprost eye drops are not identical to the branded polyquarternium-1-preserved travoprost eye drop: Effect on cultured human conjunctival goblet cells and their physicochemical properties. Acta Ophthalmol 2022; 100:819-827. [PMID: 35527390 PMCID: PMC9790398 DOI: 10.1111/aos.15163] [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] [Received: 12/20/2021] [Revised: 03/07/2022] [Accepted: 04/18/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To investigate the effect of polyquaternium-1 (PQ)-preserved and benzalkonium chloride (BAK)-preserved travoprost eye drops on viability of primary human conjunctival goblet cell (GC) cultures and on secretion of mucin and cytokines. Furthermore, to evaluate the physicochemical properties of the branded travoprost eye drop Travatan® and available generics. METHODS The effect of travoprost eye drops was evaluated on GC cultures. Cell viability was assessed through lactate dehydrogenase (LDH) and tetrazolium dye (MTT) colorimetric assays. Mucin secretion was evaluated by immunohistochemical staining. Secretion of interleukin (IL)-6 and IL-8 was measured using BD Cytometric Bead Arrays. pH, viscosity, droplet mass, osmolality and surface tension were measured for all included eye drops. RESULTS In the LDH assay, BAK travoprost caused significant GC loss after 2 hrs of incubation compared to the control. PQ travoprost caused no GC loss at any time point. Both PQ- and BAK travoprost caused secretion of mucin to the cytoplasma. No difference in IL-6 and IL-8 secretion was identified compared to controls. The pH values for the generics were lower (pH 6.0) than the pH value for Travatan (pH 6.7; p < 0.0001). The viscosity was lowest for Travatan, while the mean droplet mass was higher for Travatan (35 mg) than the generics (28-30 mg; p ≤ 0.0318). The osmolality and surface tension did not differ between the eye drops investigated. CONCLUSION BAK travoprost caused GC loss, indicating that PQ preservation may be preferable in treatment of glaucoma. Furthermore, physicochemical properties of branded and generic travoprost eye drops can not be assumed to be identical.
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Affiliation(s)
- Anne Hedengran
- Department of Drug Design and PharmacologyUniversity of CopenhagenCopenhagenDenmark,Department of OphthalmologyCopenhagen University Hospital, RigshospitaletGlostrupDenmark
| | | | - Pernille May Hansen
- Department of Drug Design and PharmacologyUniversity of CopenhagenCopenhagenDenmark,Department of OphthalmologyCopenhagen University Hospital, RigshospitaletGlostrupDenmark
| | - Jette Jacobsen
- Department of PharmacyUniversity of CopenhagenCopenhagenDenmark
| | | | | | - Kristine Freude
- Pathobiological Sciences, Department of Veterinary and Animal SciencesUniversity of CopenhagenFrederiksberg CDenmark
| | - Gerard Boix‐Lemonche
- Center for Eye Research, Department of OphthalmologyOslo University Hospital and Institute for Clinical Medicine, Faculty of Medicine, University of OsloOsloNorway
| | - Goran Petrovski
- Center for Eye Research, Department of OphthalmologyOslo University Hospital and Institute for Clinical Medicine, Faculty of Medicine, University of OsloOsloNorway
| | - Steffen Heegaard
- Department of OphthalmologyCopenhagen University Hospital, RigshospitaletGlostrupDenmark,Department of PathologyUniversity Hospital RigshospitaletCopenhagenDenmark
| | - Miriam Kolko
- Department of Drug Design and PharmacologyUniversity of CopenhagenCopenhagenDenmark,Department of OphthalmologyCopenhagen University Hospital, RigshospitaletGlostrupDenmark
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19
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Zhou B, Bekerman VP, Khouri AS. Use of Latanoprostene Bunod as Adjunctive Glaucoma Therapy in Refractory Glaucoma. J Curr Glaucoma Pract 2022; 16:166-169. [PMID: 36793262 PMCID: PMC9905875 DOI: 10.5005/jp-journals-10078-1386] [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] [Received: 01/12/2022] [Accepted: 07/27/2022] [Indexed: 01/25/2023] Open
Abstract
Aim To investigate the long-term efficacy of adjunctive use of latanoprostene bunod (LBN), a new nitric oxide donating prostaglandin medication, in refractory cases of glaucoma at a tertiary care center. Materials and methods A review for patients who received add-on LBN was conducted from 1st January 2018 to 31st August 2020. A total of 33 patients (53 eyes) met the inclusion criteria of being on ≥3 topical medications, having an intraocular pressure measurement prior to starting LBN, and having adequate follow-up. Baseline demographics, prior treatments, adverse effects, and intraocular pressures measured at baseline, 3, 6, and 12 months were recorded. Results Mean baseline intraocular pressure (IOP) [mm Hg ± standard deviation (SD)] was 19.9 ± 6.0. At 3 months, 49 eyes had a mean IOP of 17.3 ± 5.5 (p < 0.01) with an absolute reduction of 2.6 ± 6.6 and a percent reduction of 9 ± 28%. At 6 months, 35 eyes had a mean IOP of 17.2 ± 4.7 (p < 0.01) with an absolute reduction of 3.6 ± 7.4 and a percent reduction of 11 ± 30%. At 12 months, 28 eyes had a mean IOP of 16 ± 4.5 (p < 0.01) with an absolute reduction of 5.8 ± 7.4 and a percent reduction of 19 ± 38%. Over the course of the study, 18 eyes were lost to follow-up. Three eyes had a laser trabeculoplasty, and four eyes required incisional surgery. No eyes discontinued the medication due to adverse effects. Conclusion Adjunctive use of LBN in refractory glaucoma showed clinically and statistically significant IOP reductions at 3, 6, and 12-month time points. IOP reduction in patients was stable throughout the course of the study, with the largest decreases seen at the 12-month interval. Clinical significance LBN was well tolerated by patients and may be useful as an additive agent in providing long-term intraocular pressure reduction for patients with severe glaucoma on maximal therapy. How to cite this article Zhou B, Bekerman VP, Khouri AS. Use of Latanoprostene Bunod as Adjunctive Glaucoma Therapy in Refractory Glaucoma. J Curr Glaucoma Pract 2022;16(3):166-169.
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Affiliation(s)
- Benjamin Zhou
- Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| | - Vladislav P Bekerman
- Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| | - Albert S Khouri
- Institute of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, United States
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Tekeli O, Köse HC. Evaluation of the Use of Brinzolamide-Brimonidine Fixed Combination in Maximum Medical Therapy. Turk J Ophthalmol 2022; 52:262-269. [PMID: 36017234 PMCID: PMC9421937 DOI: 10.4274/tjo.galenos.2021.25488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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21
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Kernohan A, Homer T, Shabaninejad H, King AJ, Hudson J, Fernie G, Azuara-Blanco A, Burr J, Sparrow JM, Garway-Heath D, Barton K, Norrie J, Maclennan G, Vale L. Cost-effectiveness of primary surgical versus primary medical management in the treatment of patients presenting with advanced glaucoma. Br J Ophthalmol 2022; 107:bjophthalmol-2021-320887. [PMID: 35882513 PMCID: PMC10579172 DOI: 10.1136/bjo-2021-320887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 06/29/2022] [Indexed: 11/04/2022]
Abstract
SYNOPSIS Advanced glaucoma is associated with sight loss. This within-trial economic evaluation compares medical and surgical management strategies. At 2 years, medication appears more cost-effective though longitudinal outcomes are an important subject in future research. BACKGROUND/AIMS Open angle glaucoma (OAG) is a progressive optic neuropathy. Approximately 25% of newly diagnosed patients with OAG present with advanced disease in at least one eye. The vision loss associated with OAG can lead to significant impacts on vision, quality of life and health care resources. The Treatment of Advanced Glaucoma Study is a randomised controlled trial comparing the effectiveness of primary surgical and medical management for newly diagnosed advanced patients with OAG. An economic evaluation was carried out to understand the costs and benefits of each strategy. METHODS A cost utility analysis was carried out from a National Health Service perspective over a 2-year time horizon inclusive of patient costs. The primary outcome was patient health-related quality of life measured by the EQ-5D-5L, Health Utilities Index 3 (HUI3) and Glaucoma Utility Index (GUI). Results were expressed as incremental cost per QALY gained. RESULTS Trabeculectomy was associated with higher costs and greater effect, the EQ-5D-5L results have an incremental cost per QALY of £45,456. The likelihood of surgery being cost-effective at a £20, 000, £30,000 and £50,000 QALY threshold is 0%, 12% and 56%, respectively. The results for the HUI3, GUI and inclusion of patient costs do not change the conclusions of the study. CONCLUSION This is the first study to evaluate management strategies for those presenting with advanced glaucoma. At a 2-year time horizon, medication is the more cost-effective approach for managing glaucoma. Future research can focus on the costs and benefits of the treatments over a longer time horizon.
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Affiliation(s)
- Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Homer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hosein Shabaninejad
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Anthony J King
- Department of Ophthalmology, Nottingham University Hospital, Nottingham, UK
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Gordon Fernie
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Jennifer Burr
- School of Medicine, University of St Andrews, St Andrews, UK
| | - John M Sparrow
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - David Garway-Heath
- National Institute for Health Research (NIHR) Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Keith Barton
- National Institute for Health Research (NIHR) Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Graeme Maclennan
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Applied Research Collaboration North East and North Cumbria, NIHR, Newcastle, UK
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22
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Discrimination Between Healthy Eyes and Those With Mild Glaucoma Damage Using Hemoglobin Measurements of the Optic Nerve Head. J Glaucoma 2022; 31:567-573. [PMID: 35353776 DOI: 10.1097/ijg.0000000000002026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/17/2022] [Indexed: 01/31/2023]
Abstract
PRCIS The Laguna ONhE, a software that measures the hemoglobin (Hb) concentration of the optic nerve head (ONH) from fundus photographs, demonstrated good accuracy in discriminating healthy eyes from eyes with mild glaucoma. PURPOSE The aim was to evaluate Hb concentration of the optic nerve to distinguish between healthy eyes and eyes with mild glaucoma. METHODS Eyes from patients with mild primary open angle glaucoma (MD > -6 dB) (n=58) and from healthy subjects (n=64) were selected. Retinal nerve fiber layer thickness measurements of all eyes were acquired with optical coherence tomography. Optic disc photographs were also obtained, and the images were analyzed using the Laguna ONhE software, which measures the amount of Hb in 24 sectors of the ONH. The software also calculates the Glaucoma Discriminant Function (GDF), an index that expresses the chance of the ONH being compatible with glaucoma. Areas under the receiver operating characteristic curve and sensitivities at fixed specificities of 90% and 95% of each Laguna ONhE parameter were calculated. RESULTS The mean retinal nerve fiber layer thickness and vertical cup/disc ratio of the control and glaucoma groups were 90.0±10.6 μm versus 66.28±9.85 μm ( P <0.001) and 0.5±0.09 versus 0.65±0.09 ( P <0.001), respectively. Total Hb (67.9±4.45 vs. 62.89±4.89, P <0.001) and GDF (11.57±15.34 vs. -27.67±20.94, P <0.001) were significantly higher in the control group. The Hb concentration was also significantly higher in 21 of the 24 sectors in the control group compared with the glaucoma group ( P <0.05). The GDF had the largest areas under the receiver operating characteristic curve (0.93), with 79.3% sensitivity at a fixed specificity of 95%. CONCLUSION Measurements of optic nerve Hb concentration using a colorimetry photographic device demonstrated good accuracy in discriminating healthy eyes from eyes with mild glaucoma. Further studies are need to understand vascular factors implicated in the development of glaucoma.
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Skov AG, Rives AS, Freiberg J, Virgili G, Azuara‐Blanco A, Kolko M. Comparative efficacy and safety of preserved versus preservative-free beta-blockers in patients with glaucoma or ocular hypertension: a systematic review. Acta Ophthalmol 2022; 100:253-261. [PMID: 34128326 DOI: 10.1111/aos.14926] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/20/2021] [Indexed: 12/28/2022]
Abstract
Preservative-free topical medications have been introduced for glaucoma care to reduce ocular adverse events associated with preservatives. This is a systematic review and meta-analysis of randomized clinical trials (RCTs) comparing the efficacy and safety of beta-blockers, or combination using beta-blockers, with and without preservatives. PubMed, EMBASE and Web of Science were examined. Risk of bias was assessed using the Cochrane Handbook for Systematic Reviews. The primary outcome was change in intraocular pressure (IOP) from baseline to final follow-up. Secondary outcomes included ocular and systemic side effects, and other clinical and quality of life outcomes. Of 242 records identified, seven RCTs (1125 patients) were included. The follow-up period ranged from one to 12 months. Timolol was used in five studies, and two studies used a combination (timolol with bimatoprost or dorzolamide). The difference in mean change (MD) in IOP between the preservative-free and the preserved drugs was statistically significant but not clinically relevant: (MD 0.29 mmHg, 95% confidence interval 0.07-0.51 mmHg, p = 0.010; moderate-certainty evidence). Regarding adverse events: Level of evidence for all ocular surface outcome was low or very low and reported in few studies. No significant difference was observed on ocular surface symptoms. Tear break-up time (TBUT) was better with preservative-free drops (p < 0.001). Schirmer's test was better in the preservative-free group (p < 0.001). Level of evidence for all ocular surface outcomes was low or very low. There was no difference in other secondary outcomes. We found no clinically relevant difference in mean change in IOP between the preserved and the preservative-free treatments. Data on adverse events used different methods and were incompletely reported. Although some measures of ocular surface health favoured preservative-free medications, more evidence is needed. The increasing use of preservative-free drops may be associated with better ocular surface and tolerability, but strong evidence from RCTs would be welcome.
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Affiliation(s)
- Anne Guldhammer Skov
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet‐Glostrup Glostrup Denmark
| | | | - Josefine Freiberg
- Department of Drug Design and Pharmacology University of Copenhagen Copenhagen Denmark
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA) University of Firenze and AOU Careggi Florence Italy
- Centre for Public Health Queen’s University Belfast Belfast UK
| | | | - Miriam Kolko
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet‐Glostrup Glostrup Denmark
- Department of Drug Design and Pharmacology University of Copenhagen Copenhagen Denmark
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24
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Risk factors for undergoing surgery in patients with newly diagnosed open-angle glaucoma. Sci Rep 2022; 12:5661. [PMID: 35383265 PMCID: PMC8983768 DOI: 10.1038/s41598-022-09832-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 03/28/2022] [Indexed: 11/16/2022] Open
Abstract
Despite the clinical importance of glaucoma surgery, studies on its prevalence and risk factors are limited. We analyzed a database comprising approximately 1,000,000 Korean residents to investigate the prevalence and risk factors for undergoing glaucoma surgery within 5 years of diagnosis with open-angle glaucoma. Of the 4,303 patients evaluated, 226 (5.3%) underwent glaucoma surgery. Factors associated with the likelihood of glaucoma surgery included the use of two or more eye drops (odds ratio [OR], 30.30; 95% confidence interval [CI], 10.95–83.84), intake of oral carbonic anhydrase inhibitor (OR, 1.79; 95% CI, 1.23–2.61), age > 55 years (55–65 years: OR, 1.71; 95% CI, 1.06–2.76; > 65 years: OR 1.72; 95% CI, 1.10–2.70), female sex (OR, 1.46; 95% CI, 1.10–1.94), middle- and high-income (OR, 2.36; 95% CI, 1.30–4.28, OR, 1.86; 95% CI, 1.03–3.35, respectively), and metropolitan residence (OR, 1.61; 95% CI, 1.14–2.26). Our nomogram for predicting the likelihood of glaucoma surgery showed an acceptable result. In conclusion, older age, female sex, and the intensity of intraocular pressure lowering treatment increased the likelihood of undergoing glaucoma surgery. Our findings indicated that a lower socioeconomic status may forestall receiving this necessary surgery, which requires further attention.
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25
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Müllertz O, Hedengran A, Mouhammad ZA, Freiberg J, Nagymihály R, Jacobsen J, Larsen SW, Bair J, Utheim T, Dartt DA, Heegaard S, Petrovski G, Kolko M. Impact of benzalkonium chloride-preserved and preservative-free latanoprost eye drops on cultured human conjunctival goblet cells upon acute exposure and differences in physicochemical properties of the eye drops. BMJ Open Ophthalmol 2022; 6:e000892. [PMID: 34993350 PMCID: PMC8689192 DOI: 10.1136/bmjophth-2021-000892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/30/2021] [Indexed: 01/09/2023] Open
Abstract
Objective To investigate the short-term impact on human conjunctival goblet cell (GC) survival and mucin release of acute exposure to benzalkonium chloride (BAK) preserved and preservative-free (PF) 0.005% (w/v) latanoprost (LT) eye drops, and to compare the eye drops’ physicochemical properties. Methods and analysis Primary GC cultures were established from human conjunctival donor tissue. The impact of eye drops on GC survival was assessed using a lactate dehydrogenase assay. Mucin release was evaluated through mucin-specific immunostaining. pH value, osmolality, drop mass and surface tension for all LT eye drops were measured. Results After application with PF-LT for 30 min (min), the GC survival was maintained compared with control (p=0.9941), while all BAK-LT eye drops reduced survival with approximately 30% (p<0.02). Following application with PF-LT for 30 min, mucin was found around the GC nucleus, as seen in the vehicle control, indicating no secretion. In contrast, BAK-LT caused diffuse staining of mucin, similar to the secretagogue histamine, indicating stimulation of secretion. The pH value of the BAK-LT and PF-LT eye drops were 6.0–6.9 and 6.8, respectively. The osmolality was 258–288 mOsm/kg for the BAK-LT eye drops and 276 for PF-LT eye drops. The mean drop mass was 26–31 mg for the BAK-LT eye drops and 30 mg for PF-LT. The surface tension was lower for all BAK-LT eye drops (31.1–32.1 mN/m) compared with PF-LT (42 mN/m). Conclusion PF-LT compared with various branded and generic LT preparations containing BAK are less cytotoxic when applied to cultured GCs.
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Affiliation(s)
- Olivia Müllertz
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Anne Hedengran
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Zaynab Ahmad Mouhammad
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Josefine Freiberg
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Richárd Nagymihály
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital and Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jette Jacobsen
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Susan Weng Larsen
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Jeffrey Bair
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - Tor Utheim
- Department of Medical Biochemistry, Oslo Universitetssykehus, Oslo, Norway.,Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
| | - Darlene A Dartt
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - Steffen Heegaard
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Goran Petrovski
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital and Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Erichev VP, Poleva RP, Ragozina EA, Kozlova IV. [Comparative evaluation of hypotensive effectiveness of topical monotherapy and selective laser trabeculectomy]. Vestn Oftalmol 2022; 138:215-220. [PMID: 36287158 DOI: 10.17116/oftalma2022138052215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Comparison of the hypotensive effects of selective laser trabeculoplasty (SLT) and drug therapy in patients with newly diagnosed primary open-angle glaucoma (POAG) and ocular hypertension. MATERIAL AND METHODS Thirty patients (30 eyes) with newly diagnosed ophthalmic hypertension or POAG were observed. Patients of the 1st group (15 eyes) underwent standard SLT as a starting treatment, patients of the 2nd group (15 eyes) were prescribed monotherapy with a prostaglandin analog. Corneal compensated intraocular pressure (IOPcc) was measured for each patient using Ocular Response Analyzer («Reichert Technologies», USA). The observation period lasted 6 months. RESULTS During the 6-months follow-up, tafluprost was found to effectively reduce IOP in 93.3% of cases, SLT - in 73.3% of cases. There were no statistically significant differences in hypotensive effectiveness between the two compared treatments, which amounted to 27.9-28.5% reduction from the baseline values. CONCLUSION Selective laser trabeculectomy and topical drug therapy have shown similar hypotensive effectiveness during the 6-months follow-up when used as the initial therapy for POAG.
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Affiliation(s)
- V P Erichev
- Research Institute of Eye Diseases, Moscow, Russia
| | - R P Poleva
- Research Institute of Eye Diseases, Moscow, Russia
| | - E A Ragozina
- Research Institute of Eye Diseases, Moscow, Russia
| | - I V Kozlova
- Research Institute of Eye Diseases, Moscow, Russia
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Sugisaki K, Inoue T, Yoshikawa K, Kanamori A, Yamazaki Y, Ishikawa S, Uchida K, Iwase A, Araie M. Factors Threatening Central Visual Function of Advanced Glaucoma Patients: A Prospective Longitudinal Observational Study. Ophthalmology 2021; 129:488-497. [PMID: 34890684 DOI: 10.1016/j.ophtha.2021.11.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To identify risk factors for further deterioration of central visual function in advanced glaucoma eyes. DESIGN Prospective observational 5-year study. PARTICIPANTS Advanced glaucoma patients with well controlled intraocular pressure (IOP), the mean deviation (MD) of Humphrey Field Analyzer 24-2 program (HFA 24-2) ≤ -20 decibels and best-corrected visual acuity (BCVA) ≥ 20/40. METHODS The HFA10-2 test and BCVA examination were performed every 6 months and the HFA 24-2 test every 12 months for 5 years. The Cox proportional hazards model was used to identify risk factors for deterioration of HFA10-2 and 24-2 results and BCVA. MAIN OUTCOME MEASURES Deterioration of HFA 10-2 results was defined by the presence of the same ≥ 3 points with negative total deviation slope ≤ -1 decibel/year at P < 0.01 in ≥ 3 consecutive tests, that of HFA 24-2 results as an increase ≥ 2 in the Advanced Glaucoma Intervention Study (AGIS) score in ≥ 2 consecutive tests and that of BCVA as an increase of ≥ 0.2 in the log MAR in ≥ 2 consecutive tests. RESULTS A total of 175 advanced glaucoma eyes of 175 patients (mean age, 64.1 years; mean baseline IOP, 13.2 mmHg; mean logMAR, 0.02; Mean HFA 24-2 and 10-2 MD, -25.9 and -22.9 decibels, respectively) were included. The mean IOP during follow-up was 13.0 mmHg. The probabilities of deterioration in HFA 10-2 and 24-2 results and BCVA were 0.269 ± 0.043 (standard error), 0.173 ± 0.031 and 0.194 ± 0.033, respectively, at 5 years. Lower BCVA at baseline (P=0.012) was significantly associated with further deterioration of HFA 10-2 results. Better HFA24-2 MD (P<0.001) and use of systemic antihypertensive agents (P=0.009) were significantly associated with further deterioration of HFA 24-2 results, and a greater β-peripapillary atrophy area/disc area ratio (P<0.001), use of systemic antihypertensive agents (P=0.025) and lower BCVA (P=0.042) were significantly associated with further deterioration of BCVA, respectively. CONCLUSIONS In advanced glaucoma eyes with well controlled IOP, BCVA, β-peripapillary atrophy area/disc area ratio and use of systemic antihypertensive agents were significant prognostic factors for further deterioration of central visual function.
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Affiliation(s)
- Kenji Sugisaki
- Department of Ophthalmology, International University of Health and Welfare, Mita Hospital, Tokyo, Japan; Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Toshihiro Inoue
- Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Akiyasu Kanamori
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Shinichiro Ishikawa
- Department of Ophthalmology, Saga University Faculty of Medicine, Saga, Japan
| | | | | | - Makoto Araie
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan; Sekikawa Hospital, Tokyo, Japan
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Jang JH, Lee KW, Baek SU. Path to Diagnosis and Clinical Characteristics of Advanced Glaucoma at Initial Diagnosis: a Tertiary Single Center Experience. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.11.1527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: As routine health examinations become more common, many patients first diagnosed with glaucoma have advanced glaucoma. We analyzed the routes to diagnosis and the characteristics of patients initially diagnosed with advanced glaucoma.Methods: We retrospectively retrieved the medical records of patients first diagnosed with advanced glaucoma in our tertiary care center. The inclusion criteria were a mean deviation (MD) less than -12 dB on the visual field test, accompanied by structural damage. All patients were classified in terms of unilateral/bilateral disease, the intraocular pressure before medication, and lens status. We divided patients into those with monocular or binocular advanced glaucoma, high- or normal-pressure glaucoma, and those who were pseudophakic or phakic.Results: We included 73 patients of mean age 69.3 years. The visual field test MD was -19.6 dB. In those with binocular advanced glaucoma, incidental ophthalmic examination was the most common means of diagnosis (52.2%). Central-island visual field defects were the most common defects (54.2%). In those with monocular advanced glaucoma, glaucoma-associated symptoms most commonly triggered diagnosis (46.9%). Both superior and inferiorvisual field defects were the most common defects (42.8%). Glaucoma-associated symptoms were present in 68.2 and 22.8% of patients with high- and normal-pressure glaucoma, respectively. Central-island visual field defects were present in 43.6 and 29.4% of those with high- and normal-pressure glaucoma, respectively.Conclusions: We analyzed the routes to diagnosis and the clinical characteristics of patients with advanced glaucoma. In those with binocular disease, glaucoma was most commonly diagnosed on incidental ophthalmic examination. Central-island visual field defects were the most common defects in patients with binocular and high-pressure glaucoma, and the pseudophakic group. A multi-center longitudinal study on risk factors for delayed glaucoma diagnosis is needed.
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Landgren K, Peters D. A prospective study on effectiveness of elevated intraocular pressure as a criterion for glaucoma referrals by optometric practitioners in Sweden. Acta Ophthalmol 2021; 99:e1098-e1105. [PMID: 33423398 PMCID: PMC8596777 DOI: 10.1111/aos.14764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 12/10/2020] [Accepted: 12/20/2020] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the outcome of referrals for suspected glaucoma based on elevated intraocular pressure (IOP) made by optometric practitioners in Sweden. METHODS This prospective study included 95 individuals referred to the Skåne University Hospital Malmö, Sweden, during 2019, by optometric practitioners, based on elevated IOP. Positive outcome was defined as a diagnosis of glaucoma, or a diagnosis of suspected glaucoma. Referral accuracy was analysed. Positive predictive values (PPV) of different hypothetical IOP and age thresholds were calculated. RESULTS In 34% (95% CI: 24-43%) of the referrals, no eye disease was found. Intraocular pressure (IOP) was the only referral criterion in 77% (73/95). The PPV was 35% (95% CI: 25-45%) for all referrals, 27% (95% CI: 16-38%) for IOP-only referrals and 59% (95% CI: 36-82%) for referrals including additional findings. In IOP-only referrals, no definite diagnosis of glaucoma was made in any patients <45 years of age. Applying a theoretical age limit of ≥45 years with a hypothetical IOP limit of ≥25 mmHg in patients 45-69 years and of ≥22 mmHg in patients ≥70 years increased the PPV to 42% (95% CI: 27-57%). IOP-only referrals would have been reduced by 27% without missing any glaucoma cases. CONCLUSION The overall predictive value of the referrals was poor. Glaucoma resources would have been used more effectively by increasing the required age for IOP-only referrals to ≥45 years in combination with different IOP thresholds for certain age groups.
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Affiliation(s)
- Karin Landgren
- Department of Ophthalmology Skåne University Hospital Malmö‐Lund Sweden
| | - Dorothea Peters
- Department of Ophthalmology Skåne University Hospital Malmö‐Lund Sweden
- Department of Clinical Sciences in Malmö Ophthalmology Lund University Malmö Sweden
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30
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Hedengran A, Begun X, Müllertz O, Mouhammad Z, Vohra R, Bair J, Dartt DA, Cvenkel B, Heegaard S, Petrovski G, Kolko M. Benzalkonium Chloride-Preserved Anti-Glaucomatous Eye Drops and Their Effect on Human Conjunctival Goblet Cells in vitro. Biomed Hub 2021; 6:69-75. [PMID: 34616748 DOI: 10.1159/000517845] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Most intraocular pressure (IOP)-lowering eye drops are preserved with benzalkonium chloride (BAK). This can increase side effects and decrease adherence. Particularly, damage to the mucin-producing conjunctival goblet cells may be an issue due to instability of the tear film. We aimed to investigate the effect of IOP-lowering eye drops preserved with BAK on cultured human conjunctival goblet cells. Methods Eye drops Brimonidine Tartrate Teva (BT) with 0.005% BAK, Dorzolamide Stada (DS) with 0.0075% BAK, Optimol® (OP) with 0.01% BAK, and Latanoprost Teva (LT) with 0.02% BAK were included. Human primary cultured goblet cell survival was evaluated using a lactate dehydrogenase assay on human goblet cells after treatment for 30 min and 6 h with the different anti-glaucoma drug formulations. Results All eye drops examined, except BT, reduced goblet cell survival. The impact of eye drops on goblet cell viability was correlated with the time of exposure as well as to the concentration of BAK. After 30 min of exposure, cell viability was 93% for BT (0.005% BAK; p = 0.93), 71% for DS (0.0075% BAK; p = 0.067), 70% for OP (0.01% BAK; p = 0.054), and 69% for LT (0.02% BAK; p = 0.022), and exposure for 6 h reduced cell survival to 74% for BT (p = 0.217), 52% for DS (p = 0.011), 34% for OP (p = 0.017), and 31% for LT (p = 0.0007). Conclusion LT, OP, and DS reduced human goblet cell survival in a time-dependent manner. BT did not affect goblet cell survival. Cell survival was correlated with the BAK concentration in the eye drops making 0.02% BAK-preserved LT most toxic and 0.005% BAK-preserved BT least toxic. Based on the present study, decreasing BAK in eye drops for chronic use seems important to reduce damage to the goblet cells. However, future studies are needed to further explore this finding.
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Affiliation(s)
- Anne Hedengran
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Xenia Begun
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Olivia Müllertz
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Zaynab 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
| | - Jeffrey Bair
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Darlene A Dartt
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Barbara Cvenkel
- Department of Ophthalmology, UMC Ljubljana, Ljubljana, Slovenia
| | - Steffen Heegaard
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Glostrup, Denmark.,Department of Pathology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Goran Petrovski
- Department of Ophthalmology, University Hospital Rikshospitalet, Oslo, Norway
| | - Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Glostrup, Denmark
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Radell JE, Sharma HK, Auyeung KL, Paul ME, Gagliuso DJ, Chadha N, Tsai JC, Serle JB. Two-Year Experience With Latanoprostene Bunod in Clinical Practice. J Glaucoma 2021; 30:776-780. [PMID: 34172630 DOI: 10.1097/ijg.0000000000001904] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/13/2021] [Indexed: 10/21/2022]
Abstract
PRECIS We retrospectively reviewed records of patients prescribed latanoprostene bunod 0.024% (LBN) to assess its efficacy and safety in a real-world clinical setting. LBN was efficacious in lowering intraocular pressure (IOP) and had a favorable safety profile. PURPOSE The aim of this study was to evaluate the usage of LBN, the first topical nitric oxide-donating prostaglandin analog (PGA) for reducing IOP, in clinical practice. PATIENTS AND METHODS Retrospective review identified patients prescribed LBN by 5 glaucoma specialists at an academic center from January 2018 to November 2019. Fifty-six patients (102 eyes) met inclusion criteria of an IOP measured at the visit LBN was prescribed and at 2 visits ≥7 days after beginning treatment, with no surgeries, lasers or medication changes during follow-up. Main outcome measures were IOP, number of ocular medications, and adverse effects. RESULTS IOP (mean±SD, mm Hg) at the visit LBN was prescribed was 16.2±4.3 on 3.2±1.5 glaucoma medications. IOP at most recent visit was 13.7±3.8 on 3.2±1.6 medications. Mean IOP reduction was 2.1±3.5 (P<0.0001) at first follow-up, after 38.7±36.5 days, and 2.5±3.3 (P<0.0001) at last follow-up, after 235.9±160.8 days. Pressure decreased ≥2 mm Hg in 60%, ≥3 mm Hg in 46%, and ≥4 mm Hg in 34% of eyes. All patients received LBN as replacement for a PGA or latanoprost/netarsudil fixed-dose combination. Forty-three patients remained on LBN throughout the follow-up period. Seven were discontinued for insufficient pressure control, 4 for adverse effects including pain and itching, and 2 for financial reasons. CONCLUSIONS In 2 years of clinical use of LBN, patients exhibited IOP reductions that were statistically significant overall and clinically meaningful in 60% of patients. LBN was well-tolerated and may be more efficacious than traditional PGAs.
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Affiliation(s)
- Jake E Radell
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital
| | - Himanshu K Sharma
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital
| | - Kelsey L Auyeung
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital
| | - Megan E Paul
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital
| | - Donna J Gagliuso
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
| | - Nisha Chadha
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
| | - James C Tsai
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
| | - Janet B Serle
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
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32
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Triggerfish Recording of IOP Patterns in Combined HFDS Minimally Invasive Glaucoma and Cataract Surgery: A Prospective Study. J Clin Med 2021; 10:jcm10163472. [PMID: 34441768 PMCID: PMC8396965 DOI: 10.3390/jcm10163472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of the study is to investigate whether the circadian IOP rhythm can be influenced by combined cataract surgery with high frequency deep sclerotomy (HFDS) and whether intraocular pressure (IOP) can be significantly reduced by HFDS. METHODS In our study 10 patients were included, in whom 24 h IOP monitoring was installed before and after HFDS/cataract surgery using a Triggerfish. HFDS is a minimally invasive glaucoma surgery (MIGS). RESULTS After performed HFDS combined with cataract surgery, the IOP was reduced from 27.7 ± 2.11 mmHg to 14.4 ± 2.59 mmHg, which is highly significant (p < 0.001). The contact lens sensor (CLS) cosinor analysis pre- and postoperatively showed that the circadian rhythm is not influenced by the surgery, i.e., the circadian IOP rhythm did not show significant differences before and after surgery. CONCLUSIONS HFDS combined with cataract surgery is a potent surgical method that can significantly reduce the IOP. However, the circadian rhythm cannot be changed by the surgery. The acrophase remained during the night in all patients.
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Aspberg J, Heijl A, Bengtsson B. Screening for Open-Angle Glaucoma and Its Effect on Blindness. Am J Ophthalmol 2021; 228:106-116. [PMID: 33823158 DOI: 10.1016/j.ajo.2021.03.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/08/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the effect of population screening on low vision and blindness from open-angle glaucoma. DESIGN Retrospective cohort study. METHODS A large population-based screening for glaucoma was conducted in Malmö, Sweden, from 1992 to 1997. A total of 42,497 subjects were invited, of which 32,918 were screened, and 9,579 were non-responders (ie, did not participate). The records of glaucoma patients who had visited the Department of Ophthalmology at Malmö University Hospital from January 1, 1987, to December 31, 2017, were reviewed. Patients diagnosed at or after the screening were assessed for moderate or severe vision impairment, here called low vision, or blindness by the World Health Organization definition. Selection bias was corrected by creating a group of potential screening participants from a comparison group of clinical patients. Main outcome measures were the risk ratios of the cumulative incidence for bilateral low vision or blindness caused by glaucoma in screened patients compared with the potential participants. RESULTS The cumulative incidence of blindness was 0.17% in the screened population versus 0.32% among the potential participants; and for low vision 0.25% versus 0.53%. The risk ratio (95% confidence interval) between the two was 0.52 (0.32-0.84) for blindness and 0.46 (0.31-0.68) for low vision. There were no differences between the proportions of potential confounders in the comparison group and those in the non-responders. CONCLUSIONS The results suggest that population screening may reduce bilateral low vision and blindness caused by glaucoma by approximately 50%.
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34
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Nilsson AG, Peters D. Effectiveness of Elevated Intraocular Pressure as a Criterion for Glaucoma Referral After 6 Years of Follow-Up. Clin Ophthalmol 2021; 15:3041-3049. [PMID: 34295143 PMCID: PMC8291828 DOI: 10.2147/opth.s318068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the long-term predictive value of the need to treat patients referred by optometric practitioners, regarding glaucoma, in Malmö, Sweden, using intraocular pressure (IOP) as the primary referral criterion. Patients and Methods This retrospective study included 94 of 108 (87%) individuals referred to the Skåne University Hospital in Malmö, Sweden, for elevated IOP during 2012–2013. Data were extracted from patient records by the end of 2019. Positive outcome was defined as glaucoma, treated suspected glaucoma or treated ocular hypertension (OH) at referral or during the follow-up period. Positive predictive values (PPV) were calculated using different hypothetical thresholds for age and IOP-levels. Long-term follow-up was used to evaluate whether the first visit diagnoses would change over time, and if this would affect the effectiveness of the referrals. Results Elevated IOP was the only referral criterion in 84% (n=79). In 28 patients (35%) among the IOP-only referrals, no ocular disease was found, and 26 patients (33%) had a positive outcome at the first visit. Median follow-up time was 6.4 years. PPV according to diagnosis after follow-up was 42% (95% CI: 32–54%) for IOP-only referrals. Including thresholds of ≥45 years of age in combination with an IOP of ≥25 mmHg in the referral criteria would have reduced the number of IOP-only referrals by 27% (21 of 79), and increased the PPV to 57% (95% CI: 45–71%) at the last visit. No positive outcome would have been missed, among those that were followed-up after the first visit, when applying these thresholds for referral, over a follow-up period of six years. Conclusion Using only elevated IOP as referral criterion showed a poor accuracy for predicting those that require IOP lowering treatment. The long-term follow-up allowed us to verify the applicability of higher hypothetical threshold requirements on age and IOP for glaucoma referrals from optometric practices.
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Affiliation(s)
- Andreas G Nilsson
- Department of Ophthalmology, Skåne University Hospital, Malmö, Sweden
| | - Dorothea Peters
- Department of Clinical Sciences Malmö, Ophthalmology, Lund University, Malmö, Sweden
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35
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Dennyson Savariraj A, Salih A, Alam F, Elsherif M, AlQattan B, Khan AA, Yetisen AK, Butt H. Ophthalmic Sensors and Drug Delivery. ACS Sens 2021; 6:2046-2076. [PMID: 34043907 PMCID: PMC8294612 DOI: 10.1021/acssensors.1c00370] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/17/2021] [Indexed: 12/15/2022]
Abstract
Advances in multifunctional materials and technologies have allowed contact lenses to serve as wearable devices for continuous monitoring of physiological parameters and delivering drugs for ocular diseases. Since the tear fluids comprise a library of biomarkers, direct measurement of different parameters such as concentration of glucose, urea, proteins, nitrite, and chloride ions, intraocular pressure (IOP), corneal temperature, and pH can be carried out non-invasively using contact lens sensors. Microfluidic contact lens sensor based colorimetric sensing and liquid control mechanisms enable the wearers to perform self-examinations at home using smartphones. Furthermore, drug-laden contact lenses have emerged as delivery platforms using a low dosage of drugs with extended residence time and increased ocular bioavailability. This review provides an overview of contact lenses for ocular diagnostics and drug delivery applications. The designs, working principles, and sensing mechanisms of sensors and drug delivery systems are reviewed. The potential applications of contact lenses in point-of-care diagnostics and personalized medicine, along with the significance of integrating multiplexed sensing units together with drug delivery systems, have also been discussed.
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Affiliation(s)
| | - Ahmed Salih
- Department
of Mechanical Engineering, Khalifa University
of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Fahad Alam
- Department
of Mechanical Engineering, Khalifa University
of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Mohamed Elsherif
- Department
of Mechanical Engineering, Khalifa University
of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Bader AlQattan
- Department
of Mechanical Engineering, Khalifa University
of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Ammar A. Khan
- Department
of Chemical Engineering, Imperial College
London, London SW7 2AZ, United Kingdom
| | - Ali K. Yetisen
- Department
of Physics, Lahore University of Management
Sciences, Lahore Cantonment 54792, Lahore, Pakistan
| | - Haider Butt
- Department
of Mechanical Engineering, Khalifa University
of Science and Technology, Abu Dhabi, United Arab Emirates
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36
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Naik M, Kapur M, Gupta V, Sethi H, Srivastava K. Ripasudil Endgame: Role of Rho-Kinase Inhibitor as a Last-Ditch-Stand Towards Maximally Tolerated Medical Therapy to a Patient of Advanced Glaucoma. Clin Ophthalmol 2021; 15:2683-2692. [PMID: 34194222 PMCID: PMC8238538 DOI: 10.2147/opth.s318897] [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] [Received: 05/07/2021] [Accepted: 05/31/2021] [Indexed: 11/11/2022] Open
Abstract
Purpose To elucidate the use of Ripasudil in patients of advanced glaucoma on maximally tolerated medical therapy who could not be offered the option of surgery due to the global pandemic lockdown. Materials and Methods Only patients with primary open angle glaucoma (POAG), who had a cup-disc ratio (CDR) of 0.9 or a near total cupping on maximum tolerated medical therapy for at least 4 weeks and yet could not meet the target IOP were included. Target IOP was defined as ≤12 mm Hg. A total of 30 patients were enrolled. All patients in study cohort were started on E/D Ripasudil BD. Patients were followed up at 1 week, 2 weeks, 4 weeks and then monthly for 6 months for their best corrected visual acuity (BCVA), intraocular pressure (IOP), disc changes (slit lamp biomicroscopy), perimetry, and retinal nerve fibre layer analysis using optical coherence tomography (OCT-RNFL). Results Mean pre-treatment IOP on five drugs was 18.3 ± 2.1 mm Hg (range 14 to 22mmHg) on maximally tolerated medical therapy. At 1 week follow-up, mean post-treatment IOP was 15.1 ± 1.7 mm Hg (range 12 to 18mmHg) and at 2 week follow-up, mean post-treatment IOP was 12.5 ± 1.9 mmHg (range 10 to 16mmHg). Thus, target IOP ≤12mmHg was attained in 28 patients at 2 weeks. This target IOP was maintained throughout the 6 months of follow-up period. Of the 2 patients who could not meet target IOP, 1 patient needed rearrangement of their fixed-drug-combinations to achieve target IOP at 4 weeks. The second patient required unfixing of all fixed-drug-combinations to achieve target IOP at maximally tolerated medical therapy at 6 weeks. Conclusion Ripasudil not only provides a better IOP control but also has a high safety profile even when started as an add-on drug to already-existing yet inadequate maximally tolerated medical therapy.
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Affiliation(s)
- Mayuresh Naik
- Department of Ophthalmology, H.I.M.S.R & H.A.H. Centenary Hospital, New Delhi, India
| | - Monika Kapur
- Department of Ophthalmology, School of Medical Sciences & Research, Sharda University, Greater Noid, Uttar Pradesh, India
| | - VishnuSwarup Gupta
- Department of Ophthalmology, H.I.M.S.R & H.A.H. Centenary Hospital, New Delhi, India
| | - HarinderSingh Sethi
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, New Delhi, 110029, India
| | - Kartikeya Srivastava
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, New Delhi, 110029, India
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Tribble JR, Otmani A, Sun S, Ellis SA, Cimaglia G, Vohra R, Jöe M, Lardner E, Venkataraman AP, Domínguez-Vicent A, Kokkali E, Rho S, Jóhannesson G, Burgess RW, Fuerst PG, Brautaset R, Kolko M, Morgan JE, Crowston JG, Votruba M, Williams PA. Nicotinamide provides neuroprotection in glaucoma by protecting against mitochondrial and metabolic dysfunction. Redox Biol 2021; 43:101988. [PMID: 33932867 PMCID: PMC8103000 DOI: 10.1016/j.redox.2021.101988] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/06/2021] [Accepted: 04/20/2021] [Indexed: 12/16/2022] Open
Abstract
Nicotinamide adenine dinucleotide (NAD) is a REDOX cofactor and metabolite essential for neuronal survival. Glaucoma is a common neurodegenerative disease in which neuronal levels of NAD decline. We assess the effects of nicotinamide (a precursor to NAD) on retinal ganglion cells (the affected neuron in glaucoma) in normal physiological conditions and across a range of glaucoma relevant insults including mitochondrial stress and axon degenerative insults. We demonstrate retinal ganglion cell somal, axonal, and dendritic neuroprotection by nicotinamide in rodent models which represent isolated ocular hypertensive, axon degenerative, and mitochondrial degenerative insults. We performed metabolomics enriched for small molecular weight metabolites for the retina, optic nerve, and superior colliculus which demonstrates that ocular hypertension induces widespread metabolic disruption, including consistent changes to α-ketoglutaric acid, creatine/creatinine, homocysteine, and glycerophosphocholine. This metabolic disruption is prevented by nicotinamide. Nicotinamide provides further neuroprotective effects by increasing oxidative phosphorylation, buffering and preventing metabolic stress, and increasing mitochondrial size and motility whilst simultaneously dampening action potential firing frequency. These data support continued determination of the utility of long-term nicotinamide treatment as a neuroprotective therapy for human glaucoma. Nicotinamide is neuroprotective in cell and animal models that recapitulate isolated features of glaucoma. Systemic nicotinamide administration has limited molecular side-effects on visual system tissue under basal conditions. Nicotinamide provides a robust reversal in the disease metabolic profile of glaucomatous animals. Nicotinamide increases oxidative phosphorylation, buffers and prevents metabolic stress, and increases mitochondrial size.
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Affiliation(s)
- James R Tribble
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Amin Otmani
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Shanshan Sun
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK.
| | - Sevannah A Ellis
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia.
| | - Gloria Cimaglia
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden; School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK.
| | - Rupali Vohra
- Department of Veterinary and Animal Sciences, Pathobiological Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Drug Design and Pharmacology, Eye Translational Research Unit, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Melissa Jöe
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Emma Lardner
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Abinaya P Venkataraman
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Alberto Domínguez-Vicent
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Eirini Kokkali
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK.
| | - Seungsoo Rho
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK; Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
| | - Gauti Jóhannesson
- Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden; Wallenberg Centre of Molecular Medicine, Umeå University, Umeå, Sweden.
| | | | - Peter G Fuerst
- WWAMI Medical Education Program, University of Idaho, Moscow, ID, USA.
| | - Rune Brautaset
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Miriam Kolko
- Department of Drug Design and Pharmacology, Eye Translational Research Unit, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Glostrup, Denmark.
| | - James E Morgan
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK; Cardiff Eye Unit, University Hospital Wales, Cardiff, UK; School of Medicine, Cardiff University, Cardiff, UK.
| | - Jonathan G Crowston
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore; Centre for Vision Research, Neuroscience and Behavioural Disorders, Duke-NUS, Singapore, Singapore.
| | - Marcela Votruba
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK; Cardiff Eye Unit, University Hospital Wales, Cardiff, UK.
| | - Pete A Williams
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden.
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Phu J, Agar A, Wang H, Masselos K, Kalloniatis M. Management of open‐angle glaucoma by primary eye‐care practitioners: toward a personalised medicine approach. Clin Exp Optom 2021; 104:367-384. [DOI: 10.1111/cxo.13114] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Jack Phu
- Centre for Eye Health, The University of New South Wales, Sydney, Australia
| | - Ashish Agar
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Henrietta Wang
- Centre for Eye Health, The University of New South Wales, Sydney, Australia
| | - Katherine Masselos
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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Tribble JR, Hui F, Jöe M, Bell K, Chrysostomou V, Crowston JG, Williams PA. Targeting Diet and Exercise for Neuroprotection and Neurorecovery in Glaucoma. Cells 2021; 10:295. [PMID: 33535578 PMCID: PMC7912764 DOI: 10.3390/cells10020295] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/15/2021] [Accepted: 01/28/2021] [Indexed: 12/11/2022] Open
Abstract
Glaucoma is a leading cause of blindness worldwide. In glaucoma, a progressive dysfunction and death of retinal ganglion cells occurs, eliminating transfer of visual information to the brain. Currently, the only available therapies target the lowering of intraocular pressure, but many patients continue to lose vision. Emerging pre-clinical and clinical evidence suggests that metabolic deficiencies and defects may play an important role in glaucoma pathophysiology. While pre-clinical studies in animal models have begun to mechanistically uncover these metabolic changes, some existing clinical evidence already points to potential benefits in maintaining metabolic fitness. Modifying diet and exercise can be implemented by patients as an adjunct to intraocular pressure lowering, which may be of therapeutic benefit to retinal ganglion cells in glaucoma.
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Affiliation(s)
- James R. Tribble
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, 171 64 Stockholm, Sweden; (J.R.T.); (M.J.)
| | - Flora Hui
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC 3002, Australia; (F.H.); (J.G.C.)
- Department of Optometry & Vision Sciences, The University of Melbourne, Melbourne, VIC 3053, Australia
| | - Melissa Jöe
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, 171 64 Stockholm, Sweden; (J.R.T.); (M.J.)
| | - Katharina Bell
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore; (K.B.); (V.C.)
| | - Vicki Chrysostomou
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore; (K.B.); (V.C.)
- Duke-NUS Medical School, Singapore 169857, Singapore
| | - Jonathan G. Crowston
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC 3002, Australia; (F.H.); (J.G.C.)
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore; (K.B.); (V.C.)
- Duke-NUS Medical School, Singapore 169857, Singapore
| | - Pete A. Williams
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, 171 64 Stockholm, Sweden; (J.R.T.); (M.J.)
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40
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Maul EJ, Kastner A, Schmidt J, Tapia JA, Morales C, Maul EA. Visual field progression in patients with severe glaucoma. Graefes Arch Clin Exp Ophthalmol 2021; 259:1579-1586. [PMID: 33417091 DOI: 10.1007/s00417-020-05036-5] [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: 08/13/2020] [Revised: 10/23/2020] [Accepted: 11/28/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To assess the cumulative risk of progression in glaucomatous eyes in the severe stage of disease. METHODS This was a retrospective observational study. Patients that had severe damage in at least one eye, as defined by three criteria including a mean deviation of ≤ - 20 dB, were included. Glaucoma progression was defined as a loss of ≥ 2 dB in mean deviation confirmed in three consecutive visual field tests, or a persistent loss of two or more lines of vision-not attributable to non-glaucomatous causes-in three consecutive follow-up examinations. Kaplan-Meier survival analysis was used to assess the cumulative incidence of progression of the first eye to reach endpoint in cases where both eyes were eligible. RESULTS A total of 143 eyes from 119 patients, were studied over a mean period of 4.9 ± 2.9 years. Baseline mean deviation was - 25.3 ± 3.6 dB. Twenty-three eyes of 22 patients reached the progression endpoint: 14 eyes by visual field criteria and 9 by visual acuity criteria. The cumulative 5-year risk of progression estimated by Kaplan-Meier analysis was 14.6% (95% confidence interval: 6.1-22.2%). CONCLUSIONS In severe glaucoma patients, we found a cumulative incidence of progression of 2.9% per year during the first 5 years of follow-up. Similar incidences have been reported in other studies of glaucoma at different stages of severity.
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Affiliation(s)
- Eugenio J Maul
- Department of Ophthalmology, School of Medicine, Pontificia Universidad Católica de Chile, Ave. Apoquindo 3990 Suite 708, PC:7550112, Santiago, Chile.
| | - Alan Kastner
- Department of Ophthalmology, School of Medicine, Pontificia Universidad Católica de Chile, Ave. Apoquindo 3990 Suite 708, PC:7550112, Santiago, Chile
| | - Jimena Schmidt
- Department of Ophthalmology, School of Medicine, Pontificia Universidad Católica de Chile, Ave. Apoquindo 3990 Suite 708, PC:7550112, Santiago, Chile
| | - Jaime A Tapia
- Department of Ophthalmology, School of Medicine, Pontificia Universidad Católica de Chile, Ave. Apoquindo 3990 Suite 708, PC:7550112, Santiago, Chile
| | - Cristobal Morales
- Department of Ophthalmology, School of Medicine, Pontificia Universidad Católica de Chile, Ave. Apoquindo 3990 Suite 708, PC:7550112, Santiago, Chile
| | - Eugenio A Maul
- Department of Ophthalmology, School of Medicine, Universidad de los Andes, Santiago, Chile
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Neustaeter A, Nolte I, Snieder H, Jansonius NM. Genetic pre-screening for glaucoma in population-based epidemiology: protocol for a double-blind prospective screening study within Lifelines (EyeLife). BMC Ophthalmol 2021; 21:18. [PMID: 33413217 PMCID: PMC7789075 DOI: 10.1186/s12886-020-01771-9] [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: 12/02/2020] [Accepted: 12/15/2020] [Indexed: 11/23/2022] Open
Abstract
Background Early detection of glaucoma is paramount to maintain patients’ eyesight, however glaucomatous vision loss tends to begin in the periphery with up to 50% of patients unaware they are affected. Because glaucomatous vision loss is permanent, screening appears attractive, but currently is not cost-effective. Therefore we aim to investigate the utility of genetic pre-screening for glaucoma in a population-based setting, called EyeLife. Methods EyeLife adopts a double blind prospective design with contrasting groups. Selected participants (n = 1600) from the Lifelines cohort are 55 years of age or older, and of either the highest or lowest 20% of the genetic risk distribution for glaucoma. We obtained a highly curated list of genetic variants from the literature to obtain each participants’ genetic risk for glaucoma. Participants will undergo comprehensive ophthalmic screening. The primary outcome is the relative risk of glaucoma given a high genetic risk compared to a low genetic risk. Discussion If genetic pre-screening is successful, it will increase the yield of a glaucoma screening program by focusing on high-risk individuals. This, in turn, may improve long-term visual health of middle-aged and elderly people. Trial registration Ethics approval was obtained on January 31, 2019, and the study was retrospectively registered with the Netherlands Trial Register (NL8718) on the 17th of June, 2020.
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Affiliation(s)
- Anna Neustaeter
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, P.O.Box 30.001, 9700 RB, Groningen, Netherlands.,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands
| | - Ilja Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands
| | - Nomdo M Jansonius
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, P.O.Box 30.001, 9700 RB, Groningen, Netherlands. .,Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands.
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42
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Topouzis F, Goldberg I, Bell K, Tatham AJ, Ridolfi A, Hubatsch D, Nicolela M, Denis P, Lerner SF. Brinzolamide/brimonidine fixed-dose combination bid as an adjunct to a prostaglandin analog for open-angle glaucoma/ocular hypertension. Eur J Ophthalmol 2021; 31:103-111. [PMID: 31595773 PMCID: PMC7859663 DOI: 10.1177/1120672119878044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 08/19/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the additive intraocular pressure-lowering effect of twice-daily brinzolamide 1%/brimonidine 0.2% fixed-dose combination (BBFC) as an adjunct to a prostaglandin analog (PGA) in patients with open-angle glaucoma or ocular hypertension insufficiently controlled with PGA monotherapy. METHODS In this Phase 4, double-masked trial, patients aged ⩾18 years, with a mean intraocular pressure of ⩾19 and <32 mm Hg in at least one eye were randomized (1:1) to receive BBFC + PGA (n = 96) or vehicle + PGA (n = 92) for 6 weeks. The primary endpoint was the mean change in diurnal intraocular pressure from baseline (averaged over 09:00 and 11:00 h) at Week 6. RESULTS The mean diurnal intraocular pressure at baseline was similar in the BBFC + PGA (22.8 mm Hg) and vehicle + PGA (22.9 mm Hg) groups. The least squares mean change in diurnal intraocular pressure from baseline at Week 6 was greater with BBFC + PGA (-5.59 mm Hg (95% confidence interval: -6.2 to -5.0)) than with vehicle + PGA (-2.15 mm Hg (95% confidence interval: -2.7 to -1.6)); the treatment difference was statistically significant in favor of BBFC + PGA (-3.44 mm Hg, (95% confidence interval: -4.2 to -2.7); p < 0.001). Ocular adverse events were reported in 21.1% and 8.7% of patients in the BBFC + PGA and vehicle + PGA groups, respectively. The most frequent ocular adverse event was ocular hyperemia (5.3%) in the BBFC + PGA group and blurred vision (2.2%) in the vehicle + PGA group. CONCLUSION BBFC + PGA significantly reduced mean diurnal intraocular pressure than PGA alone in patients with open-angle glaucoma or ocular hypertension. The safety findings with BBFC + PGA were consistent with the known safety profile of the individual medications.
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Affiliation(s)
- Fotis Topouzis
- Department of Ophthalmology, School of
Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki,
Greece
| | - Ivan Goldberg
- Discipline of Ophthalmology, The
University of Sydney, Sydney, NSW, Australia
- Glaucoma Unit, Sydney Eye Hospital,
Sydney, NSW, Australia
- Eye Associates, Sydney, NSW,
Australia
| | - Katharina Bell
- Department of Ophthalmology, University
Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Andrew J Tatham
- Princess Alexandra Eye Pavilion and
Department of Ophthalmology, University of Edinburgh, Edinburgh, UK
| | | | | | - Marcelo Nicolela
- Department of Ophthalmology & Visual
Sciences, Dalhousie University, Halifax, NS, Canada
| | - Phillipe Denis
- Service d’Ophtalmologie, Hôpital de la
Croix-Rousse, Lyon, France
| | - S Fabian Lerner
- Consultorio Oftalmologico Dr. Fabian
Lerner and Facultad de Ciencias Medicas, Universidad Favaloro, Buenos Aires,
Argentina
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Mirzania D, Thompson AC, Muir KW. Applications of deep learning in detection of glaucoma: A systematic review. Eur J Ophthalmol 2020; 31:1618-1642. [PMID: 33274641 DOI: 10.1177/1120672120977346] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Glaucoma is the leading cause of irreversible blindness and disability worldwide. Nevertheless, the majority of patients do not know they have the disease and detection of glaucoma progression using standard technology remains a challenge in clinical practice. Artificial intelligence (AI) is an expanding field that offers the potential to improve diagnosis and screening for glaucoma with minimal reliance on human input. Deep learning (DL) algorithms have risen to the forefront of AI by providing nearly human-level performance, at times exceeding the performance of humans for detection of glaucoma on structural and functional tests. A succinct summary of present studies and challenges to be addressed in this field is needed. Following PRISMA guidelines, we conducted a systematic review of studies that applied DL methods for detection of glaucoma using color fundus photographs, optical coherence tomography (OCT), or standard automated perimetry (SAP). In this review article we describe recent advances in DL as applied to the diagnosis of glaucoma and glaucoma progression for application in screening and clinical settings, as well as the challenges that remain when applying this novel technique in glaucoma.
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Affiliation(s)
| | - Atalie C Thompson
- Duke University School of Medicine, Durham, NC, USA.,Durham VA Medical Center, Durham, NC, USA
| | - Kelly W Muir
- Duke University School of Medicine, Durham, NC, USA.,Durham VA Medical Center, Durham, NC, USA
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44
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Mursch-Edlmayr AS, Ng WS, Diniz-Filho A, Sousa DC, Arnold L, Schlenker MB, Duenas-Angeles K, Keane PA, Crowston JG, Jayaram H. Artificial Intelligence Algorithms to Diagnose Glaucoma and Detect Glaucoma Progression: Translation to Clinical Practice. Transl Vis Sci Technol 2020; 9:55. [PMID: 33117612 PMCID: PMC7571273 DOI: 10.1167/tvst.9.2.55] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 09/18/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose This concise review aims to explore the potential for the clinical implementation of artificial intelligence (AI) strategies for detecting glaucoma and monitoring glaucoma progression. Methods Nonsystematic literature review using the search combinations “Artificial Intelligence,” “Deep Learning,” “Machine Learning,” “Neural Networks,” “Bayesian Networks,” “Glaucoma Diagnosis,” and “Glaucoma Progression.” Information on sensitivity and specificity regarding glaucoma diagnosis and progression analysis as well as methodological details were extracted. Results Numerous AI strategies provide promising levels of specificity and sensitivity for structural (e.g. optical coherence tomography [OCT] imaging, fundus photography) and functional (visual field [VF] testing) test modalities used for the detection of glaucoma. Area under receiver operating curve (AROC) values of > 0.90 were achieved with every modality. Combining structural and functional inputs has been shown to even more improve the diagnostic ability. Regarding glaucoma progression, AI strategies can detect progression earlier than conventional methods or potentially from one single VF test. Conclusions AI algorithms applied to fundus photographs for screening purposes may provide good results using a simple and widely accessible test. However, for patients who are likely to have glaucoma more sophisticated methods should be used including data from OCT and perimetry. Outputs may serve as an adjunct to assist clinical decision making, whereas also enhancing the efficiency, productivity, and quality of the delivery of glaucoma care. Patients with diagnosed glaucoma may benefit from future algorithms to evaluate their risk of progression. Challenges are yet to be overcome, including the external validity of AI strategies, a move from a “black box” toward “explainable AI,” and likely regulatory hurdles. However, it is clear that AI can enhance the role of specialist clinicians and will inevitably shape the future of the delivery of glaucoma care to the next generation. Translational Relevance The promising levels of diagnostic accuracy reported by AI strategies across the modalities used in clinical practice for glaucoma detection can pave the way for the development of reliable models appropriate for their translation into clinical practice. Future incorporation of AI into healthcare models may help address the current limitations of access and timely management of patients with glaucoma across the world.
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Affiliation(s)
| | - Wai Siene Ng
- Cardiff Eye Unit, University Hospital of Wales, Cardiff, UK
| | - Alberto Diniz-Filho
- Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - David C Sousa
- Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal
| | - Louis Arnold
- Department of Ophthalmology, University Hospital, Dijon, France
| | - Matthew B Schlenker
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Karla Duenas-Angeles
- Department of Ophthalmology, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, UCL Institute of Ophthalmology & Moorfields Eye Hospital, London, UK
| | - Jonathan G Crowston
- Centre for Vision Research, Duke-NUS Medical School, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Hari Jayaram
- NIHR Biomedical Research Centre for Ophthalmology, UCL Institute of Ophthalmology & Moorfields Eye Hospital, London, UK
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Girard MJA, Schmetterer L. Artificial intelligence and deep learning in glaucoma: Current state and future prospects. PROGRESS IN BRAIN RESEARCH 2020; 257:37-64. [PMID: 32988472 DOI: 10.1016/bs.pbr.2020.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Over the past few years, there has been an unprecedented and tremendous excitement for artificial intelligence (AI) research in the field of Ophthalmology; this has naturally been translated to glaucoma-a progressive optic neuropathy characterized by retinal ganglion cell axon loss and associated visual field defects. In this review, we aim to discuss how AI may have a unique opportunity to tackle the many challenges faced in the glaucoma clinic. This is because glaucoma remains poorly understood with difficulties in providing early diagnosis and prognosis accurately and in a timely fashion. In the short term, AI could also become a game changer by paving the way for the first cost-effective glaucoma screening campaigns. While there are undeniable technical and clinical challenges ahead, and more so than for other ophthalmic disorders whereby AI is already booming, we strongly believe that glaucoma specialists should embrace AI as a companion to their practice. Finally, this review will also remind ourselves that glaucoma is a complex group of disorders with a multitude of physiological manifestations that cannot yet be observed clinically. AI in glaucoma is here to stay, but it will not be the only tool to solve glaucoma.
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Affiliation(s)
- Michaël J A Girard
- Ophthalmic Engineering & Innovation Laboratory (OEIL), Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
| | - Leopold Schmetterer
- Ocular Imaging, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore; School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore; Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; Institute of Clinical and Experimental Ophthalmology, Basel, Switzerland.
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46
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Steensberg AT, Müllertz OO, Virgili G, Azuara-Blanco A, Kolko M. Evaluation of Generic versus Original Prostaglandin Analogues in the Treatment of Glaucoma: A Systematic Review and Meta-Analysis. Ophthalmol Glaucoma 2020; 3:51-59. [PMID: 32672642 DOI: 10.1016/j.ogla.2019.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/08/2019] [Accepted: 10/22/2019] [Indexed: 01/10/2023]
Abstract
TOPIC An evaluation of the efficacy and tolerability of generic prostaglandin analogues (PGAs) compared with their original counterpart. CLINICAL RELEVANCE This systematic review was initiated to enlighten ophthalmologists and patients in the use of original and generic ophthalmic solutions. METHODS A literature search was conducted on PubMed, EMBASE, MEDLINE, Clinicaltrials.gov, and the World Health Organization International Clinical Trials Registry Platform, along with a manual search, from the marketing of the first PGA, latanoprost, in 1995 to the present. Randomized controlled trials comparing an original PGA with its generic counterpart were included. The last literature search was conducted in June 2019. Risk of bias was assessed by 2 independent reviewers using the Cochrane Handbook for Systematic Reviews Tool. The primary outcome was reduction of intraocular pressure (IOP) from baseline. Secondary outcomes included tolerability, ocular surface health, quality of life, disease progression, and cost-effectiveness. Meta-analysis of the primary outcome was planned. RESULTS Of 385 screened articles, 6 were included in a broad characterization and in the meta-analysis. A total of 619 patients were enrolled. The duration of the studies ranged from 3 to 16 weeks. Meta-analysis of all 6 studies denied any clinically significant difference in efficacy, and the 95% confidence interval included nil (-0.50 to 0.04 mmHg). The evidence was of moderate certainty because of unclear or high risk of bias in all studies. There were no reported differences in tolerability. CONCLUSIONS Trials comparing original and generic PGAs did not show a clinically significant difference in IOP-lowering effect or tolerability. However, the quality of the trials is suboptimal. Overall, there is uncertainty, and further research is needed to confirm equivalence.
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Affiliation(s)
- Alvilda T Steensberg
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.
| | - Olivia O Müllertz
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Firenze and AOU, Careggi, Italy
| | | | - Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark; Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet - Glostrup, Glostrup, Denmark
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Abstract
The article reviews literature covering the etiopathogenesis and risk factors for the development of primary open-angle glaucoma (POAG). Currently, this problem is one of the most complex and controversial in ophthalmology. The review considers the main theories: vascular, mechanical (retentional, hydromechanical), dystrophic (theory of primary scleropathy), metabolic, concept of liquor hypertension, concept of the individual norm of intraocular pressure, as well as POAG risk factors.
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Affiliation(s)
- N V Eliseeva
- Belgorod State National Research University, Belgorod, Russia
| | - M I Churnosov
- Belgorod State National Research University, Belgorod, Russia
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48
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Mokhles P, van Gorcom L, Schouten JSAG, Berendschot TTJM, Beckers HJM, Webers CAB. Contributing ocular comorbidity to end-of-life visual acuity in medically treated glaucoma patients, ocular hypertension and glaucoma suspect patients. Eye (Lond) 2020; 35:883-891. [PMID: 32494040 DOI: 10.1038/s41433-020-0991-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 01/27/2023] Open
Abstract
AIM To assess the visual acuity at the end of life in glaucoma suspect patients, ocular hypertension, and patients treated for glaucoma and to find factors contributing to a reduced visual acuity in this cohort of deceased patients. METHODS In a cohort of 3883 medically treated glaucoma patients, glaucoma suspect, or patients with ocular hypertension assembled in 2001-2004, 1639 were deceased. Patient data were collected from electronic and paper patient files. The files of 1378 patients were studied and the last measured visual acuity and ocular comorbidities influencing the visual acuity were extracted. RESULTS Our results show that only 37.2% of patients had no visual impairment in either eye, 30.5% was visually impaired or blind in both eyes and 4.1% was blind in both eyes, all based on VA. The most common contributing factors for severe visual impairment or blindness (prevalence ≥ 1%) were: glaucoma, retinal vein occlusion, dry and exudative age-related macular degeneration, past retinal detachment, amblyopia, diabetic retinopathy, anterior ischemic optic neuropathy, trauma, decompensated cornea, past keratitis, enucleation, corneal transplantation, and macular hole. CONCLUSIONS Despite the current advanced treatment modalities for glaucoma, 30.5% of patients had a VA < 0.5 in both eyes and 4.1% was blind in both eyes. However, this disability cannot be confidently attributed only to glaucoma. Besides glaucoma, most common contributing factors were among others retinal and macular diseases. Patient management in glaucoma should be based on more than lowering the intraocular pressure to prevent blindness at the end of life.
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Affiliation(s)
| | - Luuk van Gorcom
- University Eye Clinic Maastricht, Maastricht, The Netherlands
| | - Jan S A G Schouten
- University Eye Clinic Maastricht, Maastricht, The Netherlands.,Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
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King AJ, Hudson J, Fernie G, Burr J, Azuara-Blanco A, Sparrow JM, Barton K, Garway-Heath DF, Kernohan A, MacLennan G. Baseline Characteristics of Participants in the Treatment of Advanced Glaucoma Study: A Multicenter Randomized Controlled Trial. Am J Ophthalmol 2020; 213:186-194. [PMID: 32006484 DOI: 10.1016/j.ajo.2020.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/14/2020] [Accepted: 01/19/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To report the baseline characteristics of participants enrolled in TAGS (Treatment of Advanced Glaucoma Study). DESIGN Pragmatic randomized control trial (RCT). METHODS Participants with newly diagnosed advanced glaucoma in at least 1 eye were recruited. Participants were patients with open angle glaucoma presenting with advanced glaucoma in at least 1 eye as defined by the Hodapp-Parrish-Anderson (HPA) criteria for severe defect. Participants were randomly allocated to receive either primary augmented trabeculectomy or primary medical management. When both eyes were eligible, the same intervention was undertaken in both eyes, and the index eye for analysis was the eye with the less severe visual field mean defect (MD). Main outcome measurements were visual field profile, defined by the HPA classification; clinical characteristics; quality of life, as measured by the National Eye Institute Visual Function Questionnaire 25 (VFQ-25), the EuroQual-5 Dimension (EQ-5D 5L), Health Utility Index-3 (HUI-3), and the Glaucoma Profile Instrument (GPI). RESULTS A total of 453 patients were recruited. The mean visual field MD was -15.0 dB ± 6.3 in the index eye and -6.2 dB in the non-index eye. Of index eyes (HPA "severe" classification) at baseline, more than 70% of participants had a MD <-12.00 dB, and nearly 90% had more than 20 points defective at the 1% level. The mean LogMAR visual acuity of the index eye was 0.2 ± 0.3. CONCLUSIONS TAGS is the first RCT to compare medical versus surgical treatments for patients presenting with advanced open angle glaucoma in a publicly funded health service. The study will provide clinical, health-related quality of life, and economic outcomes to inform future treatment choices for those presenting with advanced glaucoma.
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50
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Sandberg Melin C, Yu Z, Söderberg PG. Variance components for PIMD-2π estimation of the optic nerve head and consequences in clinical measurements of glaucoma. Acta Ophthalmol 2020; 98:190-194. [PMID: 31359591 DOI: 10.1111/aos.14197] [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] [Received: 11/14/2018] [Accepted: 07/01/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To estimate the sources of variation for Pigment epithelium central limit-Inner limit of the retina Minimal Distance averaged over 2π (PIMD-2π), and further to analyse their consequences for clinical measurements of glaucoma. METHODS Forty subjects with early to moderate stage glaucoma were included. Three SD-OCT volumes of the optic nerve head (ONH) were captured at two occasions. Each volume was segmented three times for PIMD-2π. The magnitude of the sources of variation for PIMD-2π measurements was estimated with an analysis of variance. RESULTS A 95% confidence interval for mean PIMD-2π was estimated to 215 ± 12 μm (df = 38). The estimated variance for subjects was 1280 μm2 . The within-subject estimated variance for occasions, volumes and segmentations was 10 μm2 , 30 μm2 and 40 μm2 , respectively. The within-subject variances were used to model follow-up of PIMD-2π over time. A linear loss rate of 0.05 of baseline PIMD-2π/year was assumed. A significant PIMD-2π change could be detected in approximately 16-18 months with evenly spaced visits every 4 or 6 months. CONCLUSIONS Due to the small within-subject estimated variances, a clinically undesirable PIMD-2π change from baseline can be detected in approximately 18 months. Detection of significant PIMD-2π loss in a subject requires knowledge of normal age loss and measurement variability.
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Affiliation(s)
- Camilla Sandberg Melin
- Gullstrand Lab Ophthalmology Department of Neuroscience Uppsala University Uppsala Sweden
- Centre for Research and Development Uppsala University Region Gävleborg Sweden
| | - Zhaohua Yu
- Gullstrand Lab Ophthalmology Department of Neuroscience Uppsala University Uppsala Sweden
| | - Per G. Söderberg
- Gullstrand Lab Ophthalmology Department of Neuroscience Uppsala University Uppsala Sweden
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