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Uner B, Ozdemir S, Nur Pilevne S, Rıza Cenk Celebi A. Timolol-loaded ethosomes for ophthalmic delivery: Reduction of high intraocular pressure in vivo. Int J Pharm 2023; 640:123021. [PMID: 37149109 DOI: 10.1016/j.ijpharm.2023.123021] [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: 02/24/2023] [Revised: 04/14/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
The beta-adrenoceptor blocker timolol maleate (TML) is a commonly used pharmaceutical agent for the management of glaucoma. Conventional eye drops have limitations due to biological or pharmaceutical factors. Therefore, TML-loaded ethosomes have been designed to mitigate these restrictions and give a viable solution for reducing elevated intraocular pressure (IOP). The ethosomes were prepared using the thin film hydration method. Integrating the Box-Behnken experimental strategy, the optimal formulation was identified. The physicochemical characterization studies were performed on the optimal formulation. Then, in vitro release and ex vivo permeation studies were conducted. The irritation assessment was also carried out with Hen's Egg Test-Chorioallantoic Membrane model (HET-CAM), and in vivo evaluation of the IOP lowering effect was also performed on rats. The physicochemical characterization studies demonstrated that the components of the formulation were compatible with each other. The particle size, zeta potential, and encapsulation efficiency (EE%) were found as 88.23 ± 1.25 nm, -28.7 ± 2.03 mV, and 89.73 ± 0.42 %, respectively. The in vitro drug release mechanism was found as Korsmeyer-Peppas kinetics (R2=0.9923). The HET-CAM findings verified the formulation's eligibility for biological applications. The IOP measurements revealed no statistical difference (p>0.05) between the once-a-day application of the optimal formulation and the three-times-a-day application of the conventional eye drop. A similar pharmacological response was observed at lowered application frequencies. Therefore, it was concluded that the novel TML-loaded ethosomes could be a safe and efficient alternative for glaucoma treatment.
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Affiliation(s)
- Burcu Uner
- Yeditepe University, Faculty of Pharmacy, Department of Pharmaceutical Technology, Istanbul, Turkey; University of Health Sciences and Pharmacy in St. Louis, Department of Pharmaceutical and Administrative Sciences, St. Louis, MO, USA
| | - Samet Ozdemir
- Istanbul Health and Technology University, Faculty of Pharmacy, Department of Pharmaceutical Technology, Istanbul, Turkey.
| | - Seniz Nur Pilevne
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Department of Ophthalmology, Istanbul, Turkey
| | - Ali Rıza Cenk Celebi
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Department of Ophthalmology, Istanbul, Turkey
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Vision rehabilitation in glaucoma patients. Curr Opin Ophthalmol 2023; 34:109-115. [PMID: 36718681 DOI: 10.1097/icu.0000000000000930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW Vision rehabilitation services are important but underutilized resources for patients with glaucoma. Glaucoma and its impact on vision can affect patients' abilities to read and drive, two activities of daily living that are associated with quality of life and functional independence. In this review, we provide an overview of low vision, discuss barriers to vision rehabilitation, and outline various strategies and interventions to optimize visual function and quality of life in patients with glaucoma. RECENT FINDINGS Studies have shown that glaucoma negatively impacts reading, driving and overall quality of life. Decreased visual acuity, visual field loss and reduced contrast sensitivity play a role. Low vision services and interventions can help patients maximize visual function and improve their quality of life. Barriers to receiving these services exist at multiple levels and an increased awareness and integration into routine ophthalmic care are needed to deliver comprehensive care. SUMMARY Glaucoma is one of the leading causes of low vision. Ophthalmologists who treat glaucoma often tend to focus on objective measures to monitor progression and disease severity, but the functional impact of glaucoma should also be addressed. Low vision services can benefit patients, particularly for reading and driving, and should be considered as an essential component of patient care.
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Landini L, Donati S, Digiuni M, Feltre S, Corsini G, Premi E, Radice P, Azzolini C. Glaucoma and Driving License: How to Identify Patients at Risk of Revocation. J Curr Glaucoma Pract 2022; 16:117-123. [PMID: 36128076 PMCID: PMC9452703 DOI: 10.5005/jp-journals-10078-1379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/25/2022] [Indexed: 11/23/2022] Open
Abstract
Aim To identify clinical criteria that are easily achievable with follow-up tests and can identify subjects not suitable for driving. Patients and methods We recruited 194 subjects with a clear diagnosis of glaucoma, with no other conditions that could affect the visual field (VF), and who performed a reliable VF examination. All patients underwent a full ophthalmologic evaluation and a questionnaire considering driving habits. An integrated visual field (IVF) was built using both monocular VF charts; the number of missed points (NoMP) within the central 20°, the average sensitivity (AS), and the better eye mean deviation (BEMD) were evaluated. Results A total of 128 subjects showed a valid driving license (DL); 61.7% of drivers did not show missed points within the central 20° of the IVF, 27.4% presented one to three missed points, and 10.9% had four or more missed points. Best corrected visual acuity (BCVA) was highly above the legal criteria. Stratifying drivers by their BEMD (−7, −10, and −14 dB), we confirmed that the BEMD decrease corresponds to an increased NoMP and a decreased AS. Conclusion Better eye mean deviation can be useful in clinical practice to identify patients at increased risk of being unsuitable for driving. Nevertheless, it is important to set specific cut-offs based on on-road driving performance. IVF evaluation may also be implemented in perimeter analysis software so that the composition of IVF, the BEMD, and the AS could directly describe the patient's binocular VF, excluding recourse to the Esterman visual field test (EVFT). Clinical significance This new methodology will allow every physician—not just ophthalmologists—even if not an expert in evaluating a VF test, in assessing the ability to drive of glaucomatous patients. How to cite this article Landini L, Donati S, Digiuni M, et al. Glaucoma and Driving License: How to Identify Patients at Risk of Revocation. J Curr Glaucoma Pract 2022;16(2):117-123.
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Affiliation(s)
- Luca Landini
- Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
| | - Simone Donati
- Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy; Ophthalmology Unit, ASST-Sette Laghi, Varese, Italy
- Simone Donati, Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy; Ophthalmology Unit, ASST-Sette Laghi, Varese, Italy, Phone: +393333615015, e-mail:
| | | | - Sara Feltre
- Ophthalmology Unit, ASST-Sette Laghi, Varese, Italy
| | | | - Elias Premi
- Ophthalmology Unit, ASST-Sette Laghi, Varese, Italy
| | - Paolo Radice
- Ophthalmology Unit, ASST-Sette Laghi, Varese, Italy
| | - Claudio Azzolini
- Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
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Ikeda MC, Hamada KU, Bando AH, Nakamura VPL, Prata TS, Tatham AJ, Paranhos A, Gracitelli CPB. Interventions to Improve Reading Performance in Glaucoma. Ophthalmol Glaucoma 2021; 4:624-631. [PMID: 33813064 DOI: 10.1016/j.ogla.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate whether changes to contrast, line spacing, or font size can improve reading performance in patients with glaucoma. DESIGN Cross-sectional study. PARTICIPANTS Thirty-five patients with glaucoma and 32 healthy control participants. METHODS A comprehensive ophthalmologic examination was performed followed by reading speed assessment using the Minnesota Low Vision Reading (MNREAD) test under a range of contrasts (10%, 20%, 30%, 40%, and 50%), line spacings (1.0, 1.5, 2.0, 2.5, and 3.0 lines), and font sizes (0.8, 0.9, 1.0, 1.1, and 1.2 logarithm of the minimum angle of resolution), for a total of 15 tests. Regression analyses were performed to examine the effect of varying test conditions on reading speed (measured in words per minute [wpm]). RESULTS Participants' mean age was 63.0 ± 12.6 years. Patients with glaucoma showed a visual field mean deviation in the better eye of -6.29 ± 6.35 dB. Reading speeds were significantly slower in patients with glaucoma versus control participants for 14 of the 15 MNREAD tests, despite no significant differences in age, gender, or education between groups. Increased contrast (from 10% to 50%) was associated with faster reading speed in patients with glaucoma (10.6-wpm increase per 10% increase in contrast; 95% confidence interval, 7.4-13.8 wpm; P < 0.001; R2 = 0.211). No significant improvement was found in reading speed with increase in font size or line spacing. CONCLUSIONS Patients with glaucoma showed significantly slower reading speeds than similarly aged control participants. Reading speed was improved by increasing contrast, but not by increases in line spacing or font size.
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Affiliation(s)
- Mariana C Ikeda
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Koiti U Hamada
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Andre H Bando
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Vinicius P L Nakamura
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Tiago S Prata
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil; Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil; Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida; Department of Ophthalmology, Glaucoma Service, Hospital Oftalmológico de Sorocaba-BOS, Sorocaba, Brazil
| | - Andrew J Tatham
- Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, Edinburgh, United Kingdom
| | - Augusto Paranhos
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil; Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, Vinhedo, São Paulo, Brazil.
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Schneider KJ, Hollenhorst CN, Valicevic AN, Niziol LM, Heisler M, Musch DC, Cain SM, Newman-Casey PA. Impact of the Support, Educate, Empower Personalized Glaucoma Coaching Program Pilot Study on Eye Drop Instillation Technique and Self-Efficacy. Ophthalmol Glaucoma 2020; 4:42-50. [PMID: 32781286 DOI: 10.1016/j.ogla.2020.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the Support, Educate, Empower (SEE) personalized glaucoma coaching program impact on (1) eye drop instillation technique and (2) eye drop instillation self-efficacy. DESIGN Prospective pre-post pilot study. PARTICIPANTS Patients with a diagnosis of glaucoma or ocular hypertension taking ≥1 glaucoma medication, ≥40 years old, spoke English, self-administered their eye drops, and ≤80% adherent to their glaucoma medication by electronic monitoring. METHODS Eye drop administration was video recorded before the first SEE in-person coaching session, which included teaching eye drop instillation techniques using a motivational interviewing-based approach. At the third and final in-person counseling session 6 months later, eye drop administration was video recorded. Participants' self-efficacy was assessed using the validated Eye Drop Technique Self-Efficacy Scale (EDTSES) survey at baseline and 1 month after completion of the program. Before and after intervention videos were assessed by an observer masked to time point. Before versus after intervention comparisons were made using McNemar's and paired t tests. MAIN OUTCOME MEASURES The main outcome was change in participants' eye drop instillation technique as measured by (1) accuracy of an eye drop landing on the eye, (2) ability to instill an eye drop on the first attempt, and (3) contaminating the bottle by contact with ocular surface, eyelashes, and skin. The secondary outcome measure was before versus after change in the EDTSES score (6 items, each assessed on a 3-point Likert scale, with higher scores indicating better self-efficacy). RESULTS Thirty-nine participants completed the SEE intervention, 38 with before and after EDTSES scores and 31 with video recordings. Six of 31 participants instilling drops outside the eye before intervention improved their technique after intervention, whereas 2 participants worsened (P = 0.157). From before to after intervention, participants demonstrated significant improvement in not touching the ocular surface (P = 0.046), the eyelashes (P = 0.020), or the skin (P = 0.025) with the bottle tip. A significant increase was found in eye drop instillation self-efficacy from an average score of 2.6 (standard deviation [SD], 0.3) to 2.8 (SD, 0.2) on the EDTSES score (P = 0.007). CONCLUSIONS The SEE program significantly decreased eye drop bottle contamination, increased eye drop instillation self-efficacy, and demonstrated an insignificant increase in ability to instill drops successfully and accurately.
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Affiliation(s)
- Kevin J Schneider
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Cecilia N Hollenhorst
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Autumn N Valicevic
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Stephen M Cain
- Department of Mechanical Engineering, University of Michigan School of Engineering, Ann Arbor, Michigan
| | - Paula-Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan.
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Lee J, Itoh M. Effects of driver compensatory behaviour on risks of critical pedestrian collisions under simulated visual field defects. PLoS One 2020; 15:e0231130. [PMID: 32271822 PMCID: PMC7144977 DOI: 10.1371/journal.pone.0231130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/17/2020] [Indexed: 12/03/2022] Open
Abstract
Compensatory behaviour is regarded as a helpful strategy to mediate drivers’ deteriorated hazard perception ability due to visual field defects. However, helpfulness of compensatory behaviour for drivers with advanced visual field defects has largely unexplored. This study aims to clarify the effectiveness and limitation of compensatory head movements in critical situations where included pedestrians stepping off a sidewalk under the simulation of advanced visual defects. 18 healthy-sighted drivers participated the data collection that was conducted in a driving simulator under three driving conditions: (1) without visual impairment, (2) with visual impairment and not performing active compensation, and (3) with visual impairment but performing active compensation. The result showed that active compensation led quick accelerator and brake response times, reducing the risk and number of pedestrian collisions. The active compensation led a decrease in the number of non-responses to hazardous pedestrians compared to while driving not performing compensation. However, the compensation could not reduce the number of pedestrian collisions to those of healthy-sighted drivers. Compensatory viewing behaviour contributed to improved driving performance as well as has limits to lead driving performance like healthy-sighted drivers. Developing driver assistance systems and practical compensatory strategies concerning the degrees of impairment and traffic conditions may provide opportunities to improve driving safety deteriorated hazard perception for visually impaired drivers.
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Affiliation(s)
- Jieun Lee
- Department of Risk Engineering, Graduate School of System and Information Engineering, University of Tsukuba, Tsukuba, Ibaraki, Japan
- * E-mail:
| | - Makoto Itoh
- Faculty of Engineering, Information and Systems, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Zou X, Vu HL. Mapping the knowledge domain of road safety studies: A scientometric analysis. ACCIDENT; ANALYSIS AND PREVENTION 2019; 132:105243. [PMID: 31494404 DOI: 10.1016/j.aap.2019.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/11/2019] [Accepted: 07/20/2019] [Indexed: 06/10/2023]
Abstract
As a way of obtaining a visual expression of knowledge, mapping knowledge domain (MKD) provides a vision-based analytic approach to scientometric analysis which can be used to reveal an academic community, the structure of its networks, and the dynamic development of a discipline. This study, based on the Science Citation Index Expanded (SCIE) and Social Sciences Citation Index (SSCI) articles on road safety, employs the bibliometric tools VOSviewer and CitNetExplorer to create maps of author co-citation, document co-citation, citation networks, analyze the core authors and classic documents supporting road safety studies and show the citation context and development of such studies. It shows that road safety studies clustered mainly into four groups, whose we will refer to as "effects of driving psychology and behavior on road safety", "causation, frequency and injury severity analysis of road crashes", "epidemiology, assessment and prevention of road traffic injury", and "effects of driver risk factors on driver performance and road safety", respectively. Through our analysis, the core publications and their citation relationships were quickly located and explored, and "crash frequency modeling analysis" has been identified to be the core research topic in road safety studies, with spatial statistical analysis technique emerging as a frontier of this topic.
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Affiliation(s)
- Xin Zou
- Institute of Transport Studies, Monash University, Clayton, VIC, 3800, Australia.
| | - Hai L Vu
- Institute of Transport Studies, Monash University, Clayton, VIC, 3800, Australia
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Yan MK, Kumar H, Kerr N, Medeiros FA, Sandhu SS, Crowston J, Kong YXG. Transnational review of visual standards for driving: How Australia compares with the rest of the world. Clin Exp Ophthalmol 2019; 47:847-863. [DOI: 10.1111/ceo.13572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/11/2019] [Accepted: 05/18/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Mabel K. Yan
- The Ophthalmology DepartmentAlfred Hospital Melbourne Victoria Australia
- Clinical Research DepartmentCentre for Eye Research Australia Melbourne Victoria Australia
| | - Himeesh Kumar
- The Ophthalmology DepartmentAlfred Hospital Melbourne Victoria Australia
- Clinical Research DepartmentCentre for Eye Research Australia Melbourne Victoria Australia
| | - Nathan Kerr
- Clinical Research DepartmentCentre for Eye Research Australia Melbourne Victoria Australia
- Ophthalmology DepartmentRoyal Victorian Eye and Ear Hospital Victoria Australia
| | | | - Sukhpal S. Sandhu
- Clinical Research DepartmentCentre for Eye Research Australia Melbourne Victoria Australia
- Ophthalmology DepartmentRoyal Victorian Eye and Ear Hospital Victoria Australia
| | - Jonathan Crowston
- Clinical Research DepartmentCentre for Eye Research Australia Melbourne Victoria Australia
- Ophthalmology DepartmentRoyal Victorian Eye and Ear Hospital Victoria Australia
- Centre for Vision ResearchDuke‐NUS Medical School Singapore Singapore
| | - Yu X. G. Kong
- Clinical Research DepartmentCentre for Eye Research Australia Melbourne Victoria Australia
- Ophthalmology DepartmentRoyal Victorian Eye and Ear Hospital Victoria Australia
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Patterson G, Howard C, Hepworth L, Rowe F. The Impact of Visual Field Loss on Driving Skills: A Systematic Narrative Review. Br Ir Orthopt J 2019; 15:53-63. [PMID: 32999975 PMCID: PMC7510550 DOI: 10.22599/bioj.129] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose To review the evidence on the impact of visual field loss on skills required for driving. Methods A literature search was undertaken using a systematic approach. Papers within scope were identified by two independent reviewers, and papers were grouped into similar themes for discussion. Key findings Evidence suggests that both binocular and monocular visual field defects have a negative impact on driving skills. Both central and peripheral cause difficulties, but the degree of impact is dependent on the defect severity and compensation ability. Many factors that affect compensation to visual field loss and the effects of visual field loss on driving skills are discussed, including cognitive status, age and duration of visual field loss. In summary, in central visual field loss compensation, strategies include reduction of overall driving speed; whereas, in peripheral field loss, increased scanning is reported to aid adaptation. Conclusions For driving, there is evidence that complete and/or binocular visual field loss poses more of a difficulty than partial and/or monocular loss, and central defects cause more problems than peripheral defects. A lack of evidence exists concerning the impact of superior versus inferior defects. The level of peripheral vision loss that is incompatible with safe driving remains unknown, as compensation abilities vary widely between individuals. This review highlights a lack of evidence in relation to the impact of visual field loss on driving skills. Further research is required to strengthen the evidence to allow clinicians to better support people with visual field loss with driving advice.
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Affiliation(s)
| | - Claire Howard
- Salford Royal NHS Foundation Trust, University of Liverpool, GB
| | - Lauren Hepworth
- Salford Royal NHS Foundation Trust, University of Liverpool, GB
| | - Fiona Rowe
- Salford Royal NHS Foundation Trust, University of Liverpool, GB
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Ogata NG, Daga FB, Jammal AA, Boer ER, Hill LL, Stringham JM, Susanna R, Medeiros FA. Mobile Telephone Use and Reaction Time in Drivers With Glaucoma. JAMA Netw Open 2019; 2:e192169. [PMID: 30977856 PMCID: PMC6481446 DOI: 10.1001/jamanetworkopen.2019.2169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
IMPORTANCE Combining mobile telephone use with driving is not unusual. However, distracted driving limits driving performance because of limited capacity for persons to divide attention. OBJECTIVES To investigate the frequency of mobile telephone use while driving and to assess whether patients with glaucoma had a disproportionate decrease in driving performance while conversing on a mobile telephone compared with healthy participants. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of surveys collected from 112 patients with glaucoma and 70 control participants investigating mobile telephone use while driving. A randomly selected subgroup of 37 patients with glaucoma and 28 controls drove in a driving simulator to investigate peripheral event detection performance during distracted driving at the Visual Performance Laboratory, Duke University, Durham, North Carolina. Data collection was performed from December 1, 2016, through April 30, 2017. EXPOSURES Participants answered a survey and submitted to a driving simulation test with and without mobile telephone use. MAIN OUTCOMES AND MEASURES Survey answers were collected, and distracted driving performance, assessed by reaction time to peripheral stimuli, was analyzed. RESULTS Of the 182 participants who answered the survey, the 112 participants with glaucoma included 56 women (50.0%) and had a mean (SD) age of 73.6 (9.6) years. The 70 controls included 49 women (70.0%) and had a mean (SD) age of 68.4 (10.9) years. When asked about mobile telephone use while driving, 30 patients with glaucoma (26.8%) admitted rarely using and 2 (1.8%) sometimes using it. In the control group, 20 participants (28.6%) admitted rarely using and 2 (2.9%) sometimes using the telephone while driving (P = .80). Reaction times to peripheral stimuli were significantly longer among patients with glaucoma compared with controls during mobile telephone use (median [interquartile range], 1.86 [1.42-2.29] seconds vs 1.14 [0.98-1.59] seconds; P = .02). Compared with driving performance while not using a mobile telephone, the mean (SD) increase of 0.85 (0.60) second in reaction time while conversing on the mobile telephone among patients with glaucoma was significantly greater than the mean (SD) increase of 0.68 (0.83) second for controls (P = .03). CONCLUSIONS AND RELEVANCE This study's findings indicate that patients with glaucoma use mobile telephones while driving as frequently as healthy participants. However, the findings also suggest that patients with glaucoma may experience a greater decline than healthy participants in their ability to detect peripheral events while driving when also talking on a mobile telephone. Patients with glaucoma should be informed that they may have a higher driving risk that may be worsened by distractions, such as mobile telephone use.
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Affiliation(s)
- Nara G. Ogata
- Visual Performance Laboratory, Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina
- Department of Ophthalmology, University of São Paulo, São Paulo, Brazil
| | - Fábio B. Daga
- Visual Performance Laboratory, Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Alessandro A. Jammal
- Visual Performance Laboratory, Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina
| | | | - Linda L. Hill
- Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - James M. Stringham
- Visual Performance Laboratory, Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Remo Susanna
- Department of Ophthalmology, University of São Paulo, São Paulo, Brazil
| | - Felipe A. Medeiros
- Visual Performance Laboratory, Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina
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Devos H, Ranchet M, Bollinger K, Conn A, Akinwuntan AE. Performance-based visual field testing for drivers with glaucoma: A pilot study. TRAFFIC INJURY PREVENTION 2018; 19:715-721. [PMID: 30407083 DOI: 10.1080/15389588.2018.1508834] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Conventional visual field (VF) tests are limited in predicting on-road driving performance of individuals with glaucoma. We developed a new performance-based VF test in a driving simulator for individuals with glaucoma. The aim was to evaluate the psychometric properties of the newly developed test. METHODS In this pilot study, 17 drivers with glaucoma aged 65.24 ± 9.69 and 13 control drivers aged 61.27 ± 11.45 completed the performance-based VF task. Construct validity was determined by comparing performance on the new task with results on conventional visual and perimetry tests including Humphrey Visual Field Analyzer, Keystone Vision Screener, and Useful Field of View (UFOV). Concurrent validity was evaluated by comparing performance on the new task with on-road driving performance, scored using the Test Ride for Investigating Practical fitness-to-drive (TRIP). Ten individuals (7 with glaucoma and 3 controls) participated in the test-retest reliability assessment. RESULTS Drivers with glaucoma identified fewer symbols (P = .047) and took longer to respond to the symbols (P = .048) compared to controls. In the glaucoma group, correct responses on the performance-based VF test correlated strongly (r = -0.51, P = .046) with UFOV divided attention. Both glaucoma and control groups achieved submaximal to maximal scores on the TRIP (median [Q1-Q3], glaucoma: 193 [191-196]; controls: 196 [195-196]; P = .16). No strong correlations were found between scores on the performance-based VF test and on-road driving performance in glaucoma. The intraclass correlation coefficients ranged between 0.77 for response time and 0.92 for correct responses, indicating good to excellent test-retest reliability. CONCLUSIONS We established the construct validity and test-retest reliability of the performance-based VF test. Future studies should include a larger sample with more severe driving difficulties to demonstrate the concurrent validity between performance-based VF testing and on-road driving performance in glaucoma.
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Affiliation(s)
- Hannes Devos
- a Department of Physical Therapy and Rehabilitation Science, School of Health Professions , The University of Kansas Medical Center , Kansas City , Kansas
| | | | - Kathryn Bollinger
- c Department of Ophthalmology, Medical College of Georgia , Augusta University , Augusta , Georgia
- d Culver Vision Discovery Institute, Medical College of Georgia, Augusta University , Augusta , Georgia
| | - Amber Conn
- a Department of Physical Therapy and Rehabilitation Science, School of Health Professions , The University of Kansas Medical Center , Kansas City , Kansas
| | - Abiodun E Akinwuntan
- e Dean's Office, School of Health Professions , The University of Kansas Medical Center , Kansas City , Kansas
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Ungewiss J, Kübler T, Sippel K, Aehling K, Heister M, Rosenstiel W, Kasneci E, Papageorgiou E. Agreement of driving simulator and on-road driving performance in patients with binocular visual field loss. Graefes Arch Clin Exp Ophthalmol 2018; 256:2429-2435. [PMID: 30251198 DOI: 10.1007/s00417-018-4148-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/29/2018] [Accepted: 09/18/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE On-road testing is considered the standard for assessment of driving performance; however, it lacks standardization. In contrast, driving simulators provide controlled experimental settings in a virtual reality environment. This study compares both testing conditions in patients with binocular visual field defects due to bilateral glaucomatous optic neuropathy or due to retro-chiasmal visual pathway lesions. METHODS Ten glaucoma patients (PG), ten patients with homonymous visual field defects (PH), and 20 age- and gender-matched ophthalmologically normal control subjects (CG and CH, respectively) participated in a 40-min on-road driving task using a dual brake vehicle. A subset of this sample (8 PG, 8 PH, 8 CG, and 7 CH) underwent a subsequent driving simulator test of similar duration. For both settings, pass/fail rates were assessed by a masked driving instructor. RESULTS For on-road driving, hemianopia patients (PH) and glaucoma patients (PG) showed worse performance than their controls (CH and CG groups): PH 40%, CH 30%, PG 60%, CG 0%, failure rate. Similar results were obtained for the driving simulator test: PH 50%, CH 29%, PG 38%, CG 0%, failure rate. Twenty-four out of 31 participants (77%) showed concordant results with regard to pass/fail under both test conditions (p > 0.05; McNemar test). CONCLUSIONS Driving simulator testing leads to results comparable to on-road driving, in terms of pass/fail rates in subjects with binocular (glaucomatous or retro-chiasmal lesion-induced) visual field defects. Driving simulator testing seems to be a well-standardized method, appropriate for assessment of driving performance in individuals with binocular visual field loss.
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Affiliation(s)
- Judith Ungewiss
- Study course Ophthalmic Optics, University of Applied Sciences, Aalen, Germany
| | - Thomas Kübler
- Department of Computer Science, University of Tübingen, Tübingen, Germany
| | - Katrin Sippel
- Department of Computer Science, University of Tübingen, Tübingen, Germany
| | - Kathrin Aehling
- Department of Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Martin Heister
- Department of Ophthalmology, University of Tübingen, Tübingen, Germany
| | | | - Enkelejda Kasneci
- Department of Computer Science, University of Tübingen, Tübingen, Germany
| | - Eleni Papageorgiou
- Department of Ophthalmology, University Hospital of Larissa, Mezourlo Area, 41222, Larissa, Greece.
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Abstract
PURPOSE OF REVIEW Numerous population-based studies suggest that glaucoma is an independent risk factor for falling and motor vehicle collisions, particularly for older adults. These adverse events lead to increased healthcare expenditures and decreased quality of life. Current research priorities, therefore, include identifying factors that predispose glaucoma patients to falling and unsafe driving, and developing screening strategies and targeted rehabilitation. The purpose of this article is to review recent studies that address these priorities. RECENT FINDINGS Studies continue to support that glaucoma patients, particularly those with advanced disease, have an increased risk of falling or unsafe driving. Risk factors, however, remain variable and include severity and location of visual field defects, contrast sensitivity, and performance on divided attention tasks. Such variability is likely because of the multifactorial nature of ambulating and driving and compensatory strategies used by patients. SUMMARY Falls and unsafe driving remain a serious public health issue for older adults with glaucoma. Ambulation and driving are complex tasks and there is no consensus yet, regarding the best methods for risk stratification and targeted interventions to increase safety. Therefore, comprehensive and individualized assessments are recommended to most effectively evaluate a patient's risk for falling or unsafe driving.
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Gangeddula V, Ranchet M, Akinwuntan AE, Bollinger K, Devos H. Effect of Cognitive Demand on Functional Visual Field Performance in Senior Drivers with Glaucoma. Front Aging Neurosci 2017; 9:286. [PMID: 28912712 PMCID: PMC5582159 DOI: 10.3389/fnagi.2017.00286] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/15/2017] [Indexed: 11/16/2022] Open
Abstract
Purpose: To investigate the effect of cognitive demand on functional visual field performance in drivers with glaucoma. Method: This study included 20 drivers with open-angle glaucoma and 13 age- and sex-matched controls. Visual field performance was evaluated under different degrees of cognitive demand: a static visual field condition (C1), dynamic visual field condition (C2), and dynamic visual field condition with active driving (C3) using an interactive, desktop driving simulator. The number of correct responses (accuracy) and response times on the visual field task were compared between groups and between conditions using Kruskal–Wallis tests. General linear models were employed to compare cognitive workload, recorded in real-time through pupillometry, between groups and conditions. Results: Adding cognitive demand (C2 and C3) to the static visual field test (C1) adversely affected accuracy and response times, in both groups (p < 0.05). However, drivers with glaucoma performed worse than did control drivers when the static condition changed to a dynamic condition [C2 vs. C1 accuracy; glaucoma: median difference (Q1–Q3) 3 (2–6.50) vs. controls: 2 (0.50–2.50); p = 0.05] and to a dynamic condition with active driving [C3 vs. C1 accuracy; glaucoma: 2 (2–6) vs. controls: 1 (0.50–2); p = 0.02]. Overall, drivers with glaucoma exhibited greater cognitive workload than controls (p = 0.02). Conclusion: Cognitive demand disproportionately affects functional visual field performance in drivers with glaucoma. Our results may inform the development of a performance-based visual field test for drivers with glaucoma.
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Affiliation(s)
- Viswa Gangeddula
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas CityKS, United States
| | - Maud Ranchet
- Laboratoire Ergonomie et Sciences Cognitives pour les Transports (LESCOT), IFSTTAR, TS2, Université de LyonLyon, France
| | - Abiodun E Akinwuntan
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas CityKS, United States
| | - Kathryn Bollinger
- Department of Ophthalmology, Medical College of Georgia, Augusta University, AugustaGA, United States
| | - Hannes Devos
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas CityKS, United States
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15
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Yuki K, Asaoka R, Awano-Tanabe S, Ono T, Shiba D, Murata H, Tsubota K. Predicting Future Self-Reported Motor Vehicle Collisions in Subjects with Primary Open-Angle Glaucoma Using the Penalized Support Vector Machine Method. Transl Vis Sci Technol 2017; 6:14. [PMID: 28603662 PMCID: PMC5464675 DOI: 10.1167/tvst.6.3.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 04/02/2017] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We predict the likelihood of a future motor vehicle collision (MVC) from visual function data, attitudes to driving, and past MVC history using the penalized support vector machine (pSVM) in subjects with primary open-angle glaucoma (POAG). METHODS Patients with POAG were screened prospectively for eligibility and 185 were analyzed in this study. Self-reported MVCs of all participants were recorded for 3 years from the baseline using a survey questionnaire every 12 months. A binocular integrated visual field (IVF) was calculated for each patient by merging a patient's monocular Humphrey Field Analyzer (HFA) visual fields (VFs). The IVF was divided into six regions, based on eccentricity and the right or left hemifield, and the average of the total deviation (TD) values in each of these six areas was calculated. Then, the future MVCs were predicted using various variables, including age, sex, 63 variables of 52 TD values, mean of the TD values, visual acuities (VAs), six sector average TDs with (predpenSVM_all) and without (predpenSVM_basic) the attitudes in driving, and also past MVC history, using the pSVM method, applying the leave-one-out cross validation. RESULTS The relationship between predpenSVM_basic and the future MVC approached significance (odds ratio = 1.15, [0.99-1.29], P = 0.064, logistic regression). A significant relationship was observed between predpenSVM_all and the future MVC (odds ratio = 1.21, P = 0.0015). CONCLUSIONS It was useful to predict future MVCs in patients with POAG using visual function metrics, patients' attitudes to driving, and past MVC history, using the pSVM. TRANSLATIONAL RELEVANCE Careful consideration is needed when predicting future MVCs in POAG patients using visual function, and without driving attitude and MVC history.
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Affiliation(s)
- Kenya Yuki
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Sachiko Awano-Tanabe
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
| | - Takeshi Ono
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
| | - Daisuke Shiba
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
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16
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Pabon S, Sunness JS, Kaleem MA. Low Vision Therapy for Glaucoma Patients. CURRENT OPHTHALMOLOGY REPORTS 2017. [DOI: 10.1007/s40135-017-0124-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Yuki K, Awano-Tanabe S, Ono T, Shiba D, Murata H, Asaoka R, Tsubota K. Risk Factors for Motor Vehicle Collisions in Patients with Primary Open-Angle Glaucoma: A Multicenter Prospective Cohort Study. PLoS One 2016; 11:e0166943. [PMID: 27898724 PMCID: PMC5127526 DOI: 10.1371/journal.pone.0166943] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/06/2016] [Indexed: 12/02/2022] Open
Abstract
Purpose To identify the incidence rate of motor vehicle collisions (MVCs) in patients with no ocular pathology other than primary open-angle glaucoma (POAG) and determine the putative risk factors for MVCs in this group of patients. Methods We designed a prospective cohort study across three centers utilizing a consecutive sampling method to identify all patients with POAG between the ages of 40 and 80 years old. Patients with glaucoma were consecutively screened for eligibility. All study participants answered a questionnaire about motor vehicle collisions at baseline, and answered the questionnaire again every 12 months (± 1 month) after baseline for three years. A binocular integrated visual field was calculated for each patient by merging a patient’s monocular Humphrey Field Analyzer (HFA) visual fields (VFs), using the ‘best sensitivity’ method. Patients with incident MVCs were defined as the “MVC+” group and patients without incident MVCs were defined as the “MVC-" group. Adjusted odds ratios for the incidence of MVCs were estimated with a logistic regression model. Results One hundred and ninety-one Japanese POAG patients were analyzed in this study. The age of the participants was 63.7 ± 10.2 [mean ± standard deviation]. A total of 28 participants experienced a MVC during the follow up period of three years (4.9% per year). Ten patients (5.2%) experienced a MVC in the first year, 13 patients (6.8%) in the second year, and 11 patients (5.8%) in the third year (some patients experienced multiple MVCs over different years). Best corrected visual acuity in the worst eye was significantly worse in the MVC+ group (0.03 ± 0.01, mean ± standard deviation, LogMar) compared with the MVC- group (0.01 ± 0.003, p = 0.01), and was the only variable identified as a significant predictor of future MVCs in the multiple logistic regression model [odds ratio: 1.2, 95% confidence interval (CI): 1.1 to 1.4]. Conclusion Deterioration in visual acuity in the worst eye is a risk factor for future MVCs in patients with POAG.
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Affiliation(s)
- Kenya Yuki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | | | - Takeshi Ono
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Shiba
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, Tokyo, Japan
- * E-mail:
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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18
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Weinreb RN, Leung CKS, Crowston JG, Medeiros FA, Friedman DS, Wiggs JL, Martin KR. Primary open-angle glaucoma. Nat Rev Dis Primers 2016; 2:16067. [PMID: 27654570 DOI: 10.1038/nrdp.2016.67] [Citation(s) in RCA: 276] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Glaucoma is an optic neuropathy that is characterized by the progressive degeneration of the optic nerve, leading to visual impairment. Glaucoma is the main cause of irreversible blindness worldwide, but typically remains asymptomatic until very severe. Open-angle glaucoma comprises the majority of cases in the United States and western Europe, of which, primary open-angle glaucoma (POAG) is the most common type. By contrast, in China and other Asian countries, angle-closure glaucoma is highly prevalent. These two types of glaucoma are characterized based on the anatomic configuration of the aqueous humour outflow pathway. The pathophysiology of POAG is not well understood, but it is an optic neuropathy that is thought to be associated with intraocular pressure (IOP)-related damage to the optic nerve head and resultant loss of retinal ganglion cells (RGCs). POAG is generally diagnosed during routine eye examination, which includes fundoscopic evaluation and visual field assessment (using perimetry). An increase in IOP, measured by tonometry, is not essential for diagnosis. Management of POAG includes topical drug therapies and surgery to reduce IOP, although new therapies targeting neuroprotection of RGCs and axonal regeneration are under development.
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Affiliation(s)
- Robert N Weinreb
- Shiley Eye Institute, Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, USA
| | - Christopher K S Leung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Jonathan G Crowston
- Department of Ophthalmology, Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
| | - Felipe A Medeiros
- Shiley Eye Institute, Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, USA
| | - David S Friedman
- Dana Center for Preventive Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Janey L Wiggs
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Keith R Martin
- Department of Ophthalmology and Cambridge NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
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Saunders LJ, Medeiros FA, Weinreb RN, Zangwill LM. What rates of glaucoma progression are clinically significant? EXPERT REVIEW OF OPHTHALMOLOGY 2016; 11:227-234. [PMID: 29657575 DOI: 10.1080/17469899.2016.1180246] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Clinically important rates of glaucoma progression (worsening) are ones that put a patient at risk of future functional impairment or reduction of vision-related quality of life. Rates of progression can be evaluated through measuring structural or functional changes of the optic nerve. Most treated eyes do not progress at rates that will lead to future visual impairment, but there are a significant proportion (3-17%) of eyes, that are at risk of impairment even under clinical care. While very fast rates of progression (e.g. MD progression of -1.5 dB/year) are generally problematic, much slower rates also may be deleterious for young patients, particularly those diagnosed with late disease. As a result, it is important to consider life expectancy, disease severity and vision-related quality of life based treatment targets to estimate future prognosis when evaluating whether a rate of glaucoma progression can be clinically relevant.
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20
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Glaucoma: the patient's perspective. Br J Gen Pract 2016; 66:e371-3. [PMID: 27127293 DOI: 10.3399/bjgp16x685165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/19/2015] [Indexed: 10/31/2022] Open
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