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Liu K, Yang Y, Wu Z, Sun C, Su Y, Huang N, Wu H, Yi C, Ye J, Xiao L, Niu J. Remyelination-oriented clemastine treatment attenuates neuropathies of optic nerve and retina in glaucoma. Glia 2024; 72:1555-1571. [PMID: 38829008 DOI: 10.1002/glia.24543] [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: 11/28/2023] [Revised: 04/16/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024]
Abstract
As one of the top causes of blindness worldwide, glaucoma leads to diverse optic neuropathies such as degeneration of retinal ganglion cells (RGCs). It is widely accepted that the level of intraocular pressure (IOP) is a major risk factor in human glaucoma, and reduction of IOP level is the principally most well-known method to prevent cell death of RGCs. However, clinical studies show that lowering IOP fails to prevent RGC degeneration in the progression of glaucoma. Thus, a comprehensive understanding of glaucoma pathological process is required for developing new therapeutic strategies. In this study, we provide functional and histological evidence showing that optic nerve defects occurred before retina damage in an ocular hypertension glaucoma mouse model, in which oligodendroglial lineage cells were responsible for the subsequent neuropathology. By treatment with clemastine, an Food and Drug Administration (FDA)-approved first-generation antihistamine medicine, we demonstrate that the optic nerve and retina damages were attenuated via promoting oligodendrocyte precursor cell (OPC) differentiation and enhancing remyelination. Taken together, our results reveal the timeline of the optic neuropathies in glaucoma and highlight the potential role of oligodendroglial lineage cells playing in its treatment. Clemastine may be used in future clinical applications for demyelination-associated glaucoma.
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Affiliation(s)
- Kun Liu
- Department of Ophthalmology, Army Specialty Medical Center, Third Military Medical University, Chongqing, China
- Department of Histology and Embryology, State Key Laboratory of Trauma and Chemical Poisoning, Chongqing Key Laboratory of Neurobiology, Brain and Intelligence Research Key Laboratory of Chongqing Education Commission, Third Military Medical University, Chongqing, China
| | - Yujian Yang
- Department of Ophthalmology, Army Specialty Medical Center, Third Military Medical University, Chongqing, China
- Department of Histology and Embryology, State Key Laboratory of Trauma and Chemical Poisoning, Chongqing Key Laboratory of Neurobiology, Brain and Intelligence Research Key Laboratory of Chongqing Education Commission, Third Military Medical University, Chongqing, China
| | - Zhonghao Wu
- Department of Histology and Embryology, State Key Laboratory of Trauma and Chemical Poisoning, Chongqing Key Laboratory of Neurobiology, Brain and Intelligence Research Key Laboratory of Chongqing Education Commission, Third Military Medical University, Chongqing, China
| | - Chunhui Sun
- Research Centre, Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Yixun Su
- Department of Histology and Embryology, State Key Laboratory of Trauma and Chemical Poisoning, Chongqing Key Laboratory of Neurobiology, Brain and Intelligence Research Key Laboratory of Chongqing Education Commission, Third Military Medical University, Chongqing, China
- Research Centre, Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Nanxin Huang
- Department of Histology and Embryology, State Key Laboratory of Trauma and Chemical Poisoning, Chongqing Key Laboratory of Neurobiology, Brain and Intelligence Research Key Laboratory of Chongqing Education Commission, Third Military Medical University, Chongqing, China
| | - Haoqian Wu
- Department of Ophthalmology, Army Specialty Medical Center, Third Military Medical University, Chongqing, China
| | - Chenju Yi
- Research Centre, Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Jian Ye
- Department of Ophthalmology, Army Specialty Medical Center, Third Military Medical University, Chongqing, China
| | - Lan Xiao
- Department of Histology and Embryology, State Key Laboratory of Trauma and Chemical Poisoning, Chongqing Key Laboratory of Neurobiology, Brain and Intelligence Research Key Laboratory of Chongqing Education Commission, Third Military Medical University, Chongqing, China
| | - Jianqin Niu
- Department of Histology and Embryology, State Key Laboratory of Trauma and Chemical Poisoning, Chongqing Key Laboratory of Neurobiology, Brain and Intelligence Research Key Laboratory of Chongqing Education Commission, Third Military Medical University, Chongqing, China
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Li Y, Li L, Ye Z, Zhang H, Sun X, Li C, Gui L. A Novel Implantable Piezoresistive Microsensor for Intraocular Pressure Measurement. ACS Sens 2024; 9:3958-3966. [PMID: 39069735 DOI: 10.1021/acssensors.4c00705] [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: 07/30/2024]
Abstract
Glaucoma is the world's second-leading irreversible eye disease causing blindness. Although the pathogenesis of glaucoma is not particularly well understood, high intraocular pressure (IOP) is widely recognized as a significant risk factor. In clinical practice, various devices have been used to measure IOP, but most of them cannot provide continuous measurements for a long time. To meet the needs of glaucoma patients who experience frequent fluctuations in the IOP and require constant monitoring, we fabricated an implantable piezoresistive IOP sensor based on microfluidic technology. The sensor has a sensitivity of 0.00257 Ω/mbar and demonstrates excellent linearity, stability, and repeatability. According to the calibration data, the average measurement error is ±0.5 mbar. We implanted it into the vitreous of a rabbit and successfully detected its IOP fluctuations. The sensor is simple in design, easy to fabricate, and can be used for long-term continuous IOP measurements. It presents a new approach for microfluidic-based IOP sensors and offers a novel method for the daily care of patients with glaucoma.
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Affiliation(s)
- Yuqing Li
- Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100091, China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 101408, China
| | - Luojia Li
- Department of Ophthalmology, Zhongguancun Hospital, Beijing 100801, China
| | - Zi Ye
- Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100091, China
| | - Huimin Zhang
- Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100091, China
- School of Engineering Science, University of Chinese Academy of Sciences, Beijing 101408, China
| | - Xiao Sun
- Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100091, China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 101408, China
| | - Chunwei Li
- Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100091, China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 101408, China
| | - Lin Gui
- Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100091, China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 101408, China
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Ramyashri S, Das AV, Senthil S. Intraocular pressure and gonioscopic findings in primary angle-closure disease in India-a big data study. Int J Ophthalmol 2024; 17:1495-1500. [PMID: 39156769 PMCID: PMC11286451 DOI: 10.18240/ijo.2024.08.16] [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: 09/11/2023] [Accepted: 04/28/2024] [Indexed: 08/20/2024] Open
Abstract
AIM To describe the gonioscopic profile and intraocular pressure (IOP) in primary angle-closure (PAC) disease in patients presenting to a tertiary eye care network in India. METHODS A cross-sectional hospital-based study that included 31 484 new patients presenting between 2011 and 2021. Patients with a clinical diagnosis of PAC/suspect/glaucoma were included. The data was collected from an electronic medical record system. RESULTS PAC glaucoma (PACG) (47.55%) was the most common diagnosis followed by PAC (39.49%) and PAC suspect (PACS; 12.96%). Female preponderance (54.6%) was noted with higher mean age at presentation among males (P<0.0001). PACS and PAC showed the highest prevalence in 6th decade but PACG was higher at 7th decade. The probability of angle opening was 95.93%, 90.32% and 63.36% in PACS, PAC and PACG eyes respectively post peripheral iridotomy (PI). Plateau iris syndrome (PIS) was noted in 252 eyes and all showed post dilated rise of IOP. A post dilated IOP rise was also noted with 8.86%, 33.95% and 57.19% eyes with PACS, PAC and PACG respectively with IOP rise between 6-8 mm Hg across the disease spectrum. CONCLUSION The superior quadrant is the narrowest angle and difficult to open with indentation and post PI. The probability of angle opening is less in PIS especially the complete variety along with post dilated IOP rise. The post dilated IOP rise in angle closure eyes warrants a careful dilatation, especially with PIS.
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Affiliation(s)
- Srikantaiah Ramyashri
- VST Centre for Glaucoma Care, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad 500034, India
- Drishti Eye Centre, Hyderabad 500073, India
| | - Anthony Vipin Das
- Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Sirisha Senthil
- VST Centre for Glaucoma Care, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad 500034, India
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Bagul US, Khot SV, Ashtekar KS, Monde AA, Kolhe OH, Tagalpallewar AA, Kokare CR. Fabrication of acetazolamide loaded leciplex for intraocular delivery: Optimization by 3 2 full factorial design, in vitro, ex vivo and in vivo pharmacodynamics. Int J Pharm 2024; 661:124391. [PMID: 38936444 DOI: 10.1016/j.ijpharm.2024.124391] [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: 05/09/2024] [Revised: 06/24/2024] [Accepted: 06/24/2024] [Indexed: 06/29/2024]
Abstract
The complex structure of the eye poses challenges in delivering drugs effectively, which can be circumvented by employing nanotechnologies. The present study aimed to prepareacetazolamide-loadedleciplex (ACZ - LP) using a simple one-step fabrication approach followed byoptimization employing a 32 Full Factorial Design. The ACZ - LP demonstrated high entrapment efficiency (93.25 ± 2.32 %), average diameter was recorded around 171.03 ± 3.32 with monodisperse size distribution and zeta potential of 41.33 ± 2.10 mV. Invitro release and ex vivo permeation studies of prepared formulation demonstrated an initial burst release in 1 h followed by sustained release pattern as compared to plain acetazolamide solution. Moreover, an ex vivo corneal drug retention (27.05 ± 1.20 %) and in vitro mucoadhesive studies with different concentration of mucin indicated strong electrostatic bonding confirming the mucoadhesive characteristics of the formulation. Additionally, the histopathological studies ensured that the formulation was non-irritant and nontoxic while and HET-CAM ensured substantial tolerability of the formulation. The in vivo pharmacodynamic investigation carried out on a rabbit model demonstrated that treatment with ACZ - LP resulted in a significant and prolonged reduction in intraocular pressure as compared to plain acetazolamide solution, acetazolamide oral tablet, and Brinzox®. In summary, the ACZ - LP is anefficient and versatile drug delivery approach which demonstrates significant potential in controlling glaucoma.
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Affiliation(s)
- Uddhav S Bagul
- Department of Pharmaceutics, STES Sinhgad Institute of Pharmacy (Affiliated to Savitribai Phule Pune University), Narhe, Pune 411041, Maharashtra, India.
| | - Shubham V Khot
- Department of Pharmaceutics, STES Sinhgad Institute of Pharmacy (Affiliated to Savitribai Phule Pune University), Narhe, Pune 411041, Maharashtra, India
| | - Kiran S Ashtekar
- Department of Pharmaceutics, STES Sinhgad Institute of Pharmacy (Affiliated to Savitribai Phule Pune University), Narhe, Pune 411041, Maharashtra, India
| | - Ashish A Monde
- Department of Pharmaceutics, STES Sinhgad Institute of Pharmacy (Affiliated to Savitribai Phule Pune University), Narhe, Pune 411041, Maharashtra, India
| | - Omkar H Kolhe
- Department of Quality Assurance Techniques, STES Sinhgad Institute of Pharmacy (Affiliated to Savitribai Phule Pune University), Narhe, Pune 411041, Maharashtra, India
| | - Amol A Tagalpallewar
- Department of Pharmaceutics, Dr.Vishwanath Karad MIT World Peace University, School of Health Science and Technology, Kothrud, Pune 411038, Maharashtra, India
| | - Chandrakant R Kokare
- Department of Pharmaceutics, STES Sinhgad Institute of Pharmacy (Affiliated to Savitribai Phule Pune University), Narhe, Pune 411041, Maharashtra, India
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Jan C, He M, Vingrys A, Zhu Z, Stafford RS. Diagnosing glaucoma in primary eye care and the role of Artificial Intelligence applications for reducing the prevalence of undetected glaucoma in Australia. Eye (Lond) 2024; 38:2003-2013. [PMID: 38514852 PMCID: PMC11269618 DOI: 10.1038/s41433-024-03026-z] [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: 07/25/2023] [Revised: 02/05/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024] Open
Abstract
Glaucoma is the commonest cause of irreversible blindness worldwide, with over 70% of people affected remaining undiagnosed. Early detection is crucial for halting progressive visual impairment in glaucoma patients, as there is no cure available. This narrative review aims to: identify reasons for the significant under-diagnosis of glaucoma globally, particularly in Australia, elucidate the role of primary healthcare in glaucoma diagnosis using Australian healthcare as an example, and discuss how recent advances in artificial intelligence (AI) can be implemented to improve diagnostic outcomes. Glaucoma is a prevalent disease in ageing populations and can have improved visual outcomes through appropriate treatment, making it essential for general medical practice. In countries such as Australia, New Zealand, Canada, USA, and the UK, optometrists serve as the gatekeepers for primary eye care, and glaucoma detection often falls on their shoulders. However, there is significant variation in the capacity for glaucoma diagnosis among eye professionals. Automation with Artificial Intelligence (AI) analysis of optic nerve photos can help optometrists identify high-risk changes and mitigate the challenges of image interpretation rapidly and consistently. Despite its potential, there are significant barriers and challenges to address before AI can be deployed in primary healthcare settings, including external validation, high quality real-world implementation, protection of privacy and cybersecurity, and medico-legal implications. Overall, the incorporation of AI technology in primary healthcare has the potential to reduce the global prevalence of undiagnosed glaucoma cases by improving diagnostic accuracy and efficiency.
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Affiliation(s)
- Catherine Jan
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia.
- Ophthalmology, Department of Surgery, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
- Lost Child's Vision Project, Sydney, NSW, Australia.
| | - Mingguang He
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Ophthalmology, Department of Surgery, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- Centre for Eye and Vision Research, The Hong Kong Polytechnic University, Kowloon, TU428, Hong Kong SAR
| | - Algis Vingrys
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Ophthalmology, Department of Surgery, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Zhuoting Zhu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Ophthalmology, Department of Surgery, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Randall S Stafford
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
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Tong J, Phu J, Alonso-Caneiro D, Kugelman J, Khuu S, Agar A, Coroneo M, Kalloniatis M. Exploring the relationship between 24-2 visual field and widefield optical coherence tomography data across healthy, glaucoma suspect and glaucoma eyes. Ophthalmic Physiol Opt 2024. [PMID: 39056571 DOI: 10.1111/opo.13368] [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: 01/22/2024] [Revised: 07/08/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE To utilise ganglion cell-inner plexiform layer (GCIPL) measurements acquired using widefield optical coherence tomography (OCT) scans spanning 55° × 45° to explore the link between co-localised structural parameters and clinical visual field (VF) data. METHODS Widefield OCT scans acquired from 311 healthy, 268 glaucoma suspect and 269 glaucoma eyes were segmented to generate GCIPL thickness measurements. Estimated ganglion cell (GC) counts, calculated from GCIPL measurements, were plotted against 24-2 SITA Faster visual field (VF) thresholds, and regression models were computed with data categorised by diagnosis and VF status. Classification of locations as VF defective or non-defective using GCIPL parameters computed across eccentricity- and hemifield-dependent clusters was assessed by analysing areas under receiver operating characteristic curves (AUROCCs). Sensitivities and specificities were calculated per diagnostic category. RESULTS Segmented linear regression models between GC counts and VF thresholds demonstrated higher variability in VF defective locations relative to non-defective locations (mean absolute error 6.10-9.93 dB and 1.43-1.91 dB, respectively). AUROCCs from cluster-wide GCIPL parameters were similar across methods centrally (p = 0.06-0.84) but significantly greater peripherally, especially when considering classification of more central locations (p < 0.0001). Across diagnoses, cluster-wide GCIPL parameters demonstrated variable sensitivities and specificities (0.36-0.93 and 0.65-0.98, respectively), with the highest specificities observed across healthy eyes (0.73-0.98). CONCLUSIONS Quantitative prediction of VF thresholds from widefield OCT is affected by high variability at VF defective locations. Prediction of VF status based on cluster-wide GCIPL parameters from widefield OCT could become useful to aid clinical decision-making in appropriately targeting VF assessments.
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Affiliation(s)
- Janelle Tong
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- School of Medicine (Optometry), Deakin University, Waurn Ponds, Victoria, Australia
| | - Jack Phu
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- School of Medicine (Optometry), Deakin University, Waurn Ponds, Victoria, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Concord Clinical School, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - David Alonso-Caneiro
- School of Science, Technology and Engineering, University of Sunshine Coast, Sunshine Coast, Queensland, Australia
- Contact Lens and Visual Optics Laboratory, Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Jason Kugelman
- Contact Lens and Visual Optics Laboratory, Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Sieu Khuu
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Ashish Agar
- Department of Ophthalmology, University of New South Wales at Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Minas Coroneo
- Department of Ophthalmology, University of New South Wales at Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Michael Kalloniatis
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- School of Medicine (Optometry), Deakin University, Waurn Ponds, Victoria, Australia
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Ahmed CM, Johnson HM, Lewin AS. Corneal application of SOCS1/3 peptides for the treatment of eye diseases mediated by inflammation and oxidative stress. Front Immunol 2024; 15:1416181. [PMID: 39104531 PMCID: PMC11298391 DOI: 10.3389/fimmu.2024.1416181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/05/2024] [Indexed: 08/07/2024] Open
Abstract
Several blinding diseases affecting the retina and optic nerve are exacerbated by or caused by dysregulated inflammation and oxidative stress. These diseases include uveitis, age related macular degeneration, diabetic retinopathy and glaucoma. Consequently, despite their divergent symptoms, treatments that reduce oxidative stress and suppress inflammation may be therapeutic. The production of inflammatory cytokines and their activities are regulated by a class of proteins termed Suppressors of Cytokine Signaling (SOCS). SOCS1 and SOCS3 are known to dampen signaling via pathways employing Janus kinases and signal transducer and activator of transcription proteins (JAK/STAT), Toll-like Receptors (TLR), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), mitogen activated kinase (MAPK) and NLR family pyrin domain containing 3 (NLRP3). We have developed cell-penetrating peptides from the kinase inhibitory region of the SOCS1 and SOCS3 (denoted as R9-SOCS1-KIR and R9-SOCS3-KIR) and tested them in retinal pigment epithelium (RPE) cells and in macrophage cell lines. SOCS-KIR peptides exhibited anti-inflammatory, anti-oxidant and anti-angiogenic properties. In cell culture, both Th1 and Th17 cells were suppressed together with the inhibition of other inflammatory markers. We also observed a decrease in oxidants and a simultaneous rise in neuroprotective and anti-oxidant effectors. In addition, treatment prevented the loss of gap junction proteins and the ensuing drop in transepithelial electrical resistance in RPE cells. When tested in mouse models by eye drop instillation, they showed protection against autoimmune uveitis, as a prophylactic as well as a therapeutic. Mice with endotoxin-induced uveitis were protected by eye drop administration as well. R9-SOCS3-KIR was particularly effective against the pathways acting through STAT3, e.g. IL-6 and VEGF-A mediated responses that lead to macular degeneration. Eye drop administration of R9-SOCS3-KIR stimulated production of antioxidant effectors and reduced clinical symptoms in mouse model of oxidative stress that replicates the RPE injury occurring in AMD. Because these peptides suppress multiple pathogenic stimuli and because they can be delivered topically to the cornea, they are attractive candidates for therapeutics for uveitis, macular degeneration, diabetic retinopathy and glaucoma.
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Affiliation(s)
- Chulbul M. Ahmed
- Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, FL, United States
| | - Howard M. Johnson
- Department of Microbiology and Cell Science, University of Florida, Gainesville, FL, United States
| | - Alfred S. Lewin
- Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, FL, United States
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Sadiq DR, Mikhael EM. The Achievement of IOP Target Among a Sample of Iraqi Patients with Glaucoma: A Retrospective Study. Clin Ophthalmol 2024; 18:2107-2112. [PMID: 39051024 PMCID: PMC11268619 DOI: 10.2147/opth.s478850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 07/02/2024] [Indexed: 07/27/2024] Open
Abstract
Background Glaucoma is a chronic progressive eye disorder. It is the primary cause of blindness. To prevent glaucomatous damage and blindness, the intra-ocular pressure (IOP) must be lowered to certain levels, this level is known as "IOP" target. Many studies conducted in developed countries have found that the majority of glaucoma patients failed to reach their target IOP. Purpose This study aimed to assess the achievement of IOP target among Iraqi patients with glaucoma and to determine the factors affecting it. Patients and Methods A single-center retrospective cohort study was conducted by inspecting the records of all patients with confirmed cases of glaucoma who were admitted to the Ibn-Al-Haitham Hospital outpatient unit from January 2020 to December 2022. To be included in the study, the patient must be newly diagnosed with glaucoma. In addition, full information on the patient's demographics, medical therapy used, and IOP at baseline and after 1 month of treatment must be available in the patient's case sheet. After considering the study inclusion criteria, the records of 760 patients were excluded, and only 100 patients were eligible. Results The included patients were mostly males, with an average age of 57.86 years. A 70% of the patients had elevated IOP in both eyes. Most patients (38%) were treated with two anti-glaucoma drugs. Only 35% of the patients achieved their targeted IOP. Regarding the factors influencing the achievement of the IOP target, all demographic data (age and gender) had a non-significant effect, while the number of prescribed drugs affected the ability of the patient to reach the IOP target. Conclusion Most of Iraqi glaucomatous patients do not achieve their IOP target. The number of prescribed eye drops can significantly affect the ability of glaucoma patients to reach their targeted IOP.
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Affiliation(s)
- Duaa Raad Sadiq
- Department of Clinical Pharmacy, University of Babylon, College of Pharmacy, Hillah, Iraq
| | - Ehab Mudher Mikhael
- Department of Clinical Pharmacy, University of Baghdad, College of Pharmacy, Baghdad, Iraq
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9
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Dai Y, Liu Y, Dai A, Wang Y. Influence of preoperative dilation time on the effect of cataract ultrasonography combined with goniostomy in patients with primary closed angle glaucoma and its clinical significance. Am J Transl Res 2024; 16:2889-2897. [PMID: 39114705 PMCID: PMC11301468 DOI: 10.62347/rmia8846] [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: 04/17/2024] [Accepted: 05/28/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To evaluate the impact of preoperative pupil dilation time on the outcomes of cataract ultrasonoemulsification combined with goniostomy in patients with primary angle-closure glaucoma (PACG). METHODS A retrospective analysis was conducted on 106 PACG patients who underwent cataract ultrasonoemulsification with goniostomy. Patients were divided into two groups based on pupil dilation times: group A (dilation time between 20 to 30 minutes) and group B (dilation time between 30 minutes to 1 hour). Pre- and postoperative intraocular pressure (IOP), visual acuity, pupil diameter, anterior chamber depth (ACD), and lens thickness (LT) were measured. Surgical time and cumulative dissipated energy (CDE) were also analyzed. Multivariate analysis was performed to identify independent risk factors for postoperative complications. RESULTS Both groups showed significant postoperative improvement in visual acuity (P < 0.05). Group B exhibited significantly lower postoperative IOP than group A (P < 0.05). There were significant increases in ACD and pupil diameter and a decrease in LT post-dilation in both groups (all P < 0.05). Group B showed a deeper ACD, thinner LT, and larger pupil diameter compared to group A (all P < 0.05). While CDE was similar between groups, operation duration was longer in group A (P < 0.05). Disease course > 5.5 years, preoperative IOP > 25.14 mmHg, pupil diameter before dilation < 4.895 mm, ACD before dilation < 2.105 mm, and dilation time ≤ 30 minutes were independent risk factors for postoperative complications. CONCLUSION Preoperative pupil dilation time > 30 minutes leads to better surgical outcome. Several preoperative factors, including dilation time ≤ 30 minutes, are independent risk factors for postoperative complications.
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Affiliation(s)
- Yan Dai
- Department of Ophthalmology, Lanzhou Petrochemical General HospitalLanzhou 730060, Gansu, China
| | - Yuhuan Liu
- Department of Ophthalmology, Lanzhou Petrochemical General HospitalLanzhou 730060, Gansu, China
| | - Anlang Dai
- Department of Anesthesiology, Shenyang Medical CollegeShenyang 110034, Liaoning, China
| | - Yaozeng Wang
- Department of Optometry, Xi’an No. 1 HospitalXi’an 710002, Shaanxi, China
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Ma S, A J, Perumal T SR. Multi-dimensional dense attention network for pixel-wise segmentation of optic disc in colour fundus images. Technol Health Care 2024:THC230310. [PMID: 39058458 DOI: 10.3233/thc-230310] [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: 07/28/2024]
Abstract
BACKGROUND Segmentation of retinal fragments like blood vessels, Optic Disc (OD), and Optic Cup (OC) enables the early detection of different retinal pathologies like Diabetic Retinopathy (DR), Glaucoma, etc. OBJECTIVE Accurate segmentation of OD remains challenging due to blurred boundaries, vessel occlusion, and other distractions and limitations. These days, deep learning is rapidly progressing in the segmentation of image pixels, and a number of network models have been proposed for end-to-end image segmentation. However, there are still certain limitations, such as limited ability to represent context, inadequate feature processing, limited receptive field, etc., which lead to the loss of local details and blurred boundaries. METHODS A multi-dimensional dense attention network, or MDDA-Net, is proposed for pixel-wise segmentation of OD in retinal images in order to address the aforementioned issues and produce more thorough and accurate segmentation results. In order to acquire powerful contexts when faced with limited context representation capabilities, a dense attention block is recommended. A triple-attention (TA) block is introduced in order to better extract the relationship between pixels and obtain more comprehensive information, with the goal of addressing the insufficient feature processing. In the meantime, a multi-scale context fusion (MCF) is suggested for acquiring the multi-scale contexts through context improvement. RESULTS Specifically, we provide a thorough assessment of the suggested approach on three difficult datasets. In the MESSIDOR and ORIGA data sets, the suggested MDDA-NET approach obtains accuracy levels of 99.28% and 98.95%, respectively. CONCLUSION The experimental results show that the MDDA-Net can obtain better performance than state-of-the-art deep learning models under the same environmental conditions.
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Affiliation(s)
- Sreema Ma
- Department of Electronics and Communication Engineering, Arunachala College of Engineering for Women, Manavilai, India
| | - Jayachandran A
- Department of Computer Science and Engineering, PSN College of Engineering and Technology, Tirunelveli, India
| | - Sudarson Rama Perumal T
- Department of Computer Science and Engineering, Rohini College of Engineering and Technology, Nagercoil, India
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11
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Liu J, Zhou L, Wu X, Chen Z, Zheng X, Wang H, So KF, Ma L, Wang J, Chiu K. Lycium ruthenicum water extract preserves retinal ganglion cells in chronic ocular hypertension mouse models. Front Pharmacol 2024; 15:1404119. [PMID: 39021836 PMCID: PMC11252021 DOI: 10.3389/fphar.2024.1404119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/11/2024] [Indexed: 07/20/2024] Open
Abstract
Lycium ruthenicum Murray (LR), known as "black goji berry" or "black wolfberry", is widely utilized in chinese herbal medicine. LR fruit showed its antioxidant and/or anti-inflammation activity in treating cardiac injury, experimental colitis, nonalcoholic fatty liver disease, fatigue, and aging. Glaucoma is the leading cause of irreversible blindness. Besides elevated intraocular pressure (IOP), oxidative stress and neuroinflammation were recognized to contribute to the pathogenesis of glaucoma. This study investigated the treatment effects of LR water extract (LRE) on retinal ganglion cells (RGCs) threatened by sustained IOP elevation in a laser-induced chronic ocular hypertension (COH) mouse model and the DBA/2J mouse strain. The antioxidation and anti-inflammation effects of LRE were further tested in the H2O2-challenged immortalized microglial (IMG) cell line in vitro. LRE oral feeding (2 g/kg) preserved the function of RGCs and promoted their survival in both models mimicking glaucoma. LRE decreased 8-hydroxyguanosine (oxidative stress marker) expression in the retina. LRE reduced the number of Iba-1+ microglia in the retina of COH mice, but not in the DBA/2J mice. At the mRNA level, LRE reversed the COH induced HO-1 and SOD-2 overexpressions in the retina of COH mice. Further in vitro study demonstrated that LRE pretreatment to IMG cells could significantly reduce H2O2 induced oxidative stress through upregulation of GPX-4, Prdx-5, HO-1, and SOD-2. Our work demonstrated that daily oral intake of LRE can be used as a preventative/treatment agent to protect RGCs under high IOP stress probably through reducing oxidative stress and inhibiting microglial activation in the retina.
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Affiliation(s)
- Jinfeng Liu
- Shenzhen Eye Hospital, Shenzhen Eye Institute, Jinan University, Shenzhen, China
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Lina Zhou
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xueping Wu
- Jinzhou Medical University, Jinzhou, China
| | - Zihang Chen
- Department of Sports Medicine, The First Affiliated Hospital, Guangdong Provincial Key Laboratory of Speed Capability, The Guangzhou Key Laboratory of Precision Orthopedics and Regenerative Medicine, Jinan University, Guangzhou, China
| | - Xiaofei Zheng
- Department of Sports Medicine, The First Affiliated Hospital, Guangdong Provincial Key Laboratory of Speed Capability, The Guangzhou Key Laboratory of Precision Orthopedics and Regenerative Medicine, Jinan University, Guangzhou, China
| | - Huajun Wang
- Department of Sports Medicine, The First Affiliated Hospital, Guangdong Provincial Key Laboratory of Speed Capability, The Guangzhou Key Laboratory of Precision Orthopedics and Regenerative Medicine, Jinan University, Guangzhou, China
| | - Kwok Fai So
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Guangdong-Hongkong-Macau Institute of CNS Regeneration, Jinan University, Guangzhou, China
| | - Lan Ma
- Institute of Biopharmaceutical and Health Engineering, Tsinghua University Shenzhen Graduate School, Tsinghua University, Shenzhen, China
- Institute of Biomedical Health Technology and Engineering, Shenzhen Bay Laboratory, Shenzhen, China
- State Key Laboratory of Chemical Oncogenomics, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
| | - Jiantao Wang
- Shenzhen Eye Hospital, Shenzhen Eye Institute, Jinan University, Shenzhen, China
| | - Kin Chiu
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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12
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Chen L, Tseng VS, Tsung TH, Lu DW. A multi-label transformer-based deep learning approach to predict focal visual field progression. Graefes Arch Clin Exp Ophthalmol 2024; 262:2227-2235. [PMID: 38334809 DOI: 10.1007/s00417-024-06393-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/19/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
PURPOSE Tracking functional changes in visual fields (VFs) through standard automated perimetry remains a clinical standard for glaucoma diagnosis. This study aims to develop and evaluate a deep learning (DL) model to predict regional VF progression, which has not been explored in prior studies. METHODS The study included 2430 eyes of 1283 patients with four or more consecutive VF examinations from the baseline. A multi-label transformer-based network (MTN) using longitudinal VF data was developed to predict progression in six VF regions mapped to the optic disc. Progression was defined using the mean deviation (MD) slope and calculated for all six VF regions, referred to as clusters. Separate MTN models, trained for focal progression detection and forecasting on various numbers of VFs as model input, were tested on a held-out test set. RESULTS The MTNs overall demonstrated excellent macro-average AUCs above 0.884 in detecting focal VF progression given five or more VFs. With a minimum of 6 VFs, the model demonstrated superior and more stable overall and per-cluster performance, compared to 5 VFs. The MTN given 6 VFs achieved a macro-average AUC of 0.848 for forecasting progression across 8 VF tests. The MTN also achieved excellent performance (AUCs ≥ 0.86, 1.0 sensitivity, and specificity ≥ 0.70) in four out of six clusters for the eyes already with severe VF loss (baseline MD ≤ - 12 dB). CONCLUSION The high prediction accuracy suggested that multi-label DL networks trained with longitudinal VF results may assist in identifying and forecasting progression in VF regions.
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Affiliation(s)
- Ling Chen
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Vincent S Tseng
- Department of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Ta-Hsin Tsung
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec.2, Chenggong Rd., Neihu District, Taipei, Taiwan
| | - Da-Wen Lu
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec.2, Chenggong Rd., Neihu District, Taipei, Taiwan.
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13
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Wood-Yang AJ, Gerberich BG, Prausnitz MR. Computational modelling of scleral photocrosslinking: from rat to minipig to human. J R Soc Interface 2024; 21:20240111. [PMID: 39081249 PMCID: PMC11289678 DOI: 10.1098/rsif.2024.0111] [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: 02/13/2024] [Revised: 05/24/2024] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
Selective scleral crosslinking has been proposed as a novel treatment to increase scleral stiffness to counteract biomechanical changes associated with glaucoma and high myopia. Scleral stiffening has been shown by transpupillary peripapillary scleral photocrosslinking in rats, where the photosensitizer, methylene blue (MB), was injected retrobulbarly and red light initiated crosslinking reactions with collagen. Here, we adapted a computational model previously developed to model this treatment in rat eyes to additionally model MB photocrosslinking in minipigs and humans. Increased tissue length and subsequent diffusion and light penetration limitations were found to be barriers to achieving the same extent of crosslinking as in rats. Per cent inspired O2, injected MB concentration and laser fluence were simultaneously varied to overcome these limitations and used to determine optimal combinations of treatment parameters in rats, minipigs and humans. Increasing these three treatment parameters simultaneously resulted in maximum crosslinking, except in rats, where the highest MB concentrations decreased crosslinking. Additionally, the kinetics and diffusion of photocrosslinking reaction intermediates and unproductive side products were modelled across space and time. The model provides a mechanistic understanding of MB photocrosslinking in scleral tissue and a basis for adapting and screening treatment parameters in larger animal models and, eventually, human eyes.
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Affiliation(s)
- Amy J. Wood-Yang
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA30332, USA
| | - Brandon G. Gerberich
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA30332, USA
| | - Mark R. Prausnitz
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA30332, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA30332, USA
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14
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Johnson GA, Kodati B, Nahomi RB, Pham JH, Krishnamoorthy VR, Phillips NR, Krishnamoorthy RR, Nagaraj RH, Stankowska DL. Mechanisms contributing to inhibition of retinal ganglion cell death by cell permeable peptain-1 under glaucomatous stress. Cell Death Discov 2024; 10:305. [PMID: 38942762 PMCID: PMC11213865 DOI: 10.1038/s41420-024-02070-8] [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: 02/22/2024] [Revised: 06/03/2024] [Accepted: 06/13/2024] [Indexed: 06/30/2024] Open
Abstract
This study assesses the neuroprotective potential of CPP-P1, a conjugate of an anti-apoptotic peptain-1 (P1) and a cell-penetrating peptide (CPP) in in vitro, in vivo, and ex vivo glaucoma models. Primary retinal ganglion cells (RGCs) were subjected to either neurotrophic factor (NF) deprivation for 48 h or endothelin-3 (ET-3) treatment for 24 h and received either CPP-P1 or vehicle. RGC survival was analyzed using a Live/Dead assay. Axotomized human retinal explants were treated with CPP-P1 or vehicle for seven days, stained with RGC marker RBPMS, and RGC survival was analyzed. Brown Norway (BN) rats with elevated intraocular pressure (IOP) received weekly intravitreal injections of CPP-P1 or vehicle for six weeks. RGC function was evaluated using a pattern electroretinogram (PERG). RGC and axonal damage were also assessed. RGCs from ocular hypertensive rats treated with CPP-P1 or vehicle for seven days were isolated for transcriptomic analysis. RGCs subjected to 48 h of NF deprivation were used for qPCR target confirmation. NF deprivation led to a significant loss of RGCs, which was markedly reduced by CPP-P1 treatment. CPP-P1 also decreased ET-3-mediated RGC death. In ex vivo human retinal explants, CPP-P1 decreased RGC loss. IOP elevation resulted in significant RGC loss in mid-peripheral and peripheral retinas compared to that in naive rats, which was significantly reduced by CPP-P1 treatment. PERG amplitude decline in IOP-elevated rats was mitigated by CPP-P1 treatment. Following IOP elevation in BN rats, the transcriptomic analysis showed over 6,000 differentially expressed genes in the CPP-P1 group compared to the vehicle-treated group. Upregulated pathways included CREB signaling and synaptogenesis. A significant increase in Creb1 mRNA and elevated phosphorylated Creb were observed in CPP-P1-treated RGCs. Our study showed that CPP-P1 is neuroprotective through CREB signaling enhancement in several settings that mimic glaucomatous conditions. The findings from this study are significant as they address the pressing need for the development of efficacious therapeutic strategies to maintain RGC viability and functionality associated with glaucoma.
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Affiliation(s)
- Gretchen A Johnson
- North Texas Eye Research Institute, School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
- Department of Microbiology, Immunology, and Genetics, School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Bindu Kodati
- North Texas Eye Research Institute, School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
- Department of Pharmacology and Neuroscience, School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Rooban B Nahomi
- Department of Ophthalmology, School of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Jennifer H Pham
- North Texas Eye Research Institute, School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
- Department of Microbiology, Immunology, and Genetics, School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
| | | | - Nicole R Phillips
- Department of Microbiology, Immunology, and Genetics, School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Raghu R Krishnamoorthy
- North Texas Eye Research Institute, School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
- Department of Pharmacology and Neuroscience, School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Ram H Nagaraj
- Department of Ophthalmology, School of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Dorota L Stankowska
- North Texas Eye Research Institute, School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA.
- Department of Microbiology, Immunology, and Genetics, School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA.
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15
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Abbott CJ, Allen PJ, Williams CE, Williams RA, Epp SB, Burns O, Thomas R, Harrison M, Thien PC, Saunders A, McGowan C, Sloan C, Luu CD, Nayagam DAX. Chronic electrical stimulation with a peripheral suprachoroidal retinal implant: a preclinical safety study of neuroprotective stimulation. Front Cell Dev Biol 2024; 12:1422764. [PMID: 38966426 PMCID: PMC11222648 DOI: 10.3389/fcell.2024.1422764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/05/2024] [Indexed: 07/06/2024] Open
Abstract
Purpose Extraocular electrical stimulation is known to provide neuroprotection for retinal cells in retinal and optic nerve diseases. Currently, the treatment approach requires patients to set up extraocular electrodes and stimulate potentially weekly due to the lack of an implantable stimulation device. Hence, a minimally-invasive implant was developed to provide chronic electrical stimulation to the retina, potentially improving patient compliance for long-term use. The aim of the present study was to determine the surgical and stimulation safety of this novel device designed for neuroprotective stimulation. Methods Eight normally sighted adult feline subjects were monocularly implanted in the suprachoroidal space in the peripheral retina for 9-39 weeks. Charge balanced, biphasic, current pulses (100 μA, 500 µs pulse width and 50 pulses/s) were delivered continuously to platinum electrodes for 3-34 weeks. Electrode impedances were measured hourly. Retinal structure and function were assessed at 1-, 2-, 4-, 6- and 8-month using electroretinography, optical coherence tomography and fundus photography. Retina and fibrotic thickness were measured from histological sections. Randomized, blinded histopathological assessments of stimulated and non-stimulated retina were performed. Results All subjects tolerated the surgical and stimulation procedure with no evidence of discomfort or unexpected adverse outcomes. The device position was stable after a post-surgery settling period. Median electrode impedance remained within a consistent range (5-10 kΩ) over time. There was no change in retinal thickness or function relative to baseline and fellow eyes. Fibrotic capsule thickness was equivalent between stimulated and non-stimulated tissue and helps to hold the device in place. There was no scarring, insertion trauma, necrosis, retinal damage or fibroblastic response in any retinal samples from implanted eyes, whilst 19% had a minimal histiocytic response, 19% had minimal to mild acute inflammation and 28% had minimal to mild chronic inflammation. Conclusion Chronic suprathreshold electrical stimulation of the retina using a minimally invasive device evoked a mild tissue response and no adverse clinical findings. Peripheral suprachoroidal electrical stimulation with an implanted device could potentially be an alternative approach to transcorneal electrical stimulation for delivering neuroprotective stimulation.
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Affiliation(s)
- Carla J. Abbott
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Department of Surgery (Ophthalmology), University of Melbourne, East Melbourne, VIC, Australia
| | - Penelope J. Allen
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Department of Surgery (Ophthalmology), University of Melbourne, East Melbourne, VIC, Australia
- Vitreoretinal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
| | - Chris E. Williams
- Bionics Institute, East Melbourne, VIC, Australia
- Medical Bionics Department, University of Melbourne, Fitzroy, VIC, Australia
| | - Richard A. Williams
- Department of Clinical Pathology, University of Melbourne, Parkville, VIC, Australia
- Dorevitch Pathology, Heidelberg, VIC, Australia
| | | | - Owen Burns
- Bionics Institute, East Melbourne, VIC, Australia
| | - Ross Thomas
- Bionics Institute, East Melbourne, VIC, Australia
| | | | - Patrick C. Thien
- Bionics Institute, East Melbourne, VIC, Australia
- Medical Bionics Department, University of Melbourne, Fitzroy, VIC, Australia
| | | | | | | | - Chi D. Luu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Department of Surgery (Ophthalmology), University of Melbourne, East Melbourne, VIC, Australia
| | - David A. X. Nayagam
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Department of Clinical Pathology, University of Melbourne, Parkville, VIC, Australia
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Powers AM, Patel D, DeAngelis MM, Feng C, Allison K. Risk factors affecting the utilization of eye care services evaluated by the CDC's behavior risk factor surveillance system from 2018 to 2021. Front Public Health 2024; 12:1335427. [PMID: 38915755 PMCID: PMC11194383 DOI: 10.3389/fpubh.2024.1335427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 05/21/2024] [Indexed: 06/26/2024] Open
Abstract
When thinking about major health concerns in the U.S. and around the world, eye care ranks lower compared to cardiovascular disease, cancer, and diabetes. However, people do not think about the direct connection between diabetes and eye health. Untreated diabetes can lead to visual impairments such as blindness or difficulty seeing. Studies have found that eye health associated with nutrition, occupational exposure, diabetes, high blood pressure, and heart disease are some of the known risk factors. This study aimed to identify the potential risk factors that are associated with visual impairment (VI). The data used for this analysis were obtained from the Centers for Disease Control and Prevention (CDC) - Behavioral Risk Factor Surveillance System (BRFSS) from 2018 to 2021. We found important characteristics, such as the U.S. region, general health perception, employment status, income status, age, and health insurance source, that are associated with VI. Our study confirmed that the common demographical factors including age, race/ethnicity, the U.S. region, and gender are associated with VI. The study also highlights associations with additional risk factors such as health insurance source, general health perceptions, employment status, and income status. Using this information, we can reach out to communities with large numbers of individuals experiencing vision challenges and help educate them on prevention and treatment protocols, thereby effectively addressing VI and blindness challenges within our communities, neighborhoods, and finally, the broader society.
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Affiliation(s)
| | - Deepkumar Patel
- University of San Francisco, San Francisco, CA, United States
| | | | | | - Karen Allison
- University of Rochester, Rochester, NY, United States
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Long Y, Kozhemyakin M, Wu SM, Pang JJ. TRPV4 affects visual signals in photoreceptors and rod bipolar cells. Front Cell Neurosci 2024; 18:1404929. [PMID: 38903773 PMCID: PMC11188360 DOI: 10.3389/fncel.2024.1404929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/17/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction Mechanical sensitive channels expressed in mammalian retinas are effectors of elevated pressure stresses, but it is unclear how their activation affects visual function in pressure-related retinal disorders. Methods This study investigated the role of the transient potential channel vanilloid TRPV4 in photoreceptors and rod bipolar cells (RBCs) with immunohistochemistry, confocal microscopy, electroretinography (ERG), and patch-clamp techniques. Results TRPV4 immunoreactivity (IR) was found in the outer segments of photoreceptors, dendrites and somas of PKCα-positive RBCs and other BCs, plexiform layers, and retinal ganglion cells (RGCs) in wild-type mice. TRPV4-IR was largely diminished in the retinas of homozygous TRPV4 transgenic mice. Genetically suppressing TRPV4 expression moderately but significantly enhanced the amplitude of ERG a- and b-waves evoked by scotopic and mesopic lights (0.55 to 200 Rh*rod-1 s-1) and photopic lights (105-106 Rh*rod-1 s-1) compared to wild-type mice in fully dark-adapted conditions. The implicit time evoked by dim lights (0.55 to 200 Rh*rod-1 s-1) was significantly decreased for b-waves and elongated for a-waves in the transgenic mice. ERG b-wave evoked by dim lights is primarily mediated by RBCs, and under voltage-clamp conditions, the latency of the light-evoked cation current in RBCs of the transgenic mice was significantly shorter compared to wild-type mice. About 10% of the transgenic mice had one eye undeveloped, and the percentage was significantly higher than in wild-type mice. Conclusions The data indicates that TRPV4 involves ocular development and is expressed and active in outer retinal neurons, and interventions of TRPV4 can variably affect visual signals in rods, cones, RBCs, and cone ON BCs.
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Affiliation(s)
| | | | | | - Ji-Jie Pang
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, United States
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18
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Bastelica P, Renard JP, Aptel F, Labbé A, Schweitzer C, Poli M, Rousseau A, Lamirel C, Baudouin C. The PRAMOS Study: PRostaglandin Analogues Monotherapy-Awareness Survey on Ocular Surface Involvement. Ophthalmol Ther 2024; 13:1537-1551. [PMID: 38587775 PMCID: PMC11109058 DOI: 10.1007/s40123-024-00936-9] [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: 02/20/2024] [Accepted: 03/12/2024] [Indexed: 04/09/2024] Open
Abstract
INTRODUCTION Even though the local tolerance of prostaglandin (PG) analogues has improved drastically since the introduction of preservative-free (PF) eye drops, prescription patterns still vary widely among practitioners and between countries and could have an impact on the ocular surface of treated patients and, in consequence, their adherence. The aim of this study is to explore the prescribing patterns of PG analogues monotherapy in France and to evaluate their impact on ocular surface status. METHODS This was a national multicenter cross-sectional observational study that was conducted by 18 glaucoma experts in France. Patients over 18 years of age and receiving monotherapy with topical PG analogues for the treatment of ocular hypertension and/or glaucoma, with no history of prior glaucoma surgery, were consecutively selected from the glaucoma outpatient clinics of participating physicians and underwent an ocular surface examination. RESULTS A total of 344 eyes of 344 patients were enrolled between November 2022 and November 2023. Prescribed PG monotherapy was PF in 271 (78.7%) patients. Clinical history and ocular surface evaluation indicated that 79.4% of the study population (n = 273) presented with at least one symptom or clinical sign of dry eye and that three patients out of four had an unstable tear film. Subgroup analysis comparing preserved and PF PG analogues showed a higher prevalence of conjunctival hyperemia and corneal staining in the preserved group. Multivariate analysis identified conjunctival hyperemia as consistently associated with preservative use (odds ratio = 7.654; p = 0.003 for moderate conjunctival hyperemia). CONCLUSIONS This study highlights the growing trend toward PF PG analogue prescriptions by specialists in France. However, ocular surface issues remain prevalent, impacting patient adherence and treatment efficacy. Comprehensive ocular surface examinations are crucial in glaucoma management to enhance long-term tolerance, compliance, and overall treatment success.
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Affiliation(s)
- Paul Bastelica
- Quinze-Vingts National Ophthalmology Hospital, INSERM-DHOS CIC 1423, IHU FOReSIGHT, 75012, Paris, France.
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, 28 rue de Charenton, 75012, Paris, France.
| | - Jean Paul Renard
- Department of Ophthalmology, Hôpital d'Instruction des Armées Bégin, 94160, Saint-Mandé, France
- Académie du Service de Santé des Armées du Val de Grâce, 75005, Paris, France
| | - Florent Aptel
- Cabinet d'ophtalmologie-Visis, 66000, Perpignan, France
- Polyclinique Médipôle Saint-Roch-Elsan, 66330, Cabestany, France
| | - Antoine Labbé
- Quinze-Vingts National Ophthalmology Hospital, INSERM-DHOS CIC 1423, IHU FOReSIGHT, 75012, Paris, France
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, 28 rue de Charenton, 75012, Paris, France
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles St Quentin, Paris Saclay University, 91190, Gif-sur-Yvette, France
| | - Cédric Schweitzer
- Department of Ophthalmology, CHU Bordeaux, Univ. Bordeaux, ISPED, INSERM, U1219-Bordeaux Population Health Research Centre, 33000, Bordeaux, France
| | - Muriel Poli
- Centre Ophtalmologique Pôle Vision, Clinique du Val d'Ouest, 69130, Ecully, France
- Clinique de la Sauvegarde-Ramsay Santé, 69009, Lyon, France
| | - Antoine Rousseau
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, 28 rue de Charenton, 75012, Paris, France
- Department of Ophthalmology, Bicêtre Hospital, AP-HP, Paris-Saclay University, 91190, Gif-Sur-Yvette, France
| | - Cédric Lamirel
- Department of Ophthalmology, Hôpital Fondation Adolphe de Rothschild, 75019, Paris, France
| | - Christophe Baudouin
- Quinze-Vingts National Ophthalmology Hospital, INSERM-DHOS CIC 1423, IHU FOReSIGHT, 75012, Paris, France
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, 28 rue de Charenton, 75012, Paris, France
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles St Quentin, Paris Saclay University, 91190, Gif-sur-Yvette, France
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Lozano AC, Serrano A, Salazar D, Rincón JV, Pardo Bayona M. Telemedicine for Screening and Follow-Up of Glaucoma: A Descriptive Study. Telemed J E Health 2024; 30:1901-1908. [PMID: 38662524 DOI: 10.1089/tmj.2023.0676] [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: 07/20/2024] Open
Abstract
Introduction: Glaucoma is a leading cause of irreversible blindness. It is a prevalent disease worldwide, affecting ∼70 million people and expected to reach up to 112 million by 2040. Purpose: The aim of this study is to describe the implementation and initial experience of a telemedicine program to monitor glaucoma and glaucoma suspect patients in a large, integrated health care system during the COVID-19 pandemic. Methods: A retrospective chart review of established glaucoma or glaucoma suspect patients who participated in a telemedicine evaluation at the ophthalmic center of a large, Colombian health care system between June 2020 and April 2023 was conducted. Clinical and sociodemographic variables were analyzed. Generated clinical orders for additional testing, surgical procedures, follow-ups, and referrals, as well as changes in medical treatment, were evaluated. Results: A total of 11,034 telemedicine consults were included. The mean ± standard deviation age of this group was 63 ± 17.2 years and 67% were female. Of the patients who attended teleconsults, 49% were glaucoma suspects and 38.5% were followed with a diagnosis of open-angle glaucoma. After the consult, 25% of patients were referred to a glaucoma specialist, 40% had additional testing ordered, and 8% had a surgical procedure ordered, mainly laser iridotomy (409 cases). Almost a third of patients returned for subsequent telemedicine visits after the initial encounter. Despite some technical difficulties, 99.8% of patients attended and completed their scheduled telemedicine appointments. Conclusions: A telemedicine program aimed to monitor established glaucoma patients can be successfully implemented. Established patients within an integrated health care system have high adherence to the virtual model. Further research by health care institutions and government agencies will be key to expand coverage to additional populations. Clinical Trial Registration Number: CEIFUS 1026-24.
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Affiliation(s)
- Andrea Caycedo Lozano
- Oftalmosanitas-Clínica Colsanitas (Colsanitas Clinic), Bogotá, Colombia
- Member of Vision Colombia Research Group, Bogota, Colombia
| | - Alejandro Serrano
- Clínica de Oftalmología San Diego (San Diego Ophthalmology Clinic), Medellín, Colombia
| | - Diana Salazar
- Ophthalmic Private Practice, Falls Church, Virginia, USA
| | - Juliana Vanessa Rincón
- Member of Vision Colombia Research Group, Bogota, Colombia
- Research Unit, Fundación Universitaria Sanitas (Unisanitas University), Bogotá, Colombia
| | - Mónica Pardo Bayona
- Member of Vision Colombia Research Group, Bogota, Colombia
- Research Unit, Fundación Universitaria Sanitas (Unisanitas University), Bogotá, Colombia
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20
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Yin J, Li H, Guo N. Prevalence of Depression and Anxiety Disorders in Patients with Glaucoma: A Systematic Review and Meta-Analysis Based on Cross-Sectional Surveys. ACTAS ESPANOLAS DE PSIQUIATRIA 2024; 52:325-333. [PMID: 38863056 PMCID: PMC11190447 DOI: 10.62641/aep.v52i3.1561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
OBJECTIVE Glaucoma is a chronic disease with an insidious onset that often brings severe psychological burden to patients. Therefore, based on a systematic review and meta-analysis, we explore the prevalence and severity of depression and anxiety in glaucoma patients, and provide clinically valuable information for medical staff. METHODS Computer searches were conducted for relevant studies in PubMed, Embase, ProQuest PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, The Cochrane Library, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure, Wanfang Database, and China VIP Database. The search date range was from the establishment of the database to December 2023. Literature was screened and data were extracted. The Cochrane risk of bias assessment tool was used to evaluate the quality of the literature, and RevMan5.4 was used for meta-analysis. RESULTS The total sample size of the 15 included studies was 24,334 cases. All included studies were of high quality. The results of the meta-analysis revealed that, compared with control patients without glaucoma, patients with glaucoma were more likely to experience depression and to have more severe depressive symptoms [RR (Relative Risk) = 5.92, 95% CI (Confidence Interva) (3.29, 10.66), p < 0.01]; they were also more likely to experience anxiety and to have more severe anxiety symptoms [RR = 2.99, 95% CI (1.93, 4.64), p < 0.01]. The results of the sensitivity analysis showed that the two studies by Cumurcu E. 2005 and Yochim 2012 were the sources of heterogeneity in the meta-analysis of depression; and the three studies by Mabuchi 2012, Otori 2017, and Yochim 2012 were the sources of heterogeneity in the meta-analysis of anxiety disorders. CONCLUSION People with glaucoma are more likely to experience depression and anxiety than people without glaucoma. Medical staff should pay greater attention to patients' emotional problems and help patients improve their quality of life.
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Affiliation(s)
- Junfei Yin
- Department of Ophthalmology, Taizhou Municipal Hospital, 318000 Taizhou, Zhejiang, China
| | - Huijun Li
- Department of Ophthalmology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 317000 Taizhou, Zhejiang, China
| | - Nina Guo
- Department of Ophthalmology, Taizhou Central Hospital (Taizhou University Hospital), 318000 Taizhou, Zhejiang, China
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21
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Nitikarun P, Kongsap P. Comparative Analysis of Glaucoma Screening Uptake Among First-Degree Relatives After Community-Based and Hospital-Based Approaches. Clin Ophthalmol 2024; 18:1563-1573. [PMID: 38832077 PMCID: PMC11146622 DOI: 10.2147/opth.s459318] [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: 01/12/2024] [Accepted: 05/13/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose Glaucoma is the second leading cause of irreversible blindness globally. Primary open-angle glaucoma (POAG) can be genetically transmitted among first-degree relatives (FDRs). Therefore, screening for glaucoma in FDRs can significantly increase the chances of early detection. This study aimed to evaluate the differences in glaucoma screening uptake among FDRs in community and hospital-based settings and the underlying factors, as well as the prevalence of glaucoma in FDRs. Patients and Methods Probands and FDRs who underwent screening were classified into two: community-based (group 1) and hospital-based (group 2). They were invited for screening by Village Health Volunteers and ophthalmic nurses, respectively, using information brochures. The FDRs underwent eye examinations, and those with suspected glaucoma underwent further testing for confirmation. Results The response rates of probands were 261 (38.2%) for group 1 and 196 (48.8%) for group 2. The uptake screening of FDRs was 30.1% and 64.5%, respectively. Multivariate analysis identified that female FDRs {odds ratio [OR]=1.64; 95% CI 1.14-2.38} and those aged above 45 years (OR=2.06; 95% CI 1.32-3.21) were more likely to participate. FDRs residing outside Chanthaburi Province were less likely to attend than those within Chanthaburi (OR=0.36;95% CI 0.22-0.58). FDRs related to probands with blindness were more likely to participate (OR=1.69; 95% CI 1.13-2.54), as were FDRs with secondary school education or higher (OR=2.49;95% CI 1.48-4.18). Those receiving both medical and surgical treatment were more likely to participate (OR=2.22;95% CI 1.51-3.25). The prevalence of glaucoma was 8.3%, and 19.2% of screened FDRs were glaucoma suspects. Conclusion Group 1 showed a significantly lower screening uptake than Group 2. The factors influencing the uptake of screening by FDRs are gender, age, geographic location, visual acuity of the worse eye in probands, education status of FDRs, and treatment modalities of probands.
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Affiliation(s)
- Porntip Nitikarun
- Prapokklao Hospital, Department of Ophthalmology, Chanthaburi, 22000, Thailand
| | - Pipat Kongsap
- Prapokklao Hospital, Department of Ophthalmology, Chanthaburi, 22000, Thailand
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22
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Tsai YC, Lee HP, Tsung TH, Chen YH, Lu DW. Unveiling Novel Structural Biomarkers for the Diagnosis of Glaucoma. Biomedicines 2024; 12:1211. [PMID: 38927418 PMCID: PMC11200849 DOI: 10.3390/biomedicines12061211] [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: 04/29/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Glaucoma, a leading cause of irreversible blindness, poses a significant global health burden. Early detection is crucial for effective management and prevention of vision loss. This study presents a collection of novel structural biomarkers in glaucoma diagnosis. By employing advanced imaging techniques and data analysis algorithms, we now can recognize indicators of glaucomatous progression. Many research studies have revealed a correlation between the structural changes in the eye or brain, particularly in the optic nerve head and retinal nerve fiber layer, and the progression of glaucoma. These biomarkers demonstrate value in distinguishing glaucomatous eyes from healthy ones, even in the early stages of the disease. By facilitating timely detection and monitoring, they hold the potential to mitigate vision impairment and improve patient outcomes. This study marks an advancement in the field of glaucoma, offering a promising avenue for enhancing the diagnosis and possible management.
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Affiliation(s)
- Yu-Chien Tsai
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- Department of Ophthalmology, Taoyuan Armed Forces General Hospital, Taoyuan 325, Taiwan
| | - Hsin-Pei Lee
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Ta-Hsin Tsung
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Da-Wen Lu
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
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23
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Figueiredo R, Barbosa-Breda J. The efficacy of adjunctive mitomycin C and/or anti-VEGF agents on glaucoma tube shunt drainage device surgeries: a systematic review. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06476-z. [PMID: 38656422 DOI: 10.1007/s00417-024-06476-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 03/05/2024] [Accepted: 03/29/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE The effectiveness of mitomycin C (MMC) in trabeculectomy has long been established. The aim of this review is to evaluate the efficacy and safety of adjunctive agents in tube shunt drainage device surgery for glaucoma or ocular hypertension, since controversy still exists regarding their benefit. METHODS We searched CENTRAL, PubMed, Embase, Web of Science, Scopus, and BASE for RCTs, which have used adjuvant antimetabolites-either MMC or 5-Fluorouracil (5-FU)-and/or anti-vascular endothelial growth factors (anti-VEGF) agents. The main outcome was IOP reduction at 12 months. RESULTS Ten studies met our inclusion criteria. Nine used the Ahmed Glaucoma Valve (AGV) implant, while the double-plate Molteno implant was used in one study. Four studies used MMC. The remaining six studies used an anti-VEGF drug - either bevacizumab, ranibizumab or conbercept. Only one MMC-study reported a significant difference in the IOP reduction between groups at 12 months, favouring the MMC group (55% and 51%; p < 0.01). A significant difference was also reported by two out of five bevacizumab-studies, both favouring the bevacizumab group (55% and 51%, p < 0.05; 58% and 27%, p < 0.05), with the highest benefit seen in neovascular glaucoma cases, especially when panretinal photocoagulation (PRP) was also used. Neither ranibizumab nor conbercept were found to produce significant differences between groups regarding IOP reduction. CONCLUSION There is no high-quality evidence to support the use of MMC in tube shunt surgery. As for anti-VEGF agents, specifically bevacizumab, significant benefit seems to exist in neovascular glaucoma patients, especially if combined with PRP.
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Affiliation(s)
| | - Joao Barbosa-Breda
- Department of Surgery and Physiology, UnIC@RISE, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Ophthalmology, Centro Hospitalar E Universitário São João, Porto, Portugal
- Research Group Ophthalmology, Department of Neurosciences, KULeuven, Louvain, Belgium
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24
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Wang D, Pu Y, Tan S, Wang X, Zeng L, Lei J, Gao X, Li H. Identification of immune-related biomarkers for glaucoma using gene expression profiling. Front Genet 2024; 15:1366453. [PMID: 38694874 PMCID: PMC11062407 DOI: 10.3389/fgene.2024.1366453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/03/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction: Glaucoma, a principal cause of irreversible vision loss, is characterized by intricate optic neuropathy involving significant immune mechanisms. This study seeks to elucidate the molecular and immune complexities of glaucoma, aiming to improve our understanding of its pathogenesis. Methods: Gene expression profiles from glaucoma patients were analyzed to identify immune-related differentially expressed genes (DEGs). Techniques used were weighted gene co-expression network analysis (WGCNA) for network building, machine learning algorithms for biomarker identification, establishment of subclusters related to immune reactions, and single-sample gene set enrichment analysis (ssGSEA) to explore hub genes' relationships with immune cell infiltration and immune pathway activation. Validation was performed using an NMDA-induced excitotoxicity model and RT-qPCR for hub gene expression measurement. Results: The study identified 409 DEGs differentiating healthy individuals from glaucoma patients, highlighting the immune response's significance in disease progression. Immune cell infiltration analysis revealed elevated levels of activated dendritic cells, natural killer cells, monocytes, and immature dendritic cells in glaucoma samples. Three hub genes, CD40LG, TEK, and MDK, were validated as potential diagnostic biomarkers for high-risk glaucoma patients, showing increased expression in the NMDA-induced excitotoxicity model. Discussion: The findings propose the three identified immune-related genes (IRGs) as novel diagnostic markers for glaucoma, offering new insights into the disease's pathogenesis and potential therapeutic targets. The strong correlation between these IRGs and immune responses underscores the intricate role of immunity in glaucoma, suggesting a shift in the approach to its diagnosis and treatment.
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Affiliation(s)
- Dangdang Wang
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for the Prevention and Treatment of Major Blinding Eye Diseases, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Yanyu Pu
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for the Prevention and Treatment of Major Blinding Eye Diseases, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Sisi Tan
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for the Prevention and Treatment of Major Blinding Eye Diseases, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Xiaochen Wang
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for the Prevention and Treatment of Major Blinding Eye Diseases, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Lihong Zeng
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for the Prevention and Treatment of Major Blinding Eye Diseases, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Junqin Lei
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for the Prevention and Treatment of Major Blinding Eye Diseases, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Xi Gao
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for the Prevention and Treatment of Major Blinding Eye Diseases, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Hong Li
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for the Prevention and Treatment of Major Blinding Eye Diseases, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
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25
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Paleel F, Qin M, Tagalakis AD, Yu-Wai-Man C, Lamprou DA. Manufacturing and characterisation of 3D-printed sustained-release Timolol implants for glaucoma treatment. Drug Deliv Transl Res 2024:10.1007/s13346-024-01589-8. [PMID: 38578377 DOI: 10.1007/s13346-024-01589-8] [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] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
Timolol maleate (TML) is a beta-blocker drug that is commonly used to lower the intraocular pressure in glaucoma. This study focused on using a 3D printing (3DP) method for the manufacturing of an ocular, implantable, sustained-release drug delivery system (DDS). Polycaprolactone (PCL), and PCL with 5 or 10% TML implants were manufactured using a one-step 3DP process. Their physicochemical characteristics were analysed using light microscopy, scanning electronic microscopy (SEM), differential scanning calorimetry (DSC) / thermal gravimetric analysis (TGA), and Fourier-transform infrared spectroscopy (FTIR). The in vitro drug release was evaluated by UV-spectrophotometry. Finally, the effect of the implants on cell viability in human trabecular meshwork cells was assessed. All the implants showed a smooth surface. Thermal analysis demonstrated that the implants remained thermally stable at the temperatures used for the printing, and FTIR studies showed that there were no significant interactions between PCL and TML. Both concentrations (5 & 10%) of TML achieved sustained release from the implants over the 8-week study period. All implants were non-cytotoxic to human trabecular cells. This study shows proof of concept that 3DP can be used to print biocompatible and personalised ocular implantable sustained-release DDSs for the treatment of glaucoma.
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Affiliation(s)
- Fathima Paleel
- School of Pharmacy, Queen's University Belfast, BT9 7BL, Belfast, UK
- Faculty of Life Sciences & Medicine, King's College London, SE1 7EH, London, UK
| | - Mengqi Qin
- Faculty of Life Sciences & Medicine, King's College London, SE1 7EH, London, UK
| | | | - Cynthia Yu-Wai-Man
- Faculty of Life Sciences & Medicine, King's College London, SE1 7EH, London, UK.
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26
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Choe E, Poleon S, Thomas T, Racette L. The association between perceived cause of glaucoma and illness perceptions. Front Med (Lausanne) 2024; 11:1363732. [PMID: 38638934 PMCID: PMC11024309 DOI: 10.3389/fmed.2024.1363732] [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: 12/31/2023] [Accepted: 03/14/2024] [Indexed: 04/20/2024] Open
Abstract
Purpose The perceived cause of disease is an important factor that has been linked with treatment outcomes but has not been fully assessed in primary open-angle glaucoma (POAG). This study assessed the accuracy of patients' perceived cause of POAG and identified associations between accuracy, illness perceptions, medication adherence, and quality of life (QoL). Methods The Brief Illness Perception Questionnaire (BIPQ) was used to assess illness perceptions and asked patients to rank the three most important causes of their disease in order of importance. POAG risk factors recognized by the American Academy of Ophthalmology were used to code responses as accurate or inaccurate based on the following three methods: (1) coding any reported cause, regardless of rank, (2) coding only the first-ranked cause, and (3) coding and weighting all reported causes. Medication adherence was measured electronically. QoL was measured using the Glaucoma Quality of Life questionnaire. Mann-Whitney U test was used to detect differences in illness perceptions, medication adherence, and QoL between accuracy groups. Results A total of 97 patients identified a cause of their POAG and were included in this analysis. A higher proportion of patients reported an accurate cause (86.6% using method 1, 78.4% using method 2, and 79.4% using method 3; all p < 0.001). Mean medication adherence was 86.0% ± 17.8 and was similar across accuracy groups (all p > 0.05). Using method 2 (p = 0.045) and method 3 (p = 0.028), patients who reported an accurate cause of their POAG believed that their illness would last for a longer time compared to patients who reported an inaccurate cause. Method 3 also revealed that patients who reported an accurate cause of their POAG had lower perceived understanding of their illness (p = 0.048) compared to patients who reported an inaccurate cause. There were no differences in QoL between accuracy groups (all p > 0.05). Conclusion This study highlights the association between perceived cause of POAG and illness perceptions related to knowledge level and POAG duration. Future studies should assess associations between perceived cause of disease and other critical dimensions of illness perception.
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Affiliation(s)
| | | | | | - Lyne Racette
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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27
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Kaya O, Akif Aydin M, Teymoori M, Kaan Erden O, Sadeghzadeh S, Dedeoglu UO, Demir S, Muhikanci O, Sahin A, Torun H, Dundar G, Yalcinkaya AD. A first-in-human pilot study of a novel electrically-passive metamaterial-inspired resonator-based ocular sensor embedded contact lens monitoring intraocular pressure fluctuations. Cont Lens Anterior Eye 2024; 47:102102. [PMID: 38114379 DOI: 10.1016/j.clae.2023.102102] [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: 08/09/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 12/21/2023]
Abstract
Glaucoma is a leading cause of blindness with no cure, but early treatment and effective monitoring can often slow the progression of the disease. Monitoring of glaucoma is based on the measurement of intra-ocular pressure (IOP) that is a physiological parameter related to the mechanical state and parameters of the eye. Conventionally, diagnosing and assessing the progression of glaucoma is based on the method of measuring IOP discretely at clinics. Recent studies have demonstrated the importance of continuously monitoring IOP for 24 h to elucidate the effect of circadian rhythm. In this work, a metamaterial-inspired electrically-passive sensor-embedded contact lens is presented to monitor the IOP fluctuations based on a first-in-human pilot study. The sensor inside the contact lens is an electrically passive, metamaterial-based resonator that can be measured using a wearable antenna patch. The system has been tested with six healthy volunteers during an experiment to induce deliberate IOP changes via water-loading and placing the individuals in supine position using a recliner seat. The initial data compared with tonometer measurements suggest that the system can be used to assess the variation of IOP continuously.
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Affiliation(s)
- Ozgur Kaya
- Glakolens, Bogazici Universitesi Teknopark 302, 34470 Istanbul, Turkiye
| | - M Akif Aydin
- Glakolens, Bogazici Universitesi Teknopark 302, 34470 Istanbul, Turkiye
| | - Morteza Teymoori
- Glakolens, Bogazici Universitesi Teknopark 302, 34470 Istanbul, Turkiye
| | - Oguz Kaan Erden
- Glakolens, Bogazici Universitesi Teknopark 302, 34470 Istanbul, Turkiye
| | | | - Ulas O Dedeoglu
- Glakolens, Bogazici Universitesi Teknopark 302, 34470 Istanbul, Turkiye
| | - Saibe Demir
- Glakolens, Bogazici Universitesi Teknopark 302, 34470 Istanbul, Turkiye
| | - Omer Muhikanci
- Glakolens, Bogazici Universitesi Teknopark 302, 34470 Istanbul, Turkiye
| | - Afsun Sahin
- Department of Ophthalmology, Koc University Medical School, Istanbul, Turkiye
| | - Hamdi Torun
- Faculty of Engineering & Environment, University of Northumbria, Newcastle Upon Tyne, NE1 8ST, UK.
| | - Gunhan Dundar
- Department of Electrical and Electronics Engineering, Bogazici University, Bebek 34342 Istanbul, Turkiye
| | - Arda D Yalcinkaya
- Department of Electrical and Electronics Engineering, Bogazici University, Bebek 34342 Istanbul, Turkiye
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28
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Shokoohi-Rad S, Ansar AR, Vatandoost A, Firoozi J. Evaluation of Intrascleral Lakes after Phaco-Viscocanalostomy using Anterior Segment Optical Coherence Tomography. J Ophthalmic Vis Res 2024; 19:161-171. [PMID: 39055504 PMCID: PMC11267143 DOI: 10.18502/jovr.v19i2.13228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/06/2023] [Indexed: 07/27/2024] Open
Abstract
Purpose This study aimed to investigate the results of combined phacoemulsification and viscocanalostomy (phaco-VC) in a six-month follow-up and its relationship with intrascleral lake (IL) using anterior segment optical coherence tomography (AS-OCT) in patients with primary open-angle glaucoma (POAG). Methods In total, 36 eyes with POAG eligible for phaco-VC were enrolled in this prospective observational study. All patients underwent AS-OCT evaluation and ophthalmologic examination including Goldman tonometry, cup-disc ratio assessment, best corrected visual acuity (BCVA) measurement, and antiglaucoma medication(s) prior to surgery and one, three, and six months after the surgery. The width, length, area, and circumference of the ILs were evaluated using AS-OCT at each follow-up. Results A total of 36 eyes of 34 patients with POAG were investigated in this study. According to the results, the mean age of the patients was 70.09 ± 8.73 years, and the majority of the cases were male (n = 23; 63.9%). The mean preoperative intraocular pressure (IOP) was 20.11 ± 7.22 mmHg on 2.47 ± 1.1 medications, and the mean postoperative IOP reduced to 11.11 ± 2.58 mmHg on 0.11 medications, which was statistically significant (P < 0.001). ILs were detectable in all cases which resulted in a 100% qualified success rate. The reduction in the width, area, and circumference of the IL was significant during the six-month follow-up. The relationship between IOP changes and IL parameters on AS-OCT was not significant. Conclusion This study evaluated the associations between IL changes and IOP reduction after phaco-VC. A six-month follow-up showed a notable reduction in the IL, but unexpectedly, IOP control did not decline. A reduction in IL diameter, when there is sufficient IOP control, indicates that there may be various IOP lowering mechanisms through VC other than the IL diameters. Further evaluation of VC focusing on long-term changes in IL and Schlemm's canal diameter is necessary to explain the precise mechanisms of lowering the IOP.
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Affiliation(s)
- Saeed Shokoohi-Rad
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir-reza Ansar
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Vatandoost
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Firoozi
- Eye Research Center, The Five Senses Research Institute, Rassoul Akram Hospital, Iran University of Medical Sciences,
Tehran, Iran
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29
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Johansyah CAP, Bambang L. A Systematic Review of Cyclophotocoagulation Techniques: Continuous Wave Versus Micropulse for Glaucoma Treatment. BEYOGLU EYE JOURNAL 2024; 9:1-7. [PMID: 38504958 PMCID: PMC10944853 DOI: 10.14744/bej.2024.47123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/31/2023] [Accepted: 01/05/2024] [Indexed: 03/21/2024]
Abstract
Objectives Micro-pulse cyclophotocoagulation (MP-CPC) represents the latest iteration of minimally invasive laser procedures aimed at reducing intraocular pressure (IOP) through the disruption of pigmented ciliary body epithelium. This systematic review aims to assess the efficacy and safety profile of the MP-CPC procedure in comparison to CW-CPC for the treatment of glaucoma. Methods We initiated a search on PubMed, ScienceDirect, and the Cochrane Library databases for studies that compared micro-pulse and traditional CW-CPC in terms of their efficacy and safety profiles. We employed medical subject headings terms and keywords such as "cyclophotocoagulation," "cyclodestructive," "photocoagulation," "CPC," "micropulse," "micro-pulse," and "glaucoma" within the timeframe from 2015 to 2023. We assessed the success rate, IOP reduction, antiglaucoma medications, and complications of MP-CPC and CW-CPC. Results We included six articles in this study, comprising two randomized controlled trials, three retrospective, and one prospective cohort, published between 2015 and 2023. Five out of six reported a significant reduction in IOP for both procedures with comparable success rates observed in MP-CPC compared to CW-CPC. One article reported an increase in IOP in MP-CPC. Both groups reported a decrease in the number of antiglaucoma medications, while one study reported an increase in medications in both MP-CPC and CW-CPC groups. Complication rates were lower in the MP-CPC group with two articles reporting a significant decrease compared to the CW-CPC group. Conclusion MP-CPC has shown promising results in the treatment of glaucoma in the adult population. With comparable results in IOP reduction and fewer instances of serious ocular complications, MP-CPC may open new possibilities for the use of cyclophotocoagulation procedures in the earlier stages of glaucoma. However, its efficacy in the pediatric population and for neovascular glaucoma remains less defined, thus warranting further studies to establish optimal laser parameters for different types of glaucoma and specific populations of glaucoma patients.
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Affiliation(s)
| | - Leliana Bambang
- Department of Ophthalmology, Oen General Hospital, Sukoharjo, Central Java, Indonesia
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30
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Green S, Ng RJ, Phillips G, Gosling D, Patel HY. Glaucoma Agreement in New Zealand (GAINZ). Clin Exp Optom 2024; 107:204-212. [PMID: 38166354 DOI: 10.1080/08164622.2023.2291063] [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: 10/13/2022] [Accepted: 11/25/2023] [Indexed: 01/04/2024] Open
Abstract
CLINICAL RELEVANCE With an ageing population, ophthalmologists are becoming burdened with glaucoma management, and patient care can be delayed. Therefore, the use of optometrists in glaucoma management can help alleviate the burden. BACKGROUND The ageing population and subsequent rise of glaucoma prevalence are putting a strain on the public health system in New Zealand. Glaucoma collaborative care between optometrists and ophthalmologists has been gaining support with the aim to reduce this burden on ophthalmologists. There has been little investigation of the agreement in care and management of mild-to-moderate severity glaucoma patients by optometrists and ophthalmologists. METHODS One hundred and three glaucomatous eyes were used in a survey where clinical history and examination, intraocular pressures (IOPs), visual field testing and optical coherence tomography (OCT) imaging were evaluated for glaucoma progression and decision-making regarding subsequent management by four participants. Two participants were glaucoma-credentialled optometrists (Group 1), and the other two were glaucoma specialists (Group 2). RESULTS With respect to glaucoma progression, Spearman coefficients identified strong agreement between the two groups for IOP, visual fields and overall status and moderate agreement for OCT imaging. A confusion matrix was used to analyse management and found 80% ± 10% agreement between the two groups. Review periods gave an agreement of 55% ± 20% between the two groups. CONCLUSION There was strong agreement in the assessment of glaucoma progression between the two groups. The 80% level of agreement for subsequent management between the two groups is comparable to other published reports. These results provide some reassurance that a collaborative care system can perform safely and as intended.
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Affiliation(s)
- Stephanie Green
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
- New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Robert J Ng
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
- New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Geraint Phillips
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
- New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Daniel Gosling
- Department of Ophthalmology, Te Whatu Ora Health New Zealand (Northern Region), Auckland, New Zealand
| | - Hussain Y Patel
- New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Te Whatu Ora Health New Zealand (Northern Region), Auckland, New Zealand
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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Terheyden JH, Fink DJ, Mercieca K, Wintergerst MWM, Holz FG, Finger RP. Knowledge about age-related eye diseases in the general population in Germany. BMC Public Health 2024; 24:409. [PMID: 38331775 PMCID: PMC10851458 DOI: 10.1186/s12889-024-17889-0] [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: 11/15/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND With a rising prevalence of age-related eye diseases, prevention and early diagnosis of these conditions are key goals of public eye health. Disease-related knowledge in the general public supports these goals but there is little data available. Thus, we have assessed knowledge of cataract, glaucoma, age-related macular degeneration (AMD) and diabetic eye disease in the German adult general population in a cross-sectional study and identified target groups for health education interventions. METHODS Knowledge assessment content was identified based on a literature review, expert input, and a list of items was generated after a qualitative selection process. The resulting 16-item instrument (4 items per condition) was administered to 1,008 participants from a survey panel, demographically representative of the adult German population. Test properties were evaluated based on a Rasch model and multiple correspondence analysis (MCA). Binary-logistic regression analysis was performed to investigate associations with age, sex, education level, employment status, marital status, income, reported health status, visual difficulties, and recent general practitioner (GP) and ophthalmologist consultations. RESULTS Replies were correct for a median of 9 out of 16 (range 2 - 16) items, which differed between conditions (p < 0.0001). Most responses were correct for cataract items (median: 3 / 4) and least were correct for AMD items (median: 2 / 4). 27%, 9%, 1% and 19% of respondents replied correctly to all cataract, glaucoma, AMD and diabetic eye disease-related items, respectively. Rasch analysis suggested an adequate targeting of items and in MCA, no evidence of multidimensionality was present. Older age, being retired, decreased general health and recent GP or ophthalmology consultations were significantly associated with more knowledge about common eye conditions (p ≤ 0.005). GP or ophthalmology consultations remained significant in a multivariable model (p ≤ 0.011). CONCLUSIONS Knowledge gaps regarding eye health are considerable in the German general population and should therefore be addressed in educational interventions targeting the public. Special attention when designing such campaigns needs to be paid to infrequent users of the healthcare system. Knowledge of AMD seems to be poorer compared to other eye conditions.
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Affiliation(s)
- Jan Henrik Terheyden
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, NRW, Germany.
| | - David J Fink
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, NRW, Germany
| | - Karl Mercieca
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, NRW, Germany
| | | | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, NRW, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, NRW, Germany
- Department of Ophthalmology, University Hospital Mannheim & Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Husain KA, Alaali H, Alarayedh GG. Prevalence and Characteristics of Glaucoma Among Patients Presenting to Ophthalmology Clinics in a Tertiary Hospital in the Kingdom of Bahrain. Cureus 2024; 16:e54129. [PMID: 38487113 PMCID: PMC10939155 DOI: 10.7759/cureus.54129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction The aim of this study was to determine the prevalence and characteristics of glaucoma in patients presenting to the ophthalmology department in a tertiary hospital in Bahrain for the first time. Methods A retrospective study was conducted at the Salmaniya Medical Complex, Manama, Bahrain. The medical records of all patients who presented for the first time to an eye clinic between January and December 2019 were reviewed. Patients who were diagnosed with glaucoma were included in this study. Data regarding age, sex, ethnicity, type of glaucoma, previous treatment, best corrected visual acuity, cup-to-disc ratio, intraocular pressure, central corneal thickness, optical coherence tomography (OCT) retinal nerve fiber layer (RNFL), and visual field findings were collected. Results Of a total of 18,238 new patients in 2019, 173 patients (0.97%) had glaucoma. The mean age of patients with glaucoma was 59.6 ± 11.3 years and approximately 60% of them were males (n=103, 59.5%). In 93% of the cases, glaucoma involved both eyes (n=161). Primary open-angle glaucoma (n=97, 56.1%), normal tension glaucoma (n=28, 16.2%), and chronic angle closure glaucoma (n=15, 8.7%) were the most frequently encountered types of glaucoma. Approximately 16.76% (n=29) of the patients were blind in one or two eyes at the time of presentation. Conclusion There seems to be a low prevalence of glaucoma among the encountered cases on the first visit to ophthalmology clinics in Bahrain, with primary open-angle glaucoma being the most common type.
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Affiliation(s)
- Khatoon A Husain
- Ophthalmology Department, Salmaniya Medical Complex, Manama, BHR
| | - Haneen Alaali
- Ophthalmology Department, Salmaniya Medical Complex, Manama, BHR
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Elabd IH, Elsayed AA, Elgazzar AF, Ezzeldin ER, Hassanein M, Soliman HB, GadElkareem AM, Eltantawy B, Omran MY, Okasha MG, Mahmoud H, Alkady AMM, Abd Rbu MH, Hegazy HS, Mansour MN, Tharwat E. Non-penetrating deep sclerectomy versus combined trabeculotomy-trabeculectomy in primary congenital glaucoma. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2024; 12:168-176. [PMID: 38601053 PMCID: PMC11002464 DOI: 10.51329/mehdiophthal1483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/29/2024] [Indexed: 04/12/2024]
Abstract
Background The primary mode of therapy in children with primary congenital glaucoma (PCG) and mild or no corneal edema is goniotomy, which has a high success rate. However, in developing countries, the diagnosis of PCG is usually delayed, and corneal cloudiness interferes with goniotomy. Therefore, trabeculotomy may be the best choice in such eyes. We compared the short-term efficacy and safety of primary combined trabeculotomy-trabeculectomy (primary CTT) with that of non-penetrating deep sclerectomy (NPDS) in managing PCG. Methods This prospective, randomized, comparative study included patients with PCG referred to Al-Azhar University Hospitals within a 1-year period. Eyes were randomly allocated to one of two groups: eyes in NPDS group underwent NPDS, and those in primary CTT group underwent primary CTT. Baseline and frequent postoperative assessments of intraocular pressure (IOP), cup-to-disc ratio (C/D ratio), corneal diameter, and axial length were performed for up to 6 months. The success rates were recorded in both groups. Results Forty eyes of 26 patients were included, with 20 eyes allocated to each group. The mean (standard deviation) age of all patients was 12.9 (9.5) months, with comparable ages and sex ratios between groups (both P > 0.05). Both groups demonstrated a significant reduction in IOP and C/D ratio at each postoperative visit compared to the baseline visit (all P < 0.001), with no significant difference detected between the groups (all P > 0.05), except for a significantly lower IOP in NPDS group at 1 month (P < 0.05). The corneal diameter and axial length were comparable between groups at baseline and remained unchanged at all postoperative visits (all P > 0.05). The groups had comparable success rates (P > 0.05). No serious complications were detected. Conclusions CTT and NPDS both yielded reasonable IOP control and reversal of cupping in eyes with PCG. We observed equal effectiveness of the surgical procedures without major safety concerns. Further large-scale clinical trials with longer follow-up periods are needed to verify our preliminary findings.
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Affiliation(s)
- Ibrahim Hassan Elabd
- Department of Ophthalmology, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
| | - Ahmed A Elsayed
- Department of Ophthalmology, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
| | - Akram Fekry Elgazzar
- Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | | | - Mohamed Hassanein
- Department of Ophthalmology, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
| | - Haitham Beshr Soliman
- Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | | | - Basheer Eltantawy
- Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Mohamed Yahia Omran
- Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Mohamed Gaber Okasha
- Department of Ophthalmology, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
| | - Hatem Mahmoud
- Department of Ophthalmology, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
| | | | - Mahmoud H Abd Rbu
- Department of Ophthalmology, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
| | - Hanan Saied Hegazy
- Department of Ophthalmology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Mona N Mansour
- Department of Ophthalmology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Ehab Tharwat
- Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
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Zarzecki M, Obuchowska I, Ustymowicz A, Konopińska J. Glaucoma Surgery and Ocular Blood Flow in Colour Doppler Imaging: Is There a Link? Clin Ophthalmol 2024; 18:49-60. [PMID: 38205265 PMCID: PMC10778180 DOI: 10.2147/opth.s441805] [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: 09/24/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
Glaucoma is a common cause of blindness worldwide. This disease is characterised by increased intraocular pressure (IOP) and the concomitant disruption of ocular haemodynamic. Several studies have demonstrated that trabeculectomy is associated with changes in extraocular blood flow. In this study, we reviewed the available evidence on the use of colour Doppler imaging to evaluate and manage patients with open-angle glaucoma. We present the detailed anatomy of ocular blood flow to provide a background for the research findings. We also discuss the physiological foundations of ocular blood flow and detailed flow characteristics of specific extraocular vessels. Finally, we reviewed published studies that analysed the effects of glaucoma surgery on the blood flow parameters of the eye.
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Affiliation(s)
- Mateusz Zarzecki
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, Poland
| | - Iwona Obuchowska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, Poland
| | - Andrzej Ustymowicz
- Department of Radiology, Medical University of Bialystok, Bialystok, Poland
| | - Joanna Konopińska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, Poland
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Shin YI, Jeong Y, Huh MG, Kim YK, Park KH, Jeoung JW. Longitudinal evaluation of advanced glaucoma: ten year follow-up cohort study. Sci Rep 2024; 14:476. [PMID: 38177211 PMCID: PMC10766632 DOI: 10.1038/s41598-023-50512-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
This study focused on patients with advanced open-angle glaucoma (OAG) and aimed to identify key factors for monitoring them. We included 127 such patients who were followed for seven years or more, undergoing annual ophthalmic examinations. Glaucoma progression was defined as a deterioration in either structure or function. The progression rates and risk factors were evaluated. The patients were divided into upper- and lower-half subgroups based on the reduction in intraocular pressure (IOP) from the baseline. Over an 11-year period, glaucoma progression was detected in 59 eyes (46.5%). The rate of change in mean deviation (MD) was - 0.43 dB/year for the entire population; - 0.67 dB/year for progressors; and - 0.20 dB/year for non-progressors. Hypertension and disc hemorrhage (DH) were more common in progressors compared to non-progressors (45.8 vs. 23.5%, 11.9 vs. 1.5%; P = 0.008 and P = 0.016). Multivariate Cox's proportional hazard model revealed that the presence of DH and a better baseline MD were associated with glaucoma progression. Additionally, patients with a higher percentage reduction in IOP (> 20.94%) had a lower risk of progression compared to those with less reduction. Inadequate IOP reduction, better baseline MD, presence of DH, and lower central corneal thickness were identified as risk factors for progression in advanced OAG patients.
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Affiliation(s)
- Young In Shin
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Yoon Jeong
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Min Gu Huh
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
- Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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36
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Aprelev AE, Sukmanyuk EO, Medunitsyna AM. [The association between myopia and glaucoma]. Vestn Oftalmol 2024; 140:93-98. [PMID: 38450472 DOI: 10.17116/oftalma202414001193] [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: 03/08/2024]
Abstract
Myopia and glaucoma are the leading causes of irreversible blindness in the world, and as the number of nearsighted people is predicted to increase sharply in the upcoming decades, an increase in combined pathology is expected. This article analyzes literature sources to assess the epidemiology of glaucoma and myopia both worldwide and in the Russian Federation, examine the anatomical changes of the eyeball associated with these diseases, and identify the diagnostic criteria that facilitate the verification of glaucoma when combined with myopia.
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Affiliation(s)
- A E Aprelev
- Orenburg State Medical University, Orenburg, Russia
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37
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Kuciel-Polczak I, Kawka-Osuch M, Krysik K, Dobrowolski D, Janiszewska-Bil D, Wylęgała E, Grabarek BO, Białkowska M, Lyssek-Boroń A. Efficacy of Continuous-Wave Transscleral Cyclophotocoagulation Post-Pars Plana Vitrectomy in Glaucoma Patients: A Retrospective Study from Poland. Med Sci Monit 2023; 29:e941770. [PMID: 38130054 PMCID: PMC10750432 DOI: 10.12659/msm.941770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Glaucoma, a vision-threatening condition, results from optic nerve damage and affects millions of people worldwide. Often asymptomatic, it is hereditary, with risk factors like hypertension, diabetes, and steroid use. Despite its link with intraocular pressure (IOP), not everyone with high IOP develops glaucoma. After pars plana vitrectomy (PPV), patients face increased IOP risks. Traditional treatment includes pharmacotherapy, and, when ineffective, surgical interventions. Continuous-wave transscleral cyclophotocoagulation (CW-TSCPC) is an alternative for refractory glaucoma but can have complications. Our study compares the efficacy and safety of CW-TSCPC after PPV. MATERIAL AND METHODS The study group consisted of 18 patients diagnosed with glaucoma who underwent the CW-TSCP procedure as the first-choice therapy after conservative treatment of glaucoma proved ineffective. The comparison group consisted of 12 patients who underwent the CW-TSCP procedure after conservative drug treatment and in whom surgical treatment of glaucoma had been unsuccessful. All patients had inadequate control of IOP after PPV. RESULTS Study and comparison group patients showed a decrease in IOP during the follow-up, independent of the type of endotamponade used (P<0.05). When the indication for PPV was retinal detachment hemorrhage into the vitreous chamber, a significant decrease in IOP between 0 days and 180 days was only found in the study group (P<0.05). In contrast, when the indication for PPV was the state after uveitis or proliferative diabetic retinopathy, a significant decrease in IOP was found at 180 days in the study and comparison groups (P<0.05). CONCLUSIONS The analysis showed that the CW-TSCPC procedure can be recommended as the first-choice invasive treatment in patients with increased IOP after PPV.
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Affiliation(s)
- Izabela Kuciel-Polczak
- Department of Ophthalmology, Trauma Centre, St. Barbara Hospital, Sosnowiec, Poland
- Department of Ophthalmology, Faculty of Medicine in Zabrze, Academy of Silesia, Katowice, Poland
| | | | - Katarzyna Krysik
- Department of Ophthalmology, Trauma Centre, St. Barbara Hospital, Sosnowiec, Poland
- Department of Ophthalmology, Faculty of Medicine in Zabrze, Academy of Silesia, Katowice, Poland
| | - Dariusz Dobrowolski
- Department of Ophthalmology, Trauma Centre, St. Barbara Hospital, Sosnowiec, Poland
- Chair and Clinical Department of Ophthalmology, Division of Medical Science in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
- Department of Ophthalmology, District Railway Hospital, Katowice, Poland
| | - Dominika Janiszewska-Bil
- Department of Ophthalmology, Trauma Centre, St. Barbara Hospital, Sosnowiec, Poland
- Optegra Clinic in Katowice, Katowice, Poland
- Collegium Medicum, WSB University, Dąbrowa Górnicza, Poland
| | - Edward Wylęgała
- Chair and Clinical Department of Ophthalmology, Division of Medical Science in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | | | - Monika Białkowska
- The Higher School of Strategic Planning in Dąbrowa Górnicza, Dąbrowa Górnicza, Poland
| | - Anita Lyssek-Boroń
- Department of Ophthalmology, Trauma Centre, St. Barbara Hospital, Sosnowiec, Poland
- Department of Ophthalmology, Faculty of Medicine in Zabrze, Academy of Silesia, Katowice, Poland
- Optegra Clinic in Cracow, Cracow, Poland
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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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Andini EA, Avianty A, Herman H, Choliq A. Efficacy and Safety of Manual Small-Incision Cataract Surgery With Trabeculectomy Versus Phacotrabeculectomy in Patients With Glaucoma and Cataract: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e51025. [PMID: 38264398 PMCID: PMC10804908 DOI: 10.7759/cureus.51025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/25/2024] Open
Abstract
The coexistence of two globally leading causes of blindness, glaucoma and cataracts, is common. Combining trabeculectomy with cataract surgery is a common practice while determining the preferred surgical management for patients is a complex consideration. Therefore, a systematic review and meta-analysis were conducted to compare the efficacy and safety of two surgical procedures, manual small-incision cataract surgery (MSICS) combined with trabeculectomy and phacotrabeculectomy. A comprehensive search was performed in PubMed, Science Direct, and Cochrane Library published up to March 2023. Articles not indexed in those databases were also searched. Pooled odds ratios (OR) and mean differences (MD) with corresponding 95% confidence interval (CI) were also retrieved to compare the outcomes estimating efficacy and safety. Biases in selected studies were assessed. A total of seven studies consisting of 352 eyes for MSICS with trabeculectomy and 348 eyes for phacotrabeculectomy were included. Postoperative intraocular pressure (IOP) was comparable between the two techniques (MD: -0.45; 95% CI: -1.07 to 0.16; p = 0.15). Postoperative best corrected visual acuity (BCVA) <6/12 (OR: 1.26; 95% CI: 0.62 to 2.53; p = 0.52), complete success (OR: 0.92; 95% CI: 0.51 to 1.67; p = 0.78), and postoperative complications (OR: 1.27; 95% CI: 0.75 to 2.15, p = 0.38) did not differ significantly. This meta-analysis indicated comparable efficacy and safety profile between MSICS with trabeculectomy and phacotrabeculectomy. Further high-quality studies are required to confirm these findings.
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Affiliation(s)
- El A Andini
- Ophthalmology, Gunung Jati Regional General Hospital, Cirebon, IDN
| | - Astri Avianty
- Ophthalmology, Gunung Jati Regional General Hospital, Cirebon, IDN
| | - Herman Herman
- Ophthalmology, Gunung Jati Regional General Hospital, Cirebon, IDN
| | - Abdul Choliq
- Ophthalmology, Gunung Jati Regional General Hospital, Cirebon, IDN
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Dickinson A, Leidy L, Nusair O, Rachapudi S, Valenzuela T, Ramulu P, Mihailovic A, Yohannan J, Kaleem M, Johnson TV, An J. Prediction of MIGS outcomes on second eyes using first eyes' response. Medicine (Baltimore) 2023; 102:e36006. [PMID: 38013328 PMCID: PMC10681506 DOI: 10.1097/md.0000000000036006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/17/2023] [Indexed: 11/29/2023] Open
Abstract
To evaluate how well outcomes following cataract extraction and microinvasive glaucoma surgery in one eye predict outcomes in sequential second eye. Retrospective study of 78 patients who underwent cataract extraction and microinvasive glaucoma surgery in both eyes. Linear regressions using Pearson correlation coefficients were used to evaluate correlations in intraocular pressure and glaucoma medication change between eyes. Multivariable logistic regression models were used to evaluate the associations between first-eye variables and the likelihood of second-eye surgical success at 6 months. Surgical success was defined as meeting target intraocular pressure without additional medications compared to baseline or secondary surgical interventions. Baseline ocular characteristics were comparable between fellow eyes, with the majority having mild glaucoma. Intraocular pressure changes between fellow eyes at 6 months were modestly correlated between eyes (R = 0.48; P < .001). Changes in glaucoma medications were strongly correlated between eyes at all time points, and month 6 demonstrated the most significant correlation (R = 0.80; P < .001). First and second eye cohorts achieved 82% and 83% surgical success. Multivariate analysis for predictive factors of successful second eye surgery showed patients with successful first eye surgery at 6 months were significantly more likely to have successful second eye surgery (odds ratio, 20.67; P < .001). Reductions in intraocular pressure and glaucoma medications at 6 months following surgery in first eyes are correlated to second eye reductions. Successful surgical outcomes at 6 months following first eye surgeries are strongly associated with successful sequential second eye outcomes.
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Affiliation(s)
- Anna Dickinson
- Eastern Virginia Medical School, Norfolk, VA
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Luke Leidy
- Eastern Virginia Medical School, Norfolk, VA
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Omar Nusair
- Johns Hopkins University School of Medicine, Baltimore, MD
- Northeast Ohio Medical University, Rootstown, OH
| | - Sruti Rachapudi
- Johns Hopkins University School of Medicine, Baltimore, MD
- University of Texas Medical Branch School of Medicine, Galveston, TX
| | - Tony Valenzuela
- Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Faculty of Medicine, Baltimore, MD
| | - Pradeep Ramulu
- Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Faculty of Medicine, Baltimore, MD
| | - Aleksandra Mihailovic
- Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Faculty of Medicine, Baltimore, MD
| | - Jithin Yohannan
- Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Faculty of Medicine, Baltimore, MD
| | - Mona Kaleem
- Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Faculty of Medicine, Baltimore, MD
| | - Thomas V. Johnson
- Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Faculty of Medicine, Baltimore, MD
| | - Jella An
- Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Faculty of Medicine, Baltimore, MD
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Rossi A, Rahimi M, Son T, Chan RVP, Heiferman MJ, Yao X. Preserving polarization maintaining photons for enhanced contrast imaging of the retina. BIOMEDICAL OPTICS EXPRESS 2023; 14:5932-5945. [PMID: 38021139 PMCID: PMC10659774 DOI: 10.1364/boe.501636] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/08/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023]
Abstract
The purpose of this study is to demonstrate the feasibility of using polarization maintaining photons for enhanced contrast imaging of the retina. Orthogonal-polarization control has been frequently used in conventional fundus imaging systems to minimize reflection artifacts. However, the orthogonal-polarization configuration also rejects the directly reflected photons, which preserve the polarization condition of incident light, from the superficial layer of the fundus, i.e., the retina, and thus reduce the contrast of retinal imaging. We report here a portable fundus camera which can simultaneously perform orthogonal-polarization control to reject back-reflected light from the ophthalmic lens and parallel-polarization control to preserve the backscattered light from the retina which partially maintains the polarization state of the incoming light. This portable device utilizes miniaturized indirect ophthalmoscopy illumination to achieve non-mydriatic imaging, with a snapshot field of view of 101° eye-angle (67° visual-angle). Comparative analysis of retinal images acquired with a traditional orthogonal-polarization fundus camera from both normal and diseased eyes was conducted to validate the usefulness of the proposed design. The parallel-polarization control for enhanced contrast in high dynamic range imaging has also been validated.
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Affiliation(s)
- Alfa Rossi
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL 60607, USA
| | - Mojtaba Rahimi
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL 60607, USA
| | - Taeyoon Son
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL 60607, USA
| | - R. V. Paul Chan
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Michael J. Heiferman
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Xincheng Yao
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL 60607, USA
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL 60612, USA
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Wolfram C, Vu TPL, Klemm M, Spitzer M, Beuse A, Grohmann C. [Use of antiglaucomatous drugs in the urban adult population : New Insights into the prevalence of glaucoma from the Hamburg City Health Study]. DIE OPHTHALMOLOGIE 2023; 120:1098-1106. [PMID: 37874364 DOI: 10.1007/s00347-023-01942-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Glaucoma is a widespread ophthalmological disease. Knowledge about the spread of the disease in the population is necessary with respect to further questions on comorbidities, risk factors and the provision of care. OBJECTIVE An analysis of the use of glaucoma medications and the prevalence of glaucoma in an urban adult population was carried out. MATERIAL AND METHODS The Hamburg City Health Study (HCHS) is a prospective, long-term, population-based cohort study that includes a random sample of 45,000 participants aged between 45 and 79 years from the general population of Hamburg, Germany. Apart from various medical parameters, data include premedication and the medical history of the participants. The use of antiglaucomatous medication among the first 10,000 study participants was analyzed and the prevalence of glaucoma was estimated according to the use of medications as well as by the self-reported history of glaucoma. Descriptive analysis and logistic regression analysis were performed to analyze the data and to calculate correlations by age and gender. RESULTS In the study population 319 persons were on medication to lower the intraocular pressure (IOP, mean age 67.1 years, SD = 7.57 years), which is equivalent to an estimated prevalence of 3.35% (95% confidence interval, CI 3.00-3.70%). A positive correlation was observed between age and the use of IOP-lowering medication, which is statistically highly significant (p = < 0.001). The analysis by gender showed a slightly higher prevalence among women, which was not statistically significant. The estimated prevalence according to glaucoma medication and history were only partly congruent. DISCUSSION This estimated prevalence of glaucoma is comparable to other epidemiological studies. The study results cover not only patients with manifest glaucoma but also persons who were treated for ocular hypertension. The inconsistency between the prevalence of glaucoma medication and the diagnosis of glaucoma can be explained by different treatment strategies and also by information deficits.
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Affiliation(s)
- Christian Wolfram
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Tran Phuong Linh Vu
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - Maren Klemm
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - Martin Spitzer
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - Ansgar Beuse
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - Carsten Grohmann
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
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Kuang G, Salowe R, O'Brien J. Paving the way while playing catch up: mitochondrial genetics in African ancestry primary open-angle glaucoma. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1267119. [PMID: 38983031 PMCID: PMC11182247 DOI: 10.3389/fopht.2023.1267119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/28/2023] [Indexed: 07/11/2024]
Abstract
Glaucoma, the leading cause of irreversible blindness worldwide, disproportionately affects individuals of African descent. Specifically, previous research has indicated that primary open-angle glaucoma (POAG), the most common form of disease, is more prevalent, severe, early-onset, and rapidly-progressive in populations of African ancestry. Recent studies have identified genetic variations that may contribute to the greater burden of disease in this population. In particular, mitochondrial genetics has emerged as a profoundly influential factor in multiple neurodegenerative diseases, including POAG. Several hypotheses explaining the underlying mechanisms of mitochondrial genetic contribution to disease progression have been proposed, including nuclear-mitochondrial gene mismatch. Exploring the fundamentals of mitochondrial genetics and disease pathways within the understudied African ancestry population can lead to groundbreaking advancements in the research and clinical understanding of POAG. This article discusses the currently known involvements of mitochondrial genetic factors in POAG, recent directions of study, and potential future prospects in mitochondrial genetic studies in individuals of African descent.
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Affiliation(s)
- Grace Kuang
- Penn Medicine Center for Genetics in Complex Disease, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Rebecca Salowe
- Penn Medicine Center for Genetics in Complex Disease, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Joan O'Brien
- Penn Medicine Center for Genetics in Complex Disease, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Song J, Wang Y, Chen F, Zhu X, Zhu C. The effect and benefit of continuous nursing care in glaucoma patients. Minerva Surg 2023; 78:566-567. [PMID: 36951676 DOI: 10.23736/s2724-5691.23.09827-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Affiliation(s)
- Jia Song
- Department of Ophthalmology, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Yanxi Wang
- Department of Ophthalmology, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Fenglan Chen
- Department of Ophthalmology, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Xiayi Zhu
- Department of Ophthalmology, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Chengxiang Zhu
- Department of Ophthalmology, The Affiliated Hospital of Southwest Medical University, Sichuan, China -
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Cheong AJY, Wang SKX, Woon CY, Yap KH, Ng KJY, Xu FWX, Alkan U, Ng ACW, See A, Loh SRH, Aung T, Toh ST. Obstructive sleep apnoea and glaucoma: a systematic review and meta-analysis. Eye (Lond) 2023; 37:3065-3083. [PMID: 36977937 PMCID: PMC10564942 DOI: 10.1038/s41433-023-02471-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/13/2022] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) has been thought to be associated with glaucoma, however there are many conflicting studies on this topic. With many new studies having been published since the previous meta-analysis, we believe it is important to clarify this association. Hence, in this study we meta-analyse the recent literature regarding the association between OSA and glaucoma. METHODS Pubmed, Embase, Scopus and Cochrane Library were searched from inception till the 28th February 2022 for observational as well as cross-sectional studies examining the association between OSA and glaucoma. Two reviewers selected studies, extracted data, graded the quality of included non-randomized studies using the Newcastle-Ottawa scale. The overall quality of evidence was assessed using GRADE. Random-effects models were used to meta-analyse the maximally covariate- adjusted associations. RESULTS 48 studies were included in our systematic review, with 46 suitable for meta-analysis. Total study population was 4,566,984 patients. OSA was associated with a higher risk of glaucoma (OR 3.66, 95% CI 1.70 to 7.90, I2 = 98%, p < 0.01). After adjustment for various important confounders including age, gender and patient comorbidities such as hyperlipidaemia, hypertension, cardiovascular diseases and diabetes, patients with OSA had up to 40% higher odds of glaucoma. Substantial heterogeneity was eliminated through subgroup and sensitivity analyses after consideration of glaucoma subtype, OSA severity and adjustment for confounders. CONCLUSIONS In this meta-analysis, OSA was associated with higher risk of glaucoma, as well as more severe ocular findings characteristic of the glaucomatous disease process. We suggest more clinical studies looking into the effects of OSA treatment on the progression of glaucoma to help clinical decision making for patients.
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Affiliation(s)
- Alex Jia Yang Cheong
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Sean Kang Xuan Wang
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Chang Yi Woon
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Ki Han Yap
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Kevin Joo Yang Ng
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Flora Wen Xin Xu
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Uri Alkan
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adele Chin Wei Ng
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Anna See
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Shaun Ray Han Loh
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Tin Aung
- Singapore National Eye Centre and Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Song Tar Toh
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- Surgery Academic Clinical Program, SingHealth, Singapore, Singapore.
- Singhealth Duke-NUS Sleep Centre, Singhealth, Singapore, Singapore.
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46
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Meesala A, Tripathy R, Chaudhury HC, Sahoo JP. A Drug Utilization Study of Anti-glaucoma Drugs in a Tertiary Care Hospital. Cureus 2023; 15:e46765. [PMID: 37954708 PMCID: PMC10632242 DOI: 10.7759/cureus.46765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Today, branded medications and polytherapy are frequently prescribed for glaucoma, even without giving the patient the proper instructions. Hence, the safety, effectiveness, cost, and patient compliance of glaucoma medication must be weighed, and the anti-glaucoma medicine usage must be studied. Analysis of glaucoma patients' prescription usage was the objective of this study. MATERIAL AND METHODS Between January 2021 and February 2022, this prospective and observational study was carried out at Andhra Medical College in Vishakhapatnam. One hundred prescriptions of those with primary open-angle and angle closure glaucoma were assessed. Age and gender-based subgroup analyses were conducted. R software (version 4.2.1) (The R Foundation for Statistical Computing, Vienna, Austria) was leveraged for data analysis. RESULTS Out of 146 examined prescriptions, 100 (69%) were deemed suitable for analysis. Participants' mean age was 54.2 ± 10.8 years. Sixty-two were over 50 years old, and 36 were men. The mean intraocular pressure was 25.4 ± 1.7 mm of Hg. Per prescription, there were about 1.75 anti-glaucoma drugs. Fixed-dose combinations (FDC) were found in 43 prescriptions. Generic medications and patient instructions prevailed in most prescriptions (78%) and (84%). Timolol was used in each FDC with brimonidine, dorzolamide, or bimatoprost. CONCLUSION The most often prescribed anti-glaucoma drug, timolol, was also identified as an essential component of the FDC. Doctors must prescribe generic medications with detailed directions for the patients.
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Affiliation(s)
- Anusha Meesala
- Pharmacology, Andhra Medical College, Visakhapatnam, IND
- Pharmacology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
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Chiarini LB, Petrs-Silva H, Linden R. Novel approaches to glaucomatous neurodegeneration, based on the integrated stress response. MOLECULAR THERAPY. NUCLEIC ACIDS 2023; 33:845-847. [PMID: 37662966 PMCID: PMC10474567 DOI: 10.1016/j.omtn.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Luciana B. Chiarini
- Laboratório de Neurogênese, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Hilda Petrs-Silva
- Laboratório de Terapia Gênica e Vetores Virais, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Rafael Linden
- Laboratório de Neurogênese, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, RJ, Brazil
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Ujiie N, Norden PR, Fang R, Beckmann L, Cai Z, Kweon J, Liu T, Tan C, Kuhn MS, Stamer WD, Aoto K, Quaggin SE, Zhang HF, Kume T. Differential roles of FOXC2 in the trabecular meshwork and Schlemm's canal in glaucomatous pathology. Life Sci Alliance 2023; 6:e202201721. [PMID: 37414529 PMCID: PMC10326420 DOI: 10.26508/lsa.202201721] [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: 09/12/2022] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023] Open
Abstract
Impaired development and maintenance of Schlemm's canal (SC) are associated with perturbed aqueous humor outflow and intraocular pressure. The angiopoietin (ANGPT)/TIE2 signaling pathway regulates SC development and maintenance, whereas the molecular mechanisms of crosstalk between SC and the neural crest (NC)-derived neighboring tissue, the trabecular meshwork (TM), are poorly understood. Here, we show NC-specific forkhead box (Fox)c2 deletion in mice results in impaired SC morphogenesis, loss of SC identity, and elevated intraocular pressure. Visible-light optical coherence tomography analysis further demonstrated functional impairment of the SC in response to changes in intraocular pressure in NC-Foxc2 -/- mice, suggesting altered TM biomechanics. Single-cell RNA-sequencing analysis identified that this phenotype is predominately characterized by transcriptional changes associated with extracellular matrix organization and stiffness in TM cell clusters, including increased matrix metalloproteinase expression, which can cleave the TIE2 ectodomain to produce soluble TIE2. Moreover, endothelial-specific Foxc2 deletion impaired SC morphogenesis because of reduced TIE2 expression, which was rescued by deleting the TIE2 phosphatase VE-PTP. Thus, Foxc2 is critical in maintaining SC identity and morphogenesis via TM-SC crosstalk.
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Affiliation(s)
- Naoto Ujiie
- Feinberg Cardiovascular and Renal Research Institute, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Pieter R Norden
- Feinberg Cardiovascular and Renal Research Institute, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Raymond Fang
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Lisa Beckmann
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Zhen Cai
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Junghun Kweon
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Ting Liu
- Feinberg Cardiovascular and Renal Research Institute, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Can Tan
- Feinberg Cardiovascular and Renal Research Institute, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Megan S Kuhn
- Duke Eye Center, Duke University, Durham, NC, USA
| | | | - Kazushi Aoto
- Department of Biochemistry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Susan E Quaggin
- Feinberg Cardiovascular and Renal Research Institute, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hao F Zhang
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
- Department of Ophthalmology, Northwestern University, Chicago, IL, USA
| | - Tsutomu Kume
- Feinberg Cardiovascular and Renal Research Institute, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Ophthalmology, Northwestern University, Chicago, IL, USA
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Bacharach J, Ahmed IIK, Sharpe ED, Korenfeld MS, Zhang S, Baudouin C. Preservative-Free versus Benzalkonium Chloride-Preserved Latanoprost Ophthalmic Solution in Patients with Primary Open-Angle Glaucoma or Ocular Hypertension: A Phase 3 US Clinical Trial. Clin Ophthalmol 2023; 17:2575-2588. [PMID: 37674591 PMCID: PMC10478989 DOI: 10.2147/opth.s414015] [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: 03/29/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023] Open
Abstract
Purpose To evaluate the safety and efficacy of a preservative-free latanoprost 0.005% formulation (T2345) in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT) compared to benzalkonium chloride-preserved latanoprost 0.005% (BPL) formulation in the United States (US). Patients and Methods A prospective, randomized, multicenter, observer-masked, parallel-group study enrolled 335 patients diagnosed with POAG or OHT from 31 US sites who had adequately controlled intraocular pressure (IOP; ≤18 mm Hg) with latanoprost monotherapy. After a ≥72-hour washout period, patients were randomized to T2345 (n=165) or BPL (n=170) groups. Study drugs were dosed once-daily from Day 0 to Day 84 in one or both eyes. The study eye was the eye with lower IOP at baseline. The primary efficacy measure was the between-group comparison of the mean IOP values in the study eye at each time point (8 AM, 10 AM, and 4 PM on Days 15, 42, and 84). Safety measurements included ocular and systemic treatment-emergent adverse events (TEAEs). Results Both T2345 and BPL adequately controlled IOP with 95% CIs within 1.5 mm Hg in the study eye at all assessed time points. The percentages of patients with diurnal IOP <18 mm Hg at Day 84 were 73.1% vs 78.7% for the T2345 and BPL groups, respectively. Adverse events were generally mild-to-moderate and primarily ocular. Fewer patients in the T2345 group experienced ocular TEAEs (13.9% vs 22.5%, respectively) and TEAEs with a suspected relationship to the study medication compared with the BPL group (5.5% vs 11.8%, respectively). The most common ocular TEAEs were instillation site pain and conjunctival hyperemia. Conclusion In patients with POAG or OHT, both T2345 and BPL maintained IOP at or below clinically meaningful values for the duration of the study. T2345 showed a favorable safety profile, with numerically lower incidences of ocular TEAEs than BPL.
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Affiliation(s)
| | | | | | | | | | - Christophe Baudouin
- Quinze-Vingts National Ophthalmology Hospital & Vision Institute, Paris Saclay-Versailles-Saint Quentin University, IHU Foresight, Paris, France
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Young J, Entwistle L, DeSousa JL, Haigh M, MacDonald F, Hill K. Evaluation of a nurse-led glaucoma assessment clinic for non-complex patients. J Clin Nurs 2023; 32:6743-6750. [PMID: 36869616 DOI: 10.1111/jocn.16670] [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: 08/15/2022] [Revised: 11/17/2022] [Accepted: 02/06/2023] [Indexed: 03/05/2023]
Abstract
AIMS AND OBJECTIVES The purpose of this study was to assess the safety, feasibility and effectiveness of a nurse-led glaucoma assessment clinic service. BACKGROUND Glaucoma is a group of serious, irreversible optic neuropathies that progressively damage the optic nerve resulting in blindness. Over 64.3 million people globally are affected by glaucoma with numbers projected to increase to 111.8 million by 2040. Glaucoma is a major public health concern that requires the development of innovative models of care to meet current and future health care demands. METHODS/DESIGN A mixed method design was used to evaluate the assessment of non-complex glaucoma patients attending a new nurse-led clinic. Under an ophthalmologist's supervision, the glaucoma nurse completed 100 hof clinical training and assessment to ensure they were competent in completing and interpreting the required glaucoma assessment protocols. Interrater reliability between the glaucoma nurse and ophthalmology doctor was undertaken. Glaucoma patient waitlist appointment data were also compared before and after the introduction of the nurse-led clinics. This study adhered to the SQUIRE checklist for the reporting of excellence with quality improvement projects. PATIENT CONTRIBUTION Patients contributed to the evaluation of this new nurse-led service by providing follow-up feedback on their experience. RESULTS Agreement between clinicians for appropriate follow-up appointment times was high with 93% (n = 315) agreement achieved. Furthermore in 297 (87.5%) cases, both clinicians agreed on the patient being referred to the doctor for follow-up review. Glaucoma consultations were shown to increase from 3,115 appointments in 2019/20 to 3,504 appointments in 2020/21 after the introduction of the nurse-led clinic. The nurse-led clinics accounted for 14.5% (n = 512) of clinic appointments. CONCLUSIONS The introduction of the nurse-led glaucoma assessment clinic service allowed patients to be reviewed safely, efficiently and satisfactorily. This new service subsequently allowed for more complex glaucoma patients to be seen by the ophthalmologists. RELEVANCE TO CLINICAL PRACTICE Findings revealed that suitably trained glaucoma nurses are able to clinically assess and safely monitor stable non-complex glaucoma patients. Highlights the need for appropriate investment in clinical training and supervision to ensure that glaucoma assessment nurses are adequately prepared to undertake this new practice role.
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Affiliation(s)
- Jeanne Young
- Royal Perth Bentley Group (RPBG) Organisational Learning and Development, Perth, Australia
| | - Lauren Entwistle
- Outpatients Department, Royal Perth Bentley Group (RPBG), Perth, Australia
| | - Jean-Louis DeSousa
- Department of Ophthalmology, Royal Perth Bentley Group (RPBG), Perth, Australia
| | - Meredyth Haigh
- Royal Perth Bentley Group (RPBG) Organisational Learning and Development, Perth, Australia
| | - Fiona MacDonald
- Royal Perth Bentley Group (RPBG) Organisational Learning and Development, Perth, Australia
| | - Kim Hill
- Outpatients Department, Royal Perth Bentley Group (RPBG), Perth, Australia
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