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Samico GA, Abe RY, Prata TS, Teixeira SH, Paranhos A, Gracitelli CPB. Relationship between the number of glaucoma medications, ocular surface disorder, and treatment adherence. Arq Bras Oftalmol 2023; 87:e20210525. [PMID: 37851737 DOI: 10.5935/0004-2749.2021-0525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 12/20/2022] [Indexed: 04/03/2023] Open
Abstract
PURPOSE To determine the relationship of ocular surface disease, the number of glaucoma medications prescribed and its influence on treatment adherence. METHODS In this cross-sectional study, demographic data of patients with glaucoma were collected, and patients completed the ocular surface disease index questionnaire and the glaucoma treatment compliance assessment tool. Ocular surface parameters were assessed by "Keratograph 5M." Patients were stratified into two groups according to the amount of prescribed ocular hypotensive eye drops (Group 1, one or two classes of medications; Group 2, three or four classes). RESULTS In total, 27 eyes of 27 patients with glaucoma were included: 17 using 1 or 2 topical medications (Group 1) and 10 eyes using 3 or 4 classes (Group 2). For the Keratograph assessment, patients using ≥3 medications had significantly smaller tear meniscus height (0.27 ± 0.10 vs. 0.43 ± 0.22; p=0.037). The analysis of Ocular Surface Disease Index questionnaire showed higher scores among the groups using more hypotensive eye drops (18.67 ± 13.53 vs. 38.82 ± 19.72; p=0.004). Regarding the glaucoma treatment compliance assessment tool, Group 2 had worse scores in components of forgetfulness (p=0.027) and barriers due to lack of drops (p=0.031). CONCLUSION Patients with glaucoma using more hypotensive eye drops had worse tear meniscus height and ocular surface disease index scores than those using fewer topical medications. Patients using three or four drug classes had worse predictors of glaucoma adherence. Despite worse ocular surface disease results, no significant difference in self-reported side effects was found.
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Affiliation(s)
- Gustavo A Samico
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Ricardo Y Abe
- Hospital Oftalmológico de Brasília, Brasília, DF, Brazil
| | - Tiago S Prata
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Sergio Henrique Teixeira
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Zantut F, P B Gracitelli C, Teixeira SH, Paranhos A. Comparison between Surgical Techniques Used for Revision of the Filter Bleb: A Randomized Controlled Clinical Trial. Ophthalmic Res 2023; 66:1006-1013. [PMID: 37285822 DOI: 10.1159/000531424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION/PURPOSE The aim of this study was to compare two surgical revision techniques in failed trabeculectomies after 6 months. METHODS Patients diagnosed with open-angle glaucoma who underwent trabeculectomy in at least one eye with uncontrolled intraocular pressure (IOP) after trabeculectomy performed at least 6 months before were enrolled in this prospective trial. All participants underwent a complete ophthalmological examination at baseline. Randomization was performed to one eye per patient to double-masked trabeculectomy revision or needling. Patients were examined on the first day, 7 days, 14 days, and then monthly until completing 1 year after surgical intervention. All follow-up visits included the following: patients reported ocular and systemic events, best-corrected visual acuity, IOP, slit-lamp examination, and optic disc evaluation for cup-to-disc ratio. Gonioscopy and stereoscopic optic disc photographs were taken at baseline and 12 months. After 1-year, the IOP and number of medications were compared between the groups. Absolute success criteria in the study were IOP <16 mm Hg, for 2 consecutive measurements without using a hypotensive medication. RESULTS Forty patients were included in this study. Among them, 38 completed 1-year follow-up (18 in revision group and 20 in needling group). The age ranged from 21 to 86 years, with a mean of 66.82 ± 13.44. At baseline, the average IOP was 21.64 ± 5.12 mm Hg (range from 14 to 38 mm Hg) in the entire group. All patients were using at least two classes of hypotensive eye drops, and 3 patients were using oral acetazolamide. The mean use of hypotensive eye drop medications was 3.11 ± 0.67 at the baseline for the entire group. In the present study, 58% of the patients presented complete success, 18% qualified success, and 24% failed in both groups. After 1-year treatment, both techniques were similar for IOP parameters and also for number of medications (p = 0.834 and p = 0.433, respectively). Regarding intra- or postoperative complications, one patient in each group needed a new surgical intervention, one in the needling group due to shallow anterior chamber and one in the revision group due to spontaneous Seidel sign, and one patient in the needling group underwent posterior revision due to fail. CONCLUSIONS Both techniques were safe and effective for IOP control after 1 year of follow-up in patients who underwent to trabeculectomy more than 6 months before.
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Affiliation(s)
- Fabio Zantut
- Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
- Vera Cruz Oftalmologia, Campinas, Brazil
| | - Sergio H Teixeira
- Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
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Lira RPC, Rocha EM, Kara-Junior N, Costa DC, Procianoy F, Paula JSD, Gracitelli CPB, Prata TDS, Regatieri CV, Biccas Neto L, Alves M. Challenges and advantages of being a scientific journal editor in the era of ChatGPT. Arq Bras Oftalmol 2023; 86:5-7. [PMID: 37283374 DOI: 10.5935/0004-2749.2023-1003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/27/2023] [Indexed: 06/08/2023] Open
Affiliation(s)
| | - Eduardo Melani Rocha
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirao Preto Medical School, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Newton Kara-Junior
- Department of Ophthalmology, Medical School, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Dácio Carvalho Costa
- Department of Ophthalmology, Public Health School of Ceara, Universidade Estadual do Ceará, Fortaleza, CE, Brazil
| | - Fernando Procianoy
- Department of Ophthalmology, Medical School, Universidade Federal do Rio Grande do Sul, Proto Alegre, RS, Brazil
| | - Jayter Silva de Paula
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirao Preto Medical School, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Tiago da Silva Prata
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Caio V Regatieri
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Monica Alves
- Department of Ophthalmology & Otorhinolaryngology, Medical Sciences Faculty, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Taniguchi EV, Almeida INF, Gracitelli CPB, Agapito C, Zett C, Sant'Ana L, Kayser C, Prata TS, Paranhos A. Peripheral Microvascular Abnormalities Associated with Open-Angle Glaucoma. Ophthalmol Glaucoma 2023; 6:291-299. [PMID: 36307064 DOI: 10.1016/j.ogla.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/20/2022] [Accepted: 10/12/2022] [Indexed: 05/26/2023]
Abstract
PURPOSE To investigate peripheral microvascular abnormalities associated with patients with open-angle glaucoma (OAG). DESIGN This was a cross-sectional study. PARTICIPANTS Patients with OAG and controls. METHODS All subjects underwent detailed ophthalmic evaluation, including Humphrey visual field (HVF) tests and swept source OCT. To evaluate peripheral microvascular abnormalities, nailfold capillaroscopy (NFC) and laser Doppler imaging (LDI) were performed. The presence of microhemorrhages, tortuous capillaries, dilated capillaries, avascular areas, and the capillary density, among other characteristics, were recorded using NFC; fingertip blood flow (FBF) was measured using LDI at different time points, before and 1, 10, and 20 minutes after exposure to a cold stimulus. In addition, venous blood samples were collected to measure serum endothelin-1 (ET-1) concentrations as well as serum autoantibodies. MAIN OUTCOME MEASURES Presence of microhemorrhages, tortuous capillaries, and dilated capillaries; FBF; ET-1; and autoantibodies. RESULTS Sixty-eight subjects (43 patients with OAG and 25 controls) were enrolled in the study. Microhemorrhages were found in the nail bed of 65.1% of the patients with OAG compared with 25.0% of the controls (P = 0.003). There was a significant difference in the mean FBF at the baseline in patients with OAG versus controls (293.6 ± 100.2 vs 388.8 ± 52.0 perfusion units, respectively, P < 0.001), together with a significant decrease in the mean FBF 10 and 20 minutes after cold stimulus in patients with OAG in comparison to controls (P < 0.001 for all comparisons). There was a positive correlation between mean baseline FBF and HVF mean deviation (r = 0.27, P = 0.03) and between mean baseline FBF and average retinal nerve fiber layer thickness (r = 0.44, P = 0.001). Neither the analysis of ET-1 concentrations (P= 0.71) nor the autoantibodies measurements (P > 0.05, for all) showed any difference between the 2 groups. CONCLUSIONS Significant peripheral microvascular abnormalities were found in patients with OAG compared to controls, suggesting that microvascular changes might play a role in the pathogenesis of the disease. In addition, part of these peripheral microvascular abnormalities seems to be correlated with both functional and structural glaucomatous damage. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Elise V Taniguchi
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil; Hospital de Olhos de Blumenau, Blumenau, Brazil
| | - Izabela N F Almeida
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil; Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, Vinhedo, São Paulo, Brazil.
| | - Cecília Agapito
- Department of Rheumatology, Federal University of São Paulo, São Paulo, Brazil
| | - Claudio Zett
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil; Facultad de Ciencias, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Letícia Sant'Ana
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Cristiane Kayser
- Department of Rheumatology, Federal University of São Paulo, São Paulo, Brazil
| | - Tiago S Prata
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil; Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida; Department of Ophthalmology, Glaucoma Service, Hospital Oftalmológico de Sorocaba - BOS, Sorocaba, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
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Almeida INF, Taniguchi E, Tito CVA, Dias DT, Ushida M, Dorairaj S, Ritch R, Teixeira SH, Paranhos A, Gracitelli CPB, Kayser C, Prata TS. Vascular parameters and endothelin-1 measurements in glaucoma patients with low- and high-tension optic disc hemorrhages. Sci Rep 2023; 13:5023. [PMID: 36977700 PMCID: PMC10050085 DOI: 10.1038/s41598-023-31682-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
This prospective study aimed to compare vascular parameters (endothelin-1 [ET-1] blood levels, laser Doppler imaging [LDI] of distal phalanxes, and nailfold capillaroscopy) between open-angle glaucoma patients with low- and high-tension optic disc hemorrhages (LTDH and HTDH, respectively). The 33 enrolled patients (mean age, 62.3 ± 13 years) were classified as LTDH or HTDH if they presented at the time of DH detection an intraocular pressure (IOP) < 16 mmHg or ≥ 16 mmHg, respectively. Demographic and ophthalmological data, ET-1 concentrations, LDI (before and 1, 10, and 20 min after cold stimulation), and nailfold capillaroscopy findings were evaluated. The ET-1 blood level was 65% higher in the LTDH (2.27 ± 1.46 pg/ml) than in the HTDH (1.37 ± 0.57 pg/ml; p = 0.03) group. Moreover, there was a statistically significant negative correlation between ET-1 blood concentration and IOP at the time of DH detection (r = -0.45, p = 0.02). Blood flow measurements 10 and 20 min after cold stimulation were lower in the LTDH group than in the HTDH group (p < 0.01). Patients developing DH with lower IOPs have higher ET-1 blood levels and more peripheral vascular dysfunction as estimated by LDI than those with higher IOPs. These findings suggest that distinct underlying mechanisms may be involved in patients developing DH within different IOP ranges.
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Affiliation(s)
- Izabela N F Almeida
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil
| | - Elise Taniguchi
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil
| | | | - Diego Torres Dias
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, SP, Brazil
| | - Michele Ushida
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, SP, Brazil
| | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
| | - Sérgio H Teixeira
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil
- Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, Vinhedo, São Paulo, Brazil
| | - Cristiane Kayser
- Rheumatology Division, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Tiago Santos Prata
- Department of Ophthalmology, Federal University of São Paulo, Rua Dr Jose Rodrigues Alves Sobrinho, 125, Alto de Pinheiros, São Paulo, SP, 05466-040, Brazil.
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, SP, Brazil.
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA.
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Bando AH, Hamada KU, Nakamura VPL, Abe RY, Ferrari PV, Herrerias BT, Hirai FE, Gracitelli CPB. Long-term visual acuity results from cataract surgery and its association with self-reported visual function: Catquest applicability. Arq Bras Oftalmol 2022; 87:S0004-27492022005011219. [PMID: 36350917 DOI: 10.5935/0004-2749.2022-0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/30/2022] [Indexed: 02/17/2024] Open
Abstract
PURPOSES This study aimed to determine the association of the long-term refractive outcomes of cataract surgery with self-reported visual function obtained using Catquest-9SF. METHODS Patients recruited from the cataract outpatient clinic of VER MAIS Oftalmologia underwent a complete ophthalmologic examination. Patients who were diagnosed with cataract with indications for phacoemulsification and intraocular lens implantation received the Catquest-9SF questionnaire before and after surgery at 30 days and 1 year. RESULTS A total of 133 patients were recruited, but 32 patients were lost to follow-up; finally, data from 101 patients (48 men, 53 women) were analyzed. The crude variance explained by the data was 69.9%, and the unexplained variance in the first contrast was 2.39 eigenvalues (>2); thus, these results are different from those expected from random data. The people separation index was 2.95 (>2), and the people trust value was 0.9 (>0.8). These indices were evaluated in the assessment of skill levels. Visual acuity was the main variable that correlated with the Catquest score. CONCLUSIONS The Catquest-9SF translated into Portuguese proved to be a one-dimensional and psychometrically valid tool to assess visual dysfunction in patients with cataract, and it is successful in objectively quantifying improvements after surgery. The results of this tool could be predictive and concordant of visual acuity improvement.
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Affiliation(s)
- Andre Hiroshi Bando
- Glaucoma Service, Department of Ophthalmology and Visual Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Koiti Uchida Hamada
- Glaucoma Service, Department of Ophthalmology and Visual Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Vinícius Pereira Leite Nakamura
- Glaucoma Service, Department of Ophthalmology and Visual Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Ricardo Y Abe
- Hospital Oftalmológico de Brasília, Brasília, DF, Brazil
| | - Pedro Vanalle Ferrari
- Glaucoma Service, Department of Ophthalmology and Visual Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Centro de Estudos Alcides Hirai, VER MAIS Oftalmologia, Vinhedo, SP, Brazil
| | - Bruno Torres Herrerias
- Glaucoma Service, Department of Ophthalmology and Visual Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Centro de Estudos Alcides Hirai, VER MAIS Oftalmologia, Vinhedo, SP, Brazil
| | - Flavio Eduardo Hirai
- Glaucoma Service, Department of Ophthalmology and Visual Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Centro de Estudos Alcides Hirai, VER MAIS Oftalmologia, Vinhedo, SP, Brazil
| | - Carolina P B Gracitelli
- Glaucoma Service, Department of Ophthalmology and Visual Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Centro de Estudos Alcides Hirai, VER MAIS Oftalmologia, Vinhedo, SP, Brazil
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Dias DT, Almeida I, Ushida M, Lopes FS, Kanadani FN, Gracitelli CPB, Prata TS. Subtenon triamcinolone as an adjuvant in mitomycin-C-enhanced trabeculectomy in non-inflammatory glaucomas: A randomized clinical trial. PLoS One 2022; 17:e0268623. [PMID: 35617211 PMCID: PMC9135266 DOI: 10.1371/journal.pone.0268623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/04/2022] [Indexed: 11/18/2022] Open
Abstract
This unicentric randomized clinical trial was designed to compare the surgical outcomes of mitomycin C-enhanced trabeculectomy (MMC-TRAB) with and without subtenon triamcinolone acetonide (TAAC) injection in patients with non-inflammatory glaucomas. This trial is registered at the Brazilian Registry of Clinical Trials (ReBEC) under the register number RBR-53f8nh. Consecutive non-inflammatory glaucoma patients requiring surgical intervention were randomized into two groups. In the control group, eyes underwent standard MMC-TRAB, while in the intervention group, besides the standard MMC-TRAB, these eyes also received a subtenon TAAC injection (4mg) close to the bleb site at the end of the surgery. The main outcomes of the study were surgical success rates, intraocular pressure (IOP) and number of medications at all timepoints. Success was defined as IOP ≤ 15 mmHg and subdivided in complete or qualified according to the need of medication. A total of 75 eyes of 63 different patients were included (intervention group = 39 eyes; control group = 36 eyes). There was no difference between groups at baseline (p>0.11). Multivariable regression analysis indicated that IOP levels were significantly lower in the intervention group at 18 and 24 months of follow-up when number of medications was considered as a covariate (P<0.001). Complete success rates were higher in the intervention group at 06 (90.9% vs 68.7%; p = 0.03), 12 (87.2% vs 66.7%; p = 0.02) and 18 months (87.2% vs 66.7%; p = 0.02). Additionally, although success rates at 24 months were higher in the intervention group (82.0% vs 66.7%; p = 0.09), this difference did not reach statistical significance. Qualified success rates did not significantly differ between groups at all timepoints. In conclusion, this study found significantly lower IOPs levels at 18 and 24 months of follow-up and higher complete success rates until 18 months of follow-up, with the use of subtenon TAAC as an adjuvant to standard MMC-TRABs in non-inflammatory glaucoma patients.
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Affiliation(s)
- Diego T. Dias
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
- Glaucoma Department, Hospital de Olhos de Sergipe, Aracaju, Sergipe, Brazil
- * E-mail:
| | - Izabela Almeida
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Michele Ushida
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
| | - Flavio S. Lopes
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Fábio N. Kanadani
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Tiago S. Prata
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
- Department of Ophthalmology, Hospital Oftalmológico de Sorocaba, Sorocaba, São Paulo, Brazil
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Almeida INF, Dias DT, Alhadeff PA, Lopes FSS, Paranhos A, Ritch R, Gracitelli CPB, Prata TS. Clinical Profiles of Glaucomatous Patients With High-tension and Low-tension Optic Disc Hemorrhages: A Comparative Study. J Glaucoma 2022; 31:178-182. [PMID: 34506356 DOI: 10.1097/ijg.0000000000001937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 08/24/2021] [Indexed: 11/26/2022]
Abstract
PRCIS Patients with low-tension optic disc hemorrhages (DHs) are more frequently women, have a diagnosis of normal-tension glaucoma (NTG) diagnosis and greater visual field (VF) loss. Symptoms of vascular dysregulation and Asian race also seem to be more prevalent in this clinical subtype. PURPOSE Optic DH is an important glaucoma risk factor, and occurs in a wide intraocular pressure (IOP) range. We sought to characterize distinct clinical subtypes of patients with high-tension disc hemorrhage (HTDH) and low-tension disc hemorrhage (LTDH). PATIENTS AND METHODS In this cross-sectional study, treated glaucomatous patients with DHs from 2 glaucoma services were consecutively enrolled. Disc photographs were evaluated for the presence of DH by 2 glaucoma specialists. After inclusion, patients were classified on HTDH (IOP≥16 mm Hg) and LTDH (IOP<16 mm Hg; median split). Clinical and ocular data from the time of DH detection were compared between groups. RESULTS One hundred thirty-three DH patients were included (LTDH=66 eyes; HTDH=67 eyes). Patients with LTDH were more often women than those with HTDH (77% vs. 42%; P=0.030). There was also a trend for a higher prevalence of Asian descendants (24% vs. 9%; P=0.058) and symptoms suggestive of vascular dysregulation (34% vs. 14%; P=0.057) in LTDH patients. Eyes with LTDH also had worse VF mean deviation index (P=0.037), higher prevalence of NTG diagnosis (46% vs. 17%; P<0.001), and tended to have thinner central corneas (P=0.066). CONCLUSIONS Patients developing DHs with treated IOPs in the low teens seem to more frequently fit in a profile represented by women, NTG diagnosis and greater VF loss. The presence of symptoms suggestive of vascular dysregulation and race also seem to differ between these 2 clinical subtypes. A closer optic disc surveillance is recommended for patients with the LTDH subtype, as they may develop DHs despite seemingly well-controlled IOP.
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Affiliation(s)
| | - Diego T Dias
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, SP, Brazil
| | - Paula A Alhadeff
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
| | - Flavio S S Lopes
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo
| | - Augusto Paranhos
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
| | | | - Tiago S Prata
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, SP, Brazil
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL
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Fares NT, Portela RC, Machado LF, Polizelli M, Freitas DD, Paranhos A, Prata TS, Gracitelli CPB. Effect of steroid eyedrops after trabeculectomy in glaucoma patients: a keratograph analysis. Arq Bras Oftalmol 2021; 84:345-351. [PMID: 33567039 DOI: 10.5935/0004-2749.20210050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/28/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate the use of preoperative steroid eyedrops in glaucoma patients undergoing trabeculectomy for ocular surface disease. METHODS A total of 31 eyes of 31 glaucoma patients were included. Only glaucoma patients who had been using at least three topical intraocular pressure-lowering medications for longer than 6 months were included. All patients were treated with loteprednol etabonate ophthalmic suspension 0.5% four times per day for 1 week before trabeculectomy. Data from baseline (day of surgery) and the follow-up visit (2 weeks after surgery) were included. All patients underwent a detailed ophthalmologic examination. Ocular surface disease was evaluated using the Ocular Surface Disease Index questionnaire and clinical measures, including tear breakup time, conjunctival hyperemia, and biomicroscopy to detect the presence or absence of keratitis. Ocular Surface Disease Index scores greater than 13 indicated a clinically relevant presence of ocular surface disease. In addition, all patients underwent keratograph analysis. The comparison of ocular surface disease before and after trabeculectomy was assessed using a paired test. RESULTS The mean age of the glaucoma patients was 69.90 ± 10.77 years. The average visual acuity was 0.40 ± 0.34 logMAR. The overall Ocular Surface Disease Index prevalence rate was 27.20 ± 17.56 units. Clinical assessment revealed no significant difference in bulbar redness, breakup time, or keratitis before and after surgery (p>0.05 for all comparisons). Keratograph analysis showed that the only two parameters that were significantly different before and after trabeculectomy ewere the bulbar redness by keratograph (BR-K) and the average noninvasive tear breakup time. Patients presented more conjunctival hyperemia and shorter noninvasive tear breakup time after trabeculectomy as compared with before surgery (p=0.013 and p=0.041, respectively). CONCLUSIONS The present study not only confirms the high prevalence of clinical findings of ocular surface disease in glaucoma patients but also reveals new objective parameters measured by keratograph analysis. Apart from using loteprednol etabonate ophthalmic suspension 0.5% 1 week before the surgery, our sample presented a worsening of conjunctival hyperemia (bulbar redness by keratograph) and also a shorter noninvasive tear breakup time postoperatively.
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Affiliation(s)
- Nikoly T Fares
- Department of Ophthalmology and Visual Science, Glaucoma Service, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renata C Portela
- Department of Ophthalmology and Visual Science, Glaucoma Service, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lilian F Machado
- Department of Ophthalmology and Visual Science, Glaucoma Service, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Murilo Polizelli
- Department of Ophthalmology and Visual Science, Glaucoma Service, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Denise de Freitas
- Department of Ophthalmology and Visual Science, Glaucoma Service, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology and Visual Science, Glaucoma Service, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tiago S Prata
- Department of Ophthalmology and Visual Science, Glaucoma Service, Universidade Federal de São Paulo, São Paulo, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, SP, Brazil.,Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA.,Department of Ophthalmology, Glaucoma Service, Hospital Oftalmológico de Sorocaba, Sorocaba, SP, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology and Visual Science, Glaucoma Service, Universidade Federal de São Paulo, São Paulo, Brazil.,Glaucoma Unit, Ver Mais Oftalmologia, Vinhedo, SP, Brazil
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10
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Gracitelli CPB, Rolim-de-Moura C. Care pathway for childhood glaucoma detection and monitoring in Brazil: how advances in primary and tertiary care integration could improve existing barriers. Arq Bras Oftalmol 2021; 84:305-309. [PMID: 34287514 DOI: 10.5935/0004-2749.202100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Carolina P B Gracitelli
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, Vinhedo, SP, Brazil
| | - Christiane Rolim-de-Moura
- Institute of Psychology, Universidade de São Paulo, São Paulo, SP, Brazil.,Universidade Federal de São Paulo, São Paulo, SP, Brazil
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11
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Lourenço AS, Araújo CCQD, Santos PMD, Prata TS, Lopes NLV, Santos RCRD, Gracitelli CPB, Faria NVLD. Assessment of short-term intraocular pressure parameters in phakic and pseudophakic patients with primary open-angle glaucoma. Arq Bras Oftalmol 2021; 84:425-429. [PMID: 34320100 DOI: 10.5935/0004-2749.20210066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/09/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate intraocular pressure peaks in phakic and pseudophakic patients with primary open-angle glaucoma. METHOD Overall, 40 patients with primary open-angle glaucoma were assessed. Of these, 20 patients were phakic and 20 pseudophakic. One eye (randomly selected) was included in the study. All patients underwent the intraocular pressure curves test, followed by the water-drinking test. RESULTS A statistically significant difference was observed between the phakic and pseudophakic patients regarding the mean of the peaks in the intraocular pressure curves (p=0.045). A statistically significant intergroup difference was noted regarding the intraocular pressure peaks in the water-drinking test, with higher values observed in the phakic patients (p 0.004). CONCLUSION The intraocular pressure peaks in the water-drinking test and intraocular pressure curves were higher in the phakic group than in the pseudophakic group.
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Affiliation(s)
| | | | | | - Tiago S Prata
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Ophthalmology, Mayo Clinic, Jacksonville, United States.,Ophthalmology, Hospital Medicina dos Olhos, Osasco, SP, Brazil
| | - Nara Lidia Vieira Lopes
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Centro Brasileiro da Visão, Brasilia, DF, Brazil
| | | | - Carolina P B Gracitelli
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Ver Mais Oftalmologia, Vinhedo, São Paulo, SP, Brazil.,Vera Cruz Oftalmologia, Campinas, São Paulo, SP, Brazil
| | - Nubia Vanessa Lima de Faria
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Centro Brasileiro da Visão, Brasilia, DF, Brazil
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12
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Rossetto JD, Forno EA, Morales MC, Moreira JC, Ferrari PV, Herrerias BT, Hirai FE, Gracitelli CPB. Upper Eyelid Necrosis Secondary to Hordeolum: A Case Report. Case Rep Ophthalmol 2021; 12:270-276. [PMID: 34054469 PMCID: PMC8138243 DOI: 10.1159/000513958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/20/2020] [Indexed: 12/02/2022] Open
Abstract
We reported a case of upper eyelid necrosis initially misdiagnosed as a preseptal cellulitis following a hordeolum externum resulting in great damage to the upper eyelid (anterior lamella). The infection was successfully treated with surgical cleansing, drainage, and endovenous antibiotics. Early treatment may avoid severe complications such as eyelid deformity, systemic involvement, and blindness.
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Affiliation(s)
- Júlia D Rossetto
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Department of Pediatric Ophthalmology, Institute of Childcare and Pediatrics Martagão Gesteira-Federal University of Rio de Janeiro (IPPMG-UFRJ), Rio de Janeiro, Brazil
| | | | - Melina Correia Morales
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, São Paulo, Brazil.,Vera Cruz Oftalmologia, Campinas, Brazil.,Fundação Roberto Rocha Brito, Hospital Vera Cruz, Campinas, Brazil
| | - Julio Cesar Moreira
- Vera Cruz Oftalmologia, Campinas, Brazil.,Fundação Roberto Rocha Brito, Hospital Vera Cruz, Campinas, Brazil
| | - Pedro V Ferrari
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, São Paulo, Brazil.,Vera Cruz Oftalmologia, Campinas, Brazil.,Fundação Roberto Rocha Brito, Hospital Vera Cruz, Campinas, Brazil
| | - Bruno T Herrerias
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, São Paulo, Brazil.,Vera Cruz Oftalmologia, Campinas, Brazil.,Fundação Roberto Rocha Brito, Hospital Vera Cruz, Campinas, Brazil
| | - Flavio E Hirai
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, São Paulo, Brazil.,Vera Cruz Oftalmologia, Campinas, Brazil.,Fundação Roberto Rocha Brito, Hospital Vera Cruz, Campinas, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, São Paulo, Brazil.,Vera Cruz Oftalmologia, Campinas, Brazil.,Fundação Roberto Rocha Brito, Hospital Vera Cruz, Campinas, Brazil
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13
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Ikeda MC, Hamada KU, Bando AH, Nakamura VPL, Prata TS, Tatham AJ, Paranhos A, Gracitelli CPB. Interventions to Improve Reading Performance in Glaucoma. Ophthalmol Glaucoma 2021; 4:624-631. [PMID: 33813064 DOI: 10.1016/j.ogla.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate whether changes to contrast, line spacing, or font size can improve reading performance in patients with glaucoma. DESIGN Cross-sectional study. PARTICIPANTS Thirty-five patients with glaucoma and 32 healthy control participants. METHODS A comprehensive ophthalmologic examination was performed followed by reading speed assessment using the Minnesota Low Vision Reading (MNREAD) test under a range of contrasts (10%, 20%, 30%, 40%, and 50%), line spacings (1.0, 1.5, 2.0, 2.5, and 3.0 lines), and font sizes (0.8, 0.9, 1.0, 1.1, and 1.2 logarithm of the minimum angle of resolution), for a total of 15 tests. Regression analyses were performed to examine the effect of varying test conditions on reading speed (measured in words per minute [wpm]). RESULTS Participants' mean age was 63.0 ± 12.6 years. Patients with glaucoma showed a visual field mean deviation in the better eye of -6.29 ± 6.35 dB. Reading speeds were significantly slower in patients with glaucoma versus control participants for 14 of the 15 MNREAD tests, despite no significant differences in age, gender, or education between groups. Increased contrast (from 10% to 50%) was associated with faster reading speed in patients with glaucoma (10.6-wpm increase per 10% increase in contrast; 95% confidence interval, 7.4-13.8 wpm; P < 0.001; R2 = 0.211). No significant improvement was found in reading speed with increase in font size or line spacing. CONCLUSIONS Patients with glaucoma showed significantly slower reading speeds than similarly aged control participants. Reading speed was improved by increasing contrast, but not by increases in line spacing or font size.
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Affiliation(s)
- Mariana C Ikeda
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Koiti U Hamada
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Andre H Bando
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Vinicius P L Nakamura
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Tiago S Prata
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil; Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil; Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida; Department of Ophthalmology, Glaucoma Service, Hospital Oftalmológico de Sorocaba-BOS, Sorocaba, Brazil
| | - Andrew J Tatham
- Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, Edinburgh, United Kingdom
| | - Augusto Paranhos
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil; Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, Vinhedo, São Paulo, Brazil.
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Machado LF, Furlanetto RL, Gracitelli CPB. Anatomy and evaluation of the optic nerve head. Arq Bras Oftalmol 2021; 85:636-643. [DOI: 10.5935/0004-2749.20220080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 05/27/2021] [Indexed: 11/20/2022] Open
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15
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Nazareth T, Rocha J, Scoralick ALB, Dias DT, Gracitelli CPB, Kanadani FN, Prata TS. <p>Retinal Sensitivity Thresholds Obtained Through Easyfield and Humphrey Perimeters in Eyes with Glaucoma: A Cross-Sectional Comparative Study</p>. Clin Ophthalmol 2020; 14:4201-4207. [PMID: 33299296 PMCID: PMC7719433 DOI: 10.2147/opth.s280692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/10/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To compare global retinal sensitivity thresholds obtained through the Easyfield perimeter (EF) and Humphrey visual field analyzer (HFA). Design Observational cross-sectional study. Participants Glaucomatous patients and glaucoma suspects enrolled between October 2018 and April 2019. Materials and Methods All participants underwent EF (SPARK Precision) and HFA perimetry (SITA-Standard). After inclusion, demographic and ocular data were collected, including measurements of retinal nerve fiber layer (RNFL) thickness obtained from spectral-domain optical coherence tomography (SD-OCT). Global indices (mean deviation, MD; pattern standard deviation, PSD) values were compared between perimeters, and their correlation and agreement were evaluated. We used regression analysis to investigate structure-functional correlations between SD-OCT measurements and MD index of each perimeter. Results We investigated 111 eyes from 69 patients. Mean MD (mean difference=1.49dB) and PSD values (mean difference=0.42dB) from the HFA were significantly larger than those from the EF perimeter (p<0.001). There were significant linear correlations between EF-MD and HFA-MD (r=0.56), and EF-PSD and HFA-PSD (r=0.38; p<0.001). We found significant non-linear associations between average RNFL thickness and MD values derived from both EF (R2=0.41) and HFA (R2=0.17) perimeters (p≤0.012). A difference <2dB between EF-MD and HFA-MD was found in 53% of the eyes, while 71% of them had a difference <1dB between EF-PSD and HFA-PSD. Conclusion While we found a moderate correlation and a small mean sensitivity difference between test results, EF’s correlation with structural measurements was at least comparable to that of the HFA. Our findings suggest that although these tests should not be used interchangeably, EF SPARK Precision could be used as an alternative for functional assessment in eyes with mild glaucoma.
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Affiliation(s)
- Thaissa Nazareth
- Glaucoma Service, Instituto de Olhos Ciências Médicas, Belo Horizonte, Brazil
| | - Janaina Rocha
- Glaucoma Service, Instituto de Olhos Ciências Médicas, Belo Horizonte, Brazil
- Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
| | | | - Diego T Dias
- Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
| | | | - Fabio N Kanadani
- Glaucoma Service, Instituto de Olhos Ciências Médicas, Belo Horizonte, Brazil
- Ophthalmology Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Tiago S Prata
- Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
- Ophthalmology Department, Mayo Clinic, Jacksonville, Florida, USA
- Correspondence: Tiago S Prata Ophthalmology Department, Federal University of São Paulo, Rua Dr João Lourenço, 713; Vila Nova Conceição, São PauloCEP: 04508-031, BrazilTel +55 11 43019481Fax +55 11 3683-0404 Email
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Olyntho Junior MADC, Augusto LB, Gracitelli CPB, Tatham AJ. The Effect of Corneal Thickness, Densitometry and Curvature on Intraocular Pressure Measurements Obtained by Applanation, Rebound and Dynamic Contour Tonometry. Vision (Basel) 2020; 4:vision4040045. [PMID: 33096873 PMCID: PMC7711663 DOI: 10.3390/vision4040045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/10/2020] [Accepted: 10/19/2020] [Indexed: 02/01/2023] Open
Abstract
Evaluate the effect of corneal thickness, densitometry and curvature on intraocular pressure (IOP) measurements obtained by Goldmann applanation tonometry (GAT), non-contact tonometry (NCT), rebound tonometry (RT), and dynamic contour tonometry (DCT). A cross-sectional prospective study involving 40 participants was performed. Corneal measurements were obtained using Pentacam (Oculus GMbH, Wetzlar, Germany), densitometry was measured at annuli of 0–2, 2–6, 6–10 and 10–12 mm. The relationship between corneal thickness (central, 4 and 6 mm), corneal astigmatism and corneal densitometry and IOP was examined. There was a significant relationship between corneal thickness (central, 4 and 6 mm) and GAT180, GAT90, RT, and NCT (P < 0.001 for all comparisons) but not for DCT. Higher corneal densitometry (6–10 mm and 10–12 mm zones) was associated with higher IOP from GAT180 and GAT90, and higher densitometry in the 6–10 mm zone correlated with higher IOP from NCT, however corneal densitometry increased with age. Accounting for age, the relationship between corneal densitometry and IOP measurements was not significant. In eyes with greater corneal astigmatism there was a greater difference between GAT90 and GAT180 measurements. IOP measurements may be affected by corneal thickness, densitometry and curvature. DCT was less affected by properties of the cornea compared to other devices.
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Affiliation(s)
| | | | - Carolina P B Gracitelli
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, 13565-905 São Paulo, Brazil
- Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, 07750-000 Vinhedo, São Paulo, Brazil
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Gracitelli CPB, Duque-Chica GL, Sanches LG, Moura AL, Nagy BV, Teixeira SH, Amaro E, Ventura DF, Paranhos A. Structural Analysis of Glaucoma Brain and its Association With Ocular Parameters. J Glaucoma 2020; 29:393-400. [PMID: 32079996 DOI: 10.1097/ijg.0000000000001470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PRECIS Glaucoma patients presented a decreased occipital pole surface area in both hemispheres. Moreover, these parameters are independently correlated with functional and structural ocular parameters. PURPOSE The purpose of this study was to evaluate structural brain abnormalities in glaucoma patients using 3-Tesla magnetic resonance imaging and assess their correlation with associated structural and functional ocular findings. PATIENTS AND METHODS This cross-sectional prospective study included 30 glaucoma patients and 18 healthy volunteers. All participants underwent standard automated perimetry, spectral-domain optical coherence tomography, and 3.0-Tesla magnetic resonance imaging. RESULTS There was a significant difference between the surface area of the occipital pole in the left hemisphere of glaucoma patients (mean: 1253.9±149.3 mm) and that of control subjects (mean: 1341.9±129.8 mm), P=0.043. There was also a significant difference between the surface area of the occipital pole in the right hemisphere of glaucoma patients (mean: 1910.5±309.4 mm) and that of control subjects (mean: 2089.1±164.2 mm), P=0.029. There was no significant difference between the lingual, calcarine, superior frontal, and inferior frontal gyri of glaucoma patients and those of the control subjects (P>0.05 for all comparisons). The surface area of the occipital pole in the left hemisphere was significantly correlated with perimetry mean deviation values, visual acuity, age, and retinal nerve fiber layer thickness (P=0.001, <0.001, 0.010, and 0.006, respectively). The surface area of the occipital pole in the right hemisphere was significantly correlated with perimetry mean deviation values, visual field indices, visual acuity, age, and retinal nerve fiber layer thickness (P<0.001, 0.007, <0.001, 0.046, and <0.001, respectively). CONCLUSION Glaucoma patients presented a decreased occipital pole surface area in both hemispheres that independently correlated with functional and structural ocular parameters.
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Affiliation(s)
- Carolina P B Gracitelli
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo
| | - Gloria L Duque-Chica
- Institute of Psychology, University of São Paulo.,Department of Psychology, University of Medellin, Medellin, Colombia
| | - Liana G Sanches
- Brain Institute-Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Ana L Moura
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo.,Institute of Psychology, University of São Paulo
| | - Balazs V Nagy
- Institute of Psychology, University of São Paulo.,Department of Mechatronics, Optics and Engineering Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Sergio H Teixeira
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo
| | - Edson Amaro
- Brain Institute-Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Dora F Ventura
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo.,Institute of Psychology, University of São Paulo
| | - Augusto Paranhos
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo.,Brain Institute-Hospital Israelita Albert Einstein, São Paulo, Brazil
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18
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Duque-Chica GL, Gracitelli CPB, Moura ALA, Nagy BV, Vidal KS, de Melo G, Paranhos A, Cahali MB, Ventura DF. Contributions of the Melanopsin-Expressing Ganglion Cells, Cones, and Rods to the Pupillary Light Response in Obstructive Sleep Apnea. Invest Ophthalmol Vis Sci 2019; 60:3002-3012. [PMID: 31310657 DOI: 10.1167/iovs.19-26944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the impact of obstructive sleep apnea (OSA) on the contribution of inner and outer retinal photoreceptors to the pupillary light response (PLR). Methods Ninety-three eyes from 27 patients with OSA and 25 healthy controls were tested. OSA severity was graded according to the apnea-hypopnea index. PLR was measured monocularly with an eye tracker in a Ganzfeld in response to 1-second blue (470 nm) and red (640 nm) flashes at -3, -2, -1, 0, 1, 2, and 2.4 log cd/m2. Peak pupil constriction amplitude, peak latency, and the postillumination pupil response were measured. The Cambridge Colour Test, standard automatic perimetry, spectral domain optical coherence tomography, polysomnography, and the Pittsburgh Sleep Quality Index were used. Results OSA patients have a significantly decreased peak pupil constriction amplitude for blue stimuli at -3, -2, -1, 1 log cd/m2 and at all red flash luminances (P < 0.050), revealing reduction of outer retina contributions to PLR. OSA patients showed reduced peak latency for blue (-2, 0, 2, 2.4 log cd/m2) and red stimuli (-2, 0 log cd/m2; P < 0.040). No significant difference was found in the melanopsin-mediated PLR. Conclusions This study is the first to evaluate the inner and outer retinal contributions to PLR in OSA patients. The results showed that the outer retinal photoreceptor contributions to PLR were affected in moderate and severe OSA patients. In contrast, the inner retina contributions to PLR are preserved.
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Affiliation(s)
- Gloria L Duque-Chica
- Experimental Psychology Department, Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil.,Department of Psychology, University of Medellin, Medellin, Colombia
| | - Carolina P B Gracitelli
- Department of Ophthalmology and Visual Science, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Ana L A Moura
- Experimental Psychology Department, Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil.,Department of Ophthalmology and Visual Science, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Balázs V Nagy
- Experimental Psychology Department, Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil.,Department of Mechatronics, Optics and Engineering Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Kallene S Vidal
- Experimental Psychology Department, Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil.,Prevent Senior institute, Sao Paulo, Brazil
| | - Geraldine de Melo
- Department of Ophthalmology and Visual Science, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology and Visual Science, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Michel B Cahali
- Department of Otolaryngology, Hospital das Clínicas, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Dora F Ventura
- Experimental Psychology Department, Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil
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19
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Gracitelli CPB, Zangwill LM, Diniz-Filho A, Abe RY, Girkin CA, Weinreb RN, Liebmann JM, Medeiros FA. Detection of Glaucoma Progression in Individuals of African Descent Compared With Those of European Descent. JAMA Ophthalmol 2019; 136:329-335. [PMID: 29450497 DOI: 10.1001/jamaophthalmol.2017.6836] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Individuals of African descent have been reported to be at higher risk for becoming visually impaired from glaucoma compared with individuals of European descent. Objective To investigate racial differences in longitudinal visual field variability and their impact on time to detect visual field progression. Design, Setting, and Participants This multicenter prospective observational cohort study included 236 eyes of 173 individuals of European descent and 235 eyes of 171 individuals of African descent followed up for a mean (SD) time of 7.5 (3.4) years. Main Outcomes and Measures Differences in test-retest variability and simulated time to detect progression in individuals of African descent and of European descent with glaucoma. Standard automated perimetry mean deviation values were regressed over time for each eye, and SD of the residuals was used as a measure of variability. Distributions of residuals were used in computer simulations to reconstruct "real-world" standard automated perimetry mean deviation trajectories under different assumptions about rate of change and frequency of testing. Times to detect progression were obtained for the simulated visual fields. Results Among the 344 patients, the mean (SD) age at baseline was 60.2 (10.0) and 60.6 (9.0) years for individuals of African descent and of European descent, respectively; 94 (52%) and 86 (48%) of individuals of African descent and of European descent were women, respectively. The mean SD of the residuals was larger in eyes of individuals of African descent vs those of European descent (1.45 [0.83] dB vs 1.12 [0.48] dB; mean difference: 0.33 dB; 95% CI of the difference, 0.21-0.46; P < .001). The eyes in individuals of African descent had a larger increase in variability with worsening disease (P < .001). When simulations were performed assuming common progression scenarios, there was a delay to detect progression in eyes of individuals of African descent compared with those of European descent. For a scenario with baseline mean deviation of -10 dB and rate of change of -0.5 dB/y, detection of progression in individuals of African descent was delayed by 3.1 (95% CI, 2.9-3.2) years, when considered 80% power and annual tests. Conclusions and Relevance Patients of African descent with glaucoma showed increased visual field variability compared with those of European descent, resulting in delayed detection of progression that may contribute to explain higher rates of glaucoma-related visual impairment in individuals of African descent compared with those of European descent with glaucoma.
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Affiliation(s)
- Carolina P B Gracitelli
- Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla.,Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Linda M Zangwill
- Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Alberto Diniz-Filho
- Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Ricardo Y Abe
- Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla
| | | | - Robert N Weinreb
- Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Jeffrey M Liebmann
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Felipe A Medeiros
- Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla.,Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina
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20
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Gracitelli CPB, de Faria NVL, Almeida I, Dias DT, Vieira JM, Dorairaj S, Kanadani FN, Prata TS. Exercise-Induced Changes in Ocular Blood Flow Parameters in Primary Open-Angle Glaucoma Patients. Ophthalmic Res 2019; 63:309-313. [PMID: 31484192 DOI: 10.1159/000501694] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 06/21/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate exercise-induced changes in ocular blood flow (OBF) parameters in primary open-angle glaucoma (POAG) patients. METHODS A prospective observational study was carried out, in which medically treated patients with POAG were enrolled. Following inclusion, all patients performed a 40-min cycloergometry in a standardized fashion. The following parameters were measured and compared immediately before and 1 and 30 min after the exercise: intraocular pressure (IOP; Goldman applanation tonometry), mean arterial pressure (MAP), ocular pulse amplitude (OPA; assessed by dynamic contour tonometry), and ocular perfusion pressure (OPP; 2/3 MAP - IOP). In addition, we investigated possible factors associated with OBF parameter changes immediately after exercise. RESULTS A total of 30 eyes (30 patients; mean age was 62.9 ± 1.7 years) were included. Most patients were women (53%), and median visual field mean deviation index was -3.5 dB. Both MAP (mean change, 21%) and IOP (mean change, 17.3%) increased significantly immediately after the workout (p < 0.01), persisting higher than baseline following 30 min (p < 0.01%). Regarding OBF parameters, both OPA (mean change, 58.8%) and OPP (mean change, 21.7%) increased significantly immediately after the workout and persisted higher than baseline 30 min after the workout (p < 0.01). Regression analysis revealed that only age was significantly associated with OPA variation (R2 0.14; p < 0.05). No significant associations were found for OPP (p ≥ 0.19). CONCLUSION Aerobic exercise leads to a significant short-time increase in OBF parameters in patients with POAG. Even though IOP seems to present a modest elevation, it is accompanied by a significant increase in MAP, leading to higher OBF measurements. Exercise-induced short-term changes and its possible implications for glaucoma prognosis deserve further investigation.
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Affiliation(s)
- Carolina P B Gracitelli
- Glaucoma Division, Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil, .,Glaucoma Division, Ver Mais Oftalmologia, Vinhedo, Brazil,
| | - Nubia Vanessa Lima de Faria
- Glaucoma Division, Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
| | - Izabela Almeida
- Glaucoma Division, Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil.,Glaucoma Division, Hospital Medicina dos Olhos, Osasco, Brazil
| | - Diego Torres Dias
- Glaucoma Division, Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil.,Glaucoma Division, Hospital Medicina dos Olhos, Osasco, Brazil
| | | | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Tiago Santos Prata
- Glaucoma Division, Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil.,Glaucoma Division, Hospital Medicina dos Olhos, Osasco, Brazil.,Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, USA.,Glaucoma Service, Department of Ophthalmology, Hospital Oftalmológico de Sorocaba - BOS, Sorocaba, Brazil
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21
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Rossetto JD, Gracitelli CPB, Osaki TH, Osaki MH. Diseases, conditions, and drugs associated with cicatricial ectropion. Arq Bras Oftalmol 2019; 82:345-353. [PMID: 31116320 DOI: 10.5935/0004-2749.20190068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/14/2018] [Indexed: 11/20/2022] Open
Abstract
Cicatricial ectropion may be a consequence of certain systemic diseases as well as the result of drug use. Our goal here was to research the different causes of this condition as reported in the literature, including more recently suspected etiologies. A detailed PubMed literature search indicated many different etiologies were associated with cicatricial ectropion development, from severe cases of systemic diseases, such as ichthyosis and lupus erythematosus, to reversible scenarios secondary to anti-glaucomatous drug use. More recently reported connections include periorbital necrotizing fasciitis, frontal osteomyelitis, and antineoplastic agents. Indeed, cicatricial ectropion may be highly symptomatic; being able to determine its real etiology is imperative to managing patients properly. In this investigation, we felt that an explicitly multidisciplinary approach was essential, especially for cases associated with systemic conditions.
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Affiliation(s)
- Júlia D Rossetto
- Departamento de Oftalmologia e Ciências Visuais, Divisão de Cirurgia Plástica Ocular, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Carolina P B Gracitelli
- Departamento de Oftalmologia e Ciências Visuais, Divisão de Cirurgia Plástica Ocular, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Tammy H Osaki
- Departamento de Oftalmologia e Ciências Visuais, Divisão de Cirurgia Plástica Ocular, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Midori H Osaki
- Departamento de Oftalmologia e Ciências Visuais, Divisão de Cirurgia Plástica Ocular, Universidade Federal de São Paulo, São Paulo, Brasil
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22
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Correa PC, Medeiros FA, Abe RY, Diniz-Filho A, Gracitelli CPB. Assessing driving risk in patients with glaucoma. Arq Bras Oftalmol 2019; 82:245-252. [DOI: 10.5935/0004-2749.20190046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/19/2018] [Indexed: 11/20/2022] Open
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23
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Machado LF, Kawamuro M, Portela RC, Fares NT, Bergamo V, Souza LMD, Paranhos Júnior A, Prata TS, Gracitelli CPB. Factors associated with vision-related quality of life in Brazilian patients with
glaucoma. Arq Bras Oftalmol 2019; 82:463-470. [DOI: 10.5935/0004-2749.20190089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 01/29/2019] [Indexed: 11/20/2022] Open
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24
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Gemelli H, Fidalgo TM, Gracitelli CPB, de Andrade EP. Retinal nerve fiber layer analysis in cocaine users. Psychiatry Res 2019; 271:226-229. [PMID: 30502559 DOI: 10.1016/j.psychres.2018.11.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 10/16/2018] [Accepted: 11/24/2018] [Indexed: 10/27/2022]
Abstract
Cocaine is a well-known factor of tissue ischemia and may be related to thinning of the inner retinal layers. The present study aimed to evaluate and determine whether cocaine users show retinal nerve fiber layer (RNFL) thinning by means of spectral-domain optical coherence tomography. A group of 17 cocaine users and 18 non-users were recruited for complete ophthalmologic examination. Spectral domain optical coherence tomography (Cirrus OCT) was used to evaluate peripapillary RNFL and macular thickness. The average RNFL measurement in the cocaine users group was significantly thinner compared to the control group. Subjects in the cocaine users group showed significant thinning in the nasal, superior and inferior quadrant. There were no significant differences in macular thickness or in the temporal quadrant between the two groups. This study supports further research with larger sample sizes to precisely determine the effect of cocaine on the RNFL.
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Affiliation(s)
- Henrique Gemelli
- Department of Ophthalmology, Hospital do Servidor Público Estadual Francisco Morato de Oliveira, São Paulo, Brazil.
| | - Thiago M Fidalgo
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Eric Pinheiro de Andrade
- Department of Ophthalmology, Hospital do Servidor Público Estadual Francisco Morato de Oliveira, São Paulo, Brazil
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25
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Lopes NLV, Gracitelli CPB, Chalita MR, de Faria NVL. Ocular Surface Evaluation After the Substitution of Benzalkonium Chloride Preserved Prostaglandin Eye Drops by a Preservative-free Prostaglandin Analogue. Med Hypothesis Discov Innov Ophthalmol 2019; 8:52-56. [PMID: 30923724 PMCID: PMC6433198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
To evaluate ocular surface changes after withdrawal of Benzalkonium chloride (BAK) in patients with glaucoma in monotherapy with BAK-preserved prostaglandin. This was a prospective observational study. All patients underwent complete ophthalmologic examination and evaluation of ocular surface. A questionnaire was filled regarding symptoms of dry eye (Ocular Surface Disease Index [OSDI]) at the beginning of study. The treatment was switched to preservative-free tafluprost for 6 weeks and after this period, all patients were re-evaluated. All patients reported improvement of symptoms. The green lissamine test showed a significant improvement of the ocular surface, with most patients classified as light dry eye (P < 0.001). A significant improvement in the score (P < 0.001) was also found, with an average of 17.95 ± 5.35 points, which classifies the patients' symptoms in the normal to light zone. Benzalkonium chloride withdrawal reduced the signs and symptoms of dry eye in patients with primary open angle glaucoma (POAG).
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Affiliation(s)
- Nara Lidia Vieira Lopes
- Department of Ophthalmology and Vision Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
- Department of Ophthalmology, Federal University of Brasilia, Brasilia, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology and Vision Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
| | - Maria Regina Chalita
- Department of Ophthalmology and Vision Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
- Department of Ophthalmology, Federal University of Brasilia, Brasilia, Brazil
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26
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Daga FB, Gracitelli CPB, Diniz-Filho A, Medeiros FA. Is vision-related quality of life impaired in patients with preperimetric glaucoma? Br J Ophthalmol 2018; 103:955-959. [PMID: 30049801 DOI: 10.1136/bjophthalmol-2018-312357] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/09/2018] [Accepted: 07/13/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To investigate whether subjects with preperimetric glaucoma exhibit decline in patient-reported vision-related quality of life (QoL) compared with healthy individuals. METHODS This cross-sectional study included 45 patients with preperimetric glaucoma, 102 patients with perimetric glaucoma and 81 healthy controls. Perimetric glaucoma was defined by the presence of repeatable abnormal standard automated perimetry tests and corresponding optic nerve damage in at least one eye. Preperimetric glaucoma was defined based on the presence of retinal nerve fibre layer (RNFL) loss as detected by spectral-domain optical coherence tomography in the absence of visual field loss. Patient-reported QoL was measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). RESULTS Patients with preperimetric glaucoma had significantly thinner average RNFL in the better eye compared with controls (79.9±9.2 µm vs 97.8±8.6 µm; p<0.001). There was no significant difference in Rasch-calibrated NEI VFQ-25 scores between the preperimetric and control groups (72.8±16.8 vs 73.7±20.2, respectively; p=0.964). The average NEI VFQ-25 score in the perimetric glaucoma group was 58.9±18.6 and was significantly different than the average score in the preperimetric glaucoma and healthy groups (p<0.001 for both comparisons). CONCLUSION Contrary to patients with perimetric damage, preperimetric glaucoma does not seem to be associated with loss in QoL. Prevention of disability from glaucoma may benefit from early diagnosis during a 'window of opportunity' given by detecting structural loss before visual field damage.
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Affiliation(s)
- Fábio B Daga
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, North Carolina, USA.,Department of Ophthalmology and Vision Science, Federal University of São Paulo, São Paulo, Brazil.,Department of Ophthalmology, University of California, San Diego, California, USA
| | - Carolina P B Gracitelli
- Department of Ophthalmology and Vision Science, Federal University of São Paulo, São Paulo, Brazil.,Department of Ophthalmology, University of California, San Diego, California, USA
| | - Alberto Diniz-Filho
- Department of Ophthalmology, University of California, San Diego, California, USA
| | - Felipe A Medeiros
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, North Carolina, USA .,Department of Ophthalmology, University of California, San Diego, California, USA
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27
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Lopes NLV, Gracitelli CPB, Moura CRD. Creation of a childhood glaucoma registry database. Arq Bras Oftalmol 2018; 81:271-275. [DOI: 10.5935/0004-2749.20180055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 12/19/2017] [Indexed: 11/20/2022] Open
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Daga FB, Diniz-Filho A, Boer ER, Gracitelli CPB, Abe RY, Medeiros FA. Fear of falling and postural reactivity in patients with glaucoma. PLoS One 2017; 12:e0187220. [PMID: 29211742 PMCID: PMC5718417 DOI: 10.1371/journal.pone.0187220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/16/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose To investigate the relationship between postural metrics obtained by dynamic visual stimulation in a virtual reality environment and the presence of fear of falling in glaucoma patients. Methods This cross-sectional study included 35 glaucoma patients and 26 controls that underwent evaluation of postural balance by a force platform during presentation of static and dynamic visual stimuli with head-mounted goggles (Oculus Rift). In dynamic condition, a peripheral translational stimulus was used to induce vection and assess postural reactivity. Standard deviations of torque moments (SDTM) were calculated as indicative of postural stability. Fear of falling was assessed by a standardized questionnaire. The relationship between a summary score of fear of falling and postural metrics was investigated using linear regression models, adjusting for potentially confounding factors. Results Subjects with glaucoma reported greater fear of falling compared to controls (-0.21 vs. 0.27; P = 0.039). In glaucoma patients, postural metrics during dynamic visual stimulus were more associated with fear of falling (R2 = 18.8%; P = 0.001) than static (R2 = 3.0%; P = 0.005) and dark field (R2 = 5.7%; P = 0.007) conditions. In the univariable model, fear of falling was not significantly associated with binocular standard perimetry mean sensitivity (P = 0.855). In the multivariable model, each 1 Nm larger SDTM in anteroposterior direction during dynamic stimulus was associated with a worsening of 0.42 units in the fear of falling questionnaire score (P = 0.001). Conclusion In glaucoma patients, postural reactivity to a dynamic visual stimulus using a virtual reality environment was more strongly associated with fear of falling than visual field testing and traditional balance assessment.
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Affiliation(s)
- Fábio B. Daga
- Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina, United States of America
- Department of Ophthalmology and Vision Science, Federal University of São Paulo, São Paulo, Brazil
- Department of Ophthalmology, University of California, San Diego, La Jolla, California, United States of America
| | - Alberto Diniz-Filho
- Department of Ophthalmology, University of California, San Diego, La Jolla, California, United States of America
| | - Erwin R. Boer
- Department of Ophthalmology, University of California, San Diego, La Jolla, California, United States of America
| | - Carolina P. B. Gracitelli
- Department of Ophthalmology and Vision Science, Federal University of São Paulo, São Paulo, Brazil
- Department of Ophthalmology, University of California, San Diego, La Jolla, California, United States of America
| | - Ricardo Y. Abe
- Department of Ophthalmology, University of California, San Diego, La Jolla, California, United States of America
| | - Felipe A. Medeiros
- Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina, United States of America
- Department of Ophthalmology, University of California, San Diego, La Jolla, California, United States of America
- * E-mail:
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Daher F, Almeida I, Ushida M, Soares B, Dorairaj S, Kanadani FN, Paranhos A, Gracitelli CPB, Prata TS. Intraocular Pressure Spikes within First Postoperative Hours following Standard Trabeculectomy: Incidence and Associated Factors. Ophthalmic Res 2017; 59:142-147. [PMID: 29069653 DOI: 10.1159/000480736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/28/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the incidence of intraocular pressure (IOP) spikes within the first postoperative hours following trabeculectomy (TRAB) and to determine possible associated factors. METHODS An observational study was carried out. We enrolled consecutive patients undergoing standard TRAB with mitomycin C. They were examined twice within the first few postoperative hours (hours 1-2 and 4-6) and 3 times after TRAB (on days 1, 7, and 30). Demographic and ocular data were collected. Main outcome measurements were postoperative IOP values at each time point and the frequency of IOP spikes, defined as IOP ≥25 mm Hg. RESULTS A total of 40 eyes of 40 patients were included (mean age 59.62 ± 13.37 years). Although IOP was significantly reduced to 11.14 ± 7.99 mm Hg at hours 1-2 (p < 0.01) and to 11.52 ± 7.30 mm Hg at hours 4-6 (p < 0.01), IOP spikes were documented in 3 patients (7.5%). In the group of patients with IOP spikes, we noted that there was a high incidence of black patients and that the surgeries had been performed by fellow surgeons. CONCLUSION Although the majority of the cases (92.5% of the patients) did not present IOP spikes, 7.5% of our patients presented the event. In selected cases, such as those with advanced disease, fixation threat, and of black race, IOP should be monitored during the first few postoperative hours for the identification and adequate management of potential IOP spikes, preventing undesirable outcomes.
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Affiliation(s)
- Felipe Daher
- Department of Ophthalmology and Visual Sciences, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil
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Abe RY, Diniz-Filho A, Zangwill LM, Gracitelli CPB, Marvasti AH, Weinreb RN, Baig S, Medeiros FA. The Relative Odds of Progressing by Structural and Functional Tests in Glaucoma. Invest Ophthalmol Vis Sci 2017; 57:OCT421-8. [PMID: 27409501 PMCID: PMC4968922 DOI: 10.1167/iovs.15-18940] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the effect of disease severity and number of tests acquired during follow-up on the relative odds of identifying progression by structural or functional tests in glaucoma. METHODS This was an observational cohort study involving 462 eyes of 305 patients with glaucoma and 62 eyes of 49 healthy subjects. Glaucoma patients and healthy subjects were followed for an average of 3.6 ± 0.9 and 3.8 ± 0.9 years, with a median (interquantile range) of 8 (6-9) and 7 (6-8) visits, respectively. At each visit, subjects underwent visual field assessment with standard automated perimetry (SAP) and retinal nerve fiber layer (RNFL) evaluation by spectral-domain optical coherence tomography (SD-OCT). Slopes of change in SAP mean sensitivity and OCT RNFL thickness over time were estimated by linear regression using progressively cumulative visits over time. Cutoff values for age-related expected rates of change for each test were obtained from the healthy group. Progression by SD-OCT and/or SAP was determined if the slope of change was statistically significant and also lower (faster) than the fifth percentile cutoff calculated from the healthy group. A generalized estimating equation logistic regression model was used to evaluate the relative odds of progressing by OCT versus SAP in glaucoma eyes. RESULTS Eyes with less severe disease at baseline had a higher chance of being detected as progressing by SD-OCT but not by SAP, whereas an increase in disease severity at baseline increased the chance that the eye would be detected as progressing by SAP but not SD-OCT. Each 1 dB higher MD was associated with a 5% increase in the odds of detecting progression by SD-OCT versus SAP (odds ratio = 1.05 per 1 dB; 95% confidence interval: 1.01-1.09; P = 0.005). CONCLUSIONS The ability to detect glaucoma progression by SAP versus SD-OCT is significantly influenced by the stage of disease. Our results may provide useful information for guiding clinicians on the relative utility of these tests for detecting change throughout the disease continuum.
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Diniz-Filho A, Abe RY, Cho HJ, Baig S, Gracitelli CPB, Medeiros FA. Reply. Ophthalmology 2017; 124:e21. [PMID: 28126089 DOI: 10.1016/j.ophtha.2016.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 05/20/2016] [Indexed: 10/20/2022] Open
Affiliation(s)
- Alberto Diniz-Filho
- Laboratory of Performance and Visual Function, Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Ricardo Y Abe
- Laboratory of Performance and Visual Function, Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Hyong Jin Cho
- Laboratory of Performance and Visual Function, Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Saif Baig
- Laboratory of Performance and Visual Function, Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Carolina P B Gracitelli
- Laboratory of Performance and Visual Function, Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Felipe A Medeiros
- Laboratory of Performance and Visual Function, Department of Ophthalmology, University of California, San Diego, La Jolla, California.
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Gracitelli CPB, Osaki TH, Hirai FE, Yabumoto C, Viana GAP, Osaki MH. Assessment of self-esteem and psychological aspects in patients undergoing upper blepharoplasty. Revista Brasileira de Oftalmologia 2017. [DOI: 10.5935/0034-7280.20170058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chun M, Gracitelli CPB, Lopes FS, Biteli LG, Ushida M, Prata TS. Selective laser trabeculoplasty for early glaucoma: analysis of success predictors and adjusted laser outcomes based on the untreated fellow eye. BMC Ophthalmol 2016; 16:206. [PMID: 27881155 PMCID: PMC5120519 DOI: 10.1186/s12886-016-0385-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To identify success predictors and to study the role of the fellow untreated eye as a co-variable for adjustment of intraocular pressure (IOP) outcomes following selective laser trabeculoplasty (SLT) in early open-angle glaucoma (OAG) patients. METHODS A case series was carried out. Patients with uncontrolled early OAG or ocular hypertension (inadequate IOP control requiring additional treatment) underwent SLT (one single laser session) performed by the same surgeon in a standardized fashion. The same preoperative medical regimen was maintained during follow-up for all patients. Post-treatment assessments were scheduled at week 1 and months 1, 2, and 3. In order to account for possible influence of IOP fluctuation on laser outcomes, post-laser IOP values of the treated eye of each patient were also analyzed adjusting for IOP changes (between visits variation) of the untreated fellow eye (adjusted analysis). Pre and post-laser IOP values were compared using paired t-test. Factors associated with the magnitude of IOP reduction were investigated using multiple regression analysis. RESULTS A total of 45 eyes of 45 patients were enrolled. Mean IOP was reduced from 20.8 ± 5.1 to 14.9 ± 2.9 mmHg at month 3 (p < 0.001). Adjusted success rate (defined as IOP reduction ≥ 20%) was 64% and mean percentage of IOP reduction was 23.1 ± 14.3% at last follow-up visit. Considering unadjusted post-laser IOP values, it was found a 20% greater absolute IOP reduction (median [interquartile range] 6 mmHg [4-7] vs 5 mmHg [3-7]; p = 0.04), with a success rate of 76%. Although baseline IOP was significantly associated with both adjusted and unadjusted post-laser IOP reduction, a stronger association was found when unadjusted IOP values were considered (p < 0.001 and R 2 = 0.35; p < 0.001 and R 2 = 0.67, respectively). Age, mean deviation (MD) index, central corneal thickness and type of glaucoma were not significant predictors (p ≥ 0.150). CONCLUSIONS In this group of patients with early OAG or ocular hypertension, our short-term results confirmed SLT as a safe and effective alternative for IOP reduction. Although better outcomes were found in eyes with higher preoperative IOP, this effect was mitigated when results were adjusted to the fellow untreated eye (to the influence of between visits-IOP fluctuations).
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Affiliation(s)
- Mikael Chun
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821. Vila Clementino, São Paulo, São Paulo, CEP: 04023-062, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821. Vila Clementino, São Paulo, São Paulo, CEP: 04023-062, Brazil.
| | - Flavio S Lopes
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821. Vila Clementino, São Paulo, São Paulo, CEP: 04023-062, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
| | - Luis G Biteli
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821. Vila Clementino, São Paulo, São Paulo, CEP: 04023-062, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
| | - Michele Ushida
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
| | - Tiago S Prata
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821. Vila Clementino, São Paulo, São Paulo, CEP: 04023-062, Brazil.,Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
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Gracitelli CPB, Tatham AJ, Zangwill LM, Weinreb RN, Abe RY, Diniz-Filho A, Paranhos A, Baig S, Medeiros FA. Asymmetric Macular Structural Damage Is Associated With Relative Afferent Pupillary Defects in Patients With Glaucoma. Invest Ophthalmol Vis Sci 2016; 57:1738-46. [PMID: 27064394 PMCID: PMC4829086 DOI: 10.1167/iovs.15-18079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We examined the relationship between relative afferent pupillary defects (RAPDs) and macular structural damage measured by macular thickness and macular ganglion cell-inner plexiform layer (mGCIPL) thickness in patients with glaucoma. METHODS A cross-sectional study was done of 106 glaucoma patients and 85 healthy individuals from the Diagnostic Innovations in Glaucoma Study. All subjects underwent standard automated perimetry (SAP) and optic nerve and macular imaging using Cirrus Spectral Domain Optical Coherence Tomography (SDOCT). Glaucoma was defined as repeatable abnormal SAP or progressive glaucomatous changes on stereo photographs. Pupil responses were assessed using an automated pupillometer, which records the magnitude of RAPD (RAPD score), with additional RAPD scores recorded for each of a series of colored stimuli (blue, red, green, and yellow). The relationship between RAPD score and intereye differences (right minus left eye) in circumpapillary retinal nerve fiber layer (cpRNFL) thickness, mGCIPL, macular thickness, and SAP mean deviation (MD), was examined using linear regression. RESULTS There was fair correlation between RAPD score and asymmetric macular structural damage measured by intereye difference in mGCIPL thickness (R(2) = 0.285, P < 0.001). The relationship between RAPD score and intereye difference in macular thickness was weaker (R(2) = 0.167, P < 0.001). Intereye difference in cpRNFL thickness (R(2) = 0.350, P < 0.001) and SAP MD (R(2) = 0.594, P < 0.001) had stronger association with RAPD scores compared to intereye difference in mGCIPL and macular thickness. CONCLUSIONS Objective assessment of pupillary responses using a pupillometer was associated with asymmetric macular structural damage in patients with glaucoma.
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Affiliation(s)
- Carolina P B Gracitelli
- Hamilton Glaucoma Center and Department of Ophthalmology University of California San Diego, La Jolla, California, United States 2Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Andrew J Tatham
- Hamilton Glaucoma Center and Department of Ophthalmology University of California San Diego, La Jolla, California, United States 3Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, United Kingdom
| | - Linda M Zangwill
- Hamilton Glaucoma Center and Department of Ophthalmology University of California San Diego, La Jolla, California, United States
| | - Robert N Weinreb
- Hamilton Glaucoma Center and Department of Ophthalmology University of California San Diego, La Jolla, California, United States
| | - Ricardo Y Abe
- Hamilton Glaucoma Center and Department of Ophthalmology University of California San Diego, La Jolla, California, United States
| | - Alberto Diniz-Filho
- Hamilton Glaucoma Center and Department of Ophthalmology University of California San Diego, La Jolla, California, United States
| | - Augusto Paranhos
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Saif Baig
- Hamilton Glaucoma Center and Department of Ophthalmology University of California San Diego, La Jolla, California, United States
| | - Felipe A Medeiros
- Hamilton Glaucoma Center and Department of Ophthalmology University of California San Diego, La Jolla, California, United States
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Diniz-Filho A, Abe RY, Zangwill LM, Gracitelli CPB, Weinreb RN, Girkin CA, Liebmann JM, Medeiros FA. Association between Intraocular Pressure and Rates of Retinal Nerve Fiber Layer Loss Measured by Optical Coherence Tomography. Ophthalmology 2016; 123:2058-65. [PMID: 27554036 DOI: 10.1016/j.ophtha.2016.07.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 06/30/2016] [Accepted: 07/07/2016] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To evaluate the relationship between intraocular pressure (IOP) and rates of retinal nerve fiber layer (RNFL) thickness change over time measured by spectral-domain (SD) optical coherence tomography (OCT). DESIGN Observational cohort study. PARTICIPANTS The study involved 547 eyes of 339 patients followed up for an average of 3.9±0.9 years. Three hundred eight (56.3%) had a diagnosis of glaucoma and 239 (43.7%) were considered glaucoma suspects. METHODS All eyes underwent imaging using the Spectralis SD OCT (Heidelberg Engineering GmbH, Heidelberg, Germany), along with IOP measurements and standard automated perimetry (SAP). Glaucoma progression was defined as a result of "Likely Progression" from the Guided Progression Analysis software for SAP. Linear mixed models were used to investigate the relationship between average IOP during follow-up and rates of RNFL thickness change, while taking into account potential confounding factors such as age, race, corneal thickness, and baseline disease severity. MAIN OUTCOME MEASURES The association between IOP and rates of global and sectorial RNFL thickness loss measured by SD OCT. RESULTS Forty-six eyes (8.4%) showed progression on SAP during follow-up. Rates of global RNFL thickness change in eyes that progressed by SAP were faster than in those that did not progress (-1.02 vs. -0.61 μm/year, respectively; P = 0.002). For progressing eyes, each 1-mmHg higher average in IOP during follow-up was associated with an additional average loss of 0.20 μm/year (95% confidence interval [CI]: 0.08 to 0.31 μm/year; P < 0.001) of global RNFL thickness versus only 0.04 μm/year (95% CI: 0.01 to 0.07 μm/year; P = 0.015) for nonprogressing eyes. The largest associations between IOP and rates of RNFL change were seen for measurements from the temporal superior and temporal inferior sectors, whereas the smallest association was seen for measurements from the nasal sector. CONCLUSIONS Higher levels of IOP during follow-up were associated with faster rates of RNFL loss over time measured by SD OCT. These findings support the use of SD OCT RNFL thickness measurements as biomarkers for the evaluation of the efficacy of IOP-lowering therapies to slow down the rate of disease progression.
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Affiliation(s)
- Alberto Diniz-Filho
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Y Abe
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Carolina P B Gracitelli
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Christopher A Girkin
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey M Liebmann
- Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Felipe A Medeiros
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California.
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Baig S, Diniz-Filho A, Wu Z, Abe RY, Gracitelli CPB, Cabezas E, Medeiros FA. Association of Fast Visual Field Loss With Risk of Falling in Patients With Glaucoma. JAMA Ophthalmol 2016; 134:880-6. [DOI: 10.1001/jamaophthalmol.2016.1659] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Saif Baig
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Alberto Diniz-Filho
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Zhichao Wu
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Ricardo Y. Abe
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Carolina P. B. Gracitelli
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Eric Cabezas
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Felipe A. Medeiros
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, La Jolla
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Diniz-Filho A, Abe RY, Cho HJ, Baig S, Gracitelli CPB, Medeiros FA. Fast Visual Field Progression Is Associated with Depressive Symptoms in Patients with Glaucoma. Ophthalmology 2016; 123:754-9. [PMID: 26920097 DOI: 10.1016/j.ophtha.2015.12.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/26/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To evaluate the association between the rates of progressive visual field loss and the occurrence of depressive symptoms in patients with glaucoma followed over time. DESIGN Prospective observational cohort study. PARTICIPANTS The study included 204 eyes of 102 patients with glaucomatous visual field defects on standard automated perimetry (SAP). METHODS All patients had Geriatric Depression Scale (GDS) questionnaires and visual field tests obtained over a mean follow-up time of 2.2±0.6 years. Change in depressive symptoms was assessed by calculating the difference between GDS scores at the last follow-up visit from those at baseline. Rates of visual field loss were assessed by SAP. An integrated binocular visual field was estimated from the monocular SAP tests, and rates of change in mean sensitivity (MS) over time were obtained from linear mixed models. Regression models were used to investigate the association between progressive visual field loss and changes in depressive symptoms, adjusting for potentially confounding clinical and socioeconomic variables. MAIN OUTCOME MEASURES The association between rates of change in binocular SAP MS and change in GDS questionnaire scores. RESULTS There was a significant correlation between change in the GDS scores during follow-up and change in binocular SAP sensitivity. Each 1 decibel (dB)/year change in binocular SAP MS was associated with a change of 2.0 units in the GDS scores during the follow-up period (P = 0.025). In a multivariable model adjusting for baseline disease severity, change in visual acuity, age, gender, race, Montreal Cognitive Assessment score, education, income, and comorbidity index, each 1 dB/year change in binocular SAP MS was associated with a change of 3.0 units in the GDS score (P = 0.019). CONCLUSIONS Faster visual field progression was associated with the occurrence of depressive symptoms in patients with glaucoma.
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Affiliation(s)
- Alberto Diniz-Filho
- Laboratory of Performance and Visual Function, Department of Ophthalmology, University of California San Diego, La Jolla, California; Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Y Abe
- Laboratory of Performance and Visual Function, Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Hyong Jin Cho
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Saif Baig
- Laboratory of Performance and Visual Function, Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Carolina P B Gracitelli
- Laboratory of Performance and Visual Function, Department of Ophthalmology, University of California San Diego, La Jolla, California; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Felipe A Medeiros
- Laboratory of Performance and Visual Function, Department of Ophthalmology, University of California San Diego, La Jolla, California.
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Abe RY, Diniz-Filho A, Costa VP, Gracitelli CPB, Baig S, Medeiros FA. The Impact of Location of Progressive Visual Field Loss on Longitudinal Changes in Quality of Life of Patients with Glaucoma. Ophthalmology 2015; 123:552-7. [PMID: 26704883 DOI: 10.1016/j.ophtha.2015.10.046] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/25/2015] [Accepted: 10/27/2015] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate the association between rates of progressive loss in different regions of the visual field and longitudinal changes in quality of life (QoL). DESIGN Prospective, observational cohort study. PARTICIPANTS The study included 236 patients with glaucomatous visual field loss followed for an average of 4.3±1.5 years. METHODS All subjects had the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) performed annually and standard automated perimetry (SAP) at 6-month intervals. Subjects were included if they had a minimum of 2 NEI VFQ-25 and 5 SAP tests during follow-up. Evaluation of rates of visual field change was performed using 4 different regions (central inferior, central superior, peripheral inferior, and peripheral superior) of the integrated binocular visual field. The association between change in NEI VFQ-25 Rasch-calibrated scores and change in different regions of the visual field was investigated with a joint multivariable longitudinal linear mixed model. MAIN OUTCOME MEASURES The relationship between change in QoL scores and change of mean sensitivity in different regions of the visual field. RESULTS There was a significant correlation between change in the NEI VFQ-25 Rasch scores during follow-up and change in different regions of the visual field. Each 1 decibel (dB)/year change in binocular mean sensitivity of the central inferior area was associated with a decline of 2.6 units/year in the NEI VFQ-25 scores (R(2) = 35%; P < 0.001). Corresponding associations with change in QoL scores for the peripheral inferior, central superior, and peripheral superior areas of the visual field had R(2) values of 30%, 24%, and 19%, respectively. The association for the central inferior visual field area was statistically significantly stronger than those of the central superior area (P = 0.011) and peripheral superior area (P = 0.001), but not the peripheral inferior area (P = 0.171). Greater declines in NEI VFQ-25 scores were also seen in patients who had worse visual field sensitivity at baseline. CONCLUSIONS Progressive decline in sensitivity in the central inferior area of the visual field had the strongest association with longitudinal decline in QoL of patients with glaucoma.
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Affiliation(s)
- Ricardo Y Abe
- Visual Performance Laboratory, Department of Ophthalmology, University of California San Diego, La Jolla, California; Department of Ophthalmology, University of Campinas, Campinas, Brazil
| | - Alberto Diniz-Filho
- Visual Performance Laboratory, Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Vital P Costa
- Department of Ophthalmology, University of Campinas, Campinas, Brazil
| | - Carolina P B Gracitelli
- Visual Performance Laboratory, Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Saif Baig
- Visual Performance Laboratory, Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Felipe A Medeiros
- Visual Performance Laboratory, Department of Ophthalmology, University of California San Diego, La Jolla, California.
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Gracitelli CPB, Tatham AJ, Boer ER, Abe RY, Diniz-Filho A, Rosen PN, Medeiros FA. Predicting Risk of Motor Vehicle Collisions in Patients with Glaucoma: A Longitudinal Study. PLoS One 2015; 10:e0138288. [PMID: 26426342 PMCID: PMC4591330 DOI: 10.1371/journal.pone.0138288] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 08/29/2015] [Indexed: 11/19/2022] Open
Abstract
Purpose To evaluate the ability of longitudinal Useful Field of View (UFOV) and simulated driving measurements to predict future occurrence of motor vehicle collision (MVC) in drivers with glaucoma. Design Prospective observational cohort study. Participants 117 drivers with glaucoma followed for an average of 2.1 ± 0.5 years. Methods All subjects had standard automated perimetry (SAP), UFOV, driving simulator, and cognitive assessment obtained at baseline and every 6 months during follow-up. The driving simulator evaluated reaction times to high and low contrast peripheral divided attention stimuli presented while negotiating a winding country road, with central driving task performance assessed as “curve coherence”. Drivers with MVC during follow-up were identified from Department of Motor Vehicle records. Main Outcome Measures Survival models were used to evaluate the ability of driving simulator and UFOV to predict MVC over time, adjusting for potential confounding factors. Results Mean age at baseline was 64.5 ± 12.6 years. 11 of 117 (9.4%) drivers had a MVC during follow-up. In the multivariable models, low contrast reaction time was significantly predictive of MVC, with a hazard ratio (HR) of 2.19 per 1 SD slower reaction time (95% CI, 1.30 to 3.69; P = 0.003). UFOV divided attention was also significantly predictive of MVC with a HR of 1.98 per 1 SD worse (95% CI, 1.10 to 3.57; P = 0.022). Global SAP visual field indices in the better or worse eye were not predictive of MVC. The longitudinal model including driving simulator performance was a better predictor of MVC compared to UFOV (R2 = 0.41 vs R2 = 0.18). Conclusions Longitudinal divided attention metrics on the UFOV test and during simulated driving were significantly predictive of risk of MVC in glaucoma patients. These findings may help improve the understanding of factors associated with driving impairment related to glaucoma.
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Affiliation(s)
- Carolina P. B. Gracitelli
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, California, United States of America
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Andrew J. Tatham
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, California, United States of America
- Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, Edinburgh, United Kingdom
| | - Erwin R. Boer
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, California, United States of America
- Entropy Control, Inc., La Jolla, California, United States of America
| | - Ricardo Y. Abe
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, California, United States of America
- Department of Ophthalmology, University of Campinas, Campinas, São Paulo, Brazil
| | - Alberto Diniz-Filho
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, California, United States of America
- Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Peter N. Rosen
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, California, United States of America
| | - Felipe A. Medeiros
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, California, United States of America
- * E-mail:
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Liu T, Tatham AJ, Gracitelli CPB, Zangwill LM, Weinreb RN, Medeiros FA. Rates of Retinal Nerve Fiber Layer Loss in Contralateral Eyes of Glaucoma Patients with Unilateral Progression by Conventional Methods. Ophthalmology 2015; 122:2243-51. [PMID: 26383993 DOI: 10.1016/j.ophtha.2015.07.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/22/2015] [Accepted: 07/25/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To determine whether progressive retinal nerve fiber layer (RNFL) loss occurs in the contralateral eye of patients with glaucoma showing unilateral progression according to conventional diagnostic methods. DESIGN Prospective, longitudinal, observational cohort study. PARTICIPANTS Three hundred forty-six eyes of 173 patients (118 eyes with glaucoma and 228 eyes with suspect glaucoma at baseline) followed up for an average of 3.5±0.7 years. METHODS All subjects underwent standard automated perimetry (SAP; Humphrey Field Analyzer; Carl Zeiss Meditec, Dublin, CA) and spectral-domain (SD) optical coherence tomography (OCT; Spectralis; Heidelberg Engineering, Inc., Carlsbad, CA) in both eyes at 6-month intervals. Eyes were determined as progressing by conventional methods if there was progression on masked grading of optic disc stereophotographs or SAP Guided Progression Analysis (GPA; Carl Zeiss Meditec; "likely progression"). Rates of change in SD OCT average RNFL thickness were obtained using a linear mixed effects model. Rate of global loss was calculated using a random coefficient model and compared for nonprogressing patients, progressing eyes, and fellow eyes of unilateral progressing patients. MAIN OUTCOMES MEASURES Rate of change in global RNFL thickness. RESULTS Thirty-nine subjects showed evidence of unilateral progression by GPA, disc photographs, or both during follow-up. Mean ± standard error rate of RNFL loss in eyes progressing by conventional methods was -0.89±0.22 μm/year (P<0.001). The contralateral eyes of these subjects also showed significant loss of RNFL over time (-1.00±0.20 μm/year; P<0.001). One hundred thirty-four subjects did not show progression by conventional methods in either eye. These eyes also showed a significant decline over time in average RNFL thickness (-0.71±0.09 μm/year; P<0.001); however, the rate of change in these eyes was slower than that of the contralateral eye of patients showing unilateral progression (P<0.001). CONCLUSIONS Loss of RNFL thickness was seen in a substantial number of contralateral eyes of glaucoma patients showing unilateral progression by conventional methods. These findings indicate that assessment of RNFL thickness by SD OCT may show progressive glaucomatous damage that is not detected by visual fields or optic disc stereophotography.
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Affiliation(s)
- Ting Liu
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Ophthalmology, Daping Hospital & Research Institute of Surgery, Third Military Medical University of the People's Liberation Army, Chongqing, China
| | - Andrew J Tatham
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California; Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, Edinburgh, United Kingdom
| | - Carolina P B Gracitelli
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Linda M Zangwill
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Robert N Weinreb
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Felipe A Medeiros
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California.
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Abe RY, Gracitelli CPB, Diniz-Filho A, Zangwill LM, Weinreb RN, Medeiros FA. Frequency Doubling Technology Perimetry and Changes in Quality of Life of Glaucoma Patients: A Longitudinal Study. Am J Ophthalmol 2015; 160:114-122.e1. [PMID: 25868760 DOI: 10.1016/j.ajo.2015.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 04/03/2015] [Accepted: 04/06/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the relationship between rates of change on frequency doubling technology (FDT) perimetry and longitudinal changes in quality of life (QoL) of glaucoma patients. DESIGN Prospective observational cohort study. METHODS One hundred fifty-two subjects (127 glaucoma and 25 healthy) were followed for an average of 3.2 ± 1.1 years. All subjects were evaluated with National Eye Institute Visual Function Questionnaire (NEI VFQ-25), FDT, and standard automated perimetry (SAP). Glaucoma patients had a median of 3 NEI VFQ-25, 8 FDT, and 8 SAP tests during follow-up. Mean sensitivities of the integrated binocular visual fields were estimated for FDT and SAP and used to calculate rates of change. A joint longitudinal multivariable mixed model was used to investigate the association between change in binocular mean sensitivities and change in NEI VFQ-25 Rasch-calibrated scores. RESULTS There was a statistically significant correlation between change in binocular mean sensitivity for FDT and change in NEI VFQ-25 scores during follow-up in the glaucoma group. In multivariable analysis with the confounding factors, each 1 dB/year change in binocular FDT mean sensitivity corresponded to a change of 0.8 units per year in the NEI VFQ-25 scores (P = .001). For binocular SAP mean sensitivity, each 1 dB/year change was associated with 2.4 units per year change in NEI VFQ-25 scores (P < .001). The multivariable model containing baseline and rate of change information from SAP had stronger ability to predict change in NEI VFQ-25 scores compared to the equivalent model for FDT (R(2) of 50% and 30%, respectively; P = .001). CONCLUSION SAP performed significantly better than FDT in predicting change in NEI VFQ-25 scores in our population, suggesting that it may still be the preferable perimetric technique for predicting risk of disability from the disease.
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Affiliation(s)
- Ricardo Y Abe
- Department of Ophthalmology, Visual Performance Laboratory and Hamilton Glaucoma Center, University of California, San Diego, La Jolla, California
| | - Carolina P B Gracitelli
- Department of Ophthalmology, Visual Performance Laboratory and Hamilton Glaucoma Center, University of California, San Diego, La Jolla, California
| | - Alberto Diniz-Filho
- Department of Ophthalmology, Visual Performance Laboratory and Hamilton Glaucoma Center, University of California, San Diego, La Jolla, California
| | - Linda M Zangwill
- Department of Ophthalmology, Visual Performance Laboratory and Hamilton Glaucoma Center, University of California, San Diego, La Jolla, California
| | - Robert N Weinreb
- Department of Ophthalmology, Visual Performance Laboratory and Hamilton Glaucoma Center, University of California, San Diego, La Jolla, California
| | - Felipe A Medeiros
- Department of Ophthalmology, Visual Performance Laboratory and Hamilton Glaucoma Center, University of California, San Diego, La Jolla, California.
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Gracitelli CPB, Abe RY, Tatham AJ, Rosen PN, Zangwill LM, Boer ER, Weinreb RN, Medeiros FA. Association between progressive retinal nerve fiber layer loss and longitudinal change in quality of life in glaucoma. JAMA Ophthalmol 2015; 133:384-90. [PMID: 25569808 DOI: 10.1001/jamaophthalmol.2014.5319] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Evaluation of structural optic nerve damage is a fundamental part of diagnosis and management of glaucoma. However, the relationship between structural measurements and disability associated with the disease is not well characterized. Quantification of this relationship may help validate structural measurements as markers directly relevant to quality of life. OBJECTIVE To evaluate the relationship between rates of retinal nerve fiber layer (RNFL) loss and longitudinal changes in quality of life in glaucoma. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study including 260 eyes of 130 patients with glaucoma followed up for a mean (SD) of 3.5 (0.7) years. All patients had repeatable visual field defects on standard automated perimetry (SAP) at baseline. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was performed annually, and spectral-domain optical coherence tomography and SAP were performed at 6-month intervals. A joint model was used to investigate the association between change in NEI VFQ-25 Rasch-calibrated scores and change in RNFL thickness, adjusting for confounding socioeconomic and clinical variables. MAIN OUTCOMES AND MEASURES Association between change in binocular RNFL thickness (RNFL thickness in the better eye at each point) and change in NEI VFQ-25 scores. RESULTS Progressive binocular RNFL thickness loss was associated with worsening of NEI VFQ-25 scores over time. In a multivariable model adjusting for baseline disease severity and the rate of change in binocular SAP sensitivity, each 1-μm-per-year loss of RNFL thickness was associated with a decrease of 1.3 units (95% CI, 1.02-1.56) per year in NEI VFQ-25 scores (P < .001). After adjusting for the contribution from SAP, 26% (95% CI, 12%-39%) of the variability of change in NEI VFQ-25 scores was associated uniquely with change in binocular RNFL thickness. The P value remained less than .001 after adjusting for potential confounding factors. CONCLUSIONS AND RELEVANCE Progressive binocular RNFL thickness loss was associated with longitudinal loss in quality of life, even after adjustment for progressive visual field loss. These findings suggest that rates of binocular RNFL change are valid markers for the degree of neural loss in glaucoma with significant relationship to glaucoma-associated disability.
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Affiliation(s)
- Carolina P B Gracitelli
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego2Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Ricardo Y Abe
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego3Department of Ophthalmology, University of Campinas, Campinas, Brazil
| | - Andrew J Tatham
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego4Princess Alexandra Eye Pavilion, Department of Ophthalmology, University of Edinburgh, Edinburgh, Scotland
| | - Peter N Rosen
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego
| | - Linda M Zangwill
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego
| | - Erwin R Boer
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego
| | - Robert N Weinreb
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego
| | - Felipe A Medeiros
- Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego
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Tatham AJ, Boer ER, Gracitelli CPB, Rosen PN, Medeiros FA. Relationship Between Motor Vehicle Collisions and Results of Perimetry, Useful Field of View, and Driving Simulation in Drivers With Glaucoma. Transl Vis Sci Technol 2015; 4:5. [PMID: 26046007 DOI: 10.1167/tvst.4.3.5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/26/2015] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To examine the relationship between Motor Vehicle Collisions (MVCs) in drivers with glaucoma and standard automated perimetry (SAP), Useful Field of View (UFOV), and driving simulator assessment of divided attention. METHODS A cross-sectional study of 153 drivers from the Diagnostic Innovations in Glaucoma Study. All subjects had SAP and divided attention was assessed using UFOV and driving simulation using low-, medium-, and high-contrast peripheral stimuli presented during curve negotiation and car following tasks. Self-reported history of MVCs and average mileage driven were recorded. RESULTS Eighteen of 153 subjects (11.8%) reported a MVC. There was no difference in visual acuity but the MVC group was older, drove fewer miles, and had worse binocular SAP sensitivity, contrast sensitivity, and ability to divide attention (UFOV and driving simulation). Low contrast driving simulator tasks were the best discriminators of MVC (AUC 0.80 for curve negotiation versus 0.69 for binocular SAP and 0.59 for UFOV). Adjusting for confounding factors, longer reaction times to driving simulator divided attention tasks provided additional value compared with SAP and UFOV, with a 1 standard deviation (SD) increase in reaction time (approximately 0.75 s) associated with almost two-fold increased odds of MVC. CONCLUSIONS Reaction times to low contrast divided attention tasks during driving simulation were significantly associated with history of MVC, performing better than conventional perimetric tests and UFOV. TRANSLATIONAL RELEVANCE The association between conventional tests of visual function and MVCs in drivers with glaucoma is weak, however, tests of divided attention, particularly using driving simulation, may improve risk assessment.
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Affiliation(s)
- Andrew J Tatham
- Visual Performance Laboratory Department of Ophthalmology, University of California, San Diego, CA, USA ; Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, UK
| | - Erwin R Boer
- Entropy Control, Inc., La Jolla, CA, USA ; Department of Mechanical Engineering, Delft University of Technology, The Netherlands
| | - Carolina P B Gracitelli
- Visual Performance Laboratory Department of Ophthalmology, University of California, San Diego, CA, USA ; Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
| | - Peter N Rosen
- Visual Performance Laboratory Department of Ophthalmology, University of California, San Diego, CA, USA
| | - Felipe A Medeiros
- Visual Performance Laboratory Department of Ophthalmology, University of California, San Diego, CA, USA
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Abe RY, Gracitelli CPB, Medeiros FA. The Use of Spectral-Domain Optical Coherence Tomography to Detect Glaucoma Progression. Open Ophthalmol J 2015; 9:78-88. [PMID: 26069520 PMCID: PMC4460225 DOI: 10.2174/1874364101509010078] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 03/30/2015] [Accepted: 03/30/2015] [Indexed: 11/26/2022] Open
Abstract
Detection of progression and measurement of rates of change is at the core of glaucoma management, and the use of Spectral Domain Optical Coherence Tomography (SD-OCT) has significantly improved our ability to evaluate change in the disease. In this review, we critically assess the existing literature on the use of SD-OCT for detecting glaucoma progression and estimating rates of change. We discuss aspects related to the reproducibility of measurements, their accuracy to detect longitudinal change over time, and the effect of aging on the ability to detect progression. In addition, we discuss recent studies evaluating the use of combined structure and function approaches to improve detection of glaucoma progression.
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Affiliation(s)
- Ricardo Y Abe
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA ; Department of Ophthalmology, University of Campinas, Campinas, Brazil
| | - Carolina P B Gracitelli
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA ; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Felipe A Medeiros
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
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Gracitelli CPB, Abe RY, Medeiros FA. Spectral-Domain Optical Coherence Tomography for Glaucoma Diagnosis. Open Ophthalmol J 2015; 9:68-77. [PMID: 26069519 PMCID: PMC4460228 DOI: 10.2174/1874364101509010068] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 03/30/2015] [Accepted: 03/30/2015] [Indexed: 11/26/2022] Open
Abstract
Identification of structural damage to the optic nerve and retinal nerve fiber layer (RNFL) is an essential component of diagnosis and management of glaucoma. The introduction of spectral-domain OCT (SD-OCT) has allowed objective quantification of damage to these structures with unprecedented resolution. In addition, recent attention has been directed towards imaging the macular area for quantifying loss of neural tissue caused by the disease. Many studies have evaluated and compared the diagnostic accuracies of a variety of parameters that can be obtained from imaging these areas of the ocular fundus. In this article, we critically review the existing literature evaluating the diagnostic accuracy of SD-OCT in glaucoma and we discuss issues related to how SD-OCT results should be incorporated into clinical practice.
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Affiliation(s)
- Carolina P B Gracitelli
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA ; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Ricardo Y Abe
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA ; Department of Ophthalmology, University of Campinas, Campinas, Brazil
| | - Felipe A Medeiros
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
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Abstract
Schizophrenia is a complex mental disorder associated with not only cognitive dysfunctions, such as memory and attention deficits, but also changes in basic sensory processing. Although most studies on schizophrenia have focused on disturbances in higher-order brain functions associated with the prefrontal cortex or frontal cortex, recent investigations have also reported abnormalities in low-level sensory processes, such as the visual system. At very early stages of the disease, schizophrenia patients frequently describe in detail symptoms of a disturbance in various aspects of visual perception that may lead to worse clinical symptoms and decrease in quality of life. Therefore, the aim of this review is to describe the various studies that have explored the visual issues in schizophrenia.
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Affiliation(s)
- Carolina P. B. Gracitelli
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, 9500 Gilman Drive, La Jolla, CA 92093-0946, USA; Department of Ophthalmology, Federal University of São Paulo, Botucatu Street, 821. Vila Clementino, São Paulo, SP 04023-062, Brazil
| | - Ricardo Y. Abe
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, 9500 Gilman Drive, La Jolla, CA 92093-0946, USA; ; Department of Ophthalmology, University of Campinas, Vital Brasil Street, 251, Cidade Universitária Zeferino Vaz, Campinas, SP 13083-970, Brazil
| | - Alberto Diniz-Filho
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, 9500 Gilman Drive, La Jolla, CA 92093-0946, USA; ; Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Alfredo Balena Avenue, 190 Santa Efigenia, Belo Horizonte, MG 30130-100, Brazil
| | | | - Augusto Paranhos
- Department of Ophthalmology, Federal University of São Paulo, Botucatu Street, 821. Vila Clementino, São Paulo, SP 04023-062, Brazil;
| | - Felipe A. Medeiros
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, 9500 Gilman Drive, La Jolla, CA 92093-0946, USA;
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Abstract
The lamina cribrosa is the putative site of retinal ganglion cell axonal injury in glaucoma. Although histological studies have provided evidence of structural changes to the lamina cribrosa, even in early stages of glaucoma, until recently, the ability to evaluate the lamina cribrosa in vivo has been limited. Recent advances in optical coherence tomography, including enhanced depth and swept-source imaging, have changed this, providing a means to image the lamina cribrosa. Imaging has identified general and localized configurational changes in the lamina of glaucomatous eyes, including posterior laminar displacement, altered laminar thickness, and focal laminar defects with spatial association with conventional structural and functional losses. In addition, although the temporal relationship between changes to the lamina cribrosa and glaucomatous retinal ganglion cell loss is yet to be elucidated, quantitative measurements of laminar microarchitecture have good reproducibility and offer the potential to serve as biomarkers for glaucoma diagnosis and progression.
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Affiliation(s)
- Ricardo Y Abe
- Department of Ophthalmology, Hamilton Glaucoma Center, University of California, San Diego, San Diego, USA ; Department of Ophthalmology, University of Campinas, Campinas, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology, Hamilton Glaucoma Center, University of California, San Diego, San Diego, USA ; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Alberto Diniz-Filho
- Department of Ophthalmology, Hamilton Glaucoma Center, University of California, San Diego, San Diego, USA ; Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Andrew J Tatham
- Department of Ophthalmology, Hamilton Glaucoma Center, University of California, San Diego, San Diego, USA ; Department of Ophthalmology, Princess Alexandra Eye Pavilion, University of Edinburgh, Edinburgh, Scotland
| | - Felipe A Medeiros
- Department of Ophthalmology, Hamilton Glaucoma Center, University of California, San Diego, San Diego, USA
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Gracitelli CPB, Duque-Chica GL, Moura AL, Nagy BV, de Melo GR, Roizenblatt M, Borba PD, Teixeira SH, Ventura DF, Paranhos A. A positive association between intrinsically photosensitive retinal ganglion cells and retinal nerve fiber layer thinning in glaucoma. Invest Ophthalmol Vis Sci 2014; 55:7997-8005. [PMID: 25406281 DOI: 10.1167/iovs.14-15146] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess the integrity of intrinsically photosensitive retinal ganglion cells (ipRGCs) using the pupillary light reflex in glaucoma patients. METHODS A cross-sectional study was conducted, including 76 eyes from 38 patients with primary open-angle glaucoma and 36 eyes from 18 control subjects. The patients were tested in the dark with light stimuli using the Ganzfeld system, and the pupil diameter was measured with the assistance of an eye tracker consisting of two infrared cameras fit to an eyeglass frame. To preferentially stimulate ipRGCs, we used a 1-second 470-nm flash with a luminance of 250 cd/m(2). To stimulate different retinal photoreceptors (cones and rods), we used a 1-second 630-nm flash with a luminance of 250 cd/m(2). Standard automated perimetry (SAP), matrix frequency-doubling technology (FDT), and high-definition optical coherence tomography (Cirrus HD-OCT) were also performed. The correlation between the ipRGC-mediated sustained response following the pupillary light reflex and the structural and functional changes in glaucoma patients was analyzed using generalized estimating equation. RESULTS An association was observed between the average retinal nerve fiber layer (RNFL) thickness, as measured by Cirrus HD-OCT, and the sustained pupillary response to the blue flash (P = 0.024). The severity of glaucoma, based on the mean deviation of SAP (Hodapp-Anderson-Parrish system), was also associated with the sustained response to the blue flash (P = 0.006). CONCLUSIONS This study showed a correlation between the mean RNFL thickness and the pupillary light response. A decrease in the number of ipRGCs is potentially related to the reduced RNFL thickness.
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Affiliation(s)
| | | | - Ana Laura Moura
- Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil Psychology Institute, University of São Paulo, São Paulo, Brazil
| | - Balazs V Nagy
- Psychology Institute, University of São Paulo, São Paulo, Brazil
| | - Geraldine R de Melo
- Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
| | - Marina Roizenblatt
- Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
| | - Paula D Borba
- Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
| | - Sérgio H Teixeira
- Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
| | - Dora F Ventura
- Psychology Institute, University of São Paulo, São Paulo, Brazil
| | - Augusto Paranhos
- Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil
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Medeiros FA, Gracitelli CPB, Boer ER, Weinreb RN, Zangwill LM, Rosen PN. Longitudinal changes in quality of life and rates of progressive visual field loss in glaucoma patients. Ophthalmology 2014; 122:293-301. [PMID: 25444345 DOI: 10.1016/j.ophtha.2014.08.014] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 07/07/2014] [Accepted: 08/13/2014] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the association between longitudinal changes in quality of life (QoL) and rates of progressive visual field loss in glaucoma. DESIGN Prospective observational cohort study. PARTICIPANTS We recruited 322 eyes of 161 patients with glaucomatous visual field loss from the Diagnostic Innovations Glaucoma Study followed for an average of 3.5±0.7 years. METHODS All subjects had National Eye Institute Visual Function Questionnaire (NEI VFQ)-25 performed annually and standard automated perimetry (SAP) at 6-month intervals. Subjects were included if they had a minimum of 2 NEI VFQ-25 and ≥5 SAP during follow-up. Evaluation of rates of visual field change was performed using the mean sensitivity (MS) of the integrated binocular visual field (BVF). Rasch analysis was performed to obtain final scores of disability as measured by the NEI VFQ-25. A joint longitudinal multivariate mixed model was used to investigate the association between change in NEI VFQ-25 Rasch-calibrated scores and change in BVF sensitivity. Potentially confounding socioeconomic and clinical variables also were analyzed. MAIN OUTCOME MEASURES The relationship between change in NEI VFQ-25 Rasch-calibrated scores and change in binocular SAP MS. RESULTS There was a significant correlation between change in the NEI VFQ-25 Rasch scores during follow-up and change in binocular SAP sensitivity. Each 1-dB change in binocular SAP MS per year was associated with a change of 2.9 units per year in the NEI VFQ-25 Rasch scores during the follow-up period (R(2) = 26%; P<0.001). Eyes with more severe disease at baseline were also more likely to have a decrease in NEI VFQ-25 scores during follow-up (P<0.001). For subjects with the same amount of change in SAP sensitivity, those with shorter follow-up times had larger changes in NEI VFQ-25 scores (P = 0.005). A multivariable model containing baseline and rate of change in binocular MS had an adjusted R(2) of 50% in predicting change in NEI VFQ-25 scores. CONCLUSIONS Baseline severity, magnitude, and rates of change in BVF sensitivity were associated with longitudinal changes in QoL of glaucoma patients. Assessment of longitudinal visual field changes may help to identify patients at greater risk for developing disability from the disease.
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Affiliation(s)
- Felipe A Medeiros
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California.
| | - Carolina P B Gracitelli
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Erwin R Boer
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Robert N Weinreb
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Linda M Zangwill
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Peter N Rosen
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California
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Gracitelli CPB, Tatham AJ, Zangwill LM, Weinreb RN, Liu T, Medeiros FA. Estimated rates of retinal ganglion cell loss in glaucomatous eyes with and without optic disc hemorrhages. PLoS One 2014; 9:e105611. [PMID: 25157619 PMCID: PMC4144879 DOI: 10.1371/journal.pone.0105611] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 07/22/2014] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate whether optic disc hemorrhages are associated with faster rates of estimated retinal ganglion cell (RGC) loss in glaucoma. METHODS A longitudinal observational cohort study of 222 eyes of 122 patients with glaucoma recruited from the Diagnostic Innovations Glaucoma Study (DIGS) followed for an average of 3.74±0.85 years. All subjects had optical coherence tomography and standard automated perimetry during follow up. Optic disc hemorrhages were detected by masked evaluation of stereophotographs. Rates of change in estimated numbers of RGCs were determined using a previously described method. A random coefficients model was used to investigate the relationship between disc hemorrhages and rates of change in estimated RGC counts over time. RESULTS 19 eyes of 18 subjects had at least one disc hemorrhage during follow up. At baseline, average estimated RGC counts in eyes with and without disc hemorrhages were 677,994 cells and 682,021 cells, respectively (P = 0.929). Eyes with optic disc hemorrhages during follow-up had significantly faster rates of estimated RGC loss than eyes without disc hemorrhages (22,233 cells/year versus 10,704 cells/year, P = 0.020). The effect of disc hemorrhages on the rates of estimated RGC loss remained significant after adjusting for confounding variables. CONCLUSION Eyes with disc hemorrhages showed faster rates of RGC loss compared to eyes without disc hemorrhages. These results provide further evidence that disc hemorrhages should be considered as an indicator of increased risk for faster neural loss in glaucoma.
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Affiliation(s)
- Carolina P. B. Gracitelli
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, San Diego, California, United States of America
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo Brazil
| | - Andrew J. Tatham
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, San Diego, California, United States of America
- Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, Edinburgh, United Kingdom
| | - Linda M. Zangwill
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, San Diego, California, United States of America
| | - Robert N. Weinreb
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, San Diego, California, United States of America
| | - Ting Liu
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, San Diego, California, United States of America
| | - Felipe A. Medeiros
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, San Diego, California, United States of America
- * E-mail:
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