1
|
Andoh JE, Mehta SK, Mir TA, Chen EM, Nwanyanwu K, Teng CC. Domestic Violence-Related Ocular Injuries Among Adult Patients: Data from the Nationwide Emergency Department Sample, 2008-2017. Ophthalmic Epidemiol 2024; 31:169-177. [PMID: 37345877 PMCID: PMC10739625 DOI: 10.1080/09286586.2023.2222792] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 01/19/2023] [Accepted: 06/01/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE To investigate domestic violence (DV)-related ocular injuries among adult emergency department (ED) patients in the US. METHODS This was a retrospective, cross-sectional study of patients with a diagnosis of DV and diagnosis of ocular injury in the Nationwide Emergency Department Sample (NEDS) from 2008-2017. We identified patient- and hospital-level variables associated with DV-related ocular injuries. We calculated annual incidence rates using US Census data. Adjusting for inflation using the Consumer Price Index, we calculated mean and total charges. RESULTS From 2008-2017, there were 26,215 ED visits for ocular injuries related to DV with an average incidence of 1.09 per 100,000 adult population (female patients, 84.5%; mean age [SE], 34.3 [0.2]). DV-related ocular injuries were most prevalent among patients in the lowest income quartile (39.1%) and on Medicaid (37.4%). Most ED visits presented to metropolitan teaching (55.4%), non-trauma (46.7%), and south regional (30.5%) hospitals. The most common ocular injury was contusion of eye/adnexa (61.1%). The hospital admission rate was 5.2% with a mean hospital stay of 2.9 [0.2]. The inflation-adjusted mean cost for medical services was $38,540 [2,310.8] per encounter with an average increase of $2,116 per encounter, annually. The likelihood of hospital admission increased for patients aged ≥60 years old, on Medicare, and with open globes or facial/orbital fractures (all p < .05). CONCLUSION Contusion of the eye/adnexa was the most common ocular injury among patients with DV-related ED visits. To better facilitate referrals to social services, ophthalmologists should utilize DV screenings, especially towards women and patients of less privileged socioeconomic status.
Collapse
Affiliation(s)
- Joana E. Andoh
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
- Solomon Center for Health Law & Policy, Yale Law School, New Haven, Connecticut
| | - Sumarth K. Mehta
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Tahreem A. Mir
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Evan M. Chen
- Department of Ophthalmology, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Kristen Nwanyanwu
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Christopher C. Teng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
2
|
Kim HS, Sarrafpour S, Teng CC, Liu J. External Disruption of Ocular Development in Utero. Yale J Biol Med 2024; 97:41-48. [PMID: 38559457 PMCID: PMC10964818 DOI: 10.59249/rrmm8911] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The intricate steps of human ocular embryology are impacted by cellular and genetic signaling pathways and a myriad of external elements that can affect pregnancy, such as environmental, metabolic, hormonal factors, medications, and intrauterine infections. This review focuses on presenting some of these factors to recognize the multifactorial nature of ocular development and highlight their clinical significance. This review is based on English-language articles sourced from PubMed, Web of Science, and Google Scholar; keywords searched included "ocular development in pregnancy," "ocular embryology," "maternal nutrition," "ophthalmic change," and "visual system development." While some animal models show the disruption of ocular embryology from these external factors, there are limited post-birth assessments in human studies. Much remains unknown about the precise mechanisms of how these external factors can disrupt normal ocular development in utero, and more significant research is needed to understand the pathophysiology of these disruptive effects further. Findings in this review emphasize the importance of additional research in understanding the dynamic association between factors impacting gestation and neonatal ocular development, particularly in the setting of limited resources.
Collapse
Affiliation(s)
- Hyun Sue Kim
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Department of
Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT,
USA
| | - Soshian Sarrafpour
- Department of
Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT,
USA
| | - Christopher C. Teng
- Department of
Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT,
USA
| | - Ji Liu
- Department of
Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT,
USA
| |
Collapse
|
3
|
Singer MB, Fu JJ, Chow J, Teng CC. Development and Evaluation of Aeyeconsult: A Novel Ophthalmology Chatbot Leveraging Verified Textbook Knowledge and GPT-4. J Surg Educ 2024; 81:438-443. [PMID: 38135548 DOI: 10.1016/j.jsurg.2023.11.019] [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] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/08/2023] [Accepted: 11/25/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE There has been much excitement on the use of large language models (LLMs) such as ChatGPT in ophthalmology. However, LLMs are limited in that they are trained on unverified information and do not cite their sources. This paper highlights a new methodology to create a generative AI chatbot to answer eye care related questions which uses only verified ophthalmology textbooks as data and cites its sources. SETTING Yale School of Medicine Department of Ophthalmology and Visual Science. DESIGN/METHODS Aeyeconsult, an ophthalmology chatbot, was developed using GPT-4 (the LLM used to power the publicly available chatbot ChatGPT-4), LangChain, and Pinecone. Ophthalmology textbooks were processed into embeddings and stored in Pinecone. User queries were similarly converted, compared to stored embeddings, and GPT-4 generated responses. The interface was adapted from public code. Both Aeyeconsult and ChatGPT-4 were tested on the same 260 questions from OphthoQuestions.com, with the first response from Aeyeconsult and ChatGPT-4 recorded as the answer. RESULTS Aeyeconsult outperformed ChatGPT-4 on the OKAP dataset, with 83.4% correct answers compared to 69.2% (p = 0.0118). Aeyeconsult also had fewer instances of no answer and multiple answers. Both systems performed best in General Medicine, with Aeyeconsult achieving 96.2% accuracy. Aeyeconsult's weakest performance was in Clinical Optics at 68.1%, but it still outperformed ChatGPT-4 in this category (45.5%). CONCLUSION LLMs may be useful in answering ophthalmology questions but their trustworthiness and accuracy is limited due to training on unverified internet data and lack of source citation. We used a new methodology, using verified ophthalmology textbooks as source material and providing citations, to mitigate these issues, resulting in a chatbot more accurate than ChatGPT-4 in answering OKAPs style questions.
Collapse
Affiliation(s)
- Maxwell B Singer
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut.
| | - Julia J Fu
- Yale School of Medicine, New Haven, Connecticut
| | - Jessica Chow
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
4
|
Andoh JE, Miguez S, Andoh SE, Mehta S, Mir TA, Chen EM, Jain S, Teng CC, Nwanyanwu K. Epidemiologic trends of domestic violence-related ocular injuries among pediatric patients: data from the Nationwide Emergency Department Sample 2008-2017. J AAPOS 2023; 27:335.e1-335.e8. [PMID: 37931837 PMCID: PMC10859911 DOI: 10.1016/j.jaapos.2023.09.008] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/05/2023] [Accepted: 09/26/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE To study the epidemiology of all domestic violence (DV)-related ocular injuries among pediatric emergency department (ED) patients in the United States. METHODS This is a retrospective, cross-sectional study of isolated children (<18 years of age) with a diagnosis of DV and primary or secondary diagnosis of ocular injuries in the Nationwide Emergency Department Sample, 2008-2017. We calculated annual incidence of DV-related ocular injuries and prevalence by demographic variables, including age, sex, and income quartile. Median charges, median length of inpatient hospital stay, and factors associated with hospitalization were also measured. RESULTS From 2008 to 2017, there were 4,125 ED encounters, with an average incidence of 0.56 per 100,000 population (males, 50.0%; mean age [SE], 9.2 [0.3]). Patients in the lowest income quartile (42.6%) and with Medicaid insurance (63.2%) were the most prevalent. The most common known perpetrator was a family member (29.4%). Most ED encounters took place at southern regional (28.6%), metropolitan teaching (67.1%) and designated trauma hospitals (57.8%). Contusion of the eye/adnexa and being struck by or against an object were the most common ocular diagnosis and known mechanism of injury, respectively. An estimated 12.4% of patients were admitted with a median hospital stay of 4 (IQR, 2-6). Median charges during the study period were $27,415.10 (IQR, $13,142.70-$54,454.90). CONCLUSIONS DV-related ocular injuries were most prevalent among patients with a low socioeconomic status. Given the historical underreporting of DV, future studies are warranted to identify more specific social determinants of health that contribute to such presentations.
Collapse
Affiliation(s)
- Joana E Andoh
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
| | - Sofia Miguez
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Sarah E Andoh
- University of Vermont, Larner College of Medicine, UVMMC, Burlington, Vermont
| | - Sumarth Mehta
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Tahreem A Mir
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Evan M Chen
- Department of Ophthalmology, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Srimathy Jain
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Kristen Nwanyanwu
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
5
|
Andoh JE, Mir TA, Teng CC, Wang EA, Nwanyanwu K. Factors Associated With Visual Impairment Among Adults With a History of Criminal Justice Involvement. J Correct Health Care 2023; 29:329-337. [PMID: 37733299 DOI: 10.1089/jchc.22.07.0056] [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] [Indexed: 09/22/2023]
Abstract
The purpose of this study was to investigate the prevalence of and factors associated with visual impairment among adults with a history of criminal justice involvement (CJI). This retrospective, cross-sectional study reviewed adult respondents from the 2015-2018 National Survey on Drug Use and Health. We analyzed sociodemographic and health characteristics to determine factors associated with visual impairment among adults with and without a history of CJI. In this national, population-based study, we found similar rates of visual impairment among adults with and without CJI (5.7% vs. 4.2%, p < .001). However, adults with CJI were more likely to report visual impairment at a younger age. Among adults with CJI, visual impairment was associated with female sex, older age, Black/African American race, less education, lower income, and chronic health conditions (including diabetes, heart disease, respiratory illness, mental health symptoms, and hearing impairment). CJI in the past year (probation [adjusted odds ratio, AOR, 0.70; 95% confidence interval, CI, 0.53-0.93]; one arrest [AOR, 1.47; 95% CI, 1.14-1.89]; two or more arrests [AOR, 1.73; 95% CI, 1.29-2.33]) was uniquely associated with visual impairment among adults with a CJI history (p < .05 for all relationships). Research, screening, and treatment for visual impairment should include those with justice involvement to improve health equity.
Collapse
Affiliation(s)
- Joana E Andoh
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
- Solomon Center for Health Law and Policy, Yale Law School, New Haven, Connecticut, USA
| | - Tahreem A Mir
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Emily A Wang
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kristen Nwanyanwu
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
6
|
Fliney GD, Kim E, Sarwana M, Wong S, Tai TYT, Liu J, Sarrafpour S, Chadha N, Teng CC. Kahook Dual Blade versus Trabectome (KVT): Comparing Outcomes in Combination with Cataract Surgery. Clin Ophthalmol 2023; 17:145-154. [PMID: 36647517 PMCID: PMC9840398 DOI: 10.2147/opth.s391527] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Purpose To compare the safety and efficacy of Kahook Dual Blade (KDB) versus Trabectome with cataract surgery in reducing intraocular pressure (IOP) and medications used by patients with glaucoma. Methods Retrospective chart review comparing eyes after KDB or Trabectome with cataract surgery at 2 academic centers. Surgical success was defined as IOP <21 mmHg with ≥20% IOP reduction at post-operative month 12 (POM12). Changes in IOP, number of glaucoma medications, and adverse events were assessed. Results Ninety eyes in the KDB group and 125 eyes in the Trabectome group were included. Mean changes in IOP at POM12 were -1.9 ± 4.9 mmHg (11.2%, P = 0.002) in the KDB group and -3.5 ± 5.5 mmHg (19.1%, P < 0.001) in the Trabectome group, without a significant difference between the groups (P = 0.20). Mean change in glaucoma medications at POM12 was -0.8 ± 1.5 in the KDB group (58%, P < 0.001) and -0.3 ± 1.3 (38%, P = 0.003) in the Trabectome group, with KDB having a greater decrease in medications (P = 0.02). The percentage of eyes achieving success was 30% for the KDB group and 54% for the Trabectome group (P = 0.01). Hyphema was the most common complication, with an incidence of 3% for the KDB group and 14% for the Trabectome group (P = 0.01). Conclusion KDB or Trabectome with cataract surgery is safe and effective at lowering IOP and medication burden, with KDB resulting in a greater reduction in medications and Trabectome more frequently achieving success with an increased incidence of hyphema. Considering the study's limitations, the outcomes were similar.
Collapse
Affiliation(s)
- Greg D Fliney
- Yale University School of Medicine, Department of Ophthalmology and Visual Science, New Haven, CT, USA
| | - Eliott Kim
- Icahn School of Medicine at Mount Sinai/New York Eye and Ear, Eye and Vision Research Institute, New York, NY, USA
| | | | - Sze Wong
- Icahn School of Medicine at Mount Sinai/New York Eye and Ear, Eye and Vision Research Institute, New York, NY, USA
| | - Tak Yee Tania Tai
- Icahn School of Medicine at Mount Sinai/New York Eye and Ear, Eye and Vision Research Institute, New York, NY, USA
| | - Ji Liu
- Yale University School of Medicine, Department of Ophthalmology and Visual Science, New Haven, CT, USA
| | - Soshian Sarrafpour
- Yale University School of Medicine, Department of Ophthalmology and Visual Science, New Haven, CT, USA
| | - Nisha Chadha
- Icahn School of Medicine at Mount Sinai/New York Eye and Ear, Eye and Vision Research Institute, New York, NY, USA
| | - Christopher C Teng
- Yale University School of Medicine, Department of Ophthalmology and Visual Science, New Haven, CT, USA
- Correspondence: Christopher C Teng, Yale University School of Medicine, Department of Ophthalmology and Visual Science, 40 Temple Street Suite 3D, New Haven, CT, 06510, USA, Tel +1 203-785-2020, Fax +1 203-7856220, Email
| |
Collapse
|
7
|
Marks V, Steren BJ, Linderman W, Teng CC, Chow JH, Kombo N. Top 5 Tips for Preparing Ophthalmology Residency and Fellowship Applicants. Journal of Academic Ophthalmology 2023. [DOI: 10.1055/s-0042-1758564] [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] [Indexed: 01/15/2023] Open
Affiliation(s)
- Victoria Marks
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT
| | - Benjamin J. Steren
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT
| | - Wendy Linderman
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT
| | - Christopher C. Teng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT
| | - Jessica H. Chow
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT
| | - Ninani Kombo
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT
| |
Collapse
|
8
|
Chang EL, Apostolopoulos N, Mir TA, Freedman IG, Teng CC. Large Hyphema following Femtosecond Laser-assisted Cataract Surgery (FLACS) and Trabectome Resulting in Endocapsular Hematoma. J Curr Glaucoma Pract 2022; 16:195-198. [PMID: 36793266 PMCID: PMC9905881 DOI: 10.5005/jp-journals-10078-1372] [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: 06/19/2021] [Accepted: 03/30/2022] [Indexed: 01/25/2023] Open
Abstract
Aim To report a large hyphema following femtosecond laser-assisted cataract surgery (FLACS) and trabectome resulting in endocapsular hematoma. Background Hyphema has previously been described following trabectome, however, no cases have been reported following FLACS or FLACS combined with microinvasive glaucoma surgery (MIGS). We report a case of a large hyphema following FLACS combined with MIGS that resulted in an endocapsular hematoma. Case description A 63-year-old myopic female with exfoliation glaucoma underwent FLACS with a trifocal intraocular lens implant and Trabectome in the right eye. Significant intraoperative bleeding ensued following the trabectome and was treated with viscoelastic tamponade, anterior chamber (AC) washout, and cautery. The patient developed a large hyphema with intraocular pressure (IOP) rise that was treated with multiple AC taps, paracentesis, and eye drops. The hyphema took approximately 1 month to completely clear, leaving an endocapsular hematoma. This was treated successfully with Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser posterior capsulotomy. Conclusion Hyphema may occur with angle-based MIGS in combination with FLACS and may cause endocapsular hematoma. An increase in episcleral venous pressure during the docking and suction phase of the laser may predispose to bleeding. Endocapsular hematoma is an uncommon finding after cataract surgery and may be treated with Nd:YAG posterior capsulotomy. How to cite this article Chang EL, Apostolopoulos N, Mir TA, et al. Large Hyphema following Femtosecond Laser-assisted Cataract Surgery (FLACS) and Trabectome Resulting in Endocapsular Hematoma. J Curr Glaucoma Pract 2022;16(3):195-198.
Collapse
Affiliation(s)
- Eileen L Chang
- Department of Ophthalmology & Visual Science, Yale University, Yale, New Haven, Connecticut, United States
| | - Nicholas Apostolopoulos
- Department of Ophthalmology & Visual Science, Yale University, Yale, New Haven, Connecticut, United States
| | - Tahreem A Mir
- Department of Ophthalmology & Visual Science, Yale University, Yale, New Haven, Connecticut, United States
| | - Isaac G Freedman
- Department of Ophthalmology & Visual Science, Yale University, Yale, New Haven, Connecticut, United States
| | - Christopher C Teng
- Department of Ophthalmology & Visual Science, Yale University, Yale, New Haven, Connecticut, United States
| |
Collapse
|
9
|
Mehta SK, Mir T, Freedman IG, Sheth AH, Sarrafpour S, Liu J, Teng CC. Emergency Department Presentations of Acute Primary Angle Closure in the United States from 2008 to 2017. Clin Ophthalmol 2022; 16:2341-2351. [PMID: 35924186 PMCID: PMC9342660 DOI: 10.2147/opth.s368453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/11/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose Acute primary angle closure (APAC) is an ophthalmologic emergency. Nationwide data on the epidemiology and clinical characteristics of APAC are lacking despite the associated visual morbidity. Patients and Methods A retrospective cross-sectional study using the Nationwide Emergency Department Sample (NEDS). The NEDS was queried by ICD-9/10 code for cases of APAC presenting to the United States emergency departments over a ten-year period from 2008 to 2017. All identified cases were included to produce nationally representative estimates. Linear regression and seasonality tests were used to identify trends. Reported outcomes include the incidence, demographics, seasonality, and economic impact of APAC regionally and nationwide. Results A total of 23,203 APAC-related ED visits were identified. The mean (SD) and median ages were 58.8 (16.2) and 60 years, respectively. Females (59.4%, p < 0.01), those in the lowest income quartile (6983, 30.1%, p < 0.01), and those in the seventh decade of life (5599, 24.1%) presented more frequently with APAC. The incidence of ED presentations within each age group rose with age and increased significantly over the study period (p < 0.01). The Northeast region had the highest average incidence (0.93 per 100,000 population). Significant seasonal variation was seen regionally and nationally (p < 0.01), with the highest average incidence in December and lowest in April. Median inflation adjusted charge per ED visit was $2496.10, and the total inflation adjusted charges equaled $101.5 million. Conclusion The incidence of APAC-related ED visits continues to rise in the United States. High-risk groups include women, individuals of low socioeconomic status, and those between ages 50 and 70. Significant seasonal and regional trends were observed in ED presentations of APAC.
Collapse
Affiliation(s)
- Sumarth K Mehta
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
- Correspondence: Sumarth K Mehta, Department of Ophthalmology and Visual Science, Yale School of Medicine, 40 Temple Street, New Haven, CT, 06510, USA, Tel +1 203-785-2020, Email
| | - Tahreem Mir
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Isaac G Freedman
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Amar H Sheth
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Soshian Sarrafpour
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Ji Liu
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
10
|
Andoh JE, Feng PW, Mir TA, Yoon J, Chadha N, Teng CC. Gender Differences in Ophthalmic Procedural Volume: A Study of Male versus Female Glaucoma Specialists. Ophthalmol Glaucoma 2022; 5:594-601. [PMID: 35405381 DOI: 10.1016/j.ogla.2022.03.010] [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: 08/04/2021] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate whether differences in procedural volume exist between practicing male and female glaucoma specialists. DESIGN A cross-sectional analysis SUBJECTS: A total of 213 female and 666 male glaucoma specialists who performed greater than or equal to 11 traditional incisional glaucoma procedures for Medicare beneficiaries between 2014 and 2018. METHODS The 2014-2018 Medicare Provider Utilization and Payment Data was queried using Current Procedural Terminology (CPT) and Evaluation and Management (E&M) codes to identify clinic visits, cataract, glaucoma drainage implant (GDI), trabeculectomy, minimally invasive glaucoma surgery (MIGS), and office-based glaucoma laser procedures. The number of procedures performed per provider was averaged and compared between male and female specialists. Univariate ordinary least squares linear regression analysis was used to investigate the effects of gender on procedural volume. Multivariate ordinary least squares linear regression analysis was used to examine the effects of gender, number of group practice members, and years after medical school graduation on cataract, GDI, trabeculectomy, MIGS, and glaucoma laser procedural volume. MAIN OUTCOME MEASURES Mean difference in the number of procedures by gender and predictors of procedural volume. RESULTS In the univariate analysis, males performed an estimated 7.8 more MIGS (95% Confidence Interval [CI] 2.7-12.9; p=0.003), 138.9 more cataract (95% CI 59.6-218.3; p=0.0006), and 1.99 more GDI procedures (95% CI 0.03-3.95; p=0.046) than their female counterparts. This relationship remained true for MIGS and cataract procedures in the multivariate analysis after controlling for clinical volume, number of group practice members, and years after medical school graduation (MIGS, ß=6.1 [95% CI 0.5-11.8], p=0.03; cataract, ß= 110.2 [95% CI 16.9-203.5]; p=0.02). Glaucoma drainage implant procedures were no longer associated with the gender of the surgeon in the multivariate analysis (ß= 2.1 [95% CI -0.1-4.2], p=0.06). The volume of trabeculectomy and office-based glaucoma laser procedures did not differ between genders in both the univariate (glaucoma laser, ß= 7.0 [95% CI -4.4-18.5], p=0.23; trabeculectomy, ß= 2.7 [95% CI -0.8-6.2], p=0.13) and multivariate analyses (glaucoma laser, ß= -7.3 [95% CI -18.7-4.1], p=0.21; trabeculectomy, ß= -1.7 [95% CI -5.6-2.1], p=0.38). CONCLUSIONS Female glaucoma specialists performed fewer MIGS and cataract procedures compared to their male counterparts, even after controlling for clinical volume, which can be seen as a relative measure of work productivity, years after medical school graduation, a proxy for experience, and number of group practice members. After controlling for these factors, there were no differences in incisional glaucoma or glaucoma laser procedure volume between male and female specialists. Further research is needed to understand factors contributing to these differences.
Collapse
Affiliation(s)
- Joana E Andoh
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut.
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Tahreem A Mir
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - James Yoon
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Nisha Chadha
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York Eye and Ear, Eye and Vision Research Institute, New York, New York
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
11
|
Chang EL, Emmel DK, Teng CC, Sarrafpour S, Liu J. Anterior Subcapsular Cataract Formation With Long-term Topical Netarsudil Treatment for Glaucoma. J Glaucoma 2022; 31:60-63. [PMID: 34731868 DOI: 10.1097/ijg.0000000000001956] [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: 10/01/2021] [Accepted: 10/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to describe anterior subcapsular cataract development in patients on long-term topical netarsudil use. PATIENTS AND METHODS This clinical observational study summarizes a similar cataract pattern demonstrated in a series of patients from a single physician practice and a university-based outpatient clinic during their routine clinical follow-up visits from October 2020 to August 2021. All patients have been using topical netarsudil once daily for at least 15 months. No anterior capsular changes have been observed in any patient at the time when netarsudil was initiated. RESULTS Five eyes from 4 patients between the ages of 41 and 61 and 1 eye from a patient aged 84 were found to develop anterior subcapsular opacities 15 to 37 months after beginning netarsudil. These cataracts were overall small, 1 to 3 mm, round, oval or ring-shaped, central or paracentral with mild density. No other risk factors for cataract development apart from age were found in these patients. CONCLUSION Patients on long-term netarsudil should be monitored for potential development of anterior subcapsular cataracts.
Collapse
Affiliation(s)
- Eileen L Chang
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven
| | | | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven
| | - Soshian Sarrafpour
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven
| | - Ji Liu
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven
| |
Collapse
|
12
|
Sarrafpour S, Davies I, Ahmed O, Liu J, Teng CC. Cataract Surgery in Malignant Glaucoma from Complete Subluxation of Lens into Anterior Chamber. J Curr Glaucoma Pract 2021; 15:164-167. [PMID: 35173401 PMCID: PMC8807931 DOI: 10.5005/jp-journals-10078-1320] [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] [Indexed: 11/23/2022] Open
Abstract
Aim and objective To report an unusual and difficult case of malignant glaucoma induced by a traumatic mature cataract that had migrated into the anterior chamber in a developmentally delayed patient. Background Malignant glaucoma can present due to multiple mechanisms, including trauma-induced cataract migration into the anterior chamber. Case description A developmentally delayed female in her 40s with a history of self-abuse was found to have malignant glaucoma in the setting of a traumatic cataract that had migrated in front of the iris into the anterior chamber. Exam under anesthesia and ultrasound biomicroscopy (UBM) demonstrated complete subluxation of the lens into the anterior chamber. Perioperative techniques included prophylactic pars plana vitrectomy to alleviate posterior pressure as well as the creation of an irido-zonulo-hyaloido-vitrectomy (IZHV), which allowed for reformation of the anterior chamber. These maneuvers allowed for cataract surgery to be performed through a clear corneal incision, with anterior chamber intraocular lens implantation. The patient had improved vision, pressure, and pain. Conclusion Malignant glaucoma can present in unique ways and the presence of a flat anterior chamber and increased posterior pressure can make surgery challenging. Initial pars plana vitrectomy in addition to the creation of an IZHV can help relieve posterior pressure and facilitate cataract extraction. It is important to factor in patient-specific situations and goals while selecting an intraocular lens. Clinical significance Traumatic cataracts and malignant glaucoma can present in unique scenarios that may prove difficult to treat. Certain techniques can facilitate these challenging surgeries and provide the optimal outcome for patients. How to cite this article Sarrafpour S, Davies I, Ahmed O, et al. Cataract Surgery in Malignant Glaucoma from Complete Subluxation of Lens into Anterior Chamber. J Curr Glaucoma Pract 2021;15(3):164–167.
Collapse
Affiliation(s)
- Soshian Sarrafpour
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Isaiah Davies
- Department of Ophthalmology, Yale University, New Haven, Connecticut, USA
| | - Osama Ahmed
- Department of Ophthalmology, Yale University, New Haven, Connecticut, USA
| | - Ji Liu
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
13
|
Roginiel AC, Teng CC, Chow JH. A Novel Microsurgical Suturing Pilot Course for Ophthalmology Residents Based on Kern's Model for Curriculum Development. Journal of Academic Ophthalmology 2020. [DOI: 10.1055/s-0040-1717061] [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] [Indexed: 10/23/2022] Open
Abstract
AbstractBackground Sutureless ophthalmic procedures are becoming more commonplace, reducing opportunities for ophthalmology residents to learn microsurgical suturing techniques. There is no standard curriculum in place to address this gap in clinical training among ophthalmology residency programs.Objective The aim of this study was to design, implement, and evaluate a preliminary microsurgical suturing curriculum for ophthalmology residents using Kern's six-step approach for curriculum development as a guideline, and the principles of distributed practice and guided, self-directed practice.Methods We designed a faculty-led teaching session on fundamental microsurgical suturing techniques for all 15 ophthalmology residents from Yale University over one academic year. Suturing skills were evaluated, followed by a guided teaching session, 30 days of self-directed practice time, and a re-evaluation of skills. The residents were evaluated through a written knowledge assessment and practical skills assessment. The residents also evaluated their skill level before and after the teaching session and practice period through written Likert-scale surveys. Data were evaluated in Excel using descriptive statistics and the paired t-test.Results After the session, postgraduate year 2 (PGY-2) residents felt more confident in recognition and use of surgical instruments (p < 0.01). PGY-3 residents felt less confident in their knowledge of microsurgical suturing after the session (p = 0.02). PGY-4 residents felt they were better able to identify different suture types after the session (p = 0.02). All residents improved on the written knowledge assessment (p < 0.001) and in all categories of the practical skills assessment (p < 0.001).Conclusions Implementation of a faculty-led microsurgical suturing training session, followed by 1-month of practice time, significantly improved residents' knowledge and practical application of various microsurgical suturing techniques that are necessary for performing common ophthalmic procedures.
Collapse
Affiliation(s)
- Aliya C. Roginiel
- Yale University School of Medicine, New Haven, Connecticut
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck, New York
| | - Christopher C. Teng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Jessica H. Chow
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
14
|
Ma AK, Lee JH, Warren JL, Teng CC. GlaucoMap - Distribution of Glaucoma Surgical Procedures in the United States. Clin Ophthalmol 2020; 14:2551-2560. [PMID: 32943836 PMCID: PMC7473985 DOI: 10.2147/opth.s257361] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/13/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To understand the distribution of trabeculectomies, glaucoma drainage implants (GDI) and micro-invasive glaucoma surgeries (MIGS) performed in the United States through geospatial mapping. METHODS We performed an observational cohort study to evaluate glaucoma surgeries in patients age ≥65. The most recently released data from Centers for Medicare Part B Carrier Summary Files were queried to determine the number of glaucoma surgeries performed per state during the year of 2017. We created choropleth maps, titled "GlaucoMap", to characterize the rates of various surgeries performed across the United States, defined as the number of procedures performed per 10,000 individuals. A chi-squared analysis was further used to evaluate differences in surgical preferences across geographic region. Standardized residuals (SR) were calculated to determine regional influences on surgical distribution. RESULTS There were 174,788 glaucoma surgeries performed: 22,862 trabeculectomies (13.1%), 19,991 GDI (11.4%) and 131,935 (75.5%) MIGS. The Northeast had the highest trabeculectomy rate, GDI was highest in the Southeast and MIGS were highest in the Southwest. There was a statistically significant difference in proportional use of conventional surgeries versus MIGS across various regions in the United States (p < 0.0001). Given the high trabeculectomy and GDI rates and relatively low MIGS adoption in the Southeast, we observed a +7.03 SR for conventional surgeries and -4.01 SR for MIGS. The Southwest and Western states had the highest MIGS rate and contributed +3.29 and +3.24 SR toward disproportional MIGS preference, respectively. The preference for conventional surgeries in the Northeast (SR = +2.93) and MIGS in the Midwest (SR = +0.99) also contribute to the overall differences in glaucoma surgeries across the United States. CONCLUSION GlaucoMap is useful for visualizing the distribution of glaucoma surgeries in the United States. The heterogeneity in surgical preferences points to regional differences in glaucoma management.
Collapse
Affiliation(s)
| | | | - Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
15
|
Yim CK, Teng CC, Warren JL, Tsai JC, Chadha N. Microinvasive Glaucoma Surgical Training in United States Ophthalmology Residency Programs. Clin Ophthalmol 2020; 14:1785-1789. [PMID: 32636608 PMCID: PMC7326691 DOI: 10.2147/opth.s255103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/23/2020] [Accepted: 05/27/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The emergence of microinvasive glaucoma surgeries (MIGS) has expanded glaucoma management options. Resident experience with these novel procedures is unclear as no residency minimums exist for them, nor are they part of Accreditation Council for Graduate Medical Education (ACGME) procedure logs. The purpose of this study was to assess resident experience with MIGS in ACGME ophthalmology residency programs across the United States. Methods This was a cross-sectional survey study of resident MIGS experience. A survey was mailed to program directors of ACGME-accredited ophthalmology residency programs (N = 118) in January 2017. Descriptive analyses were used to characterize the respondent demographics. Chi-square, paired t-tests, and McNemar's tests were used to analyze the geographical distribution and frequency of MIGS experience. Results A total of 30 out of 118 (25%) residency program directors across all geographic regions responded. Most incorporated both MIGS lecture (87%) and wet lab (73%) didactics into their curriculum. Only 27% felt that MIGS should be part of ACGME requirements. The most common MIGS taught were iStent (70%), endoscopic cyclophotocoagulation (50%), and trabectome (40%). Few residents had completed MIGS procedures as the primary surgeon by graduation. Eleven out of 30 program directors (37%) did not feel that the experience was adequate for independent practice. Conclusion This study suggests that residents are exposed to some MIGS procedures during training, but program directors did not feel that the experience was adequate for independent practice. Further research is necessary to understand the barriers to integrating MIGS training into residency programs.
Collapse
Affiliation(s)
- Cindi K Yim
- USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye and Ear Infirmary, Eye and Vision Research Institute, New York, NY, USA
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Joshua L Warren
- Department of Biostatistics, Yale University, New Haven, CT, USA
| | - James C Tsai
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye and Ear Infirmary, Eye and Vision Research Institute, New York, NY, USA
| | - Nisha Chadha
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye and Ear Infirmary, Eye and Vision Research Institute, New York, NY, USA
| |
Collapse
|
16
|
Feng PW, Gronbeck C, Chen EM, Teng CC. Ophthalmologists in the First Year of the Merit-based Incentive Payment System. Ophthalmology 2020; 128:162-164. [PMID: 32522555 DOI: 10.1016/j.ophtha.2020.05.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/14/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Paula W Feng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut.
| | | | - Evan M Chen
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
17
|
Chen EM, Kombo N, Teng CC, Mruthyunjaya P, Nwanyanwu K, Parikh R. Ophthalmic Medication Expenditures and Out-of-Pocket Spending: An Analysis of United States Prescriptions from 2007 through 2016. Ophthalmology 2020; 127:1292-1302. [PMID: 32359935 DOI: 10.1016/j.ophtha.2020.04.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To estimate temporal trends in total and out-of-pocket (OOP) expenditures for ophthalmic prescription medications among adults in the United States. DESIGN Retrospective, longitudinal cohort study. PARTICIPANTS Participants in the 2007 through 2016 Medical Expenditure Panel Survey (MEPS) 18 years of age or older. The MEPS is a nationally representative survey of the noninstitutionalized, civilian United States population. METHODS We estimated trends in national and per capita annual ophthalmic prescription expenditures by pooling data into 2-year cycles and using weighted linear regressions. We also identified characteristics associated with greater total or OOP expenditures with multivariate weighted linear regression. Costs were adjusted to 2016 United States dollars using the gross domestic product price index. MAIN OUTCOME MEASURES Trends in total and OOP annual expenditures for ophthalmic medications from 2007 through 2016 as well as factors associated with greater expenditures. RESULTS From 2007 through 2016, 9989 MEPS participants (4.2%) reported ophthalmic medication prescription use. Annual ophthalmic medication use increased from 10.0 to 12.2 million individuals from 2007 and 2008 through 2015 and 2016. In this same period, national expenditures for ophthalmic medications increased from $3.39 billion to $6.08 billion and OOP expenditures decreased from $1.34 to $1.18 billion. Per capita expenditure increased from $338.72 to $499.42 (P < 0.001), and per capita OOP expenditure decreased from $133.48 to $96.67 (P < 0.001) from 2007 and 2008 through 2015 and 2016, respectively. From 2015 through 2016, dry eye (29.5%) and glaucoma (42.7%) medications accounted for 72.2% of all ophthalmic medication expenditures. Patients who were older than 65 years (P < 0.001), uninsured (P < 0.001), and visually impaired (P < 0.001) were significantly more likely to have greater OOP spending on ophthalmic medications. CONCLUSIONS Total ophthalmic medication expenditure in the United States increased significantly over the last decade, whereas OOP expenses decreased. Increases in coverage, copayment assistance, and use of expensive brand drugs may be contributing to these trends. Policy makers and physicians should be aware that rising overall drug expenditures ultimately may increase indirect costs to the patient and offset a decline in OOP prescription drug spending.
Collapse
Affiliation(s)
- Evan M Chen
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Ninani Kombo
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Prithvi Mruthyunjaya
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Kristen Nwanyanwu
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Ravi Parikh
- Department of Ophthalmology, NYU Langone Health, New York University School of Medicine, New York, New York; Manhattan Retina and Eye Consultants, New York, New York.
| |
Collapse
|
18
|
Abstract
Purpose This study evaluated US resident and fellow glaucoma surgical experience over a 7- and 8-year period, respectively. Methods US ophthalmology resident glaucoma case logs from 2009 to 2016 and glaucoma fellow case logs from 2008 to 2016 were reviewed. The number of total, average, median, and minimum cases, along with percentile data for filtering surgery, shunting surgery, and novel procedures were analyzed for year-to-year trends. Results Among residents training from 2009 to 2016, there was a decline in the average number of primary filtering surgeries by 20%, from 6.0±5.0 to 4.8±4.0 cases, with a concurrent increase in average primary glaucoma drainage implant (GDI) surgeries by 40%, from 4.5±4.0 to 6.3±5.0 cases, which represented an increase of 6.5% per year, P<0.001. Glaucoma fellow data from 2008 to 2015 demonstrated a decline in average primary trabeculectomy surgeries by 3.7%, from 30.1 to 29.0 cases, but then increased to 32.1 cases in 2015–2016. There was an increase in average GDI surgeries by 57.9%, from 30.2 to 47.7 cases for fellows over this 8-year period, which represented a 5.9% increase per year, P<0.001. There was no microinvasive glaucoma surgery (MIGS) or other novel procedures reported in the Accreditation Council for Graduate Medical Education (ACGME) resident case logs. From 2008 to 2016, Association of University Professors of Ophthalmology (AUPO) glaucoma fellow case logs demonstrated an increase in endocyclophotocoagulation (ECP) from 2.3 to 5.4 cases, a 15.5% increase per year, P<0.001. Conclusions Over a 7–8-year period, trainee surgical experience with GDI surgery has steadily increased, whereas surgical experience with trabeculectomy has been fluctuating and may be on a downward trend. Educators should be aware of shifts in trainee surgical experience in order to maintain appropriate training experience.
Collapse
Affiliation(s)
- Nisha Chadha
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York Eye and Ear, Eye and Vision Research Institute, NY 10029, USA, .,Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT 06510, USA,
| | - Joshua L Warren
- Department of Biostatistics, Yale University, New Haven, CT 06510, USA
| | - Ji Liu
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT 06510, USA,
| | - James C Tsai
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York Eye and Ear, Eye and Vision Research Institute, NY 10029, USA,
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT 06510, USA,
| |
Collapse
|
19
|
Abstract
Aim The aim of this study is to report cyclodialysis cleft creation during Kahook dual blade (KDB) goniotomy. Background No known reports of cyclodialysis clefts have been published to the authors’ knowledge after KDB goniotomy. Case description A 55-year-old myopic male with primary open angle glaucoma in both eyes (OU) underwent routine cataract extraction and intraocular lens implant with KDB goniotomy in the right eye (OD). Preoperative intraocular pressures (IOP) OD were in the low 20 mm Hg range on timolol and bimatoprost. Postoperative IOP was 4 mm Hg, with a moderate depth anterior chamber. Gonioscopy was slit in all quadrants, with no structures visible, and no improvement on indentation. Mild macular choroidal folds were present OD. Ultrasound biomicroscopy (UBM) revealed an area of supraciliary fluid. Anterior chamber reformation with viscoelastic was performed and repeat gonioscopy revealed a cyclodialysis cleft from 2:00 to 3:00. Treatment with multiple sessions of argon laser photocoagulation successfully closed the cleft. Conclusion KDB goniotomy may be complicated by cyclodialysis cleft formation and hypotony maculopathy. Visualization of a cleft on gonioscopy may require anterior chamber reformation. Clinical significance With an increasing use of KDB for goniotomy, previously unreported complications may arise including cyclodialysis cleft and resultant hypotony maculopathy. Because cleft following KDB goniotomy is rare, suspicion may be low and diagnosis could be delayed in the setting of postoperative hypotony with closed angles. How to cite this article Shue A, Levine RM, et al. Cyclodialysis Cleft Associated with Kahook Dual Blade Goniotomy. J Curr Glaucoma Pract 2019;13(2):74–76.
Collapse
Affiliation(s)
- Ann Shue
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Russell M Levine
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gregory M Gallousis
- New York Eye and Ear Infirmary of Mount Sinai, Mount Sinai Health System, New York, USA
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
20
|
Hussnain SA, Kovacs KD, Warren JL, Teng CC. Corneal hysteresis and anterior segment optical coherence tomography anatomical parameters in primary angle closure suspects. Clin Exp Ophthalmol 2018; 46:468-472. [PMID: 29251401 DOI: 10.1111/ceo.13135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 08/22/2017] [Revised: 11/20/2017] [Accepted: 12/05/2017] [Indexed: 11/29/2022]
Abstract
IMPORTANCE Corneal hysteresis (CH) is a dynamic marker of structural and functional changes in the cornea associated with intraocular pressure (IOP) and central corneal thickness, but its utility in assessing primary angle closure suspects (PACS) has not been fully elucidated. BACKGROUND This study assesses if anterior segment measurements correlate with CH in PACS patients. DESIGN IRB-approved retrospective review of imaging and records at a university practice. PARTICIPANTS Sixty-three eyes from 37 patients diagnosed as PACS, without other ocular pathology. METHODS Every eye underwent measurements including: ocular response analyzer (ORA), anterior segment optical coherence tomography (OCT) and a clinical evaluation. ORA measurements were correlated with other anatomic parameters using a mixed effects multivariable linear regression framework. MAIN OUTCOME MEASURES ORA measurements included: CH, corneal resistance factor, Goldmann IOP (IOPg ) and corneal compensated IOP (IOPcc ). Anterior segment OCT measurements included: central corneal thickness (CCTOCT ), nasal and temporal peripheral corneal thicknesses (PCT1 and PCT2), anterior chamber depth (ACD), nasal angle to temporal angle distance (ATA) and temporal and nasal angle measurements. Clinical measurements included: central corneal thickness via pachymetry, IOP measured by Goldmann applanation, axial length by A-scan ultrasound and spherical equivalent. RESULTS CH was negatively correlated with IOPcc, and ACD CH was positively correlated with CCTOCT , CCTp , CRF, PCT1 and PCT2. Females were found to have lower CH. In multivariable regression controlling for gender, CCT, PCT, IOP and ACD, no correlation was seen between CH and anatomic measurements. CONCLUSIONS AND RELEVANCE CH values in PACS do not correlate with anterior segment anatomy.
Collapse
Affiliation(s)
- Syed Amal Hussnain
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kyle D Kovacs
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
21
|
Abstract
The Argentinean Flag Sign is a complication that occurs during capsulorhexis construction, in which the capsulorhexis extends to the periphery due to lens intumescence. Phaco capsulotomy is a technique in which the phacoemulsification tip is used to simultaneously create the initial tear in the anterior capsule and remove a portion of the intumescent lens, thereby debulking and relieving pressure from the lens and capsule, and preventing the Argentinean Flag Sign. A detailed description of the phaco capsulotomy technique is provided, including applications and potential complications.
Collapse
Affiliation(s)
- Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
22
|
Abstract
Background Resident procedure minimums have been established in surgical training programs to ensure adequate training experience. However, achievement of these minimums may fluctuate. Review of resident experience is essential for maintaining successful training curricula. Objective To evaluate trends in ophthalmology resident surgical experience from 2009 to 2015. Methods This was a database study reviewing Accreditation Council for Graduate Medical Education ophthalmology resident surgical case logs. Case logs from 2,797 US ophthalmology residents were reviewed for trends in average surgical cases performed by residents as primary surgeon in the area of cataract, cornea, retina, glaucoma, pediatrics, plastics, and trauma from 2009 to 2015. Results Significant trends in resident surgical experience were demonstrated in the areas of cataract, retina, and glaucoma, while experience in cornea, pediatrics, plastics, and trauma remained stable. These trends included an increase in average cases of phacoemulsification cataract surgery from 143.8 to 173.6, vitreous tap/inject procedures from 31.3 to 93.1, and glaucoma shunt surgery from 4.5 to 6.7, with a decline in average cases of nonphacoemulsification cataract surgery from 3.8 to 2.2, retinal photocoagulation from 59.6 to 45.5, and filtering surgery from 6 to 4.5. Conclusion Trends in ophthalmology surgical experience in cataract, retina, and glaucoma paralleled new surgical or therapeutic developments as well as practice pattern shifts in these fields. Educators should be cognizant of the impact of such trends on resident experience and determine if curricular adjustments should be made to maintain comprehensive education of physicians-in-training.
Collapse
Affiliation(s)
- Nisha Chadha
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ji Liu
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| | - Jessica S Maslin
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
23
|
Maslin JS, Teng CC, Materin M. Free-Floating, Pigmented Cysts in the Anterior Chamber Causing Ocular Hypertension. Ocul Oncol Pathol 2016; 2:239-241. [PMID: 27843903 DOI: 10.1159/000446516] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 02/04/2016] [Revised: 04/19/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aim of this study was to describe the clinical and histopathological features of a 36-year-old male with hundreds of recurrent, unilateral, free-floating, pigmented cysts in the anterior chamber causing ocular hypertension. PROCEDURES The patient was referred to ocular oncology for blurry vision of the right eye and was found to have myriad pigmented, free-floating cysts in the anterior chamber and heavy pigmentation of the angle on gonioscopy. Anterior chamber washout was performed, and the fluid recovered was sent for pathological analysis. RESULTS The pathology report demonstrated rare nonpigmented epithelial cells, more consistent with iris stromal cysts or secondary implantation epithelial cysts. CONCLUSIONS This paper highlights the first documented case of innumerable spontaneously occurring, unilateral, free-floating, pigmented cysts in the anterior chamber. While clinical diagnosis suggested iris pigment epithelial cysts, pathology suggested iris stromal cysts or secondary implantation epithelial cysts.
Collapse
Affiliation(s)
- Jessica S Maslin
- Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Conn., USA
| | - Christopher C Teng
- Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Conn., USA
| | - Miguel Materin
- Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Conn., USA
| |
Collapse
|
24
|
Xu SC, Chow J, Liu J, Li L, Maslin JS, Chadha N, Chen B, Teng CC. Risk factors for visual impairment associated with corneal diseases in southern China. Clin Ophthalmol 2016; 10:777-82. [PMID: 27194904 PMCID: PMC4859424 DOI: 10.2147/opth.s103302] [Citation(s) in RCA: 8] [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] [Indexed: 11/30/2022] Open
Abstract
Purpose To identify the most common etiologies of corneal disease and the risk factors associated with worse visual outcomes in Changsha, Hunan, located in southern China. Methods This observational, cross-sectional study evaluated 100 consecutive patients seen at the cornea clinic of The Second Xiangya Hospital of Central South University. Ocular history, demographic information, and ocular use of traditional Chinese medicine were recorded and analyzed. Causes of infectious keratitis were diagnosed clinically. Fungal and acanthamoeba keratitis were confirmed by confocal microscopy. Visual impairment was categorized based on visual acuity according to World Health Organization recommendations. A binary logistic regression model was used to calculate odds ratio (OR). Results One hundred consecutive patients were evaluated. Sixty patients (60%) had noninfectious corneal diseases, most commonly dry eye syndrome (26.7%, n=16), followed by corneal abrasion (18.3%, n=11). Forty-five patients had infectious keratitis, five of whom had both infectious and noninfectious etiologies. Of the patients with infectious keratitis, viral keratitis was the most frequent cause (57.8%, n=26), followed by fungal (20%, n=9) and bacterial (20%, n=9). Older age (OR =5.08, P=0.048), male sex (OR =3.37, P=0.035), and rural residence (OR =3.11, P=0.017) had increased odds of having worse visual impairment. Rural residence was also associated with infectious keratitis (P=0.005), particularly bacterial and fungal keratitis (P=0.046), and a history of ocular trauma (P=0.003). Occupation was not a significant risk factor in this population. Fourteen patients reported use of traditional Chinese medicine, with no association with visual outcomes found. Conclusion Older age, male sex, and rural residence were associated with worse visual impairment. Prevalence and outcome of corneal diseases may be improved with an increased awareness in these populations.
Collapse
Affiliation(s)
- Sarah C Xu
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| | - Jessica Chow
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| | - Ji Liu
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| | - Liang Li
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Jessica S Maslin
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| | - Nisha Chadha
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| | - Baihua Chen
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
25
|
Maslin JS, Teng CC, Chadha N, Liu J. Effect of supine body position on central corneal thickness. Clin Exp Ophthalmol 2016; 44:678-683. [PMID: 26991869 DOI: 10.1111/ceo.12742] [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: 12/12/2015] [Revised: 02/28/2016] [Accepted: 03/01/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND To evaluate the effect of supine body position on central corneal thickness (CCT) in open-angle glaucoma patients and in healthy subjects. DESIGN A cross-sectional study at a university eye clinic. PARTICIPANTS Twenty-three subjects were recruited in each group, for a total of 46 patients. METHODS CCT was measured using an ultrasound pachymeter in each subject. Three consecutive measurements in each eye were first taken in the sitting position, and repeated after 10 min and 30 min in a supine position. Results were analyzed using mixed model repeated measures, which adjusted for age, gender and laterality of eyes. MAIN OUTCOME MEASURES CCT RESULTS: In healthy subjects, CCT decreased with supine positioning at 10 min (mean = -5.2 µm, P = 0.0043) and at 30 min (mean = -6.5 µm, P < 0.0001). In the glaucoma group, CCT decreased with supine positioning at 10 min (mean = -6.7 µm, P = 0.0043) and at 30 min (mean = -10.2 µm, P < 0.0001). There was no statistically significant difference between the CCT at 10 min supine and at 30 min supine in the healthy subjects (P = 0.37) and glaucoma patients (P = 0.14). CCT was shown to decrease linearly over time (P < 0.0001), and the slopes were not statistically different between groups (P = 0.40). CONCLUSIONS CCT is a dynamic measurement that can be influenced by body position. It decreases linearly in the first 30 min of supine positioning at a similar rate in both open angle glaucoma patients and in healthy subjects.
Collapse
Affiliation(s)
- Jessica S Maslin
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nisha Chadha
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Ji Liu
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
26
|
Su D, Greenberg A, Simonson JL, Teng CC, Liebmann JM, Ritch R, Park SC. Efficacy of the Amsler Grid Test in Evaluating Glaucomatous Central Visual Field Defects. Ophthalmology 2016; 123:737-43. [PMID: 26783097 DOI: 10.1016/j.ophtha.2015.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 07/28/2015] [Revised: 11/15/2015] [Accepted: 12/01/2015] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate the efficacy of the Amsler grid test in detecting central visual field (VF) defects in glaucoma. DESIGN Prospective, cross-sectional study. PARTICIPANTS Patients with glaucoma with reliable Humphrey 10-2 Swedish Interactive Threshold Algorithm standard VF on the date of enrollment or within the previous 3 months. METHODS Amsler grid tests were performed for each eye and were considered "abnormal" if there was any perceived scotoma with missing or blurry grid lines within the central 10 degrees ("Amsler grid scotoma"). An abnormal 10-2 VF was defined as ≥3 adjacent points at P < 0.01 with at least 1 point at P < 0.005 in the same hemifield on the pattern deviation plot. Sensitivity, specificity, and positive and negative predictive values of the Amsler grid scotoma area were calculated with the 10-2 VF as the clinical reference standard. Among eyes with an abnormal 10-2 VF, regression analyses were performed between the Amsler grid scotoma area and the 10-2 VF parameters (mean deviation [MD], scotoma extent [number of test points with P < 0.01 in total deviation map] and scotoma mean depth [mean sensitivity of test points with P < 0.01 in total deviation map]). MAIN OUTCOME MEASURES Sensitivity, specificity, and positive and negative predictive values of the Amsler grid scotoma area. RESULTS A total of 106 eyes (53 patients) were included (mean ± standard deviation age, 24-2 MD and 10-2 MD = 66±12 years, -9.61±8.64 decibels [dB] and -9.75±9.00 dB, respectively). Sensitivity, specificity, and positive and negative predictive values of the Amsler grid test were 68%, 92%, 97%, and 46%, respectively. Sensitivity was 40% in eyes with 10-2 MD better than -6 dB, 58% in eyes with 10-2 MD between -12 and -6 dB, and 92% in eyes with 10-2 MD worse than -12 dB. The area under the receiver operating characteristic curve of the Amsler grid scotoma area was 0.810 (95% confidence interval, 0.723-0.880, P < 0.001). The Amsler grid scotoma area had the strongest relationship with 10-2 MD (quadratic R(2)=0.681), followed by 10-2 scotoma extent (quadratic R(2)=0.611) and 10-2 scotoma mean depth (quadratic R(2)=0.299) (all P < 0.001). CONCLUSIONS The Amsler grid can be used to screen for moderate to severe central vision loss from glaucoma.
Collapse
Affiliation(s)
- Daniel Su
- Moise and Chella Safra Advanced Ocular Imaging Laboratory, Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Andrew Greenberg
- Moise and Chella Safra Advanced Ocular Imaging Laboratory, Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Joseph L Simonson
- Moise and Chella Safra Advanced Ocular Imaging Laboratory, Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Robert Ritch
- Moise and Chella Safra Advanced Ocular Imaging Laboratory, Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Sung Chul Park
- Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, New York; Department of Ophthalmology, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York.
| |
Collapse
|
27
|
Chadha N, Liu J, Teng CC. Resident and Fellow Glaucoma Surgical Experience Following the Tube Versus Trabeculectomy Study. Ophthalmology 2015; 122:1953-4. [PMID: 25911055 DOI: 10.1016/j.ophtha.2015.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 03/09/2015] [Accepted: 03/09/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Nisha Chadha
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Ji Liu
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut.
| |
Collapse
|
28
|
Ren R, Ding J, Wang N, Teng CC, de Moraes GV, Jonas JB, Ritch R. Clinical Signs and Characteristics of Exfoliation Syndrome and Exfoliative Glaucoma in Northern China. Asia Pac J Ophthalmol (Phila) 2015; 4:86-8. [PMID: 26065350 DOI: 10.1097/apo.0000000000000106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To investigate the frequency and clinical features of exfoliation syndrome (XFS) and exfoliative glaucoma (XFG) in northern China. DESIGN A retrospective medical chart review. METHODS The review was conducted in Beijing Tongren Hospital. Using diagnosis codes, all consecutive patients with XFS/XFG were included in the study. Exfoliation syndrome was diagnosed if the patient had exfoliationmaterial (XFM) on the pupillary margin or anterior lens capsule. RESULTS Of 73,976 inpatient records, 45 patients (75 eyes) with XFS/XFG were identified (27 men, 18 women). Exfoliation syndrome/XFG accounted for 0.55% (45/8205) of hospitalized patients with cataract aged 60 years or older. The mean (SD) age of the inpatients was 72.1 (8.1) years (range, 47-85 years). Thirty-six patients had XFG, comprising 4.3% (36/838) of hospitalized patients with open-angle glaucoma. The presence of XFM on the pupillary margin (66.7%) and anterior lens surface (65.3%) were the most common features. Loss of pupillary ruff (13.3%) was uncommon. Increased pigmentation (49.3%) and flecks of XFM (9.3%) were seen on the trabecular meshwork, and 25 eyes (33.3%) had narrow angles. For those with bilateral XFS/XFG (66.7%, 30/45), 7 patients had bilateral XFS, 15 patients had bilateral XFG, and 8 patients had XFS in 1 eye but XFG in another eye. Twenty-two patients (44.4%) had hypertension, and 7 (15.6%) had ischemic heart diseases. CONCLUSIONS Exfoliation syndrome/XFG is still uncommon in the northern Chinese population. Its major clinical characteristics are the deposit of XFM on the pupil rim or anterior lens surface and increased trabecular meshwork pigmentation.
Collapse
Affiliation(s)
- Ruojin Ren
- From the *Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing, China †Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; ‡Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai Health System, New York, NY; and §Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | | | | | | | | | | | | |
Collapse
|
29
|
Furlanetto RL, De Moraes CG, Teng CC, Liebmann JM, Greenfield DS, Gardiner SK, Ritch R, Krupin T. Risk factors for optic disc hemorrhage in the low-pressure glaucoma treatment study. Am J Ophthalmol 2014; 157:945-52. [PMID: 24513094 DOI: 10.1016/j.ajo.2014.02.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 01/29/2014] [Accepted: 02/02/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate risk factors for disc hemorrhage detection in the Low-Pressure Glaucoma Treatment Study. DESIGN Cohort of a randomized, double-masked, multicenter clinical trial. METHODS Low-Pressure Glaucoma Treatment Study patients with at least 16 months of follow-up were included. Exclusion criteria included untreated intraocular pressure (IOP) of more than 21 mm Hg, visual field mean deviation worse than -16 dB, or contraindications to study medications. Patients were randomized to topical treatment with timolol 0.5% or brimonidine 0.2%. Stereophotographs were reviewed independently by 2 masked graders searching for disc hemorrhages. The main outcomes investigated were the detection of disc hemorrhage at any time during follow-up and their recurrence. Ocular and systemic risk factors for disc hemorrhage detection were analyzed using the Cox proportional hazards model and were tested further for independence in a multivariate model. RESULTS Two hundred fifty-three eyes of 127 subjects (mean age, 64.7 ± 10.9 years; women, 58%; European ancestry, 71%) followed up for an average ± standard deviation of 40.6 ± 12 months were included. In the multivariate analysis, history of migraine (hazard ratio [HR], 5.737; P = .012), narrower neuroretinal rim width at baseline (HR, 2.91; P = .048), use of systemic β-blockers (HR, 5.585; P = .036), low mean systolic blood pressure (HR, 1.06; P = .02), and low mean arterial ocular perfusion pressure during follow-up (HR, 1.172; P = .007) were significant and independent risk factors for disc hemorrhage detection. Treatment randomization was not associated with either the occurrence or recurrence of disc hemorrhages. CONCLUSIONS In this cohort of Low-Pressure Glaucoma Treatment Study patients, migraine, baseline narrower neuroretinal rim width, low systolic blood pressure and mean arterial ocular perfusion pressure, and use of systemic β-blockers were risk factors for disc hemorrhage detection. Randomization assignment did not influence the frequency of disc hemorrhage detection.
Collapse
|
30
|
Hood DC, Slobodnick A, Raza AS, de Moraes CG, Teng CC, Ritch R. Early glaucoma involves both deep local, and shallow widespread, retinal nerve fiber damage of the macular region. Invest Ophthalmol Vis Sci 2014; 55:632-49. [PMID: 24370831 DOI: 10.1167/iovs.13-13130] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To better understand the nature of early glaucomatous damage of the macula by comparing the results from 10-2 visual fields, optical coherence tomography (OCT) macular cube scans, and OCT circumpapillary circle scans. METHODS One eye of each of 66 glaucoma patients or suspects, with a mean deviation (MD) on the 24-2 visual field (VF) test of better than -6 decibels (dB), was prospectively tested with 10-2 VFs and OCT macular cube and circumpapillary circle scans. Thickness and probability maps of the retinal ganglion cell plus inner plexiform (RGC+) layers were generated. A hemifield was considered abnormal if both the macular RGC+ and the 10-2 probability plots were abnormal (cluster criteria). The thickness plots of the circumpapillary retinal nerve fiber layer (RNFL) were analyzed in the context of a model that predicted the region of the disc associated with macular damage. RESULTS Twenty-seven hemifields (20 eyes) had abnormal 10-2 and RGC+ probability plots: 7 in upper VF/inferior retina, 6 in lower VF/superior retina, and 7 in both hemifields. Both shallow widespread and deep local thinning of the circumpapillary RNFL were observed. The local defects were more common and closer to fixation in the upper VF/inferior retina as predicted. CONCLUSIONS A model of glaucomatous damage of the macula predicted the location of both the widespread and local defects in the temporal and inferior disc quadrants. Optical coherence tomography scans of the circumpapillary RNFL and the macular RGC+ layer can aid in the identification of these defects and help in the interpretation of 24-2 and 10-2 VF tests.
Collapse
Affiliation(s)
- Donald C Hood
- Department of Psychology, Columbia University, New York, New York
| | | | | | | | | | | |
Collapse
|
31
|
Abstract
PURPOSE To evaluate the relevance of community eye outreach programs in the early detection of glaucoma patients in southwest Nigeria. METHODS This was a retrospective, cross-sectional study that was conducted among glaucoma patients referred to the eye clinic of the University College Hospital (UCH), Ibadan, Nigeria, between January 2009 and December 2010 from different sources, including community eye outreach programs. The source of referral, stage of glaucoma, and visual field were recorded. RESULTS Six hundred and fifty-three patients were studied during this period. The mean age was 56.3 years ± 16.6 years, with a median age of 60 years. Patients referred from eye outreach programs were more likely to have mild to moderate disease than patients referred from other sources, who were more likely to have severe disease according to both the optic nerve head assessment (P < 0.01, Pearson's Chi-square = 10.67, odds ratio = 1.7 [confidence interval = 1.23-2.31]) and visual field assessment (24-2) (P < 0.01, Pearson's Chi-square = 6.07, odds ratio = 1.5 [confidence interval = 1.08-2.03]). CONCLUSION Community eye outreach programs appear highly useful in the earlier detection of glaucoma in sub-Saharan Africa.
Collapse
Affiliation(s)
- Olusola Olawoye
- Department of Ophthalmology, University College Hospital Ibadan, Nigeria and College of Medicine University of Ibadan, Ibadan, Nigeria
| | | | | | | |
Collapse
|
32
|
Abstract
Purpose: The purpose of this study was to estimate the prevalence of exfoliation syndrome (XFS) and its association with ocular disease in patients attending the eye clinic of the University College Hospital (UCH) in Ibadan, Nigeria. Materials and Methods: A total of 448 consecutive new patients, aged 30-90 years who presented to the eye clinic of UCH between December 2009 and November 2010 were evaluated. Each patient had a complete ophthalmic examination. Patients with exfoliative material on the anterior lens surface and/or pupillary margin in either or both eyes were considered to have XFS. Means, standard deviation, and 95% confidence intervals were calculated. Results: All the patients examined were from the southern part of Nigeria. Majority (94.2%) were of the Yoruba tribe from southwestern Nigeria, while 5.8% were from southeastern Nigeria. The mean age of the study cohort was 58.5 ± 13.8, 54.8% were males, 12 (2.7%) had XFS. All patients with XFS were of the Yoruba tribe, with a mean age 65.6 ± 5.6 years. There was a male predilection (66.7%). All eyes with XFS had lenticular opacities. XFS was bilateral in eight patients (66.7%) of whom seven patients (87.5%) had glaucoma and lenticular opacities bilaterally. Conclusion: This is the first report of the existence of XFS in Nigeria. Larger studies are necessary in this population to further investigate the disease.
Collapse
Affiliation(s)
- Olusola O Olawoye
- Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
| | | | | | | | | | | |
Collapse
|
33
|
You JY, Park SC, Su D, Teng CC, Liebmann JM, Ritch R. Focal lamina cribrosa defects associated with glaucomatous rim thinning and acquired pits. JAMA Ophthalmol 2013; 131:314-20. [PMID: 23370812 DOI: 10.1001/jamaophthalmol.2013.1926] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [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 Considering the potential clinical importance of focal lamina cribrosa (LC) defects as a characteristic structural feature in glaucoma and a risk factor for glaucomatous visual field progression, it may be helpful to know the structure of focal LC defects and the spatial relationship between them and glaucomatous optic disc changes such as neuroretinal rim thinning/notching and acquired pits of the optic nerve (APON). OBJECTIVE To investigate structural and spatial relationships between focal LC defects and glaucomatous neuroretinal rim thinning/notching and APON. DESIGN In a cross-sectional analysis of data from an ongoing, prospective, longitudinal study, serial enhanced-depth imaging (EDI) optical coherence tomographic (OCT) images of the optic nerve head were obtained from patients with glaucoma and reviewed for focal LC defects (laminar holes or disinsertions). Anterior laminar insertion points and edges of laminar holes or disinsertions were marked in EDI-OCT images, reconstructed 3-dimensionally, and superimposed on optic disc photographs. SETTING A glaucoma referral practice. PARTICIPANTS Two hundred thirty-nine eyes (120 patients) were examined. Fifty-four eyes were excluded because of an incomplete horizontal or vertical set of serial EDI-OCT images or poor-quality EDI-OCT images owing to media opacity, irregular tear film, or poor patient cooperation. Among the remaining 185 eyes, 40 (from 31 patients) had laminar holes or disinsertions and were included for analysis. MAIN OUTCOME MEASURES Presence, extent, and location of laminar holes or disinsertions. RESULTS Among 185 eyes, 11 laminar holes and 36 laminar disinsertions were found in 40 eyes. Superimposed images of the 3-dimensionally reconstructed focal LC defects and disc photographs showed that the outline of the LC defect corresponded almost precisely to that of clinical APON for 6 laminar holes and that the LC defect was much larger than and enclosed APON for 10 laminar disinsertions. The remaining 5 laminar holes and 26 laminar disinsertions corresponded to focal neuroretinal rim loss, with no evidence of APON in disc photographs. CONCLUSIONS AND RELEVANCE Focal LC defects (laminar holes or disinsertions) are associated with neuroretinal rim loss and APON. The extent of LC defects can be visualized more effectively on EDI-OCT images than by clinical examination.
Collapse
Affiliation(s)
- Jae Young You
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, NY 10003, USA
| | | | | | | | | | | |
Collapse
|
34
|
Olawoye OO, Ashaye AO, Baiyeroju AM, Teng CC, Liebmann JM, Ritch R. Outcomes of trabeculectomy with 5-Fluorouracil at a nigerian tertiary hospital. J Ophthalmic Vis Res 2013; 8:126-33. [PMID: 23943687 PMCID: PMC3740464] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 01/23/2013] [Indexed: 11/02/2022] Open
Abstract
PURPOSE To report the outcomes of trabeculectomy with adjunctive 5-Fluorouracil (5- FU) at a Nigerian tertiary hospital. METHODS In this prospective study, all patients with glaucoma undergoing trabeculectomy with 5-FU at the University College Hospital, Ibadan, Nigeria, from June 2009 to May2010 were enrolled. Each patient had a complete ophthalmic evaluation. Intraocular pressure (IOP), visual acuity (VA) and complications post-trabeculectomy were assessed at one year. Success of the procedure was defined as complete when no additional medications were required to achieve an IOP of ≤18mmHg, or qualified when additional medications were required to achieve the same goal. RESULTS A total of 47 eyes of 31 patients with mean age of 48.9±19.6 (range 14-77; median 52) years including 21 (67.7%) male subjects underwent trabeculectomy with 5-FU. Mean presenting IOP was 31.8±12.2 mmHg. Mean deviation (MD) on Humphrey visual fields was -15.9±9.7dB with the majority of the patients (18 subjects 58.1%) presenting with advanced glaucoma based on MD worse than -12dB and severe glaucomatous optic neuropathy (cup to disc ratio of 0.9-1.0). At 1 year postoperatively, 95.1% achieved qualified success while 83% had complete success. CONCLUSION This prospective study adds to the existing knowledge that trabeculectomy with 5-FU is effective at controlling IOP in Nigerian patients.
Collapse
Affiliation(s)
- Olusola O. Olawoye
- University College Hospital, Ibadan, Nigeria,Department of Ophthalmology, University of Ibadan, Nigeria,Correspondence to: Olusola O. Olawoye, FWACS. Lecturer and Consultant Ophthalmologist, Department of Ophthalmology, University College Hospital, Ibadan 20004, Nigeria; Tel: +234 802 389 0063, Fax: +234 802 389 0063; e-mail:
| | - Adeyinka O. Ashaye
- University College Hospital, Ibadan, Nigeria,Department of Ophthalmology, University of Ibadan, Nigeria
| | - Aderonke M. Baiyeroju
- University College Hospital, Ibadan, Nigeria,Department of Ophthalmology, University of Ibadan, Nigeria
| | - Christopher C. Teng
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, NY, USA,Department of Ophthalmology, New York Medical College, Valhalla, NY, USA
| | - Jeffrey M. Liebmann
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, NY, USA,New York University School of Medicine, New York, NY, USA
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, NY, USA,Department of Ophthalmology, New York Medical College, Valhalla, NY, USA
| |
Collapse
|
35
|
Abstract
PURPOSE To investigate the relationship between optic disc progression and rates of visual field (VF) change in patients with treated glaucoma. METHODS Glaucoma patients with repeatable VF loss, ≥8 SITA-Standard 24-2 VF tests and good quality optic disc stereophotographs evaluated over a 10-year period were included. Optic disc photographs were reviewed for signs of glaucoma progression (neuroretinal rim change, widening of retinal nerve fibre layer defect, disc haemorrhage and enlargement of beta-zone parapapillary atrophy) by two glaucoma specialists masked to their temporal sequence. Disagreements were adjudicated by a third grader. VF progression was evaluated using automated pointwise linear regression (PLR) and defined as at least two adjacent test points progressing >1.0 dB/year at p < 0.01. VF progression outcomes were compared with photograph review results. RESULTS Three-hundred and eighty nine eyes (389 patients; mean age 64.9 ± 13.0 years; mean baseline MD, -7.1 ± 5.1 dB) were included. Most patients had primary open angle glaucoma (54%). Eighty-two eyes (21%) had confirmed optic disc progression and 115 eyes (29%) met the VF PLR criteria. Eyes with documented optic disc progression had more rapid rates of VF change (-0.66 ± 0.7 versus -0.36 ± 0.7 dB/year, p < 0.01) and met the VF PLR endpoint more often (univariate OR = 1.85, p = 0.02; multivariate OR = 1.78, p = 0.03) than eyes without optic disc progression. There was moderate spatial consistency between the location of the optic disc progression and the hemifield with more rapid progression (81%, kappa = 0.40). CONCLUSIONS Treated glaucomatous eyes with documented optic disc progression are at increased risk of diminished visual function over time and may require more aggressive therapy to prevent future vision loss. Among the indicators of structural progression, disc haemorrhage was the single most significant predictor for VF deterioration.
Collapse
Affiliation(s)
- Carlos G De Moraes
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, NY, USA.
| | | | | | | | | | | | | |
Collapse
|
36
|
Schor KS, De Moraes CG, Teng CC, Tello C, Liebmann JM, Ritch R. Rates of visual field progression in distinct optic disc phenotypes. Clin Exp Ophthalmol 2012; 40:706-12. [DOI: 10.1111/j.1442-9071.2012.02792.x] [Citation(s) in RCA: 8] [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] [Indexed: 11/28/2022]
|
37
|
Kiumehr S, Park SC, Dorairaj S, Teng CC, Tello C, Liebmann JM, Ritch R. In Vivo Evaluation of Focal Lamina Cribrosa Defects in Glaucoma. ACTA ACUST UNITED AC 2012; 130:552-9. [DOI: 10.1001/archopthalmol.2011.1309] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
38
|
Park SC, Kiumehr S, Teng CC, Tello C, Liebmann JM, Ritch R. Horizontal central ridge of the lamina cribrosa and regional differences in laminar insertion in healthy subjects. Invest Ophthalmol Vis Sci 2012; 53:1610-6. [PMID: 22266523 DOI: 10.1167/iovs.11-7577] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [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 assess the general morphology and position of the lamina cribrosa (LC) in healthy subjects using enhanced depth imaging-optical coherence tomography (EDI-OCT). METHODS Serial horizontal and vertical B-scans of the optic nerve head (interval between images, approximately 30 μm) were prospectively obtained using EDI-OCT for both eyes of each healthy subject. After delineation of the anterior laminar surface, mean and maximum LC depths were measured in 11 equally spaced horizontal B-scans, and the depth of the anterior LC insertion was measured at 32 points along its circumference (reference plane, Bruch's membrane edges) for one randomly selected eye of each subject. Three-dimensional (3D) images of the anterior laminar surface and the peripapillary sclera were reconstructed from serial horizontal EDI-OCT B-scans to assess the 3D morphology of the anterior laminar surface. RESULTS Among the 61 eyes (61 subjects) enrolled, 31 were excluded because of poor LC image quality, and 30 were included for analysis (mean age, 40 ± 18 [range, 21-78] years). Both mean and maximum LC depth profiles showed an elevation in the central area and a depression in the superior and inferior midperiphery of the LC. The anterior LC insertion was more posteriorly located in the superior and inferior than in the nasal and temporal regions. Three-dimensional LC images showed a bowtie-shaped horizontal central ridge of the LC. CONCLUSIONS The LC has a central ridge ranging from the temporal to the nasal insertion areas and inserts more posteriorly in the superior and inferior than in the nasal and temporal regions. Further investigation is needed to elucidate the significance of these findings in the pathophysiology of glaucoma.
Collapse
Affiliation(s)
- Sung Chul Park
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York, USA.
| | | | | | | | | | | |
Collapse
|
39
|
Hayes DD, Teng CC, de Moraes CG, Tello C, Liebmann JM, Ritch R. Corneal hysteresis and Beta-zone parapapillary atrophy. Am J Ophthalmol 2012; 153:358-362.e1. [PMID: 21920490 DOI: 10.1016/j.ajo.2011.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 03/23/2011] [Revised: 06/28/2011] [Accepted: 06/29/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the relationship between β-zone parapapillary atrophy (βPPA) and corneal hysteresis (CH) in patients with glaucoma. DESIGN Prospective, cross-sectional study. METHODS Glaucoma patients aged 18 to 90 years with disc photographs within 12 months of the study visit were consecutively enrolled. Exclusion criteria included ocular surgery other than clear corneal phacoemulsification, myopia >6 diopters, contact lens use, and corneal abnormality. CH was measured using the Ocular Response Analyzer (ORA). Disc photographs were evaluated in a masked fashion for βPPA. RESULTS We enrolled 99 patients (mean age 67.6 years; 45 men, 54 women). Univariate analysis showed no significant difference in CH between eyes with and without βPPA (8.72 ± 0.23 vs 8.15 ± 0.27 mm Hg, P = .11). There were no differences in corneal resistance factor (CRF) (P = .47), central corneal thickness (CCT) (P = .11), ORA wave score (P = .23), age (P = .23), sex (P = .40), IOP (P = .86), or visual field mean deviation (VFMD) (P = .45). Eyes with βPPA were more myopic (-1.49 ± 0.27 vs -0.22 ± 0.31 diopters, P = .003). Multivariate analysis showed no significant difference in CH between eyes with and without βPPA (P = .38). Eyes with asymmetric βPPA also showed no significant difference in CH (8.97 ± 0.22 vs 9.10 ± 0.22 mm Hg, P = .69). CONCLUSIONS We found no significant differences in CH between eyes with and without βPPA or between fellow eyes with asymmetric βPPA.
Collapse
Affiliation(s)
- Daniel D Hayes
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York, USA
| | | | | | | | | | | |
Collapse
|
40
|
Jung JJ, Della Torre KE, Fell MR, Teng CC, Freund KB. Presumed pyogenic granuloma associated with intravitreal anti-vascular endothelial growth factor therapy. Open Ophthalmol J 2011; 5:59-62. [PMID: 22216076 PMCID: PMC3249641 DOI: 10.2174/1874364101105010059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 05/12/2011] [Revised: 07/30/2011] [Accepted: 09/16/2011] [Indexed: 11/22/2022] Open
Abstract
To report a case of a presumed pyogenic granuloma at the site of multiple intravitreal anti-Vascular Endothelial Growth Factor (VEGF) injections. Intravitreal anti-VEGF injections can be complicated by a localized reaction of the conjunctiva.
Collapse
Affiliation(s)
- Jesse J Jung
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | | | | | | | | |
Collapse
|
41
|
Park SC, De Moraes CGV, Teng CC, Tello C, Liebmann JM, Ritch R. Enhanced depth imaging optical coherence tomography of deep optic nerve complex structures in glaucoma. Ophthalmology 2011; 119:3-9. [PMID: 21978593 DOI: 10.1016/j.ophtha.2011.07.012] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 06/13/2011] [Accepted: 07/07/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the usefulness of enhanced depth imaging (EDI) optical coherence tomography (OCT) for evaluating deep structures of the optic nerve complex (ONC; optic nerve head and peripapillary structures) in glaucoma. DESIGN Prospective, observational study. PARTICIPANTS Seventy-three established glaucoma patients (139 eyes) with a range of glaucomatous damage. METHODS Serial horizontal and vertical EDI OCT images of the ONC were obtained from both eyes of each participant. Deep ONC structures, including the lamina cribrosa (LC), short posterior ciliary artery (SPCA), central retinal artery (CRA), central retinal vein (CRV), peripapillary choroid and sclera, and subarachnoid space around the optic nerve, were investigated for their visibility and morphologic features. MAIN OUTCOME MEASURES Deep ONC structures identified in EDI OCT images. RESULTS Visual field mean deviation of 139 included eyes was -11.8 ± 8.6 dB (range, -28.70 to -2.01 dB). The anterior laminar surface was identified in all eyes in the central laminar area and in 91 (65%) eyes in the periphery beneath the neuroretinal and scleral rims or vascular structures. The LC pores with various shapes and sizes were visualized in 106 (76%) eyes, mainly in the central and temporal areas of the LC. Localized LC lesions seen on optic disc photographs were identified as focal LC defects (partial loss of LC tissue) in the EDI OCT images. The locations of the CRA and CRV were identified in all eyes. In the LC, the CRA maintained a straight shape with a consistent caliber, but the CRV (and tributaries) assumed a more irregular shape. The SPCAs, their branches through the emissary canals in the sclera, or both were visualized in 120 (86%) eyes. The subarachnoid space around the optic nerve was identified with varying degrees of clarity in 25 eyes (18%): 17 had high myopia and extensive parapapillary atrophy. Intrachoroidal cavitation or choroidal schisis, which had been unrecognized clinically, was identified in 2 eyes (1%) with high myopia. CONCLUSIONS Enhanced depth imaging OCT was able to visualize a wide variety of deep ONC structures in glaucoma patients and may be helpful in detecting, conceptualizing, and understanding basic and complicated in vivo anatomic and pathologic features of the ONC in glaucoma. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
Collapse
Affiliation(s)
- Sung Chul Park
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York 10003, USA.
| | | | | | | | | | | |
Collapse
|
42
|
Anand A, Sheha H, Teng CC, Liebmann JM, Ritch R, Tello C. Use of amniotic membrane graft in glaucoma shunt surgery. Ophthalmic Surg Lasers Imaging Retina 2011; 42:184-9. [PMID: 21563743 DOI: 10.3928/15428877-20110426-01] [Citation(s) in RCA: 26] [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: 10/30/2010] [Accepted: 03/08/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To determine the safety and efficacy of amniotic membrane graft in glaucoma drainage device surgery. PATIENTS AND METHODS Institutional retrospective case series of 44 patients undergoing glaucoma drainage device implantation with use of 300-μm thick amniotic membrane as a patch graft. Endpoints assessed were tube exposure, graft thinning, graft clarity, graft-related infection, and inflammation. RESULTS A total of 41 (93%) eyes had an uneventful course over a mean follow-up of 22 ± 3 months (range: 17 to 28 months). Tube exposure and hypotony each occurred in one eye and were successfully treated with a tube revision using double pericardial and amniotic membrane patch graft. The translucency of amniotic membrane graft enabled good visualization of the occluding suture when performing laser suture lysis in 16 eyes. Sequential anterior segment optical coherence tomography showed stable amniotic membrane graft thickness with a change from low to moderate reflectivity in the subconjunctival-graft bilayer. CONCLUSION Amniotic membrane graft offers good tectonic support and allows direct visualization of the underlying tube.
Collapse
Affiliation(s)
- Aashish Anand
- Einhorn Clinical Research Center, The New York Eye and Ear Infirmary, New York, New York, USA
| | | | | | | | | | | |
Collapse
|
43
|
De Moraes CGV, Juthani VJ, Liebmann JM, Teng CC, Tello C, Susanna R, Ritch R. Risk factors for visual field progression in treated glaucoma. ACTA ACUST UNITED AC 2011; 129:562-8. [PMID: 21555607 DOI: 10.1001/archophthalmol.2011.72] [Citation(s) in RCA: 220] [Impact Index Per Article: 16.9] [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
OBJECTIVE To determine intraocular pressure (IOP)-dependent and IOP-independent variables associated with visual field (VF) progression in treated glaucoma. DESIGN Retrospective cohort of the Glaucoma Progression Study. METHODS Consecutive, treated glaucoma patients with repeatable VF loss who had 8 or more VF examinations of either eye, using the Swedish Interactive Threshold Algorithm (24-2 SITA-Standard, Humphrey Field Analyzer II; Carl Zeiss Meditec, Inc, Dublin, California), during the period between January 1999 and September 2009 were included. Visual field progression was evaluated using automated pointwise linear regression. Evaluated data included age, sex, race, central corneal thickness, baseline VF mean deviation, mean follow-up IOP, peak IOP, IOP fluctuation, a detected disc hemorrhage, and presence of beta-zone parapapillary atrophy. RESULTS We selected 587 eyes of 587 patients (mean [SD] age, 64.9 [13.0] years). The mean (SD) number of VFs was 11.1 (3.0), spanning a mean (SD) of 6.4 (1.7) years. In the univariable model, older age (odds ratio [OR], 1.19 per decade; P = .01), baseline diagnosis of exfoliation syndrome (OR, 1.79; P = .01), decreased central corneal thickness (OR, 1.38 per 40 μm thinner; P < .01), a detected disc hemorrhage (OR, 2.31; P < .01), presence of beta-zone parapapillary atrophy (OR, 2.17; P < .01), and all IOP parameters (mean follow-up, peak, and fluctuation; P < .01) were associated with increased risk of VF progression. In the multivariable model, peak IOP (OR, 1.13; P < .01), thinner central corneal thickness (OR, 1.45 per 40 μm thinner; P < .01), a detected disc hemorrhage (OR, 2.59; P < .01), and presence of beta-zone parapapillary atrophy (OR, 2.38; P < .01) were associated with VF progression. CONCLUSIONS IOP-dependent and IOP-independent risk factors affect disease progression in treated glaucoma. Peak IOP is a better predictor of progression than is IOP mean or fluctuation.
Collapse
Affiliation(s)
- Carlos Gustavo V De Moraes
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, 310 E 14th St, New York, NY 10003, USA
| | | | | | | | | | | | | |
Collapse
|
44
|
De Moraes CG, Ketner S, Teng CC, Ehrlich JR, Raza AS, Liebmann JM, Ritch R, Hood DC. Beta-zone parapapillary atrophy and multifocal visual evoked potentials in eyes with glaucomatous optic neuropathy. Doc Ophthalmol 2011; 123:43-50. [PMID: 21735265 DOI: 10.1007/s10633-011-9280-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 06/23/2011] [Indexed: 10/18/2022]
Abstract
We investigated changes in multifocal visual evoked potential (mfVEP) responses due to beta-zone parapapillary atrophy (ßPPA). Patients with glaucomatous optic neuropathy (GON) with or without standard achromatic perimetry (SAP) abnormalities were referred for mfVEP testing during a 2-year period. Eyes with good quality optic disc stereophotographs and reliable SAP results were included. The mfVEP monocular mean latency delays (ms) and amplitudes (SNR) were analyzed. Age, SAP mean deviation (MD), pattern standard deviation (PSD), and spherical equivalent (SE) were analyzed in the multivariate model. Generalized estimated equations were used for comparisons between groups after adjusting for inter-eye associations. Of 394 eyes of 200 patients, 223 (57%) had ßPPA. The ßPPA eyes were older (59.6 ± 13.7 vs. 56.5 ± 13.7 year, P = 0.02), more myopic (-4.0 ± 3.5 vs. -1.3 ± 3.5 D, P < 0.01), and had poorer SAP scores (MD: -4.9 ± 5.2 vs. -2.6 ± 5.2 dB, P < 0.01; PSD: 4.3 ± 2.9 vs. 2.5 ± 3.0 dB, P < 0.01). By univariate analysis, mean latencies were longer in ßPPA eyes (6.1 ± 5.3 vs. 4.0 ± 5.5 ms, P < 0.01). After adjusting for differences in SE, age, and SAP MD, there was no significant difference between the two groups (P = 0.09). ßPPA eyes had lower amplitude log SNR (0.49 ± 0.16 vs. 0.56 ± 0.15, P < 0.01), which lost significance (P = 0.51) after adjusting for MD and PSD. Although eyes with ßPPA had significantly lower amplitudes and prolonged latencies than eyes without ßPPA, these differences were attributable to differences in SAP severity, age, and refractive error. Thus, ßPPA does not appear to be an independent factor affecting mfVEP responses in eyes with GON.
Collapse
|
45
|
Forchheimer I, de Moraes CG, Teng CC, Folgar F, Tello C, Ritch R, Liebmann JM. Baseline mean deviation and rates of visual field change in treated glaucoma patients. Eye (Lond) 2011; 25:626-32. [PMID: 21394112 DOI: 10.1038/eye.2011.33] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the relationships between baseline visual field (VF) mean deviation (MD) and subsequent progression in treated glaucoma. METHODS Records of patients seen in a glaucoma practice between 1999 and 2009 were reviewed. Patients with glaucomatous optic neuropathy, baseline VF damage, and ≥8 SITA-standard 24-2 VF were included. Patients were divided into tertiles based upon baseline MD. Automated pointwise linear regression determined global and localized rates (decibels (dB) per year) of change. Progression was defined when two or more adjacent test locations in the same hemifield showed a sensitivity decline at a rate of >1.0 dB per year, P<0.01. RESULTS For mild, moderate, and severe groups, progression was noted in 29.5, 31.2, and 26.0% of eyes (P=0.50) and global rates of VF change of progressing eyes were -1.3±1.2, -1.01±0.7, and -0.9±0.5 dB/year (P=0.09, analysis of variance). Within these groups, intraocular pressure (IOP) in stable vs progressing eyes were 15.5±3.3 vs 17.0±3.1 (P<0.01), 15.4±3.3 vs 15.9±2.5 (P=0.28), and 14.0±2.8 vs 14.8±2.3 mm Hg (P=0.07). More glaucoma filtering surgeries were performed in eyes with worse MD. There was no significant difference between groups regarding their risk of progression in both univariate (P=0.50) and multivariate (P=0.26) analyses adjusting for differences in follow-up IOP. CONCLUSIONS After correcting for differences in IOP in treated glaucoma patients, we did not find a relationship between the rate of VF change (dB per year) and the severity of the baseline VF MD. This finding may have been due to more aggressive IOP lowering in eyes with more severe disease. Eyes with lower IOP progressed less frequently across the spectrum of VF loss.
Collapse
Affiliation(s)
- I Forchheimer
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | | | | | | | | | | | | |
Collapse
|
46
|
de Beaufort HC, De Moraes CGV, Teng CC, Prata TS, Tello C, Ritch R, Liebmann JM. Response to: “Morphologic and functional glaucomatous change after occurrence of single or recurrent optic disc haemorrhages”. Graefes Arch Clin Exp Ophthalmol 2010. [DOI: 10.1007/s00417-010-1475-x] [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] [Indexed: 10/19/2022] Open
|
47
|
Anand A, De Moraes CGV, Teng CC, Tello C, Liebmann JM, Ritch R. Corneal hysteresis and visual field asymmetry in open angle glaucoma. Invest Ophthalmol Vis Sci 2010; 51:6514-8. [PMID: 20574009 DOI: 10.1167/iovs.10-5580] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [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 association between corneal biomechanical parameters and asymmetric primary open angle glaucoma (POAG) using the Ocular Response Analyzer (ORA). METHODS In a prospective cross-sectional study, ORA parameters were measured in 117 POAG patients with asymmetric visual fields (VF). The asymmetry in VF was defined as a five point difference between the eyes using the Advanced Glaucoma Intervention Study (AGIS) scoring system. Subjects with previous intraocular or refractive surgery, ocular comorbidities and diabetes were excluded. RESULTS In worse eyes, mean AGIS scores were significantly higher (8.1 ± 4.3 vs. 1.0 ± 1.6; P < 0.001) and mean corneal hysteresis (CH) was significantly lower (8.2 ± 1.9 vs. 8.9 ± 1.9 mm Hg; P < 0.001). Median ORA-corrected intraocular pressure was higher in the worse eyes (IOP(cc), 17.4 mm Hg vs. 16.9 mm Hg; P < 0.001). Worse eyes had a slightly lower mean corneal resistance factor (P = 0.04) and more myopic mean spherical equivalent (P = 0.02). No difference was seen in the central corneal thickness (CCT; P = 0.63) and Goldmann applanation tonometry (GAT; P = 0.32). On multivariate analysis, only CH retained an association with the worse eye (odds ratio, 25.9; 95% confidence interval, 10.1-66.5). ROC curves showed that only CH and IOP(cc) had a discriminative ability for the eye with worse VF (AUC, 0.82 and 0.70, respectively). CONCLUSIONS Asymmetric POAG was associated with asymmetry in ORA parameters but not in CCT and GAT. Lower CH was associated with worse eyes independently of its effect on IOP measurement and had the best discriminability for the eye with the worse VF.
Collapse
Affiliation(s)
- Aashish Anand
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, NY 10003, USA
| | | | | | | | | | | |
Collapse
|
48
|
Folgar FA, de Moraes CGV, Prata TS, Teng CC, Tello C, Ritch R, Liebmann JM. Glaucoma surgery decreases the rates of localized and global visual field progression. Am J Ophthalmol 2010; 149:258-264.e2. [PMID: 20103054 DOI: 10.1016/j.ajo.2009.09.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 09/14/2009] [Accepted: 09/16/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Incisional glaucoma surgical procedures produce greater intraocular pressure (IOP) reduction and less IOP variability than medical treatment. We sought to determine the efficacy of glaucoma surgery in decreasing localized and global rates of visual field (VF) progression. DESIGN Retrospective, interventional case series. METHODS Subjects in the New York Glaucoma Progression Study with glaucomatous optic neuropathy, repeatable VF loss, and 10 or more Swedish interactive threshold algorithm standard VF examinations were assessed for eligibility. Patients who underwent successful glaucoma surgery (not requiring further surgical intervention and IOP < 18 mm Hg) in either eye and who were followed up for at least 2 years before and after surgery were enrolled. Automated pointwise linear regression analysis was used to calculate global and localized rates of progression before and after surgery. Eyes with other ocular conditions likely to affect the VF and an insufficient number of VF to create a slope before and after surgery were excluded. Comparisons were performed within the same eyes before and after surgery (Student paired t test). RESULTS We enrolled 28 eyes of 28 patients (mean age, 61.2 +/- 14.5 years). The mean number +/- standard deviation of VF was 13.4 +/- 2.3, spanning 7.1 +/- 1.2 years (range, 4 to 9 years). Mean IOP +/- standard deviation decreased from 19.0 +/- 3.9 mm Hg before surgery to 11.3 +/- 3.7 mm Hg after surgery (40% reduction; P < .01). Mean global progression rates decreased from -1.48 +/- 1.4 dB/year before surgery to -0.43 +/- 0.8 dB/year after surgery (70% reduction; P = .01). Twelve eyes (42.8%) had at least 1 significantly progressing point before surgery, whereas only 2 (7.1%) had at least 1 progressing point after surgery. Each 1 mm Hg of IOP reduction after surgery resulted in a 0.1 dB/year decrease in the global rate of progression. CONCLUSIONS Successful IOP reduction after glaucoma surgery greatly reduces both the number of progressing points and the localized and general rates of VF progression.
Collapse
|
49
|
Prata TS, De Moraes CGV, Teng CC, Tello C, Ritch R, Liebmann JM. Factors Affecting Rates of Visual Field Progression in Glaucoma Patients with Optic Disc Hemorrhage. Ophthalmology 2010; 117:24-9. [DOI: 10.1016/j.ophtha.2009.06.028] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 05/17/2009] [Accepted: 06/12/2009] [Indexed: 10/20/2022] Open
|
50
|
Ahrlich KG, De Moraes CGV, Teng CC, Prata TS, Tello C, Ritch R, Liebmann JM. Visual field progression differences between normal-tension and exfoliative high-tension glaucoma. Invest Ophthalmol Vis Sci 2009; 51:1458-63. [PMID: 20042657 DOI: 10.1167/iovs.09-3806] [Citation(s) in RCA: 62] [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] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To compare the pattern, location, and rate of visual field (VF) change in normal-tension (NTG) and exfoliative high-tension glaucoma (XHTG). METHODS Records of all patients with glaucoma in the New York Glaucoma Progression Study with five or more VF tests were reviewed. Patients were divided into NTG (all known IOP < 21 mm Hg) and XHTG (untreated IOP >or= 21 mm Hg) groups. Automated pointwise linear regression analysis determined global and localized rates of change. RESULTS There were 139 NTG and 154 XHTG eyes. Patients with XHTG were significantly older than those with NTG (mean +/- SD: 72.6 +/- 9.4 years vs. 62.7 +/- 12.8 years, P < 0.01), had higher mean IOPs (16.5 +/- 3.2 mm Hg vs. 13.3 +/- 2.0 mm Hg, P < 0.01) and greater central corneal thickness (CCT, 544.0 +/- 35.7 microm vs. 533.9 +/- 35.9 microm; P = 0.01). During a similar period, XHTG progressed globally almost twice as rapidly as did NTG (-0.64 +/- 0.7 dB/y vs. -0.35 +/- 0.3 dB/y, P < 0.01), which became nonsignificant after adjustment for differences in age, mean IOP, and CCT. In a multivariate model, variables significantly associated with progression were higher mean IOP (odds ratio [OR]: 1.09, P = 0.03) and decreased CCT (OR/40 mum thinner: 1.37, P = 0.03). Progression within the paracentral VF was more common in the NTG group (75% vs. 57.3%, P = 0.04). The most important factor associated with paracentral progression among eyes that reached a progression outcome was the diagnosis of NTG. CONCLUSIONS XHTG and NTG eyes progress at a similar global rate after adjustment for differences in IOP, CCT, and age. However, NTG eyes progress more often in the central VF, independent of other factors. Glaucoma surveillance in eyes with open-angle glaucoma and statistically normal IOP should include periodic assessment of the central field.
Collapse
|