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Sarkisian SR, Ang RE, Lee AM, Berdahl JP, Heersink SB, Burden JH, Doan LV, Stephens KG, Applegate D, Kothe AC, Usner DW, Katz LJ, Navratil T. Travoprost Intracameral Implant for Open-Angle Glaucoma or Ocular Hypertension: 12-Month Results of a Randomized, Double-Masked Trial. Ophthalmol Ther 2024; 13:995-1014. [PMID: 38345710 PMCID: PMC10912401 DOI: 10.1007/s40123-024-00898-y] [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: 12/22/2023] [Accepted: 01/23/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION This prospective, multicenter, randomized, double-masked pivotal phase 3 trial evaluated the efficacy and safety of the travoprost intracameral SE-implant (slow-eluting implant, the intended commercial product) and FE-implant (fast-eluting implant, included primarily for masking purposes) compared to twice-daily (BID) timolol ophthalmic solution, 0.5% in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT). METHODS The trial enrolled adult patients with OAG or OHT with an unmedicated mean diurnal intraocular pressure (IOP) of ≥ 21 and unmedicated IOP ≤ 36 mmHg at each diurnal timepoint (8 A.M., 10 A.M., and 4 P.M.) at baseline. The eligible eye of each patient was administered an SE-implant, an FE-implant or had a sham administration procedure. Patients who received an implant were provided placebo eye drops to be administered BID and patients who had the sham procedure were provided timolol eye drops to be administered BID. The primary efficacy endpoint, for which the study was powered, was mean change from baseline IOP at 8 A.M. and 10 A.M. at day 10, week 6, and month 3. Non-inferiority was achieved if the upper 95% confidence interval (CI) on the difference in IOP change from baseline (implant minus timolol) was < 1.5 mmHg at all six timepoints and < 1 mmHg at three or more timepoints. The key secondary endpoint was mean change from baseline IOP at 8 A.M. and 10 A.M. at month 12. Non-inferiority at month 12 was achieved if the upper 95% CI was < 1.5 mmHg at both timepoints. Safety outcomes included treatment-emergent adverse events (TEAEs) and ophthalmic assessments. RESULTS A total of 590 patients were enrolled at 45 sites and randomized to one of three treatment groups: 197 SE-implant (the intended commercial product), 200 FE-implant, and 193 timolol. The SE-implant was non-inferior to timolol eye drops in IOP lowering over the first 3 months, and was also non-inferior to timolol at months 6, 9, and 12. The FE-implant was non-inferior to timolol over the first 3 months, and also at months 6 and 9. Of those patients who were on glaucoma medication at screening, a significantly greater proportion of patients in the SE- and FE-implant groups (83.5% and 78.7%, respectively) compared to the timolol group (23.9%) were on fewer topical glaucoma medications at month 12 compared to screening (P < 0.0001, chi-square test). TEAEs, mostly mild, were reported in the study eyes of 39.5% of patients in the SE-implant group, 34.0% of patients in the FE-implant group and 20.1% of patients in the timolol group. CONCLUSIONS The SE-travoprost intracameral implant demonstrated non-inferiority to timolol over 12 months whereas the FE-implant demonstrated non-inferiority over 9 months. Both implant models were safe and effective in IOP lowering in patients with OAG or OHT. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT03519386.
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Affiliation(s)
- Steven R Sarkisian
- Oklahoma Eye Surgeons, PLLC, 5600 N Portland Avenue, Oklahoma City, OK, 73112, USA
| | - Robert E Ang
- Asian Eye Institute, 8th to 10th Floor, Rockwell Center, PHINMA Plaza Building, 01200, Makati City, Philippines
| | - Andy M Lee
- Total Eye Care, 388 E. Hwy 67, Duncanville, TX, 75137, USA
| | - John P Berdahl
- Vance Thompson Vision, 3101 West 57th Street, Sioux Falls, SD, 57108, USA
| | - Sebastian B Heersink
- Eye Center South, DBA Trinity Research Group, 2800 Ross Clark Circle, Dothan, AL, 36301, USA
| | - James H Burden
- Skyline Vision Clinic and Laser Center, 3155 North Union Boulevard, Colorado Springs, CO, 80907, USA
| | - Long V Doan
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA
| | - Kerry G Stephens
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA
| | - David Applegate
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA
| | - Angela C Kothe
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA
| | - Dale W Usner
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA
| | - L Jay Katz
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA
| | - Tomas Navratil
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA.
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Hallaj S, Sinha S, Mehran NA, Morrill AM, Pro MJ, Dale E, Schmidt C, Kolomeyer NN, Shukla AG, Lee D, Moster MR, Myers JS, Jay Katz L, Razeghinejad R. Intraocular pressure profile following selective laser trabeculoplasty in pigmentary and primary open-angle glaucoma. Eur J Ophthalmol 2024:11206721241237305. [PMID: 38470322 DOI: 10.1177/11206721241237305] [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: 03/13/2024]
Abstract
PURPOSE To compare the intraocular pressure (IOP) profile and the incidence of IOP spikes following selective laser trabeculoplasty (SLT) between pigmentary glaucoma (PG) and primary open-angle glaucoma (POAG). MATERIALS AND METHODS Retrospective comparative study of 65 PG eyes of 51 patients matched with 65 POAG eyes of 65 patients who received SLT. Matching was done based on age, gender, glaucoma severity, pre-laser IOP, and number of medications. Post-SLT IOP spike was defined as IOP elevation ≥5mmHg, 30-45 min after the laser. RESULTS In PG and POAG groups, the average age was 62.33 ± 9.18 and 62.58 ± 9.19 years (p = 0.95). The glaucoma severity (p = 0.708), baseline IOP (PG = 21.61 ± 1.34mmHg vs. POAG = 21.13 ± 5.09mmHg, p = 0.943), and number of topical glaucoma medications(PG = 2.34 ± 1.34 vs. POAG = 2.1 ± 1.41, p = 0.342) were comparable. More PG patients were on oral acetazolamide (PG = 26.15% vs. POAG = 1.5%, p < 0.001). Average logMAR visual acuity was significantly higher in the POAG group (0.207 ± 0.3 vs. 0.192 ± 0.37, p = 0.012). Eyes with PG received lower laser energy (POAG = 63.65 ± 22.03 mJ vs. PG = 43.71 ± 25.68 mJ, p < 0.001). IOP spikes were recorded in 5 PG eyes (7.6%) and none in the POAG group (p = 0.058). Failure rates were similar (PG = 50.7% and POAG = 43.1%, p = 0.205). In multivariable analysis, only pre-laser IOP (coefficient = 2.154 [CI: 0.765-3.543], p = 0.003) was a significant predictor of IOP change percentage after 12 months. CONCLUSIONS SLT was comparably effective in both PG and POAG. IOP spikes were observed only in the PG group, though the total laser energy was lower in this group compared with POAG.
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Affiliation(s)
- Shahin Hallaj
- Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, 19107 PA, USA
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diegol, La Jolla, USA
| | - Sapna Sinha
- Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, 19107 PA, USA
| | - Nikki A Mehran
- Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, 19107 PA, USA
| | - Amber M Morrill
- Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, 19107 PA, USA
| | - Michael J Pro
- Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, 19107 PA, USA
| | - Elizabeth Dale
- Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, 19107 PA, USA
| | - Courtland Schmidt
- Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, 19107 PA, USA
| | - Natasha Nayak Kolomeyer
- Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, 19107 PA, USA
| | - Aakriti G Shukla
- Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, 19107 PA, USA
| | - Daniel Lee
- Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, 19107 PA, USA
| | - Marlene R Moster
- Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, 19107 PA, USA
| | - Jonathan S Myers
- Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, 19107 PA, USA
| | - L Jay Katz
- Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, 19107 PA, USA
| | - Reza Razeghinejad
- Glaucoma Service, Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, 19107 PA, USA
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Sarkisian SR, Ang RE, Lee AM, Berdahl JP, Heersink SB, Burden JH, Doan LV, Stephens KG, Kothe AC, Usner DW, Katz LJ, Navratil T. Phase 3 Randomized Clinical Trial of the Safety and Efficacy of Travoprost Intraocular Implant in Patients with Open-Angle Glaucoma or Ocular Hypertension. Ophthalmology 2024:S0161-6420(24)00161-1. [PMID: 38423216 DOI: 10.1016/j.ophtha.2024.02.022] [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: 09/27/2023] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
PURPOSE To evaluate the safety and intraocular pressure (IOP)-lowering efficacy of 2 models of the travoprost intraocular implant (fast-eluting [FE] and slow-eluting [SE] types) from 1 of 2 phase 3 trials (the GC-010 trial). DESIGN Multicenter, randomized, double-masked, sham-controlled, noninferiority trial. PARTICIPANTS Patients with open-angle glaucoma or ocular hypertension having an unmedicated baseline mean diurnal IOP (average of 8 am, 10 am, and 4 pm time points) of ≥ 21 mmHg, and IOP of ≤ 36 mmHg at each of the 8 am, 10 am, and 4 pm timepoints at baseline. METHODS Study eyes were randomized to the travoprost intraocular implant (FE implant [n = 200] or SE implant [n = 197] model) or to timolol ophthalmic solution 0.5% twice daily (n = 193). MAIN OUTCOME MEASURES The primary outcome was mean change from baseline IOP in the study eye at 8 am and 10 am, at each of day 10, week 6, and month 3. Safety outcomes included adverse events (AEs) and ophthalmic assessments. RESULTS Mean IOP reduction from baseline over the 6 time points ranged from 6.6 to 8.4 mmHg for the FE implant group, from 6.6 to 8.5 mmHg for the SE implant group, and from 6.5 to 7.7 mmHg for the timolol group. The primary efficacy end point was met; the upper limit of the 95% confidence interval of the difference between the implant groups and the timolol group was < 1 mmHg at all 6 time points. Study eye AEs, most of mild or moderate severity, were reported in 21.5%, 27.2%, and 10.8% of patients in the FE implant, SE implant, and timolol groups, respectively. The most common AEs included iritis (FE implant, 0.5%; SE implant, 5.1%), ocular hyperemia (FE implant, 3.0%; SE implant, 2.6%), reduced visual acuity (FE implant, 1.0%; SE implant, 4.1%; timolol, 0.5%), and IOP increased (FE implant, 3.5%; SE implant, 2.6%; timolol, 2.1%). One serious study eye AE occurred (endophthalmitis). CONCLUSIONS The travoprost intraocular implant demonstrated robust IOP reduction over the 3-month primary efficacy evaluation period after a single administration. The IOP-lowering efficacy in both implant groups was statistically and clinically noninferior to that in the timolol group, with a favorable safety profile. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | | | | | | | | | - James H Burden
- Skyline Vision Clinic and Laser Center, Colorado Springs, Colorado
| | - Long V Doan
- Glaukos Corporation, Aliso Viejo, California
| | | | | | | | - L Jay Katz
- Glaukos Corporation, Aliso Viejo, California
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Sacks Z, Katz LJ, Gazzard G, Van Tassel SH, Blumenthal EZ, Lerner FS, Azuara-Blanco A, Spooner GJR, Solberg Y, Samuelson T, Belkin M. A Proposal for the Use of a Fixed Low-Energy Selective Laser Trabeculoplasty for Open Angle Glaucoma. J Glaucoma 2024; 33:1-7. [PMID: 37851966 PMCID: PMC10712999 DOI: 10.1097/ijg.0000000000002306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/10/2023] [Indexed: 10/20/2023]
Abstract
Selective laser trabeculoplasty (SLT) has been in routine clinical use for over 20 years with millions of patients successfully treated and a low rate of clinically significant complications. The procedure requires the clinician to manually position the laser beam on the trabecular meshwork using a gonioscopy lens and to titrate the SLT laser energy based on the amount of pigmentation in the angle, as well as the observation of small bubbles produced by the laser effect. We propose that SLT energy titration is unnecessary either to achieve intraocular pressure (IOP) reduction or to minimize potential side effects. Ample evidence to support our proposal includes multiple clinical reports demonstrating comparable levels of IOP reduction resulting from different laser energies, a large variety of energy and other laser parameters used in commercially available SLT lasers, and the nature of the laser-induced changes in the trabecular meshwork tissue with respect to energy. Despite these variations in laser parameters, SLT consistently reduces IOP with a low complication rate. We propose that using low fixed energy for all patients will effectively and safely lower patients' IOP while reducing the complexity of the SLT procedure, potentially making SLT accessible to more patients.
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Affiliation(s)
| | - L. Jay Katz
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Gus Gazzard
- Moorfields Eye Hospital NHS Foundation Trust
- NIHR Moorfields Biomedical Research Centre
- UCL Institute of Ophthalmology, London, UK
| | | | - Eytan Z. Blumenthal
- Department of Ophthalmology, Rambam Health Care Campus
- Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel
| | - Fabian S. Lerner
- University Favaloro, School of Medical Sciences and Foundation for the Study of Glaucoma, Buenos Aires, Argentina
| | - Augusto Azuara-Blanco
- Centre for Public Health, Queen's University Belfast
- Belfast Health and Social Care Trust, UK
| | | | | | - Thomas Samuelson
- Minnesota Eye Consultants
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota MN
| | - Michael Belkin
- The Goldschleger Eye Research Institute, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Israel
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Shamseldin Shalaby W, Reddy R, Razeghinejad R, Jay Katz L. Contemporary Approach to Narrow Angles. J Ophthalmic Vis Res 2024; 19:88-108. [PMID: 38638634 PMCID: PMC11022020 DOI: 10.18502/jovr.v19i1.15443] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/12/2023] [Indexed: 04/20/2024] Open
Abstract
Glaucoma is the leading cause of irreversible blindness worldwide. Among all glaucoma types, primary angle closure glaucoma (PACG) affects approximately 23 million people worldwide, and is responsible for 50% of glaucoma-related blindness, highlighting the devastating consequences of this disease. The main mechanism of PACG is relative pupillary block. High-risk populations are female gender, Asian ethnicity, high hyperopia, short axial length, and a thick/anteriorly positioned lens. This review discusses the clinical diagnosis, classification, and management of patients with a narrow angle with and without intraocular pressure (IOP) elevation and glaucomatous optic nerve damage, including laser peripheral iridotomy (LPI), endocycloplasty (ECPL), lens extraction, and goniosynechialysis.
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Affiliation(s)
- Wesam Shamseldin Shalaby
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
- Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Rohit Reddy
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - L. Jay Katz
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
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Berdahl JP, Sarkisian SR, Ang RE, Doan LV, Kothe AC, Usner DW, Katz LJ, Navratil T. Efficacy and Safety of the Travoprost Intraocular Implant in Reducing Topical IOP-Lowering Medication Burden in Patients with Open-Angle Glaucoma or Ocular Hypertension. Drugs 2024; 84:83-97. [PMID: 38060092 PMCID: PMC10789685 DOI: 10.1007/s40265-023-01973-7] [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] [Accepted: 11/05/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE A randomized, double-masked, multicenter, phase 2 trial to evaluate the long-term safety and efficacy of travoprost intraocular implant, an extended-release drug delivery system designed to provide uninterrupted sustained intraocular pressure (IOP)-lowering therapy, thereby reducing patient treatment burden and improving adherence with IOP-lowering medication. METHODS Patients with open-angle glaucoma or ocular hypertension were administered a fast-eluting implant (FE implant, n = 51) and received twice-daily (BID) placebo eye drops, a slow-eluting (SE implant, n = 54) and received BID placebo eye drops, or underwent a sham surgical procedure and received BID timolol 0.5% (n = 49). IOP was measured at baseline, day 1-2, day 10, week 4, week 6, month 3, and every 3 months thereafter through 36 months. Efficacy was evaluated by mean change from 8:00 AM unmedicated baseline IOP through month 36, and the percentage of patients receiving the same or fewer topical IOP-lowering medications as at screening (pre-study). Safety was evaluated by adverse events and ophthalmic parameters. RESULTS Clinically and statistically relevant IOP-lowering treatment effects were observed through month 36 after a single administration of the travoprost implant compared with BID timolol with mean IOP reductions ranging from 7.6 to 8.8 mmHg for the FE implant group, from 7.3 to 8.0 mmHg for the SE implant group, and from 7.3 to 7.9 for the timolol group at the 8:00 AM timepoint (P < 0.0001 for all treatment groups at all visits). At months 12, 24, and 36, a greater percentage of FE and SE implant patients versus timolol patients were well controlled on the same or fewer topical IOP-lowering medications compared with screening with 63 and 69% for the FE and SE implants groups, respectively, versus 45% for the timolol group at month 36. The safety profile of the implant was favorable; there were no dislodgements, no explantations, no adverse events of conjunctival hyperemia or periorbital fat atrophy, no discontinuations due to study eye adverse events, nor any serious adverse events in the study eye. Comparable changes from baseline in corneal endothelial cell counts were observed in the three treatment groups over the 36 months. CONCLUSION The travoprost intraocular implant demonstrated robust IOP-lowering and substantially reduced topical IOP-lowering medication burden for up to 36 months following a single administration, while maintaining a favorable safety profile. The travoprost intraocular implant promises to be a meaningful addition to the interventional glaucoma armamentarium by addressing the key shortcomings of topical IOP-lowering medications, including low adherence and topical side effects while controlling IOP for up to 36 months. TRIAL REGISTRY ClinicalTrials.gov identifier NCT02754596 registered 28 April 2016.
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Affiliation(s)
| | | | - Robert E Ang
- Asian Eye Institute, Rockwell Center, 1200, Makati City, Philippines
| | - Long V Doan
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA
| | - Angela C Kothe
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA
| | - Dale W Usner
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA
| | - L Jay Katz
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA
- Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, 19107, USA
- Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Tomas Navratil
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA.
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Konstas AG, Boboridis KG, Athanasopoulos GP, Haidich AB, Voudouragkaki IC, Pagkalidou E, Katsanos A, Katz LJ. Changing from preserved, to preservative-free cyclosporine 0.1% enhanced triple glaucoma therapy: impact on ocular surface disease-a randomized controlled trial. Eye (Lond) 2023; 37:3666-3674. [PMID: 37221362 PMCID: PMC10686389 DOI: 10.1038/s41433-023-02578-w] [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: 10/26/2022] [Revised: 04/09/2023] [Accepted: 05/11/2023] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE Halting and reversing glaucoma therapy-related ocular surface disease (GTR-OSD) will improve the success of long-term medical therapy, impacting millions of patients worldwide. METHODS A single-centre, masked, prospective, placebo-controlled, crossover trial of 41 well-controlled open-angle glaucoma subjects with moderate to severe GTR-OSD on preserved latanoprost and dorzolamide/timolol fixed combination (DTFC) therapy was conducted. Subjects were randomized to preservative-free (PF) tafluprost and DTFC with either placebo or cyclosporine 0.1% drops for 6 months and were then crossed over to the opposite therapy. Oxford score of ocular staining was the primary outcome; osmolarity, matrix-metalloproteinase-9 (MMP-9) testing, tear film break-up time (TFBUT), meibomian gland dysfunction (MGD), punctum evaluation, adverse events and diurnal intraocular pressure (IOP) comprised secondary outcomes. RESULTS GTR-OSD findings improved with PF therapy. At 6 months the triple PF with placebo group showed improvement compared to baseline in mean Oxford score (mean difference [MD]:-3.76; 95% confidence interval [CI]:-4.74 to -2.77; p < 0.001), osmolarity (MD:-21.93; 95%CI:-27.61 to -16.24 mOsm/l; p < 0.001), punctum stenosis (p = 0.008) and conjunctival hyperaemia (p < 0.001). Similar improvements occurred in the cyclosporine enhanced period, which also provided greater improvement in MMP-9 positivity (24 vs 66%; p < 0.001) and TFBUT (p = 0.022). The cyclosporine group was superior vs placebo in mean Oxford score (MD:-0.78; 95%CI:-1.40 to -0.15); p < 0.001), itchiness and objective adverse events (p = 0.034). Cyclosporine elicited more stinging vs placebo (63 vs 24%; p < 0.001). Both PF regimens reduced mean diurnal IOP more than preserved therapy (14.7 vs 15.9 mmHg; p < 0.001). CONCLUSIONS Changing from preserved to PF glaucoma medications improves ocular surface health and IOP control. Topical cyclosporine 0.1% further reverses GTR-OSD.
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Affiliation(s)
| | - Konstadinos G Boboridis
- 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios P Athanasopoulos
- 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Epidemiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Irini C Voudouragkaki
- 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Pagkalidou
- Department of Epidemiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Katsanos
- Department of Ophthalmology, University of Ioannina, Ioannina, Greece
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
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Shamseldin Shalaby W, Patel S, S. Lam S, Ganjei A, Garg Shukla A, Kolomeyer N, Lee D, Jay Katz L, R. Moster M, Myers J, Razeghinejad R. Effect of Phacoemulsification on Intraocular Pressure in Eyes with Functioning Tube Shunts. J Ophthalmic Vis Res 2023; 18:150-156. [PMID: 37181616 PMCID: PMC10172799 DOI: 10.18502/jovr.v18i2.13180] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 08/30/2022] [Indexed: 05/16/2023] Open
Abstract
Purpose To evaluate the effect of phacoemulsification on intraocular pressure (IOP) in eyes with functioning tube shunts. Methods This was a retrospective chart review of primary open-angle glaucoma (POAG) patients with a functioning tube who underwent phacoemulsification and had ≥24 months of follow-up. The primary end point was defined as surgical failure (IOP > 21 mmHg) at month 24, progression to no light perception (NLP) vision, glaucoma reoperation, or implant removal. Surgical failure defined as IOP >18 and >15 mmHg, changes in visual acuity (VA), IOP, and number of medications were assessed. Results Twenty-seven eyes of 27 patients with moderate or severe POAG were included. The mean age of the patients was 64.2 ± 10.8 years. The interval between the tube shunt and phacoemulsification was 28.8 ± 25.0 months. At the end of the study, four (14.8%) eyes met the failure criteria; the average time to failure was 9.3 ± 3.8 months. The causes of failure were high IOP in two (50.0%) and glaucoma reoperation in two (50.0%) eyes; however, no eyes progressed to NLP vision. Surgical failure defined as IOP >18 and >15 mmHg showed an increasing failure rate (18.5% and 48.5%, respectively).Themean IOP and medications number remained stable at month 24 compared to baseline (P = 0.131 and P = 0.302, respectively). Initially, VA showed improvement, with the greatest improvement at 6 months (P = 0.001), but at 24 months the improvement was no longer significant (P = 0.430). Conclusion Phacoemulsification in patients with functioning tubes did not change the mean IOP in most of the patients (86.2%); the number of medications also did not increase.
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Affiliation(s)
- Wesam Shamseldin Shalaby
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, PA, USA
- Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Sonali Patel
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sophia S. Lam
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Allen Ganjei
- College of Medicine, Drexel University, Philadelphia, PA, USA
| | | | | | - Daniel Lee
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, PA, USA
| | - L. Jay Katz
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, PA, USA
| | | | - Jonathan Myers
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, PA, USA
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Ahmed IIK, Sheybani A, De Francesco T, Lass JH, Benetz BA, Samuelson TW, Usner D, Katz LJ. Long-Term Endothelial Safety Profile With iStent Inject in Patients With Open-Angle Glaucoma. Am J Ophthalmol 2023; 252:17-25. [PMID: 36868339 DOI: 10.1016/j.ajo.2023.02.014] [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: 01/05/2023] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE To report 5-year postoperative safety data of iStent inject, including overall stability, endothelial cell density (ECD), and endothelial cell loss (ECL) in patients with mild-to-moderate primary open-angle glaucoma (POAG). DESIGN In this 5-year follow-up safety study of the 2-year iStent inject pivotal randomized controlled trial, patients receiving iStent inject placement and phacoemulsification or phacoemulsification alone were studied for the incidence of clinically relevant complications associated with iStent inject placement and stability. METHODS Corneal endothelial endpoints were mean change in ECD from screening and proportion of patients with >30% ECL from screening, from analysis of central specular endothelial images by a central image analysis reading center at several timepoints through 60 months postoperatively. RESULTS Of 505 original randomized patients, 227 elected to participate (iStent inject and phacoemulsification group, n = 178; phacoemulsification-alone control group, n = 49). No specific device-related adverse events or complications were reported through month 60. No significant differences were observed in mean ECD, mean percentage change in ECD, or proportion of eyes with >30% ECL between the iStent inject and control groups at any timepoint; mean percentage decrease in ECD at 60 months was 14.3±13.4% in the iStent inject group and 14.8±10.3% in the control group (P = .8112). The annualized rate of ECD change from 3 to 60 months was neither clinically nor statistically significant between groups. CONCLUSIONS Implantation of iStent inject during phacoemulsification in patients with mild-to-moderate POAG did not produce any device-related complications or ECD safety concerns compared to phacoemulsification alone through 60 months.
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Affiliation(s)
- Iqbal Ike K Ahmed
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Arsham Sheybani
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Ticiana De Francesco
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Clínica de Olhos De Francesco, Fortaleza, Brazil, & Hospital de Olhos Leiria de Andrade (HOLA), Fortaleza, Brazil
| | - Jonathan H Lass
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, OH; Cornea Image Analysis Reading Center (CIARC), University Hospitals Eye Institute, Cleveland, OH
| | - Beth Ann Benetz
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, OH; Cornea Image Analysis Reading Center (CIARC), University Hospitals Eye Institute, Cleveland, OH
| | | | | | - L Jay Katz
- Glaukos Corporation, Aliso Viejo, CA; Wills Eye Hospital, Philadelphia, PA.
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Shalaby WS, Ganjei AY, Wogu B, Myers JS, Moster MR, Razeghinejad R, Lee D, Kolomeyer NN, Eid TE, Katz LJ, Shukla AG. Outcomes of Ahmed glaucoma valve and transscleral cyclophotocoagulation in neovascular glaucoma. Indian J Ophthalmol 2022; 70:1253-1259. [PMID: 35326027 PMCID: PMC9240564 DOI: 10.4103/ijo.ijo_2107_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 11/05/2022] Open
Abstract
Purpose To determine the outcomes of Ahmed glaucoma valve (AGV) and transscleral diode cyclophotocoagulation (CPC) in neovascular glaucoma (NVG). Methods This was a single-center retrospective comparative case series involving chart review of consecutive patients who underwent AGV or CPC for treatment of NVG and had ≥6 months of follow-up. Surgical failure at 6 months, defined as an IOP of >21 or <6 mm Hg with hypotony maculopathy after 1 month, progression to no light perception (NLP) vision, glaucoma reoperation, or removal of AGV were the main outcome measures. Results In total, 121 eyes of 121 patients were included (70 AGV and 51 CPC). Baseline demographics, visual acuity (VA), and intraocular pressure (IOP) were comparable between groups. At 6 months, failure was significantly higher in the CPC group than in the AGV group (43.1% vs. 17.1%, P = 0.020). Both groups had similar IOP and medication number at 6 months, but VA was significantly lower in the CPC group compared to the AGV group (2.4 ± 0.8 vs. 1.9 ± 1.0, P = 0.017). More CPC eyes required reoperation for glaucoma than AGV eyes (11.8% vs. 1.4%, P = 0.041). Multivariate regression analysis identified higher preoperative IOP (P = 0.001) and CPC surgery (P = 0.004) as independent predictors of surgical failure at 6 months. Age, sex, race, NVG etiology, bilaterality of the underlying retinal pathology, perioperative retina treatment, and prior or combined vitrectomy were not significant. Conclusion AGV and CPC had comparable IOP and medication reduction in NVG eyes at 6 months. CPC was more frequently associated with failure, reoperation for glaucoma, and worse visual outcomes. High preoperative IOP and CPC surgery independently predicted surgical failure.
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Affiliation(s)
- Wesam S Shalaby
- Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA; Department of Ophthalmology, Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Allen Y Ganjei
- College of Medicine, Drexel University, Philadelphia, PA, USA
| | - Brian Wogu
- Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jonathan S Myers
- Glaucoma Research Center, Wills Eye Hospital; Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Marlene R Moster
- Glaucoma Research Center, Wills Eye Hospital; Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Reza Razeghinejad
- Glaucoma Research Center, Wills Eye Hospital; Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel Lee
- Glaucoma Research Center, Wills Eye Hospital; Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Natasha N Kolomeyer
- Glaucoma Research Center, Wills Eye Hospital; Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Tarek E Eid
- Department of Ophthalmology, Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital; Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Aakriti G Shukla
- Glaucoma Research Center, Wills Eye Hospital; Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Samuelson TW, Singh IP, Williamson BK, Falvey H, Katz LJ, Lee WC, Odom D, McSorley D. Reply to Comment on: "Quality of Life in Primary Open-Angle Glaucoma and Cataract: An Analysis of VFQ-25 and OSDI from the iStent inject® Pivotal Trial". Am J Ophthalmol 2022; 234:329. [PMID: 34653356 DOI: 10.1016/j.ajo.2021.09.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
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12
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Shalaby WS, Ahmed OM, Waisbourd M, Katz LJ. A Review of Potential Novel Glaucoma Therapeutic Options Independent of Intraocular Pressure. Surv Ophthalmol 2021; 67:1062-1080. [PMID: 34890600 DOI: 10.1016/j.survophthal.2021.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 05/05/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 02/06/2023]
Abstract
Glaucoma, a progressive optic neuropathy characterized by retinal ganglion cell degeneration and visual field loss, is the leading cause of irreversible blindness worldwide. Intraocular pressure (IOP) is presently the only modifiable risk factor demonstrated to slow or halt disease progression; however, glaucomatous damage persists in almost 50% of patients despite significant IOP reduction. Many studies have investigated the non-IOP-related risk factors that contribute to glaucoma progression as well as interventions that can prevent or delay glaucomatous neurodegeneration and preserve vision throughout life, independently of IOP. A vast number of experimental studies have reported effective neuroprotection in glaucoma, and clinical studies are ongoing attempting to provide strong evidence of effectiveness of these interventions. In this review, we look into the current understanding of the pathophysiology of glaucoma and explore the recent advances in non-IOP related strategies for neuroprotection and neuroregeneration in glaucoma.
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Key Words
- AMD, Age-related macular degeneration
- BDNF, Brain derived neurotrophic factor
- CNTF, Ciliary neurotrophic factor
- GDNF, Glial‐derived neurotrophic factor
- Glaucoma
- IOP, Intraocular pressure
- LoGTS, Low-Pressure Glaucoma Treatment Study
- MRI, Magnetic resonance imaging
- MSCs, Mesenchymal stem cells
- NGF, Nerve growth factor
- NTG, Normal tension glaucoma
- OCTA, Optical coherence tomography angiography
- PBM, hotobiomodulation
- PDGF, Platelet derived growth factor
- POAG, Primary open angle glaucoma
- RGCs, Retinal ganglion cells
- TNF-α, Tumor necrosis factor- α
- bFGF, Basic fibroblast growth factor
- gene therapy
- intracranial pressure
- intraocular pressure
- neuroprotection
- ocular blood flow
- oxidative stress
- retinal ganglion cells
- stem cell therapy
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Affiliation(s)
- Wesam Shamseldin Shalaby
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA; Department of Ophthalmology, Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Osama M Ahmed
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA; Yale University School of Medicine, New Haven, CT, USA
| | - Michael Waisbourd
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA; Department of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA.
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Shalaby WS, Arbabi A, Myers JS, Moster MR, Razeghinejad R, Katz LJ, Shukla AG. Sociodemographic and Economic Factors in Outcomes of Tube Shunts for Neovascular Glaucoma. J Curr Glaucoma Pract 2021; 15:70-77. [PMID: 34720496 PMCID: PMC8543744 DOI: 10.5005/jp-journals-10078-1303] [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
Importance Few studies have analyzed associations between sociodemographic factors and neovascular glaucoma (NVG) outcomes. Aim and background To determine the potential impact of sociodemographic and economic factors on the NVG tube shunt surgery outcomes. Design Retrospective, single-center, comparative case series. Participants Consecutive patients who underwent tube shunt surgery for NVG and had ≥6 months of follow-up. Materials and methods Regional average adjusted gross income (AGI) was determined by cross-referencing self-reported residential zip codes with average AGI per zip code supplied by the Internal Revenue Service. Two groups were created: (1) lower-income: individuals from neighborhoods with the lowest 10% of AGI (near the United States poverty line), (2) higher-income: the remaining 90% of individuals. Main outcome measures Visual acuity (VA), intraocular pressure (IOP), and glaucoma medication number at 6 months and the most recent visit. Results The mean annual AGI in the higher-income group (130 patients) was $69,596 ± 39,700 and the lower-income group (16 patients) was $27,487 ± 1,600 (p < 0.001). Age, sex, distance to the clinic, language, and all baseline clinical variables (including VA and IOP) were comparable between groups. Lower-income was associated with non-white race (81.3 vs 52.3%; p = 0.024). At month 6, VA in the lower-income group [median: HM (20/70–NLP)] was worse than the higher-income group [median: CF (20/25–NLP)] (log MAR VA: 2.32 ± 0.8 vs 1.77 ± 1.1; p = 0.02); these trends persisted through the most recent visit (p = 0.043). Follow-up IOP and medications were similar between groups. Conclusions and relevance Lower-income may be associated with worse VA outcomes following NVG tube shunt surgery. How to cite this article Shalaby WS, Arbabi A, Myers JS, et al. Sociodemographic and Economic Factors in Outcomes of Tube Shunts for Neovascular Glaucoma. J Curr Glaucoma Pract 2021;15(2):70–77.
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Affiliation(s)
- Wesam S Shalaby
- Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA; Ophthalmology Department, Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Amirmohsen Arbabi
- Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jonathan S Myers
- Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Marlene R Moster
- Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Reza Razeghinejad
- Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Aakriti G Shukla
- Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Samuelson TW, Singh IP, Williamson BK, Falvey H, Lee WC, Odom D, McSorley D, Katz LJ. Quality of Life in Primary Open-Angle Glaucoma and Cataract: An Analysis of VFQ-25 and OSDI From the iStent inject® Pivotal Trial. Am J Ophthalmol 2021; 229:220-229. [PMID: 33737036 DOI: 10.1016/j.ajo.2021.03.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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: 10/26/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess quality of life (QOL) as measured by patient-reported outcomes (PRO) within the iStent inject® pivotal trial. DESIGN Randomized controlled trial analysis of secondary outcomes. METHODS The Vision Function Questionnaire (VFQ-25) and Ocular Surface Disease Index (OSDI) questionnaire were administered at baseline and at months 1, 6, 12, and 24. PRO responders were defined as patients reaching improvement based on minimally important differences. RESULTS A total of 505 patients were randomized (386 iStent inject® [Glaukos], 119 surgery alone). The iStent inject® group exhibited a greater percentage of PRO responders across all follow-up visits over 24 months, averaging 58.0% vs 45.8%; P < .05 for VFQ-25 composite scores and 56.7% vs 48.9%; P < .05 for OSDI composite scores. Odds of being a responder in the iStent inject® group was 60% (P < .05) higher for the VFQ-25 and 32% (P > .05) higher for the ODSI. Driving (49.0% vs 28.8%; P < .05), ocular pain (59.3% vs 47.2%; P < .05), and general vision (71.8% vs 60.0%; P < .05) were the VFQ-25 subscales responsible for differences between treatment groups. At month 24, 76.5% of VFQ-25 responders and 62.5% of nonresponders were medication free regardless of treatment group (P < .05). CONCLUSIONS Exploratory analysis suggests that by reducing medication dependence, implantation with the micro-scale iStent inject® device with cataract surgery may improve QOL vs cataract surgery alone over 24 months, with improvements influenced by ocular symptoms and vision-related activities.
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Affiliation(s)
| | - Inder Paul Singh
- Eye Centers of Racine and Kenosha, Racine, Wisconsin, USA (I.P.S.)
| | | | | | - Won Chan Lee
- Econforte Consulting LLC, San Francisco, California, USA (W.C.L)
| | - Dawn Odom
- RTI Health Solutions, Research Triangle Park, North Carolina, USA (D.O., D.M.)
| | - David McSorley
- RTI Health Solutions, Research Triangle Park, North Carolina, USA (D.O., D.M.)
| | - L Jay Katz
- Glaukos, San Clemente, California, USA (H.F., L.J.K.)
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15
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Singh IP, Sarkisian S, Hornbeak D, Katz LJ, Samuelson T. Treatment Success Across Different Levels of Preoperative Disease Burden: Stratified Two-Year Outcomes from the Pivotal Trial of iStent inject ® Trabecular Micro-Bypass in Primary Open-Angle Glaucoma and Cataract. Clin Ophthalmol 2021; 15:3231-3240. [PMID: 34376967 PMCID: PMC8349204 DOI: 10.2147/opth.s316270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/23/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To examine effectiveness outcomes stratified by preoperative disease burden in the pivotal trial of iStent inject ® with cataract surgery (INJ) vs cataract surgery alone (CS). MATERIALS AND METHODS Prospective, 3:1 randomized, single-masked, concurrently-controlled, multicenter trial enrolling 505 subjects with cataract and mild-to-moderate primary open-angle glaucoma who underwent iStent inject implantation with phacoemulsification or phacoemulsification alone, and were followed for 2 years including annual medication washouts. Post hoc stratification was completed for baseline mean diurnal intraocular pressure (BL DIOP; Low-DIOP <25mmHg, Mid-DIOP ≥25 to <30 mmHg, High-DIOP ≥30mmHg) and preoperative medication burden (Low-Med 1 medication, Mid-Med 2 medications, High-Med ≥3 medications). RESULTS The 24-month primary and secondary effectiveness endpoints were met, with significant treatment-over-control differences in percent of eyes achieving ≥20% unmedicated DIOP reduction and in unmedicated DIOP reduction, respectively. In subgroup analyses, the proportions of INJ eyes achieving the primary endpoint remained steady across all BL DIOP (75.4%, 77.1%, 74.4% in Low/Mid/High-DIOP strata, respectively) and preoperative medication levels (76.8%, 70.8%, 79.7% in Low/Mid/High-Med strata, respectively); meanwhile, the proportions of CS eyes diminished with higher BL DIOP (64.5%, 63.6%, 33.3%, respectively) and more medications (69.0%, 63.3%, 29.4%, respectively). Regarding secondary effectiveness, postoperative DIOP reduction increased with higher BL DIOP in INJ eyes (6.2mmHg, 7.8mmHg, 9.8mmHg, respectively) but plateaued in CS eyes (5.2mmHg, 5.8mmHg, 5.4mmHg, respectively). INJ eyes also had consistent DIOP reduction regardless of preoperative medication burden (6.8mmHg, 6.7mmHg, 7.8mmHg, respectively), while DIOP reduction diminished with more medications in CS eyes (6.1mmHg, 5.0mmHg, 3.3mmHg, respectively). Safety was favorable, comparable to phacoemulsification alone. CONCLUSION Significant IOP reductions occurred across all levels of BL DIOP and preoperative medication burden in iStent inject eyes. DIOP reductions increased with higher BL DIOP and remained stable across all levels of preoperative medication burden, suggesting the device's potential utility in more medically challenging cases.
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Affiliation(s)
| | | | | | - L Jay Katz
- Glaukos Corporation, San Clemente, CA, USA
- Wills Eye Hospital, Philadelphia, PA, USA
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Katz LJ. Correct Usage of the Term "Off-Label" in the Context of Corneal Cross-Linking [Letter]. Clin Ophthalmol 2021; 15:3153-3154. [PMID: 34326631 PMCID: PMC8315767 DOI: 10.2147/opth.s327558] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA.,Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Glaukos, San Clemente, CA, USA
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Tran E, Sanvicente C, Hark LA, Myers JS, Zhang Q, Shiuey EJ, Tran J, Bonafede L, Hamershock RA, Withers C, Katz LJ. Educational intervention to adopt selective laser trabeculoplasty as first-line glaucoma treatment: Randomized controlled trial: Educational intervention on selective laser trabeculoplasty. Eur J Ophthalmol 2021; 32:1538-1546. [PMID: 34041935 DOI: 10.1177/11206721211018365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/15/2022]
Abstract
PURPOSE To determine the efficacy of an educational intervention on patient adoption and attitudes toward selective laser trabeculoplasty (SLT) as first-line treatment for glaucoma. METHODS This study is a randomized controlled trial. Subjects include 33 patients within 1-year diagnosis of either primary open-angle glaucoma, ocular hypertension, or pseudoexfoliation syndrome. After informed consent, subjects were randomly assigned to a Usual Care or Educational Intervention group. All subjects completed a pre-intervention questionnaire. The Educational Intervention group was shown a slideshow presentation and a 3-min video and given a post-intervention questionnaire. Follow-up examinations were reviewed for 6 months to determine subject completion of SLT, the primary outcome. Secondary outcomes include assessment of attitude toward SLT before and after intervention. RESULTS Age, gender, and baseline characteristics between the groups did not differ. The Usual Care group had a higher proportion of African Americans (77% vs 31%, p = 0.04). At 6 months following the intervention, 63% of subjects underwent SLT compared to 35% of Usual Care subjects (p = 0.12). Older age was associated with decreased SLT uptake (OR 0.90, 95% CI 0.82-0.99, p = 0.03). Prior to the intervention, there were no differences in attitudes of both groups regarding SLT therapy. Nineteen percent of Educational Intervention subjects changed positively toward SLT (p = 0.08) and 50% scheduled an SLT appointment after intervention (p = 0.005). CONCLUSIONS A slideshow and video-based educational intervention may positively enhance patient adoption of SLT.Clinical trial registration name, number, URL: Educational Intervention to Adopt SLT as First-Line Glaucoma Treatment, NCT03365778, https://clinicaltrials.gov/ct2/show/NCT03365778.
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Affiliation(s)
- Evelyn Tran
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | | | - Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA.,Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jonathan S Myers
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Qiang Zhang
- Vickie and Jack Farber Vision Research Center, Biostatistics Consulting Core, Wills Eye Hospital, Philadelphia, PA, USA
| | - Eric J Shiuey
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Judie Tran
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Lucas Bonafede
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Rose A Hamershock
- Vickie and Jack Farber Vision Research Center, Biostatistics Consulting Core, Wills Eye Hospital, Philadelphia, PA, USA
| | - Colleen Withers
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - L Jay Katz
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
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Leiby BE, Hegarty SE, Zhan T, Myers JS, Katz LJ, Haller JA, Waisbourd M, Burns C, Divers M, Molineaux J, Henderer J, Brodowski C, Hark LA. A Randomized Trial to Improve Adherence to Follow-up Eye Examinations Among People With Glaucoma. Prev Chronic Dis 2021; 18:E52. [PMID: 34014814 PMCID: PMC8139485 DOI: 10.5888/pcd18.200567] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Appointment nonadherence is common among people with glaucoma, making it difficult for eye care providers to monitor glaucoma progression. Our objective was to determine whether the use of patient navigators, in conjunction with social worker support, could increase adherence to recommended follow-up eye appointments. Methods A randomized, controlled trial evaluated the effectiveness of an intervention that used patient navigators and social workers to improve patient adherence to follow-up eye care compared with usual care. Participants with glaucoma and other eye diseases (N = 344) were identified at primary care clinics in community settings through telemedicine screening of imaging and then randomized to enhanced intervention (EI) or usual care (UC). Data on participants’ visits with local ophthalmologists were collected for up to 3 years from randomization. Groups were compared for timely attendance at the first visit with the local ophthalmologist and adherence to recommended follow-up visits. Results Timely attendance at the first visit was higher for EI than UC (74.4% vs 39.0%; average relative risk [aRR] = 1.85; 95% CI, 1.51–2.28; P < .001). Rates of adherence to recommended annual follow-up during year 1 were 18.6% in the EI group and 8.1% in the usual care group (aRR = 2.08; 95% CI, 1.14–3.76; P = .02). The aRR across years 2 and 3 was 3.92 (95% CI, 1.24–12.43; P = .02). Conclusion An intervention using patient navigators and social workers doubled the rate of adherence to annual recommended follow-up eye care compared with usual care in community settings, and was effective at increasing connections with local ophthalmologists. Interventions to further improve long-term adherence are needed.
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Affiliation(s)
- Benjamin E Leiby
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Philadelphia, Pennsylvania
| | - Sarah E Hegarty
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Philadelphia, Pennsylvania
| | - Tingting Zhan
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Philadelphia, Pennsylvania
| | - Jonathan S Myers
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania.,Thomas Jefferson University, Sidney Kimmel Medical College, Department of Ophthalmology, Philadelphia, Pennsylvania.,Glaucoma Service, Wills Eye Hospital, 840 Walnut St, Ste 1110, Philadelphia PA 19107.
| | - L Jay Katz
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania.,Thomas Jefferson University, Sidney Kimmel Medical College, Department of Ophthalmology, Philadelphia, Pennsylvania
| | - Julia A Haller
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Ophthalmology, Philadelphia, Pennsylvania.,Wills Eye Hospital, Office of the Ophthalmologist-in-Chief, Philadelphia, Pennsylvania
| | - Michael Waisbourd
- Department of Ophthalmology, Tel Aviv Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Christine Burns
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Meskerem Divers
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Jeanne Molineaux
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Jeffrey Henderer
- Temple University School of Medicine, Department of Ophthalmology, Philadelphia, Pennsylvania
| | - Charles Brodowski
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Lisa A Hark
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania.,Columbia University Irving Medical Center, Department of Ophthalmology, New York, New York
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Konstas AG, Schmetterer L, Katsanos A, Hutnik CML, Holló G, Quaranta L, Teus MA, Uusitalo H, Pfeiffer N, Katz LJ. Dorzolamide/Timolol Fixed Combination: Learning from the Past and Looking Toward the Future. Adv Ther 2021; 38:24-51. [PMID: 33108623 PMCID: PMC7854404 DOI: 10.1007/s12325-020-01525-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/03/2020] [Indexed: 02/06/2023]
Abstract
The key clinical attributes of preserved dorzolamide/timolol fixed combination (DTFC) and the emerging potential of preservative-free (PF) DTFC are reviewed with published evidence and clinical experience. The indications and role of DTFC in current glaucoma management are critically discussed. Preserved DTFC became the first intraocular pressure (IOP)-lowering fixed combination (FC) approved by the US Food and Drug Administration (FDA) and remains one of most commonly used medications worldwide. The pharmacological properties of DTFC reflect those of its two time-tested constituents, i.e., the carbonic anhydrase inhibitor dorzolamide and the non-selective beta-blocker timolol. In regulatory studies DTFC lowers IOP on average by 9 mmHg (32.7%) at peak and by 7.7 mmHg (27%) at trough. In trials DTFC shows equivalence to unfixed concomitant therapy, but in real-life practice it may prove superior owing to enhanced convenience, elimination of the washout effect from the second drop, improved tolerability, and better adherence. PF DTFC became the first PF FC approved, first in unit-dose pipettes, and more recently in a multidose format. Cumulative evidence has confirmed that PF DTFC is at least equivalent in efficacy to preserved DTFC and provides a tangible clinical benefit to patients with glaucoma suffering from ocular surface disease by improving tolerability and adherence. Finally, we identify areas that warrant further investigation with preserved and PF DTFC
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Ahmed OM, Waisbourd M, Spaeth GL, Katz LJ. Improvement in structure and visual function in patients with glaucoma: the possible key to better treatment? Surv Ophthalmol 2020; 66:644-652. [PMID: 33316283 DOI: 10.1016/j.survophthal.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022]
Abstract
Glaucoma is characterized by retinal ganglion cell loss that can lead to permanent visual loss. Current clinical management practice assumes that glaucomatous visual loss is irreversible; however, there is increasing evidence that permanent vision loss and cell death are preceded by reversible functional and structural changes. We propose that these changes should be considered by glaucoma specialists when treating their patients. We discuss the neurobiological basis of this phenomenon and provide clinical evidence of reversibility in both structure and function. Specifically, we review the findings of visual field testing, contrast sensitivity, electroretinography, and imaging of the optic nerve and their correlation with functional changes. We then discuss the clinical value of these observations in helping guide approaches toward the diagnosis and treatment of patients with glaucoma.
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Affiliation(s)
- Osama M Ahmed
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA; Yale University School of Medicine, New Haven, CT, USA
| | - Michael Waisbourd
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA; Department of Ophthalmology, Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - George L Spaeth
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA.
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21
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Shalaby WS, Myers JS, Razeghinejad R, Katz LJ, Pro M, Dale E, Fudemberg SJ, Mantravadi AV, Shukla AG. Outcomes of Valved and Nonvalved Tube Shunts in Neovascular Glaucoma. Ophthalmol Glaucoma 2020; 4:182-192. [PMID: 32956898 DOI: 10.1016/j.ogla.2020.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE To determine the outcomes of Ahmed glaucoma valve (AGV; New World Medical Inc) and Baerveldt glaucoma implant (BGI; Advanced Medical Optics) surgery in the setting of neovascular glaucoma (NVG). DESIGN Single-center, retrospective study. PARTICIPANTS Consecutive patients who underwent AGV or BGI surgery for the treatment of NVG and had ≥6 months of follow-up. METHODS Chart review of AGV and BGI surgical outcomes in patients with NVG. MAIN OUTCOME MEASURES Progression to no light perception (NLP) vision and 6-month surgical failure, which was defined as intraocular pressure (IOP) >21 mmHg with medications or <5 mmHg at 2 consecutive visits, or glaucoma reoperation. RESULTS A total of 152 eyes (91 AGV, 61 BGI) were included with an average follow-up of 29.6 ± 25.8 months. Baseline demographics and clinical characteristics were comparable between groups. At month 6, failure was similar between AGV and BGI eyes (21.6% vs. 25.9%; P = 0.552), but glaucoma medication use was lower in BGI eyes (P < 0.001). At the final visit, 18.7% of AGV and 14.8% of BGI eyes progressed to NLP vision (P = 0.530), and medication use was lower in BGI eyes (P < 0.0001). Multivariate analysis identified lower preoperative visual acuity (VA) (P = 0.001), failure to receive panretinal photocoagulation within 2 weeks of surgery (P = 0.003), and bilaterality of the underlying ischemic retinal pathology (P = 0.026) as the strongest predictors of NLP outcome. Age, sex, race, NVG etiology, tube type, preoperative IOP, extent of synechial angle closure preoperatively, preoperative hyphema, IOP at the first NLP visit, and final IOP were not significant predictors of NLP vision. CONCLUSIONS Eyes with AGV and BGI had comparable outcomes in NVG, although fewer medications were required in BGI eyes to control IOP. Progression to NLP vision was associated with poor baseline VA, delayed retinal treatment, and bilaterality of the underlying ischemic retinal pathology.
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Affiliation(s)
- Wesam Shamseldin Shalaby
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania; Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Jonathan S Myers
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Reza Razeghinejad
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - L Jay Katz
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Michael Pro
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Elizabeth Dale
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Scott J Fudemberg
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Anand V Mantravadi
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
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Abstract
INTRODUCTION Glaucoma is the leading cause of irreversible blindness worldwide. Medical therapy is the main line of treatment of open-angle glaucoma (OAG) and ocular hypertension. Despite the expansion of the glaucoma lineup with the newly approved medication classes, many barriers and issues still exist with topical therapy. Novel non-topical drug delivery may address such issues, adding more options to glaucoma pharmacotherapy. AREAS COVERED This review outlines current topical therapies for glaucoma, in addition to new medications under trials. The issues with topical therapy, in general, are discussed, as well as the new non-topical drug delivery systems. The authors performed a comprehensive search for published studies on glaucoma medical therapy using the electronic database of PubMed and manual search for each medication and non-topical delivery options. The extra- and intraocular delivery methods and the new topical glaucoma medications under research are covered. EXPERT OPINION Medical management of glaucoma represents a challenge for both patients and clinicians. Noncompliance (e.g. difficulty with administering the eye drops), cost, side effects, and intraocular pressure fluctuation are the major problems with topical therapy. To overcome such barriers, research should continue in developing new medications and innovation of non-topical drug delivery systems.
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Affiliation(s)
- Wesam Shamseldin Shalaby
- Glaucoma Research Center, Wills Eye Hospital , Philadelphia, PA, USA.,Tanta Medical School, Tanta University , Tanta, Gharbia, Egypt
| | - Vikram Shankar
- Glaucoma Research Center, Wills Eye Hospital , Philadelphia, PA, USA
| | - Reza Razeghinejad
- Glaucoma Research Center, Wills Eye Hospital , Philadelphia, PA, USA
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital , Philadelphia, PA, USA
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Saheb H, Donnenfeld ED, Solomon KD, Voskanyan L, Chang DF, Samuelson TW, Ahmed IIK, Katz LJ. Five-Year Outcomes Prospective Study of Two First-Generation Trabecular Micro-Bypass Stents (iStent®) in Open-Angle Glaucoma. Curr Eye Res 2020; 46:224-231. [PMID: 32715828 DOI: 10.1080/02713683.2020.1795881] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess 5-year effectiveness and safety of 2 iStent® trabecular micro-bypass stents in eyes with open-angle glaucoma (OAG) not controlled on 1 medication. MATERIALS AND METHODS This prospective, interventional, single-arm, multi-surgeon study (NCT #1252862, clinicaltrials.gov) enrolled eyes with OAG, preoperative intraocular pressure (IOP) of 18-30 mmHg on 1 ocular hypotensive medication, and 22-38 mmHg after medication washout. Eyes underwent standalone implantation of 2 iStent devices and were followed through 60 months postoperatively. Efficacy was quantified by mean diurnal IOP and medication usage. Efficacy endpoints included the proportion of eyes with ≥20% IOP reduction versus baseline unmedicated IOP (primary efficacy), and the proportion of eyes with IOP ≤18 mmHg (secondary efficacy) without medication or secondary glaucoma surgery. Safety parameters included visual acuity, cup-to-disc ratio, visual field, and complications and adverse events. RESULTS Preoperative mean IOP on 1 medication was 20.6 ± 2.0 mmHg and post-washout unmedicated IOP was 24.1 ± 1.4 mmHg (n = 39). At 5 years postoperative, medication-free mean diurnal IOP reduced to 14.5 ± 2.2 mmHg, constituting a 40% decrease versus preoperative washed-out IOP (p < .0001). In addition, this 5-year medication-free IOP constituted a 30% decrease versus preoperative IOP on 1 medication (p < .0001). At Month 60, 89.7% (26/29) of eyes achieved the primary efficacy endpoint of ≥20% IOP reduction versus baseline unmedicated IOP, and 86.2% (25/29) of eyes achieved the secondary efficacy endpoint of IOP ≤18 mmHg, without medication or secondary glaucoma surgery. Throughout follow-up, 89.7-91.3% of eyes were on no medications. Favorable safety included no secondary glaucoma surgeries, minimal adverse events, and stable visual acuity, cup-to-disc ratio, and visual fields through 5 years postoperative. CONCLUSIONS This prospective interventional study demonstrates persistent 5-year reductions in IOP and freedom from medications, together with favorable safety, following implantation of 2 first-generation trabecular micro-bypass stents in eyes with OAG on 1 preoperative medication.
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Affiliation(s)
- Hady Saheb
- Department of Ophthalmology, McGill University , Montreal, Quebec, Canada
| | - Eric D Donnenfeld
- Ophthalmic Consultants of Long Island , Rockville Centre, New York, USA
| | - Kerry D Solomon
- Carolina Eyecare Physicians , Mt Pleasant, South Carolina, USA
| | | | | | | | - Iqbal Ike K Ahmed
- Department of Ophthalmology, University of Toronto , Toronto, Ontario, Canada
| | - L Jay Katz
- Department of Ophthalmology, Wills Eye Hospital, Jefferson Medical College , Philadelphia, Pennsylvania, USA
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Lin MM, Moster SJ, Zheng CX, Anderson-Quiñones CD, Katz LJ, Pro MJ, Myers JS, Moster MR, Lee D. Netarsudil’s Effect in Eyes with a History of Selective Laser Trabeculoplasty. ACTA ACUST UNITED AC 2020; 3:306-308. [DOI: 10.1016/j.ogla.2020.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/08/2020] [Accepted: 01/15/2020] [Indexed: 11/29/2022]
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Berdahl J, Voskanyan L, Myers JS, Katz LJ, Samuelson TW. iStent
inject trabecular micro‐bypass stents with topical prostaglandin as standalone treatment for open‐angle glaucoma: 4‐year outcomes. Clin Exp Ophthalmol 2020; 48:767-774. [DOI: 10.1111/ceo.13763] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/01/2020] [Accepted: 04/09/2020] [Indexed: 01/22/2023]
Affiliation(s)
- John Berdahl
- Vance Thompson Vision Sioux Falls South Dakota USA
| | | | - Jonathan S. Myers
- Wills Eye HospitalJefferson Medical College Philadelphia Pennsylvania USA
| | - L. Jay Katz
- Wills Eye HospitalJefferson Medical College Philadelphia Pennsylvania USA
- Glaukos Corporation San Clemente California USA
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Zheng CX, Copparam S, Lin MM, Moster SJ, Sanvicente CT, Katz LJ, Razeghinejad MR, Myers JS, Lee D. Outcomes of trabecular microbypass surgery: Comparison of resident trainees and attending surgeons. J Cataract Refract Surg 2019; 45:1704-1710. [PMID: 31856979 DOI: 10.1016/j.jcrs.2019.07.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/08/2019] [Accepted: 07/15/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine the efficacy, safety, and surgical outcomes of trabecular microbypass stent (iStent) surgery performed by resident trainees and attending surgeons. SETTING Wills Eye Hospital, Philadelphia, Pennsylvania, USA. DESIGN Retrospective case series. METHODS Records of all patients who had microbypass stent surgery by a resident at Wills Eye Hospital were retrospectively reviewed. The attending-performed group included any patient who had a microbypass stent implanted by an attending surgeon on the same day a resident case was performed. RESULTS Between 2016 and 2018, 31 microbypass stents were implanted by a resident supervised by an attending and 93 microbypass stents were implanted by an attending surgeon on the day a resident case was performed. The mean follow-up was 16.2 months ± 17.9 (SD). The mean intraocular pressure (IOP) decreased from 16.0 ± 4.6 mm Hg at baseline to 14.0 ± 3.1 mm Hg at most recent follow-up visit in the resident group (P = .02) and from 17.5 ± 4.8 mm Hg to 15.1 ± 4.3 mm Hg, respectively, in the attending group (P < .001). The final mean IOP and mean number of hypotensive medications were similar between the 2 groups (P = .83 and P = .12, respectively). Self-resolving hyphema occurred in 1 resident case and 2 attending cases. The resident group had 1 case of iridodialysis, which did not require additional surgery. One eye in the attending group ultimately required a trabeculectomy. CONCLUSION Microbypass stent implantation by resident trainees with attending supervision had similar efficacy and safety as surgery performed by attending surgeons.
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Affiliation(s)
- Cindy X Zheng
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA.
| | | | | | | | | | - L Jay Katz
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | | | | | - Daniel Lee
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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Hark LA, Adeghate J, Katz LJ, Ulas M, Waisbourd M, Maity A, Zhan T, Hegarty S, Leiby BE, Pasquale LR, Leite S, Saaddine JB, Haller JA, Myers JS. Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study: Cataract Classifications Following Eye Screening. Telemed J E Health 2019; 26:992-1000. [PMID: 31721654 DOI: 10.1089/tmj.2019.0170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Cataracts are a major cause of visual impairment and blindness in the United States and worldwide. Introduction: Risk factors for cataracts include age over 40 years, smoking, diabetes, low socioeconomic status, female sex, steroid use, ocular trauma, genetic factors, and exposure to ultraviolet-B light. Community-based telemedicine vision screenings can be an efficient method for detecting cataracts in underserved populations. The Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study reports the prevalence and risk factors for cataracts in individuals screened and examined for glaucoma and other eye diseases. Materials and Methods: A total of 906 high-risk individuals were screened for glaucoma using telemedicine in seven primary care practices and four Federally Qualified Health Centers in Philadelphia. Participants with suspicious nerves or other abnormalities on fundus photographs, unreadable images, and ocular hypertension returned for an eye examination with an ophthalmologist at the same community location. Results: Of the participants screened through telemedicine, 347 (38.3%) completed a follow-up eye examination by an ophthalmologist. Of these, 267 (76.9%) were diagnosed with cataracts, of which 38 (14.2%) had visually significant cataracts. Participants who were diagnosed with visually significant cataract were more likely to be older (p < 0.001), have diabetes (p = 0.003), and worse visual acuity (p < 0.001). Discussion: Our study successfully detected and confirmed cataracts in a targeted, underserved urban population at high risk for eye disease. Conclusions: Telemedicine programs offer an opportunity to identify and refer individuals who would benefit from continuous follow-up eye care and treatment to improve visual function and quality of life.
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Affiliation(s)
- Lisa A Hark
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania, USA.,Columbia University Vagelos College of Physicians and Surgeons, Edward S. Harkness Eye Institute, New York, New York, USA
| | - Jennifer Adeghate
- University of Pittsburgh, Department of Ophthalmology, Pittsburgh, Pennsylvania, USA
| | - L Jay Katz
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mikdat Ulas
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael Waisbourd
- Division of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv University Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Alisha Maity
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tingting Zhan
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Sarah Hegarty
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Benjamin E Leiby
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Louis R Pasquale
- Icahn School of Medicine at Mount Sinai, Department of Ophthalmology, New York, New York, USA
| | - Stela Leite
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania, USA
| | - Jinan B Saaddine
- Centers for Disease Control and Prevention, Division of Diabetes and Translational Research, Vision Health Initiative, Atlanta, Georgia, USA
| | - Julia A Haller
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Wills Eye Hospital, Ophthalmologist-in-Chief, Philadelphia, Pennsylvania, USA
| | - Jonathan S Myers
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Hark L, Acito M, Adeghate J, Henderer J, Okudolo J, Malik K, Molineaux J, Eburuoh R, Zhan T, Katz LJ. Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Ocular Findings at Two Health Centers. J Health Care Poor Underserved 2019; 29:1400-1415. [PMID: 30449754 DOI: 10.1353/hpu.2018.0103] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Blindness from glaucoma can be prevented by early detection and treatment. Telemedicine improves access to treatment in high-risk populations that face barriers to receiving adequate ophthalmic care. We used a practice-based telemedicine screening model at two health centers. Telemedicine imaging of the fundus and optic nerve, followed by a complete eye exam at the same location for participants with abnormal findings, unreadable images, or ocular hypertension (OHTN), was performed. A total of 182 participants were screened, of whom 108 qualified for a complete eye exam. Of these, 62 (34.1%) had abnormal images, 12 (6.6%) had OHTN, and 34 (18.7%) had unreadable images. Eighty-nine of the 108 (82%) returned for the complete eye exam. Predominantly, participants were African American with glaucoma suspect and cataract. Screening location was an important factor for follow-up. Assessment of the fundus and optic disc using telemedicine resulted in early detection of glaucoma and other ocular pathology.
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29
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Hark LA, Radakrishnan A, Madhava M, Anderson-Quiñones C, Fudemberg S, Robinson D, Myers JS, Zhan T, Adeghate J, Hegarty S, Leite S, Leiby BE, Stempel S, Katz LJ. Awareness of ocular diagnosis, transportation means, and barriers to ophthalmology follow-up in the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study. Soc Work Health Care 2019; 58:651-664. [PMID: 31120381 DOI: 10.1080/00981389.2019.1614711] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 03/15/2019] [Accepted: 04/22/2019] [Indexed: 06/09/2023]
Abstract
Purpose: The purpose of this study was to assess factors affecting follow-up eye care in participants enrolled in the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study, such as awareness of ocular diagnosis, availability of transportation methods, and reasons for missing eye care appointments. Methods: The sample included 172 participants who were randomized to the intervention group and contacted by the social worker. Results: A total of 155 participants completed the assessment form, which was used as an instrument to assess factors affecting adherence to follow-up eye care. The main reasons for missing eye exam appointments were feeling ill (38.1%, n = 59) and forgetting the appointment (34.2%, n = 53). In addition, 45 (29.2%) participants were unaware of or did not comprehend the severity of their ocular diagnosis. Common methods of transportation included public transportation (31.6%, n = 49), driving (29.7%, n = 46), and being driven (27.7%, n = 43) to their appointment. Conclusion: These results suggest that individuals in need of eye care may benefit from additional assistance of a social worker regarding ongoing eye exam appointment reminders and in-depth explanation of their ocular diagnosis.
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Affiliation(s)
- Lisa A Hark
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
- b Department of Ophthalmology , Columbia University Irving Medical Center , New York , NY , USA
| | - Anjithaa Radakrishnan
- c Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , PA , USA
| | - Malika Madhava
- c Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , PA , USA
| | - Catherine Anderson-Quiñones
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
- c Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , PA , USA
| | - Scott Fudemberg
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
- c Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , PA , USA
| | - Debra Robinson
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
| | - Jonathan S Myers
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
- c Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , PA , USA
| | - Tingting Zhan
- d Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics , Thomas Jefferson University , Philadelphia , PA , USA
| | - Jennifer Adeghate
- e Department of Ophthalmology , Weill Cornell Medical College , New York , NY , USA
| | - Sarah Hegarty
- d Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics , Thomas Jefferson University , Philadelphia , PA , USA
| | - Stela Leite
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
| | - Benjamin E Leiby
- d Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics , Thomas Jefferson University , Philadelphia , PA , USA
| | - Stella Stempel
- b Department of Ophthalmology , Columbia University Irving Medical Center , New York , NY , USA
| | - L Jay Katz
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
- c Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , PA , USA
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30
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Samuelson TW, Sarkisian SR, Lubeck DM, Stiles MC, Duh YJ, Romo EA, Giamporcaro JE, Hornbeak DM, Katz LJ, Bartlett W, Buznego C, Johnson S, D'Ambrosio FA, Dehning D, DuBiner H, Goyal R, Hughes B, Marquis RE, Noecker R, Tauber S, Perez BR, Roel L, Sarkisian S, Silverstein S, Day S, Solomon K, Tyson F, Vold S, Samuelson T, Simmons S, Stiles M, Nguyen QH, Bashford KP, Flowers B, Flynn WJ, Gira J, Okeke C, Reiss GR, Tyson SL, Parkhurst G, Linn J, Lubeck D, Solomon J, Singh IP, Johnson RD, Lin C, Kim JW, Crane CJ, Cotter F. Prospective, Randomized, Controlled Pivotal Trial of an Ab Interno Implanted Trabecular Micro-Bypass in Primary Open-Angle Glaucoma and Cataract. Ophthalmology 2019; 126:811-821. [DOI: 10.1016/j.ophtha.2019.03.006] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022] Open
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Katz LJ, Falvey H. Letter to the editor: Comparing iStent versus CyPass with or without phacoemulsification in patients with glaucoma: a meta-analysis. Ther Adv Chronic Dis 2019; 10:2040622319847050. [PMID: 31105922 PMCID: PMC6503589 DOI: 10.1177/2040622319847050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- L Jay Katz
- Glaukos Corp, 229 Avenida Fabricante, San Clemente, CA 92672, USA
| | - Heather Falvey
- Glaukos Corp, 229 Avenida Fabricante, San Clemente, CA 92672, USA
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Cui QN, Gogt P, Lam JM, Siraj S, Hark LA, Myers JS, Katz LJ, Waisbourd M. Validation and reproducibility of the Heidelberg Edge Perimeter in the detection of glaucomatous visual field defects. Int J Ophthalmol 2019; 12:577-581. [PMID: 31024809 DOI: 10.18240/ijo.2019.04.08] [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: 09/18/2018] [Accepted: 01/29/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To validate the ability of the Heidelberg Edge Perimeter (HEP) in detecting glaucomatous visual field (VF) defects compared to the Octopus Visual Field (OVF) Analyzer and to determine the test-retest repeatability of both modalities. METHODS This prospective, cross-sectional study was conducted at Wills Eye Hospital, Philadelphia, PA. Glaucoma subjects and unaffected controls underwent VF testing using HEP standard automated perimetry (SAP) III 30-2 Adaptive Staircase Thresholding Algorithm (ASTA) FAST protocol and OVF G-TOP white-on-white strategy. Testing order was randomized. Pearson's correlation coefficient was calculated for both mean deviation (MD) and pattern standard deviation/square root of loss of variance (PSD/sLV). Receiver operating characteristic (ROC) curves were used to determine the diagnostic abilities of both modalities. Glaucoma subjects returned for repeat testing and intraclass correlation coefficients (ICCs) were calculated to assess test-retest repeatability. RESULTS Seventy-nine subjects with glaucoma and 36 unaffected controls were enrolled. HEP and OVF were significantly correlated for both MD (r=-0.84; P<0.01) and PSD/sLV (r=0.79; P<0.01). Areas under the ROC curves (AUCs) were also comparable between HEP and OVF for both MD (0.74 and 0.79, respectively; P=0.26) and PSD/sLV (0.74 and 0.82; P=0.08). ICC was high for both HEP (0.96 for MD, 0.95 for PSD/sLV) and OVF (0.82 and 0.88, respectively). Mean test duration (min) was significantly shorter for OVF (2.63) compared to HEP (5.15; P<0.01). CONCLUSION HEP and OVF show strong correlation for both MD and PSD/sLV, and have similar validity for detecting glaucoma. The test-retest repeatability is high for both HEP and OVF, however the average testing duration of HEP is significantly longer than that of OVF.
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Affiliation(s)
- Qi N Cui
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA 19107, USA.,Scheie Eye Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Priyanka Gogt
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA 19107, USA
| | - Jonathan M Lam
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA 19107, USA
| | - Safa Siraj
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA 19107, USA
| | - Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA 19107, USA
| | - Jonathan S Myers
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA 19107, USA
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA 19107, USA
| | - Michael Waisbourd
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA 19107, USA.,Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
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Hark LA, Myers JS, Ines A, Jiang A, Rahmatnejad K, Zhan T, Leiby BE, Hegarty S, Fudemberg SJ, Mantravadi AV, Waisbourd M, Henderer JD, Burns C, Divers M, Molineaux J, Pizzi LT, Murchison AP, Saaddine J, Pasquale LR, Haller JA, Katz LJ. Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: confirmation between eye screening and comprehensive eye examination diagnoses. Br J Ophthalmol 2019; 103:1820-1826. [PMID: 30770354 DOI: 10.1136/bjophthalmol-2018-313451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/09/2019] [Accepted: 01/16/2019] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate agreement between ocular findings of a telemedicine eye screening (visit 1) with diagnoses of a comprehensive eye examination (visit 2). METHODS A primary care practice (PCP)-based telemedicine screening programme incorporating fundus photography, intraocular pressure (IOP) and clinical information was conducted. Eligible individuals were African American, Hispanic/Latino or Asian over the age of 40; Caucasian individuals over age 65; and adults of any ethnicity over age 40 with a family history of glaucoma or diabetes. Participants with abnormal images or elevated IOP were invited back for a complete eye examination. Both visit 1 and visit 2 were conducted at participants' local PCP. Ocular findings at visit 1 and eye examination diagnoses at visit 2 are presented, including a cost analysis. RESULTS Of 906 participants who attended visit 1, 536 were invited to visit 2 due to ocular findings or unreadable images. Among the 347 (64.9%) who attended visit 2, 280 (80.7%) were diagnosed with at least one ocular condition. Participants were predominately women (59.9%) and African American (65.6%), with a mean age (±SD) of 60.6±11.0 years. A high diagnostic confirmation rate (86.0%) was found between visit 1 and visit 2 for any ocular finding. Of 183 with suspicious nerves at visit 1, 143 (78.1%) were diagnosed as glaucoma or glaucoma suspects at visit 2. CONCLUSIONS This screening model may be adapted and scaled nationally and internationally. Referral to an ophthalmologist is warranted if abnormal or unreadable fundus images are detected or IOP is >21 mm Hg. TRIAL REGISTRATION NUMBER NCT02390245.
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Affiliation(s)
- Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA .,Ophthalmology, Columbia University Irving Medical Center, New York, New York, USA
| | - Jonathan S Myers
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrew Ines
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alicia Jiang
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kamran Rahmatnejad
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Tingting Zhan
- Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Benjamin E Leiby
- Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sarah Hegarty
- Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Scott J Fudemberg
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anand V Mantravadi
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Jeffrey D Henderer
- Ophthalmology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Christine Burns
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Meskerem Divers
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Jeanne Molineaux
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Laura T Pizzi
- School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA
| | - Ann P Murchison
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Emergency Department, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Jinan Saaddine
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Vision Health Initiative, Atlanta, Georgia, USA
| | - Louis R Pasquale
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Julia A Haller
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Wills Eye Hospital, Ophthalmologist-in-Chief, Philadelphia, Pennsylvania, USA
| | - L Jay Katz
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Wey S, Amanullah S, Spaeth GL, Ustaoglu M, Rahmatnejad K, Katz LJ. Is primary open-angle glaucoma an ocular manifestation of systemic disease? Graefes Arch Clin Exp Ophthalmol 2019; 257:665-673. [PMID: 30643967 DOI: 10.1007/s00417-019-04239-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/26/2018] [Accepted: 01/07/2019] [Indexed: 01/05/2023] Open
Abstract
Primary open-angle glaucoma is currently characterized by a pattern of progressive retinal ganglion cell loss that stems from a complex underlying pathophysiology that remains poorly elucidated. The roles of blood flow and intraocular pressure (IOP) in glaucoma pathogenesis have been extensively studied. Further, it has been established that lowering IOP can slow the progression of glaucoma. In addition, a number of influential factors have emerged and gained momentum over the years. Increasing evidence implicates the contributions of low cerebrospinal fluid pressure, autoimmunity, neurodegeneration, and impaired autoregulation towards glaucoma pathophysiology. We aggregate and explore these different camps of thought that have garnered attention over the last few decades, and, in doing so, aim to challenge the long-standing view of glaucoma as a primary disease of the eye. A shift in our perspective towards understanding glaucoma as an ocular manifestation of systemic dysregulation may lead ultimately to better clinical management of the disease.
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Affiliation(s)
- Stephanie Wey
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sarah Amanullah
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - George L Spaeth
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 1140, Philadelphia, PA, 19107, USA
| | - Melih Ustaoglu
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 1140, Philadelphia, PA, 19107, USA
| | - Kamran Rahmatnejad
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 1140, Philadelphia, PA, 19107, USA
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 1140, Philadelphia, PA, 19107, USA.
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Konstas AG, Katsanos A, Athanasopoulos GP, Voudouragkaki IC, Panagiotou ES, Pagkalidou E, Haidich AB, Giannoulis DA, Spathi E, Giannopoulos T, Katz LJ. Preservative-free tafluprost/timolol fixed combination: comparative 24-h efficacy administered morning or evening in open-angle glaucoma patients. Expert Opin Pharmacother 2018; 19:1981-1988. [DOI: 10.1080/14656566.2018.1534958] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Anastasios-Georgios Konstas
- 1st University Department of Ophthalmology, Aristotle University , Thessaloniki, Greece
- 3rd University Department of Ophthalmology, Aristotle University , Thessaloniki, Greece
| | - Andreas Katsanos
- Department of Ophthalmology, University of Ioannina , Ioannina, Greece
| | | | | | | | - Eirini Pagkalidou
- Department of Hygiene, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | | | - Eleni Spathi
- 1st University Department of Ophthalmology, Aristotle University , Thessaloniki, Greece
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Adeghate J, Rahmatnejad K, Waisbourd M, Katz LJ. Intraocular pressure-independent management of normal tension glaucoma. Surv Ophthalmol 2018; 64:101-110. [PMID: 30300625 DOI: 10.1016/j.survophthal.2018.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 08/15/2018] [Accepted: 08/20/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Jennifer Adeghate
- Wills Eye Hospital, Glaucoma Research Department, Philadelphia, Pennsylvania, USA; Weill Cornell Medical College, Department of Ophthalmology, New York, New York, USA
| | - Kamran Rahmatnejad
- Wills Eye Hospital, Glaucoma Research Department, Philadelphia, Pennsylvania, USA
| | - Michael Waisbourd
- Wills Eye Hospital, Glaucoma Research Department, Philadelphia, Pennsylvania, USA; Thomas Jefferson University, Department of Ophthalmology, Philadelphia, Pennsylvania, USA; Tel-Aviv University Medical Center, Glaucoma Research Center, Tel-Aviv, Israel
| | - L Jay Katz
- Wills Eye Hospital, Glaucoma Research Department, Philadelphia, Pennsylvania, USA; Thomas Jefferson University, Department of Ophthalmology, Philadelphia, Pennsylvania, USA.
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Myers JS, Masood I, Hornbeak DM, Belda JI, Auffarth G, Jünemann A, Giamporcaro JE, Martinez-de-la-Casa JM, Ahmed IIK, Voskanyan L, Katz LJ. Prospective Evaluation of Two iStent ® Trabecular Stents, One iStent Supra ® Suprachoroidal Stent, and Postoperative Prostaglandin in Refractory Glaucoma: 4-year Outcomes. Adv Ther 2018; 35:395-407. [PMID: 29476443 PMCID: PMC5859115 DOI: 10.1007/s12325-018-0666-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Indexed: 12/01/2022]
Abstract
Introduction This study evaluates long-term outcomes of two trabecular micro-bypass stents, one suprachoroidal stent, and postoperative prostaglandin in eyes with refractory open angle glaucoma (OAG). Methods Prospective ongoing 5-year study of 80 eligible subjects (70 with 4-year follow-up) with OAG and IOP ≥ 18 mmHg after prior trabeculectomy and while taking 1–3 glaucoma medications. Subjects received two iStent® trabecular micro-bypass stents, one iStent Supra® suprachoroidal stent, and postoperative travoprost. Postoperative IOP was measured with medication and annually following medication washouts. Performance was measured by the proportion of eyes with ≥ 20% IOP reduction on one medication (the protocol-specified prostaglandin) versus preoperative medicated IOP (primary outcome); and the proportion of eyes with postoperative IOP ≤ 15 and ≤ 18 mmHg on one medication (secondary outcome). Additional clinical and safety data included medications, visual field, pachymetry, gonioscopy, adverse events, visual acuity, and slit-lamp and fundus examinations. Results Preoperatively, mean medicated IOP was 22.0 ± 3.1 mmHg on 1.2 ± 0.4 medications, and mean unmedicated IOP was 26.4 ± 2.4 mmHg. Postoperatively, among eyes without later cataract surgery, mean medicated IOP at all visits through 48 months was ≤ 13.7 mmHg (≥ 37% reduction), and annual unmedicated IOP was ≤ 18.4 mmHg (reductions of ≥ 30% vs. preoperative unmedicated IOP and ≥ 16% vs. preoperative medicated IOP). At all postoperative visits among eyes without additional surgery or medication, ≥ 91% of eyes had ≥ 20% IOP reduction on one medication versus preoperative medicated IOP. At month 48, 97 and 98% of eyes achieved IOP ≤ 15 and ≤ 18 mmHg, respectively, on one medication. Six eyes required additional medication, no eyes required additional glaucoma surgery, and safety measurements were favorable throughout follow-up. Conclusion IOP control was achieved safely with two trabecular micro-bypass stents, one suprachoroidal stent, and postoperative prostaglandin. This microinvasive, ab interno approach introduces a possible new treatment option for refractory disease. Trial Registration NCT01456390. Funding Glaukos Corporation. Electronic supplementary material The online version of this article (10.1007/s12325-018-0666-4) contains supplementary material, which is available to authorized users.
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Cui QN, Fudemberg SJ, Resende AF, Vu TA, Zhou C, Rahmatnejad K, Hark LA, Myers JS, Katz LJ, Waisbourd M. Validation of the structure–function correlation report from the heidelberg edge perimeter and spectral-domain optical coherence tomography. Int Ophthalmol 2018; 39:533-540. [DOI: 10.1007/s10792-018-0836-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/25/2018] [Indexed: 11/30/2022]
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Serle JB, Katz LJ, McLaurin E, Heah T, Ramirez-Davis N, Usner DW, Novack GD, Kopczynski CC. Two Phase 3 Clinical Trials Comparing the Safety and Efficacy of Netarsudil to Timolol in Patients With Elevated Intraocular Pressure: Rho Kinase Elevated IOP Treatment Trial 1 and 2 (ROCKET-1 and ROCKET-2). Am J Ophthalmol 2018; 186:116-127. [PMID: 29199013 DOI: 10.1016/j.ajo.2017.11.019] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/18/2017] [Accepted: 11/25/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the efficacy and ocular and systemic safety of netarsudil 0.02% ophthalmic solution, a rho-kinase inhibitor and norepinephrine transporter inhibitor, in patients with open-angle glaucoma and ocular hypertension. DESIGN Double-masked, randomized noninferiority clinical trials: Rho Kinase Elevated IOP Treatment Trial 1 and 2 (ROCKET-1 and ROCKET-2). METHODS After a washout of all pre-study ocular hypotensive medications, eligible patients were randomized to receive netarsudil 0.02% once daily (q.d.), timolol 0.5% twice a day (b.i.d.), and (ROCKET-2 only) netarsudil 0.02% b.i.d. Data through 3 months from both studies are provided in this report. RESULTS Enrolled into the 2 studies were 1167 patients. Treatment with netarsudil q.d. produced clinically and statistically significant reductions from baseline intraocular pressure (P < .001), and was noninferior to timolol in the per-protocol population with maximum baseline IOP < 25 mm Hg in both studies (ROCKET-2, primary outcome measure and population, ROCKET-1, post hoc outcome measure). Netarsudil b.i.d. was also noninferior to timolol (ROCKET-2). The most frequent adverse event was conjunctival hyperemia, the incidence of which ranged from 50% (126/251, ROCKET-2) to 53% (108/203, ROCKET-1) for netarsudil q.d., 59% (149/253, ROCKET-2) for netarsudil b.i.d., and 8% (17/208, ROCKET-1) to 11% (27/251, ROCKET-2) for timolol (P < .0001 for netarsudil vs timolol). CONCLUSIONS In 2 large, randomized, double-masked trials reported here, once-daily dosing of netarsudil 0.02% was found to be effective and well tolerated for the treatment of patients with ocular hypertension and open-angle glaucoma. The novel pharmacology and aqueous humor dynamic effects of this molecule suggest it may be a useful addition to the armamentarium of ocular hypotensive medications.
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Katz LJ, Erb C, Carceller Guillamet A, Fea AM, Voskanyan L, Giamporcaro JE, Hornbeak DM. Long-term titrated IOP control with one, two, or three trabecular micro-bypass stents in open-angle glaucoma subjects on topical hypotensive medication: 42-month outcomes. Clin Ophthalmol 2018; 12:255-262. [PMID: 29440867 PMCID: PMC5798569 DOI: 10.2147/opth.s152268] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [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] [Indexed: 11/23/2022] Open
Abstract
Purpose Evaluate long-term outcomes after one, two, or three trabecular micro-bypass stents implanted in a standalone procedure in eyes with open-angle glaucoma taking ocular hypotensive medication. Patients and methods Prospective randomized ongoing study of 119 subjects (109 with 42-month follow-up) with open-angle glaucoma, preoperative intraocular pressure (IOP) 18-30 mmHg on one to three glaucoma medications, and unmedicated (post-washout) IOP 22-38 mmHg. Subjects were randomized to receive one (n=38), two (n=41), or three (n=40) iStent trabecular micro-bypass stents in a standalone procedure. Postoperatively, IOP was measured with medication and annually following washout. Data included IOP, medications, gonioscopy, pachymetry, visual field, visual acuity, adverse events, and slit-lamp and fundus examinations. Results Preoperative mean medicated IOP was 19.8±1.3 mmHg on 1.71 medications in one-stent eyes, 20.1±1.6 mmHg on 1.76 medications in two-stent eyes, and 20.4±1.8 mmHg on 1.53 medications in three-stent eyes. Post-washout IOP prior to stent implantation was 25.0±1.2, 25.0±1.7, and 25.1±1.9 mmHg in the three groups, respectively. Postoperatively, Month 42 medicated IOP was 15.0±2.8, 15.7±1.0 and 14.8±1.3 mmHg in the three groups, and post-washout IOP (Months 36-37) was 17.4±0.9, 15.8±1.1 and 14.2±1.5 mmHg, respectively. IOP reduction ≥20% without medication was achieved in 89%, 90%, and 92% of one-, two-, and three-stent eyes, respectively, at Month 12; and in 61%, 91%, and 91% of eyes, respectively, at Month 42. The need for additional medication remained consistent at Months 12 and 42 in multi-stent eyes (four two-stent eyes and three three-stent eyes at both time points), whereas it increased in single-stent eyes (four eyes at Month 12 versus 18 eyes at Month 42). Safety parameters were favorable in all groups. Conclusion The standalone implantation of either single or multiple iStent® device(s) produced safe, clinically meaningful IOP and medication reductions through 42 months postoperatively, with incrementally greater and more sustained reductions in multi-stent eyes.
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Affiliation(s)
- L Jay Katz
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Carl Erb
- Glaucoma Service, Eye Clinic Wittenbergplatz, Berlin, Germany
| | | | - Antonio M Fea
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Lilit Voskanyan
- Glaucoma Service, S. V. Malayan Ophthalmology Centre, Yerevan, Armenia
| | - Jane Ellen Giamporcaro
- Department of Clinical Research and Medical Affairs, Glaukos Corporation, San Clemente, CA, USA
| | - Dana M Hornbeak
- Department of Clinical Research and Medical Affairs, Glaukos Corporation, San Clemente, CA, USA
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Lin SC, Zheng CX, Waisbourd M, Molineaux J, Zeng L, Zhan T, Rahmatnejad K, Resende A, Mantravadi AV, Hark LA, Moster MR, Markoff JI, Spaeth GL, Katz LJ. Visual Field Changes in Professional Wind versus Non-wind Musical Instrument Players in the Philadelphia Orchestra. J Ophthalmic Vis Res 2018; 13:224-230. [PMID: 30090176 PMCID: PMC6058539 DOI: 10.4103/jovr.jovr_155_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/04/2022] Open
Abstract
Purpose: We compare the prevalence of glaucoma in professional wind versus non-wind instrument players in the Philadelphia Orchestra. Visual field changes in individuals with glaucoma and glaucoma suspects were evaluated, and the results were correlated with cumulative practice time. Methods: In this cross-sectional, observational study, fifty-one Philadelphia Orchestra musicians were enrolled and categorized as wind or non-wind instrument players. All study participants underwent screening fundus photography. Participants with optic discs suspicious for glaucoma underwent further evaluation, including standard automated visual field perimetry and a comprehensive eye examination by a glaucoma specialist. Results: Of the 51 musicians enrolled, 9 of the 21 wind instrument players (43%) and 8 of the 30 non-wind instrument players (27%) were suspected of developing glaucoma in at least one eye (P = 0.25), with examinations performed on 12 of the 17 returning musicians (71%) for further confirmation. Wind instrument players exhibited significantly higher Octopus visual field mean defect scores (1.08 ± 1.5 dB) than non-wind instrument players (−0.43 ± 0.7 dB; P < 0.001). There was a significant association between cumulative hours playing wind instruments and visual field mean defect (P < 0.001). Conclusion: Among members of the Philadelphia Orchestra, the difference in prevalence of glaucoma suspicious optic discs between wind and non-wind instrument players was not significant. The clinical significance of the greater visual field mean defect found in wind instrument players, and the association between the degree of visual field mean defect and the cumulative practice-time of playing wind instruments, needs further investigation.
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Affiliation(s)
- Shuai-Chun Lin
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Cindy X Zheng
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | | | - Jeanne Molineaux
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Lichuan Zeng
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Tingting Zhan
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Arthur Resende
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | | | - Lisa A Hark
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, USA
| | - Marlene R Moster
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Joseph I Markoff
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - George L Spaeth
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - L Jay Katz
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
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Sapru S, Berktold J, Crews JE, Katz LJ, Hark L, Girkin CA, Owsley C, Francis B, Saaddine JB. Applying RE-AIM to evaluate two community-based programs designed to improve access to eye care for those at high-risk for glaucoma. Eval Program Plann 2017; 65:40-46. [PMID: 28689028 DOI: 10.1016/j.evalprogplan.2017.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 01/25/2017] [Revised: 05/23/2017] [Accepted: 06/19/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Glaucoma is a leading cause of vision loss and blindness in the U.S. Risk factors include African American race, older age, family history of glaucoma, and diabetes. This paper describes the evaluation of a mobile eye health and a telemedicine program designed to improve access to eye care among people at high-risk for glaucoma. METHODS The RE-AIM (reach, efficacy, adoption, implementation, and maintenance) evaluation framework was used to harmonize indicators. Both programs provided community-based eye health education and eye services related to glaucoma detection and care. Each program reported data on participants and community partners. An external evaluator conducted site visit interviews with program staff and community partners. Quantitative and qualitative data were integrated and analyzed using the RE-AIM dimensions. DISCUSSION By targeting high-risk populations and providing comprehensive eye exams, both programs detected a large proportion of new glaucoma-related cases (17-19%) - a much larger proportion than that found in the general population (<2%). The educational intervention increased glaucoma knowledge; evidence that it led people to seek eye care was inconclusive. CONCLUSIONS Evaluation findings from the mobile eye health program and the telemedicine program may provide useful information for wider implementation in public health clinics and in optometrist clinics located in retail outlets.
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Affiliation(s)
- Saloni Sapru
- Health Studies, Westat, 1600 Research Boulevard, Rockville, MD 20850, USA.
| | - Jennifer Berktold
- Health Studies, Westat, 1600 Research Boulevard, Rockville, MD 20850, USA
| | - John E Crews
- Vision Health Initiative, Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Atlanta, GA 30341-3717 USA
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA 19107, USA
| | - Lisa Hark
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA 19107, USA
| | - Christopher A Girkin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, 700 S. 18th St, Birmingham, AL 35294-0009, USA
| | - Cynthia Owsley
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, 700 S. 18th St, Birmingham, AL 35294-0009, USA
| | - Brittney Francis
- Health Studies, Westat, 1600 Research Boulevard, Rockville, MD 20850, USA
| | - Jinan B Saaddine
- Vision Health Initiative, Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Atlanta, GA 30341-3717 USA
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Waisbourd M, Bond EA, Sullivan T, Hu WD, Shah SB, Molineaux J, Sembhi H, Spaeth GL, Myers JS, Hark LA, Katz LJ. Evaluation of Nonmydriatic Hand-held Optic Disc Photography Grading in the Philadelphia Glaucoma Detection and Treatment Project. J Glaucoma 2017; 25:e520-5. [PMID: 26900823 DOI: 10.1097/ijg.0000000000000382] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the reproducibility of optic disc photograph grading obtained by a hand-held fundus camera and to determine the diagnostic value of these photographs in detecting patients with glaucoma in a community-based glaucoma-detection program. MATERIALS AND METHODS Patients underwent slit-lamp examination by an ophthalmologist who graded each patient's optic discs using 2 methods: cup-to-disc ratio (CDR) and disc damage likelihood scale (DDLS). After a comprehensive glaucoma evaluation, patients were diagnosed as having "glaucoma," "glaucoma suspect," or "no glaucoma." Nonmydriatic, monoscopic optic disc photographs were then taken with a portable digital imaging device. On a different day, the same examiner and a second observer graded the disc photographs in a masked manner and determined a diagnostic impression based only on the disc photographs. RESULTS Of the 1649 patients examined, 119 subjects were randomly selected according to 3 groups of diagnoses: "glaucoma" (n=36), "glaucoma suspect" (n=50), and "no glaucoma" (n=33). For CDR, the intraobserver agreement was 0.71 and the interobserver agreement was 0.69. For disc DDLS, the intraobserver agreement was 0.65 and the interobserver agreement was 0.67. The area under the receiver-operating characteristic distinguishing between normal and glaucoma was 0.88 and 0.86 for CDR and disc DDLS, respectively. CONCLUSIONS Nonmydriatic, monoscopic disc photographs obtained by a hand-held camera had only moderate disc grading reproducibility. This could be due to a reduced quality of images, making interpretation more challenging, due to taking photographs through small pupils by a hand-held camera and the high percentage of patients with significant cataracts.
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Protas ME, Weh E, Footz T, Kasberger J, Baraban SC, Levin AV, Katz LJ, Ritch R, Walter MA, Semina EV, Gould DB. Mutations of conserved non-coding elements of PITX2 in patients with ocular dysgenesis and developmental glaucoma. Hum Mol Genet 2017; 26:3630-3638. [PMID: 28911203 PMCID: PMC5886142 DOI: 10.1093/hmg/ddx251] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/09/2017] [Accepted: 06/27/2017] [Indexed: 12/11/2022] Open
Abstract
Mutations in FOXC1 and PITX2 constitute the most common causes of ocular anterior segment dysgenesis (ASD), and confer a high risk for secondary glaucoma. The genetic causes underlying ASD in approximately half of patients remain unknown, despite many of them being screened by whole exome sequencing. Here, we performed whole genome sequencing on DNA from two affected individuals from a family with dominantly inherited ASD and glaucoma to identify a 748-kb deletion in a gene desert that contains conserved putative PITX2 regulatory elements. We used CRISPR/Cas9 to delete the orthologous region in zebrafish in order to test the pathogenicity of this structural variant. Deletion in zebrafish reduced pitx2 expression during development and resulted in shallow anterior chambers. We screened additional patients for copy number variation of the putative regulatory elements and found an overlapping deletion in a second family and in a potentially-ancestrally-related index patient with ASD and glaucoma. These data suggest that mutations affecting conserved non-coding elements of PITX2 may constitute an important class of mutations in patients with ASD for whom the molecular cause of their disease have not yet been identified. Improved functional annotation of the human genome and transition to sequencing of patient genomes instead of exomes will be required before the magnitude of this class of mutations is fully understood.
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Affiliation(s)
- Meredith E. Protas
- Departments of Ophthalmology and Anatomy and Institute for Human Genetics, University of California, San Francisco, CA 94143, USA
| | - Eric Weh
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Tim Footz
- Department of Medical Genetics, University of Alberta, Edmonton, AB T6G 2H7, Canada
| | - Jay Kasberger
- Celgene Quanticel Research, San Francisco, CA 94158, USA
| | - Scott C. Baraban
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA
| | - Alex V. Levin
- Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - L. Jay Katz
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Robert Ritch
- Einhorn Clinical Research Center, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
| | - Michael A. Walter
- Department of Medical Genetics, University of Alberta, Edmonton, AB T6G 2H7, Canada
| | - Elena V. Semina
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Douglas B. Gould
- Departments of Ophthalmology and Anatomy and Institute for Human Genetics, University of California, San Francisco, CA 94143, USA
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Razeghinejad MR, Havens SJ, Katz LJ. Trabeculectomy bleb-associated infections. Surv Ophthalmol 2017; 62:591-610. [DOI: 10.1016/j.survophthal.2017.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 01/25/2017] [Accepted: 01/27/2017] [Indexed: 10/20/2022]
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Hark LA, Katz LJ, Myers JS, Waisbourd M, Johnson D, Pizzi LT, Leiby BE, Fudemberg SJ, Mantravadi AV, Henderer JD, Zhan T, Molineaux J, Doyle V, Divers M, Burns C, Murchison AP, Reber S, Resende A, Bui TDV, Lee J, Crews JE, Saaddine JB, Lee PP, Pasquale LR, Haller JA. Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Methods and Screening Results. Am J Ophthalmol 2017; 181:114-124. [PMID: 28673747 DOI: 10.1016/j.ajo.2017.06.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE To describe methodology and screening results from the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study. DESIGN Screening program results for a prospective randomized clinical trial. METHODS Individuals were recruited who were African-American, Hispanic/Latino, or Asian over age 40 years; white individuals over age 65 years; and any ethnicity over age 40 years with a family history of glaucoma or diabetes. Primary care offices and Federally Qualified Health Centers were used for telemedicine (Visit 1). Two posterior fundus photographs and 1 anterior segment photograph were captured per eye in each participant, using a nonmydriatic, autofocus, hand-held fundus camera (Volk Optical, Mentor, Ohio, USA). Medical and ocular history, family history of glaucoma, visual acuity, and intraocular pressure measurements using the ICare rebound tonometer (ICare, Helsinki, Finland) were obtained. Images were read remotely by a trained retina reader and a glaucoma specialist. RESULTS From April 1, 2015, to February 6, 2017, 906 individuals consented and attended Visit 1. Of these, 553 participants were female (61.0%) and 550 were African-American (60.7%), with a mean age of 58.7 years. A total of 532 (58.7%) participants had diabetes, and 616 (68%) had a history of hypertension. During Visit 1, 356 (39.3%) participants were graded with a normal image. Using image data from the worse eye, 333 (36.8%) were abnormal and 155 (17.1%) were unreadable. A total of 258 (28.5%) had a suspicious nerve, 62 (6.8%) had ocular hypertension, 102 (11.3%) had diabetic retinopathy, and 68 (7.5%) had other retinal abnormalities. CONCLUSION An integrated telemedicine screening intervention in primary care offices and Federally Qualified Health Centers detected high rate of suspicious optic nerves, ocular hypertension, and retinal pathology.
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Schaefer JL, Meyer AM, Rodgers CD, Rosenberg NC, Leoncavallo AJ, Lukowski ZL, Greer AB, Martorana GM, Zou B, Shuster JJ, Jay Katz L, Schuman JS, Kass MA, Sherwood MB. Comparing glaucomatous disc change using stereo disc viewing and the MatchedFlicker programme in glaucoma experts and trainees. Br J Ophthalmol 2017; 102:358-363. [PMID: 28814418 DOI: 10.1136/bjophthalmol-2017-310336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/20/2017] [Revised: 05/17/2017] [Accepted: 06/19/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS The objective of this study is to evaluate the accuracy and speed of trainees and experienced glaucoma specialists using the MatchedFlicker software against the manual examination of stereoscopic disc photographs for detecting glaucomatous optic disc change. METHODS Three experienced glaucoma specialists, two resident ophthalmologists and one glaucoma fellow from multiple institutions independently evaluated the same 140 image pairs from 100 glaucomatous/ocular hypertensive eyes using a handheld stereo viewer and the MatchedFlicker programme. Fifty had progression to glaucoma as determined by the Ocular Hypertension Treatment Study (OHTS) Optic Disc Reading Group and endpoint committee, and 50 more were negative controls for progression with photos taken a few minutes apart. Twenty photo pairs from each of the two groups were duplicated for reviewer variability analysis. The initial viewing method was randomised and then alternated for each group of 70 image pairs. Reviewer accuracy and evaluation time for each method were measured. RESULTS Evaluators averaged 8.6 s faster per image pair (26%) with the MatchedFlicker programme than with the stereo viewer (p=0.0007). Evaluators correctly identified more image pairs when using the MatchedFlicker software over the stereo viewer (p=0.0003). There was no significant difference between the expert and trainee group in speed or overall accuracy for either method. Experts were significantly more consistent than trainees with the duplicate image pairs (p=0.029). Trainees appeared more reluctant to designate eyes as showing glaucoma progression than experts. CONCLUSIONS Both expert glaucoma specialists and ophthalmologists in various stages of training had greater accuracy and speed with the MatchedFlicker programme than with a handheld stereoscopic viewer.
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Affiliation(s)
- Jamie L Schaefer
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA.,Department of Ophthalmology, University at Buffalo, Ross Eye Institute, Buffalo, New York, USA
| | - Alissa M Meyer
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Cooper D Rodgers
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Nicole C Rosenberg
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | | | - Zachary L Lukowski
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Anthony B Greer
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Gina M Martorana
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Baiming Zou
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Jonathan J Shuster
- Department of Health Outcomes and Policy, University of Florida, Gainesville, Florida, USA
| | - L Jay Katz
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joel S Schuman
- Department of Ophthalmology, New York University, New York City, New York, USA
| | - Michael A Kass
- Department of Ophthalmology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mark B Sherwood
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
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Berdahl JP, Khatana AK, Katz LJ, Herndon L, Layton AJ, Yu TM, Bauer MJ, Cantor LB. Cost-comparison of two trabecular micro-bypass stents versus selective laser trabeculoplasty or medications only for intraocular pressure control for patients with open-angle glaucoma. J Med Econ 2017; 20:760-766. [PMID: 28471282 DOI: 10.1080/13696998.2017.1327439] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM Patients with open-angle glaucoma (OAG) whose intraocular pressure is not adequately controlled by one medication have several treatment options in the US. This analysis evaluated direct costs of unilateral eye treatment with two trabecular micro-bypass stents (two iStents) compared to selective laser trabeculoplasty (SLT) or medications only. MATERIALS AND METHODS A population-based, annual state-transition, probabilistic, cost-of-care model was used to assess OAG-related costs over 5 years. Patients were modeled to initiate treatment in year zero with two iStents, SLT, or medications only. In years 1-5, patients could remain on initial treatment or move to another treatment option(s), or filtration surgery. Treatment strategy change probabilities were identified by a clinician panel. Direct costs were included for drugs, procedures, and complications. RESULTS The projected average cumulative cost at 5 years was lower in the two-stent treatment arm ($4,420) compared to the SLT arm ($4,730) or medications-only arm ($6,217). Initial year-zero costs were higher with two iStents ($2,810) than with SLT ($842) or medications only ($996). Average marginal annual costs in years 1-5 were $322 for two iStents, $777 for SLT, and $1,044 for medications only. The cumulative cost differences between two iStents vs SLT or medications only decreased over time, with breakeven by 5 or 3 years post-initiation, respectively. By year 5, cumulative savings with two iStents over SLT or medications only was $309 or $1,797, respectively. LIMITATIONS This analysis relies on clinical expert panel opinion and would benefit from real-world evidence on use of multiple procedures and treatment switching after two-stent treatment, SLT, or polypharmaceutical initial approaches. CONCLUSIONS Despite higher costs in year zero, annual costs thereafter were lowest in the two-stent treatment arm. Two-stent treatment may reduce OAG-related health resource use, leading to direct savings, especially over medications only or at longer time horizons.
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Affiliation(s)
| | | | - L Jay Katz
- c Wills Eye Hospital, Thomas Jefferson University , Philadelphia , PA , USA
- d Glaukos Corporation , Laguna Hills , CA , USA
| | | | | | - Tiffany M Yu
- f Quorum Consulting, Inc , San Francisco , CA , USA
| | | | - Louis B Cantor
- g Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine , Indianapolis , IN , USA
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Pizzi LT, Waisbourd M, Hark L, Sembhi H, Lee P, Crews JE, Saaddine JB, Steele D, Katz LJ. Costs of a community-based glaucoma detection programme: analysis of the Philadelphia Glaucoma Detection and Treatment Project. Br J Ophthalmol 2017; 102:225-232. [DOI: 10.1136/bjophthalmol-2016-310078] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/28/2017] [Accepted: 05/03/2017] [Indexed: 01/25/2023]
Abstract
BackgroundGlaucoma is the foremost cause of irreversible blindness, and more than 50% of cases remain undiagnosed. Our objective was to report the costs of a glaucoma detection programme operationalised through Philadelphia community centres.MethodsThe analysis was performed using a healthcare system perspective in 2013 US dollars. Costs of examination and educational workshops were captured. Measures were total programme costs, cost/case of glaucoma detected and cost/case of any ocular disease detected (including glaucoma). Diagnoses are reported at the individual level (therefore representing a diagnosis made in one or both eyes). Staff time was captured during site visits to 15 of 43 sites and included time to deliver examinations and workshops, supervision, training and travel. Staff time was converted to costs by applying wage and fringe benefit costs from the US Bureau of Labor Statistics. Non-staff costs (equipment and mileage) were collected using study logs. Participants with previously diagnosed glaucoma were excluded.Results1649 participants were examined. Mean total per-participant examination time was 56 min (SD 4). Mean total examination cost/participant was $139. The cost/case of glaucoma newly identified (open-angle glaucoma, angle-closure glaucoma, glaucoma suspect, or primary angle closure) was $420 and cost/case for any ocular disease identified was $273.ConclusionGlaucoma examinations delivered through this programme provided significant health benefit to hard-to-reach communities. On a per-person basis, examinations were fairly low cost, though opportunities exist to improve efficiency. Findings serve as an important benchmark for planning future community-based glaucoma examination programmes.
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Amarasekera DC, Resende AF, Waisbourd M, Puri S, Moster MR, Hark LA, Katz LJ, Fudemberg SJ, Mantravadi AV. Steady-state pattern electroretinogram and short-duration transient visual evoked potentials in glaucomatous and healthy eyes. Clin Exp Ophthalmol 2017; 46:54-61. [PMID: 28600806 DOI: 10.1111/ceo.13006] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 11/28/2022]
Abstract
IMPORTANCE This study evaluates two rapid electrophysiological glaucoma diagnostic tests that may add a functional perspective to glaucoma diagnosis. BACKGROUND This study aimed to determine the ability of two office-based electrophysiological diagnostic tests, steady-state pattern electroretinogram and short-duration transient visual evoked potentials, to discern between glaucomatous and healthy eyes. DESIGN This is a cross-sectional study in a hospital setting. PARTICIPANTS Forty-one patients with glaucoma and 41 healthy volunteers participated in the study. METHODS Steady-state pattern electroretinogram and short-duration transient visual evoked potential testing was conducted in glaucomatous and healthy eyes. A 64-bar-size stimulus with both a low-contrast and high-contrast setting was used to compare steady-state pattern electroretinogram parameters in both groups. A low-contrast and high-contrast checkerboard stimulus was used to measure short-duration transient visual evoked potential parameters in both groups. MAIN OUTCOME MEASURES Steady-state pattern electroretinogram parameters compared were MagnitudeD, MagnitudeD/Magnitude ratio, and the signal-to-noise ratio. Short-duration transient visual evoked potential parameters compared were amplitude and latency. RESULTS MagnitudeD was significantly lower in glaucoma patients when using a low-contrast (P = 0.001) and high-contrast (P < 0.001) 64-bar-size steady-state pattern electroretinogram stimulus. MagnitudeD/Magnitude ratio and SNR were significantly lower in the glaucoma group when using a high-contrast 64-bar-size stimulus (P < 0.001 and P = 0.010, respectively). Short-duration transient visual evoked potential amplitude and latency were not significantly different between the two groups. CONCLUSIONS AND RELEVANCE Steady-state pattern electroretinogram was effectively able to discern between glaucomatous and healthy eyes. Steady-state pattern electroretinogram may thus have a role as a clinically useful electrophysiological diagnostic tool.
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Affiliation(s)
| | - Arthur F Resende
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | | | - Sanjeev Puri
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Marlene R Moster
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
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