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Thakur S, Lavanya R, Yu M, Tham YC, Da Soh Z, Teo ZL, Koh V, Majithia S, Qian C, Aung T, Nongpiur ME, Cheng CY. Six-Year Incidence and Risk Factors for Primary Open-Angle Glaucoma and Ocular Hypertension: The Singapore Epidemiology of Eye Diseases Study. Ophthalmol Glaucoma 2024; 7:157-167. [PMID: 37574187 DOI: 10.1016/j.ogla.2023.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 06/21/2023] [Accepted: 08/07/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To determine the incidence and risk factors for primary open-angle glaucoma (POAG) and ocular hypertension (OHT) in a multiethnic Asian population. DESIGN Population-based cohort study. PARTICIPANTS The Singapore Epidemiology of Eye Diseases study included 10 033 participants in the baseline examination between 2004 and 2011. Of those, 6762 (response rate = 78.8%) participated in the 6-year follow-up visit between 2011 and 2017. METHODS Standardized examination and investigations were performed, including slit lamp biomicroscopy, intraocular pressure (IOP) measurement, pachymetry, gonioscopy, optic disc examination and static automated perimetry. Glaucoma was defined according to a combination of clinical evaluation, ocular imaging (fundus photo, visual field, and OCT) and criteria given by International Society of Geographical and Epidemiological Ophthalmology. OHT was defined on the basis of elevated IOP over the upper limit of normal; i.e., 20.4 mmHg, 21.5 mmHg, and 22.6 mmHg for the Chinese, Indian, and Malay cohort respectively, without glaucomatous optic disc change. MAIN OUTCOME MEASURES Incidence of POAG, OHT, and OHT progression. RESULTS The overall 6-year age-adjusted incidences of POAG and OHT were 1.31% (95% confidence interval [CI], 1.04-1.62) and 0.47% (95% CI, 0.30-0.70). The rate of progression of baseline OHT to POAG at 6 years was 5.32%. Primary open-angle glaucoma incidence was similar (1.37%) in Chinese and Indians and lower (0.80%) in Malays. Malays had higher incidence (0.79%) of OHT than Indians (0.38%) and Chinese (0.37%). Baseline parameters associated with higher risk of POAG were older age (per decade: odds ratio [OR], 1.90; 95% CI, 1.54-2.35; P < 0.001), higher baseline IOP (per mmHg: OR, 1.20; 95% CI, 1.12-1.29; P < 0.001) and longer axial length (per mm: OR, 1.22; 95% CI, 1.07-1.40, P = 0.004). CONCLUSION Six-year incidence of POAG was 1.31% in a multiethnic Asian population. Older age, higher IOP, and longer axial length were associated with higher risk of POAG. These findings can help in future projections and guide public healthcare policy decisions for screening at-risk individuals. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Sahil Thakur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Raghavan Lavanya
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Marco Yu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Center for Innovation and Precision Eye Health, National University of Singapore, Singapore
| | - Zhi Da Soh
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zhen Ling Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Victor Koh
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Center for Innovation and Precision Eye Health, National University of Singapore, Singapore; Department of Ophthalmology, National University Hospital, National University Health System, Singapore
| | - Shivani Majithia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Chaoxu Qian
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Monisha E Nongpiur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Center for Innovation and Precision Eye Health, National University of Singapore, Singapore.
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Rojas-Carabali W, Mejía-Salgado G, Cifuentes-González C, Chacón-Zambrano D, Cruz-Reyes DL, Delgado MF, Gómez-Goyeneche HF, Saad-Brahim K, de-la-Torre A. Prevalence and clinical characteristics of uveitic glaucoma: multicentric study in Bogotá, Colombia. Eye (Lond) 2024; 38:714-722. [PMID: 37789110 PMCID: PMC10920824 DOI: 10.1038/s41433-023-02757-9] [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: 10/18/2022] [Revised: 08/23/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVES To describe the clinical features of patients diagnosed with uveitic glaucoma (UG) and ocular hypertension secondary to uveitis (OHT-SU). METHODS A multicentric cross-sectional study using medical records of patients with uveitis between 2013 and 2021. Uveitis and glaucoma specialists examined all patients. Variables were analyzed using the chi-square or Fisher's exact test for categorical variables. Additionally, t test, Mann-Whitney, and Kruskal-Wallis variance analysis were used for continuous variables. Finally, a Kaplan-Meier survival analysis for UG and OHT-SU development over time was done. RESULTS Of the 660 clinical records reviewed of patients with uveitis, 191 (28.9%) had OHT-SU in at least one visit, and 108 (16.4%) of them developed UG. In all ages, females were more affected than males. Anterior uveitis was the main anatomic localisation, and non-granulomatous, recurrent, and inactive uveitis were the most frequent clinical features. The mean final visual acuity was 0.3 (0.0-1.0) LogMAR. Also, 95.8% of the patients had additional sequelae related to uveitis regardless of UG and OHT-SU. Interestingly, males had earlier affection, with statistical significance in OHT for adults (P = 0.036) and UG for children (P = 0.04). Of all patients, 81.1% received topical hypotensive treatment and 29.8% required a surgical procedure. CONCLUSIONS UG and OHT-SU are common complications of uveitis in the Colombian population. These sight-threatening conditions were more common and appeared sooner in men at any age. Our results suggest that earlier and more aggressive treatment with topical hypotensive agents could positively influence the visual outcomes and the requirement of surgical procedures.
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Affiliation(s)
- William Rojas-Carabali
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Germán Mejía-Salgado
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
- Ophthalmology Interest Group, Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Carlos Cifuentes-González
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Daniela Chacón-Zambrano
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Danna Lesley Cruz-Reyes
- Grupo de Investigación Clínica. Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | | | | | | | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia.
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Wolfram C. The Epidemiology of Glaucoma - an Age-Related Disease. Klin Monbl Augenheilkd 2024; 241:154-161. [PMID: 38412979 DOI: 10.1055/a-2257-6940] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Epidemiological studies describe the distribution of glaucoma and its risk factors in the general population. MATERIAL AND METHODS Epidemiological findings from population-based studies were extrapolated for the situation in Germany, in order to estimate current and future prevalence of glaucoma by using official population statistics for Germany. RESULTS The prevalence of glaucoma in the adult population above 40 years of age is currently 2.1%, resulting in 980 thousand subjects with glaucoma, plus at least one more million subjects with ocular hypertension (OHT). Two thirds of all glaucoma cases are above 70 years of age. By 2060, the prevalence of glaucoma will increase to 2.8%, due to the aging of the population. CONCLUSIONS Despite a decrease in the population size, glaucoma will become more prevalent in the future.
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Gurnani B, Kaur K. Re: Dot et al.: Incidence of retinal detachment, macular edema, and ocular hypertension after neodymium:yttrium-aluminum-garnet capsulotomy: a population-based nationwide study-The French YAG 2 Study (Ophthalmology. 2022;130:478-487). Ophthalmology 2023; 130:e43. [PMID: 37737811 DOI: 10.1016/j.ophtha.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/04/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023] Open
Affiliation(s)
- Bharat Gurnani
- Ocular Surface and Refractive Services, Sadguru Netra Chikitsalya, Shri Sadguru Seva Sangh Trust, Janaki Kund, Chitrakoot, Madhya Pradesh, India.
| | - Kirandeep Kaur
- Ocular Surface and Refractive Services, Sadguru Netra Chikitsalya, Shri Sadguru Seva Sangh Trust, Janaki Kund, Chitrakoot, Madhya Pradesh, India
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Ikhlef M, Ailem A. [Epidemiological and clinical features of primary open angle glaucoma in Bejaia: "The Bejaia Eye Study"]. J Fr Ophtalmol 2023; 46:1182-1194. [PMID: 37872068 DOI: 10.1016/j.jfo.2023.05.027] [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: 01/06/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE To determine the prevalence of POAG and its clinical features in a population aged 40years and over in Bejaia. METHODS This was a descriptive, cross-sectional survey for analytical purposes in a representative sample from the municipality of Bejaia. The target population consists of residents of the municipality aged 40 and over who were examined in basic health facilities in the municipality of Bejaia, from May 31, 2015 to July 12, 2016. The visual field, OCT, vertical C/D and intraocular pressure (IOP) criteria were used to define whether or not primary open angle glaucoma was present. RESULTS A total of 1484 people (99 %) participated in the study. The mean age of the study population was 57.97±10.77years, with a median of 56years and sex ratio of 1.07. The prevalence of glaucoma in our study was 5.5 %: POAG 4.6 % (95% CI=3.5-5.7); PACG 0.3 % (95 % CI=0.1, 0.7); secondary glaucoma 0.5 % (95 % CI=0.2-0.7). The prevalence of ocular hypertension was 3.0 % (95% CI=2.2-4.0). The age-adjusted prevalence was 0.8 % between 40 and 49years of age and 6.9% between 60 and 69years of age. The mean age was 66.76±9.31years for men and 67.68±12.10years for women. The mean IOP was 17.53±5.69mm Hg. The mean pachymetry was 518.3±34.3μm in the right eye and 517.4±33.9μm in the left eye. The mean cup/disc ratio was 0.7±0.2 in both eyes. Multivariate analysis of risk factors in our study showed that age and ocular hypertension were significantly associated with the presence of POAG. DISCUSSION The prevalence of POAG is disparate in relation to the age difference, the method of recruitment and the diagnostic criteria: in Bejaia, it is 4.6 %; in Morocco: Marrakech 2.0 %, Fez 6.4 %; in Tunisia: Bardo 2.7 %, Mahdia 2.4 %. The prevalence of POAG increases exponentially with age without significant gender difference. The inclusion of suspect cases influences the prevalence (Beaver Dam, Namil Study). We found that the prevalence of OHT in our study approximates that of the BMES, but it did not show a significant increase with age. The mean CCT in Bejaia (526.35±34.86 microns) and Fez (522.16±41.45 microns) are comparable. The mean vertical C/D ratio in Bejaia was also comparable to data in the literature. A significant difference was observed in the mean median deviation (MD) between subjects with glaucoma and normal subjects. The retinal nerve fiber layer as well as the mean ganglion cell complex thickness in glaucoma subjects was significantly thinner than in healthy subjects. CONCLUSION The prevalence of POAG is high, similar to that of people of African descent, but at older ages and among men. The rate of glaucoma in Bejaia rises significantly with age. Glaucoma is a major ocular health problem and will become increasingly important as the population ages.
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Affiliation(s)
- M Ikhlef
- Université Abderrahmane MIRA de Bejaia, Bejaia, Algérie.
| | - A Ailem
- Université d'Alger 1, Alger, Algérie
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Smithin SS, Manju M, Chandran P, Dhavalikar M, Menaka SV, Balagiri K, Venkataraman G. Mean rate of progression of visual fields in patients with primary open-angle glaucoma and ocular hypertension attending a tertiary care center in South India - A prospective cohort study using FORUM ® Glaucoma Workplace software. Indian J Ophthalmol 2023; 71:2733-2738. [PMID: 37417113 PMCID: PMC10491075 DOI: 10.4103/ijo.ijo_1989_22] [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: 08/15/2022] [Revised: 12/27/2022] [Accepted: 05/16/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose To find out the mean rate of progression (MROP) of visual fields (VF) in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT) using FORUM® Glaucoma Workplace. Methods Two hundred and one eyes of 105 patients were included in this prospective cohort study. Patients with POAG and OHT were recruited, and VF analysis with 24-2 and or 10-2 was done using SITA standard strategy in Zeiss Humphrey Visual Field Analyzer (HFA). All the previous VFs were identified from FORUM software, and the baseline indices were recorded from the first reliable VF analysis. The present VF analysis was compared to the previous one using FORUM software, and the rate of progression (ROP) in VF was obtained by Guided Progression Analysis. Results MROP of VF in the POAG group was - 0.085 dB/year, ranging from -2.8 to 2.8 dB/year with a standard deviation (SD) of 0.69. In the OHT group, the MROP of VF was -0.003 dB/year, ranging from - 0.8 to 0.5 dB/year with an SD of 0.27. The MROP of VF in medically treated eyes with POAG was -0.14 dB/year with an SD of 0.61 and in surgically treated eyes was -0.02 dB/year with an SD of 0.78. The overall baseline mean VF index (VFI) was 83.19% and the final mean VFI was 79.80%. There was a statistically significant decrease in the mean VFI value from baseline to the final visit (P-value 0.0005). Conclusion The mean ROP of VF in the POAG group was -0.085 dB/year and in the OHT group was - 0.003 dB/year.
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Affiliation(s)
- S S Smithin
- Glaucoma Clinic, Aravind Eye Hospital, Coimbatore, Tamilnadu, India
| | - M Manju
- Glaucoma Clinic, Aravind Eye Hospital, Coimbatore, Tamilnadu, India
| | | | | | - S V Menaka
- Glaucoma Clinic, Aravind Eye Hospital, Coimbatore, Tamilnadu, India
| | - K Balagiri
- Glaucoma Clinic, Aravind Eye Hospital, Coimbatore, Tamilnadu, India
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Bae SS, Koenigstein D, Weaver T, Merkur A, Albiani D, Pakzad-Vaezi K, Kirker A. Incidence of ocular hypertension after anti-VEGF injections: examining the effect of drug filtration and silicone-free syringes. Can J Ophthalmol 2023; 58:66-72. [PMID: 34331870 DOI: 10.1016/j.jcjo.2021.06.025] [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] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the difference in incidence of ocular hypertension (OHT) following the introduction of filtered anti-vascular endothelial growth factor (anti-VEGF) medication in silicone-free syringes. DESIGN Retrospective cohort study. METHODS A retrospective review of consecutive treatment-naive patients receiving intravitreal anti-VEGF injections in a group practice was performed. Data from the cohort receiving nonfiltered anti-VEGF in insulin syringes (IS group) was collected from June 2015. Data from the cohort receiving filtered anti-VEGF in silicone-free syringes (SFS group) was collected from June 2019. Follow up data were collected at 1 year. Exclusion criteria included prior anti-VEGF treatment, known glaucoma or diagnosis of glaucoma suspect before anti-VEGF treatment, neovascular glaucoma, steroid use, or vitrectomy during follow-up. Primary outcome was the cumulative incidence of intraocular pressure (IOP) > 21 mmHg and IOP ≥ 30 mm Hg at any follow-up visit. The use of IOP lowering therapy was also recorded. RESULTS The mean age (71 ± 13 years), mean number of injections (9.6 ± 2.7), and median follow-up time (392 ± 57 days) were similar between groups. The incidence of IOP ≥ 21 mm Hg was 34% (34/100) in the IS group and 15% (15/100) in the SFS group (p = 0.025). The incidence of IOP ≥ 30 mm Hg was 8% (8/100) in the IS group and 0% (0/100) in the SFS group (p =0.004). The incidence of IOP-lowering therapy was 13% in the IS group and 0% in the SFS group (p =0.0002). CONCLUSION The incidence of OHT and treatment with IOP-lowering therapy significantly decreased after the introduction of filtered anti-VEGF medication and silicone-free syringes.
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Affiliation(s)
- Steven S Bae
- From the Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC
| | - Dvir Koenigstein
- From the Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC
| | - Travers Weaver
- From the Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC
| | - Andrew Merkur
- From the Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC
| | - David Albiani
- From the Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC
| | - Kaivon Pakzad-Vaezi
- From the Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC
| | - Andrew Kirker
- From the Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC..
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Tang C, Liang L, Zheng X, Hu H, Liu C, Long J. Glucocorticoid therapy reduces ocular hypertension in active moderate-severe thyroid-associated orbitopathy. BMC Endocr Disord 2022; 22:235. [PMID: 36151558 PMCID: PMC9503215 DOI: 10.1186/s12902-022-01153-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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/12/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Ocular hypertension (OHT) is an important clinical feature of thyroid-associated orbitopathy (TAO).While the prevalence and outcome of OHT in TAO remains unclear. This study investigates this in moderate-severe active TAO. METHODS Sixty-eight patients with active moderate-severe TAO were recruited, 49 of whom were treated with 12-week GC therapy.The clinical and biochemical parameters were collected.Treatment outcomes were evaluated after GC therapy. RESULTS The prevalence of OHT was 44.85% in moderate-severe active TAO patients,including 81.97% of mild hypertension, 13.11% of moderate hypertension and 4.92% of severe hypertension. Clinical and biochemical parameters had no significant difference between OHT patients and non-OHT patients,such as age, sex distributions, smoking status, the kind and the duration of thyroid disease,the duration of eye symptoms and the level of FT3,FT4,TSH, TR-Ab, and Tpo-Ab, Tg-Ab(all P > 0.05). After GC therapy,the intraocular pressure(IOP) in OHT eyes decreased significantly (P < 0.05), while IOP in non-OHT eyes remained unchanged (P > 0.05).There was no significant difference in CAS and the effective rate of GC therapy between OHT eyes and non-OHT eyes (P > 0.05). CONCLUSION In moderate-severe active TAO, the prevalence of OHT was 44.85%, most of which were mild hypertension.OHT was relieved by GC therapy,which had no effect on the efficacy of GC therapy.Our results will enhance physicians' confidence in GC therapy.
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Affiliation(s)
- Chengyang Tang
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Liang Liang
- Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiaoya Zheng
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Hong Hu
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Chun Liu
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jian Long
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Wu KY, Hodge DO, White LJ, McDonald J, Roddy GW. Association of Metabolic Syndrome With Glaucoma and Ocular Hypertension in a Midwest United States Population. J Glaucoma 2022; 31:e18-e31. [PMID: 34860182 PMCID: PMC9337265 DOI: 10.1097/ijg.0000000000001968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 07/09/2021] [Accepted: 11/19/2021] [Indexed: 12/29/2022]
Abstract
PRCIS For patients with glaucoma, metabolic syndrome was associated with higher intraocular pressure and greater central corneal thickness. Patients with metabolic syndrome were more likely to have ocular hypertension. PURPOSE The purpose of this study was to determine whether glaucomatous optic neuropathy, also known as glaucoma, and ocular hypertension are more likely to occur in patients with metabolic syndrome. PATIENTS AND METHODS Patients in Olmsted County, MN, were identified as having metabolic syndrome based on diagnosis codes, laboratory values, and/or medication use to meet 3 or more of the 5 standard criteria for diagnosing metabolic syndrome: systemic hypertension, hyperglycemia, hypertriglyceridemia, reduced high-density lipoprotein cholesterol, and central adiposity defined by increased body mass index. Patients with glaucoma, including primary open angle, low tension, pigment dispersion, and pseudoexfoliation, were identified using diagnostic codes. The charts of patients with glaucoma were individually reviewed to collect visual acuity, intraocular pressure, cup to disc ratio, central corneal thickness, visual field mean deviation, retinal nerve fiber layer thickness, and treatment of intraocular pressure. Patients with ocular hypertension were separately identified and similarly evaluated. RESULTS For patients with glaucoma, those with metabolic syndrome had higher intraocular pressure and greater central corneal thickness compared with those without metabolic syndrome. After adjustment for central corneal thickness, there was no longer a significant difference in intraocular pressure between groups. Metabolic syndrome was also associated with the diagnosis of ocular hypertension, and although central corneal thickness trended higher in patients with metabolic syndrome, it did not attain statistical significance. CONCLUSION In Olmsted County, though metabolic syndrome was associated with ocular hypertension and higher intraocular pressure in patients with glaucoma, the results were likely related to a thicker central corneal in this patient population.
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Affiliation(s)
- Kristi Y. Wu
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, 55905
| | - David O. Hodge
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, 3222
| | - Launia J. White
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, 3222
| | | | - Gavin W. Roddy
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, 55905
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Badrinarayanan L, Rishi P, George R, Isaac N, Rishi E. Incidence, risk factors, treatment and outcome of ocular hypertension following intravitreal steroid injections: A comparative study. Ophthalmologica 2022; 245:431-438. [PMID: 35468616 DOI: 10.1159/000522504] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/07/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the incidence, risk factors, treatment, and outcomes associated with intravitreal triamcinolone-acetonide (TA) and dexamethasone-implant (Dex) induced ocular hypertension (OHT). METHODS This retrospective study reviewed 1549 TA and Dex administrations in 1075 eyes of 897 patients. Intraocular pressure (IOP) values were monitored for a period of 6-months following intravitreal injection(s) and patients were categorized as steroid-responders (SR): IOP ≥ 21mmHg, and non-responders (NR): IOP ≤ 20mmHg. Glaucoma patients, glaucoma suspects, uveitis, trauma, and less than one month IOP follow-up cases were excluded from the study. Incidence of IOP rise, time and magnitude of IOP rise, and its management procedures were studied. Ocular and systemic association with OHT incidence was investigated. Statistical analysis was performed using SPSS.23 and p < 0.05 was considered significant. RESULT 28% of TA and 17% of Dex administered eyes developed OHT. Male subjects and elderly people (greater than 40 years) are at higher risk for OHT following steroid treatment. A high percentage of IOP rise was observed at day-1 (41%) for TA-SR, and after 1-month (50%) among Dex-SR. IOP rise was found to be more severe (>30mmHg) for TA-SR compared to Dex-SR (p=0.006). 6% TA-SR required trabeculectomy with medically uncontrollable IOP. Myopia is a risk factor for secondary OHT, whereas diabetes mellitus and hypercholesterolemia were protective of it. CONCLUSION 28% of TA and 17% of Dex administrations developed OHT. Early and severe IOP rise was more common in TA than among Dex administrations. Myopia is a risk for Dex-OHT.
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Affiliation(s)
- Lakshmi Badrinarayanan
- Central Research Instrumentation Facility, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Ronnie George
- Smt. Jadhavbai Nathmal Singhvee Glaucoma Service, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Nancy Isaac
- Central Research Instrumentation Facility, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Ekta Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
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Rezkallah A, Mathis T, Abukhashabah A, Voirin N, Malclès A, Agard É, Lereuil T, Denis P, Dot C, Kodjikian L. LONG-TERM INCIDENCE AND RISK FACTORS OF OCULAR HYPERTENSION FOLLOWING DEXAMETHASONE-IMPLANT INJECTIONS: THE SAFODEX-2 STUDY. Retina 2021; 41:1438-1445. [PMID: 33315814 DOI: 10.1097/iae.0000000000003080] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To analyze the incidence, risk factors, and time to onset of ocular hypertension (OHT) after intravitreal injections (IVI) of dexamethasone implant and to evaluate the long-term cumulative probability of intraocular pressure elevation. METHODS Eyes of patients having received at least one dexamethasone implant IVI between October 2010 and February 2015 were included in the present study. Ocular hypertension was defined as intraocular pressure > 25 mmHg and/or an increase of 10 mmHg over the follow-up period compared with baseline intraocular pressure. RESULTS Four hundred ninety-four eyes were studied in 410 patients. For a total of 1,371 IVI, the incidence of OHT was 32.6% in the study eyes with a mean follow-up period of 30 months (3-62.5) and a median follow-up of 29 months. Pressure-lowering treatment was introduced for 36.9% of eyes. Topical treatment alone was sufficient to manage OHT in 97%. Young age, male sex, uveitis and retinal vein occlusion, and glaucoma treated with a double- or triple-combination topical pressure-lowering medication were found to be risk factors for OHT. The incidence of OHT did not change with an increase in the number of IVI, and there was no cumulative effect, defining by an increase of the incidence of OHT in patients after repeated IVI (P = 0.248). CONCLUSION This study confirmed that OHT is of moderate incidence, transient, controlled by topical treatment and provides data on the long-term cumulative probability of intraocular pressure elevation in a large cohort of eyes treated with dexamethasone implant IVI. Repeat injections of dexamethasone implant neither increase nor decrease the risk of OHT.
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Affiliation(s)
- Amina Rezkallah
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thibaud Mathis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
- UMR-CNRS 5510 Matéis, Villeurbane, France
| | - Amro Abukhashabah
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Voirin
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Ariane Malclès
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Émilie Agard
- Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France; and
- French Military Health Service Academy, Val de Grâce, Paris, France
| | - Théo Lereuil
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Philippe Denis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Corinne Dot
- Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France; and
- French Military Health Service Academy, Val de Grâce, Paris, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
- UMR-CNRS 5510 Matéis, Villeurbane, France
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12
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Jain N, Kaur S, Kopsachilis N, Zia R. Risk of Airborne COVID-19 Transmission While Performing Humphrey Visual Field Testing. J Glaucoma 2021; 30:219-222. [PMID: 33394847 DOI: 10.1097/ijg.0000000000001771] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/08/2020] [Indexed: 01/13/2023]
Abstract
PRECIS Designing and demonstrating an experiment that shows the risk of airborne transmission of COVID-19 between patients having visual fields analyzed is low. PURPOSE The aim was to investigate the possibility of airborne transmission of COVID-19 during Humphrey visual field testing in a real-world scenario. METHODS A particle counter was placed within the bowl of Humphrey visual field analyzer (HFA) before and after turning on the machine to ascertain the effect of the air current produced by the ventilation system on aerosols. A second experiment was run where the particle counter was placed in the bowl and recorded particulates, in the air, as a 24-2 SITA standard was performed by a mock patient and then again immediately after the patient had moved away. We measured aerosol particle counts sized ≤0.3 μm, >0.3≤0.5 μm, >0.5≤1 μm, >1≤2.5 μm, >2.5≤5 μm, and >5≤10 μm. RESULTS Particulates of all sizes were shown to be significantly reduced within the bowl after turning the machine on, demonstrating that the air current produced by the HFA pushes air out of the bowl and it cannot stagnate. There was no significant difference in measurement of aerosol while there was a patient performing the test and immediately after they had moved away, suggesting that aerosols breathed out by the patient are not able to remain in suspension in the bowl because of the ventilation current. CONCLUSION There is no significant difference between aerosol count in the bowl of a HFA before, during and after testing. This suggests the risk of airborne transmission of COVID-19 is low between subsequent patients. This is in keeping with manufacturer's guidance on Humphrey visual field testing.
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Affiliation(s)
- Nikhil Jain
- University College Hospitals NHS Foundation Trust, London
| | - Simerdip Kaur
- East Kent Hospitals NHS Foundation Trust, Kent and Canterbury Hospital Ethelbert Road, Canterbury
| | - Nikolaos Kopsachilis
- East Kent Hospitals NHS Foundation Trust, Kent and Canterbury Hospital Ethelbert Road, Canterbury
- New Hayesbank Ophthalmology Services, Cemetery Lane, Kennington, Kent, UK
| | - Rashid Zia
- East Kent Hospitals NHS Foundation Trust, Kent and Canterbury Hospital Ethelbert Road, Canterbury
- New Hayesbank Ophthalmology Services, Cemetery Lane, Kennington, Kent, UK
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13
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Liang Y, Jiang J, Ou W, Peng X, Sun R, Xu X, Yang J, Hu C, Ye C, Congdon N, Lu F. Effect of Community Screening on the Demographic Makeup and Clinical Severity of Glaucoma Patients Receiving Care in Urban China. Am J Ophthalmol 2018; 195:1-7. [PMID: 30053479 DOI: 10.1016/j.ajo.2018.07.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/18/2018] [Accepted: 07/15/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess differences in clinical and demographic characteristics between glaucoma patients identified by community screening and those newly diagnosed in hospital in a Chinese setting. DESIGN Prospective comparative cohort study. METHODS A total of 373 patients identified with glaucoma among 27 000 persons undergoing community screening were enrolled as the Screening group. The Clinic group consisted of 119 consecutively presenting, newly diagnosed glaucoma patients in hospital. Primary outcomes were mean deviation (MD), visual field index (VFI) and pattern standard deviation (PSD) on Humphrey Field Analyzer, and intraocular pressure (IOP). Disease severity was categorized into 5 stages based on MD. RESULTS A total of 89.6% (328/373) of Screening group patients had IOP < 21 mm Hg, compared to 48.7% (58/119) in the Clinic group (P < .001). The mean VFI, MD, and PSD were 76.4% ± 23.8%, -9.7 ± 7.3 dB, and 6.4 ± 3.4 dB in the Screening group and significantly worse in the Clinic group: 44.1% ± 32.0%, -19.8 ± 9.5 dB, and 7.6 ± 3.1 dB (P < .001 for MD and VFI, P = .001 for PSD). Nearly three quarters of Screening patients had early or moderate visual field loss (monocular), while nearly half of Clinic patients had severe loss at the time of diagnosis. Screening patients were significantly more likely to be older (P < .001) and female (P < .001) than Clinic patients. CONCLUSION Glaucoma patients detected through community screening had significantly milder damage, and were more likely to include underserved groups (women, elderly) than those newly diagnosed in a clinic in this setting. Comparison with population studies suggests that cases of glaucoma with IOP < 21 mm Hg are severely underascertained in China, a situation that may be improved by screening.
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Affiliation(s)
- Yuanbo Liang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Junhong Jiang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Ningbo Eye Hospital, Ningbo, Zhejiang, China
| | - Wen Ou
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xianyao Peng
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Ningbo Eye Hospital, Ningbo, Zhejiang, China
| | - Ruizhu Sun
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiang Xu
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Juanyuan Yang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Cheng Hu
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Cong Ye
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; Division of Preventive Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; Orbis International, New York, New York, USA
| | - Fan Lu
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Lam D, Lee J, Leung E, Liu S, Yuan J, Ratra V. Non-Self-Sealing (Leaky) Anterior Chamber Paracentesis: A New Technique in Managing Postphacoemulsification Intraocular Pressure Rise in Glaucoma and Normal Eyes. Asia Pac J Ophthalmol (Phila) 2018; 7:284-287. [PMID: 30255669 DOI: 10.22608/apo.2016213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/08/2022] Open
Abstract
Phacoemulsification (phaco) for cataract extraction is 1 of the most commonly performed ophthalmic surgeries. With increasing evidence of significant intraocular pressure (IOP) reduction after phaco, the paradigm for glaucoma treatment has been shifting toward more cataract extraction instead of glaucoma surgery; thus, the population of glaucoma patients undergoing phaco is likely to continue to increase in the coming years. Although the safety of surgery has improved over the years with newer technologies and machines, postoperative IOP spike remains an important condition even after an uneventful operation. Glaucoma patients undergoing phacoemulsification are particularly at risk of further glaucomatous optic nerve damage from the transient yet potentially high pressures after phaco. Common treatments include topical, intracameral, oral, and systemic IOP-lowering medications; postoperative anterior chamber paracentesis (ACP); and so on. No single treatment to date can guarantee effective prevention or control IOP rise in the first 24 hours after phaco. Sometimes, the IOP remains high despite all of the above treatments and the risk for further glaucomatous damage may be unavoidable. In this perspective article, we discuss the incidence, causes, and treatments of IOP rise after phaco and introduce a new technique, a non-self-sealing (leaky) ACP that may be of use in regulating postoperative IOP rise, especially for patients with glaucoma.
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Affiliation(s)
- Dennis Lam
- Dennis Lam & Partners Eye Center, Central, Hong Kong
| | - Jacky Lee
- Dennis Lam & Partners Eye Center, Central, Hong Kong
| | - Enne Leung
- Dennis Lam & Partners Eye Center, Central, Hong Kong
| | - Shirley Liu
- C-Mer (Shenzhen) Dennis Lam Eye Hospital, 1 Tairan 9th Rd, Futian, Shenzhen, Guangdong, China
| | - Julianna Yuan
- C-Mer (Shenzhen) Dennis Lam Eye Hospital, 1 Tairan 9th Rd, Futian, Shenzhen, Guangdong, China
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15
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Ringeisen AL, Parke DW. Reconsidering the Postoperative Day 0 Visit for Retina Surgery. Ophthalmic Surg Lasers Imaging Retina 2018; 49:e52-e56. [PMID: 30222819 DOI: 10.3928/23258160-20180907-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 02/27/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE This study compares outcomes of patients who were examined on postoperative (PO) day 0 and PO day 1 following retina surgery. PATIENTS AND METHODS A nonrandomized, comparative, retrospective series of one vitreoretinal surgeon was conducted on 166 patients with a PO day 0 visit (approximately 5 hours following surgery) and 428 patients with a PO day 1 visit. RESULTS Among patients examined at PO day 0, 4.6% had hypotony (intraocular pressure [IOP] ≤ 5 mm Hg) and 1.8% needed intervention for elevated IOP (IOP ≥ 30 mm Hg) compared with 1.6% and 4.0% of patients, respectively, examined on PO day 1. CONCLUSION Following retina surgery, there is a similar percentage of patients with abnormal IOP when patients are examined on PO day 0 when compared with PO day 1. However, the rate of hypotony was statistically higher on PO day 0, and there was a trend toward more elevated IOP on PO day 1. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e52-e56.].
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16
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Mwanza JC, Tulenko SE, Budenz DL, Mathenge E, Herndon LH, Kim HY, Hall A, Hay-Smith G, Spratt A, Barton K. Longitudinal Change in Central Corneal Thickness in the Tema Eye Survey. Am J Ophthalmol 2018; 186:10-18. [PMID: 29141198 DOI: 10.1016/j.ajo.2017.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 08/17/2017] [Revised: 11/01/2017] [Accepted: 11/05/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE To determine the change and rate of change in central corneal thickness (CCT) and their determinants. DESIGN Longitudinal observational population-based study. METHODS A total of 758 normal and 58 glaucomatous subjects underwent complete eye examination, with CCT measurements at 2 separate visits. Change and rate of change in CCT were determined. Univariate and multivariate linear regression analyses were performed to determine the factors associated with change and rate of change. RESULTS The mean follow-up duration was 8.4 ± 0.7 years. The overall change was -8.9 ± 16.7 μm in OD and -9.8 ± 16.2 μm in OS, both P < .0001. Changes in glaucomatous and normal subjects were -14.1 ± 2.2 μm vs -8.6 ± 0.6 μm in OD (P = .02) and -14.5 ± 2.2 μm vs -9.5 ± 0.6 μm in OS (P = .03), respectively. The overall rate of thinning was -1.1 μm/year (OD) and -1.2 μm/year (OS). Rates in glaucomatous and normal eyes were -1.7 ± 0.3 μm/year vs -1.0 ± 0.1 μm/year in OD (P = .02) and -1.7 ± 0.3 μm/year vs -1.1 ± 0.1 μm/year in OS (P = .03), respectively. Change and rate of change were associated with baseline CCT (ß = -0.1 to -0.09 and -0.011, respectively, all P < .001) and glaucoma (ß = -6.8 to -5.6, P ≤ .009, and -0.75 to -0.69, P ≤ .007, respectively). CONCLUSION CCT decreased significantly over time. The change and rate of change were greater in glaucomatous than normal eyes, and were greater than described in cross-sectional studies.
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Affiliation(s)
- Jean-Claude Mwanza
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Samantha E Tulenko
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Donald L Budenz
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | | | - Leon H Herndon
- Duke Eye Center, Duke University, Durham, North Carolina
| | - Hanna Y Kim
- Department of Ophthalmology, Kaiser Permanente Woodland Hills Medical Center, Woodland Hills, California
| | - Alyson Hall
- Department of Ophthalmology, The Glaucoma Center, Bowie, Maryland
| | | | | | - Keith Barton
- Moorefields Eye Hospital and Department of Epidemiology and Genetics, Institute of Ophthalmology, University College of London, London, United Kingdom
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17
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Hitzl W, Bunce C, Reitsamer HA, Grabner G, Hornykewycz K. The Projected Increase in Glaucoma Due to the Aging Population in Austria from 2001 to 2031: Results Based on Data of the Salzburg-Moorfields Collaborative Glaucoma Study. Eur J Ophthalmol 2018; 17:45-52. [PMID: 17294382 DOI: 10.1177/112067210701700107] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of this study is to present the projected increase in definite primary open angle glaucoma (POAG) and related diseases in Austria from 2001 to 2031. METHODS The present work is based on two data sources: population projections in Austria and detection rates of the Salzburg-Moorfields Collaborative Glaucoma Study for Austrians in the age groups 40-54 years, 55-69 years, and 70 years and above. The estimates of this glaucoma screening program are based on a total of 3419 subjects. Sensitivity analyses were applied to test the effects of higher and lower sets of prevalence assumptions on the extent of the probable projections. RESULTS The number of Austrians with definite POAG, early POAG, POAG suspects, and ocular hypertension (OHT) is expected to increase until 2031 by 0.5%, 43.1%, and 65.6% in the three age groups specified above, respectively. The overall number of Austrians with POAG at the age of 40 or older is estimated to increase from 67,600 in 2001 to 96,400 in 2031. This corresponds to an increase of 42% from 2001 to 2031 (lower scenario: 37%, upper scenario: 47%). Similar increases are expected for individuals with early POAG, POAG suspects, and OHT. CONCLUSIONS These projections provide an objective basis to estimate the resources that may be needed by health authorities and care providers such as ophthalmologists in the future and should help to design glaucoma blindness prevention programs or screening studies in Austria. The predicted continuous increase of Europe's older population will prove to become a challenge for public health professionals not only for diagnosis and monitoring, but also for the treatment of glaucoma.
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Affiliation(s)
- W Hitzl
- University Clinic of Ophthalmology and Optometry, Paracelsus University Salzburg, St. Johanns-Hospital Salzburg and Research Office, Paracelsus University, Salzburg, Austria.
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18
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Xu X, Xiao H, Guo X, Chen X, Hao L, Luo J, Liu X. Diagnostic ability of macular ganglion cell-inner plexiform layer thickness in glaucoma suspects. Medicine (Baltimore) 2017; 96:e9182. [PMID: 29390457 PMCID: PMC5758159 DOI: 10.1097/md.0000000000009182] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 11/17/2017] [Accepted: 11/18/2017] [Indexed: 11/26/2022] Open
Abstract
The purpose is to assess the diagnostic ability for early glaucoma of macular ganglion cell-inner plexiform layer (GCIPL) thickness in a Chinese population including glaucoma suspects.A total of 367 eyes with primary open-angle glaucoma (168 early glaucoma, 78 moderate glaucoma, and 121 advanced glaucoma), 52 eyes with ocular hypertension (OHT), 59 eyes with enlarged cup-to-disc ratio (C/D), and 225 normal eyes were included. GCIPL thickness (average, minimum, superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal), retinal nerve fiber layer (RNFL) thickness, and optic nerve head (ONH) parameters were measured using Cirrus high-definition optical coherence tomography (OCT) and compared. The diagnostic ability of OCT parameters was assessed by area under receiver operating characteristic curve (AUROC) in 3 distinguishing groups: normal eyes and eyes with early glaucoma, normal eyes and eyes with glaucoma regardless of disease stage, and nonglaucomatous eyes (normal eyes, eyes with OHT, and enlarged C/D) and early glaucomatous eyes.Glaucomatous eyes showed a significant reduction in GCIPL thickness compared with nonglaucomatous eyes. In all 3 distinguishing groups, best-performing parameters of GCIPL thickness, RNFL thickness, and ONH parameters were minimum GCIPL thickness (expressed in AUROC, 0.899, 0.952, and 0.900, respectively), average RNFL thickness (0.904, 0.953, and 0.892, respectively), and rim area (0.861, 0.925, and 0.824, respectively). There was no statistical significance of AUROC between minimum GCIPL thickness and average RNFL thickness (all P > .05).GCIPL thickness could discriminate early glaucoma from normal and glaucoma suspects with good sensitivity and specificity. The glaucoma diagnostic ability of GCIPL thickness was comparable to that of RNFL thickness.
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19
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Daniel E, Pistilli M, Kothari S, Khachatryan N, Kaçmaz RO, Gangaputra SS, Sen HN, Suhler EB, Thorne JE, Foster CS, Jabs DA, Nussenblatt RB, Rosenbaum JT, Levy-Clarke GA, Bhatt NP, Kempen JH. Risk of Ocular Hypertension in Adults with Noninfectious Uveitis. Ophthalmology 2017; 124:1196-1208. [PMID: 28433444 DOI: 10.1016/j.ophtha.2017.03.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 12/01/2016] [Revised: 03/20/2017] [Accepted: 03/20/2017] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To describe the risk and risk factors for ocular hypertension (OHT) in adults with noninfectious uveitis. DESIGN Retrospective, multicenter, cohort study. PARTICIPANTS Patients aged ≥18 years with noninfectious uveitis seen between 1979 and 2007 at 5 tertiary uveitis clinics. METHODS Demographic, ocular, and treatment data were extracted from medical records of uveitis cases. MAIN OUTCOME MEASURES Prevalent and incident OHT with intraocular pressures (IOPs) of ≥21 mmHg, ≥30 mmHg, and increase of ≥10 mmHg from documented IOP recordings (or use of treatment for OHT). RESULTS Among 5270 uveitic eyes of 3308 patients followed for OHT, the mean annual incidence rates for OHT ≥21 mmHg and OHT ≥30 mmHg are 14.4% (95% confidence interval [CI], 13.4-15.5) and 5.1% (95% CI, 4.7-5.6) per year, respectively. Statistically significant risk factors for incident OHT ≥30 mmHg included systemic hypertension (adjusted hazard ratio [aHR], 1.29); worse presenting visual acuity (≤20/200 vs. ≥20/40, aHR, 1.47); pars plana vitrectomy (aHR, 1.87); history of OHT in the other eye: IOP ≥21 mmHg (aHR, 2.68), ≥30 mmHg (aHR, 4.86) and prior/current use of IOP-lowering drops or surgery in the other eye (aHR, 4.17); anterior chamber cells: 1+ (aHR, 1.43) and ≥2+ (aHR, 1.59) vs. none; epiretinal membrane (aHR, 1.25); peripheral anterior synechiae (aHR, 1.81); current use of prednisone >7.5 mg/day (aHR, 1.86); periocular corticosteroids in the last 3 months (aHR, 2.23); current topical corticosteroid use [≥8×/day vs. none] (aHR, 2.58); and prior use of fluocinolone acetonide implants (aHR, 9.75). Bilateral uveitis (aHR, 0.69) and previous hypotony (aHR, 0.43) were associated with statistically significantly lower risk of OHT. CONCLUSIONS Ocular hypertension is sufficiently common in eyes treated for uveitis that surveillance for OHT is essential at all visits for all cases. Patients with 1 or more of the several risk factors identified are at particularly high risk and must be carefully managed. Modifiable risk factors, such as use of corticosteroids, suggest opportunities to reduce OHT risk within the constraints of the overriding need to control the primary ocular inflammatory disease.
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Affiliation(s)
- Ebenezer Daniel
- Scheie Eye Institute, Philadelphia, Pennsylvania; Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Maxwell Pistilli
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Srishti Kothari
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Naira Khachatryan
- Scheie Eye Institute, Philadelphia, Pennsylvania; Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts
| | - R Oktay Kaçmaz
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Mallinckrodt Pharmaceuticals, Staines-upon-Thames, England, United Kingdom
| | - Sapna S Gangaputra
- Department of Ophthalmology and Visual Science, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Laboratory of Immunology, National Eye Institute, Bethesda, Maryland
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland
| | - Eric B Suhler
- Department of Ophthalmology, Department of Medicine, Oregon Health and Science University, Portland, Oregon; Portland Veteran's Affairs Medical Center, Portland, Oregon
| | - Jennifer E Thorne
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Douglas A Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, The Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - James T Rosenbaum
- Department of Ophthalmology, Department of Medicine, Oregon Health and Science University, Portland, Oregon; Legacy Devers Eye Institute, Portland, Oregon; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Nirali P Bhatt
- Scheie Eye Institute, Philadelphia, Pennsylvania; Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - John H Kempen
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Discovery Eye Center, MyungSung Christian Medical Center, Addis Ababa, Ethiopia
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Al-Saleh SA, Al-Dabbagh NM, Al-Shamrani SM, Khan NM, Arfin M, Tariq M, Al-Faleh HM. Prevalence of ocular pseudoexfoliation syndrome and associated complications in Riyadh, Saudi Arabia. Saudi Med J 2016; 36:108-12. [PMID: 25630014 PMCID: PMC4362197 DOI: 10.15537/smj.2015.1.9121] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives: To assess the prevalence of pseudoexfoliation syndrome (PEX), and associated ophthalmic complications among Saudi patients. Methods: The prevalence of PEX and associated ocular co-morbidities were determined among the Saudi patients visiting the Primary Care Clinic of Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia, between January 2009 and January 2010. A total of 1967 patients were examined biomicoscopically by ophthalmologists to determine the presence of PEX and associated ocular complications. Results: Sixty-nine of the 1967 examined patients (3.5%) showed the presence of PEX with no significant gender difference. There was an age dependent increase in the prevalence of PEX after the age of 50 years. Pseudoexfoliation syndrome was associated with higher intraocular pressure, cataract, and poor vision. There was no significant difference in the prevalence of PEX in male and female Saudi patients. Conclusion: Pseudoexfoliation syndrome is an age-related disorder, and its prevalence increases with age. Further larger population based studies are warranted to assess the prevalence of PEX and associated risk factors.
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Affiliation(s)
- Sulaiman A Al-Saleh
- Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Huang OS, Mehta JS, Htoon HM, Tan DT, Wong TT. Incidence and Risk Factors of Elevated Intraocular Pressure Following Deep Anterior Lamellar Keratoplasty. Am J Ophthalmol 2016; 170:153-160. [PMID: 27519560 DOI: 10.1016/j.ajo.2016.07.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 07/27/2016] [Accepted: 07/30/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the incidence and risk factors of elevated IOP following deep anterior lamellar keratoplasty (DALK). DESIGN A retrospective case series. METHODS A retrospective study investigating the 5-year incidence of raised IOP following DALK cases performed from 2004 to 2008 in a tertiary center. Patients with less than 6 months of follow-up were excluded. Elevated IOP was defined as IOP >21 mm Hg. RESULTS An episode of elevated IOP occurred in 36.1% of cases (44/122 cases), 11.4% (n = 5) occurring within the first week. The average duration of raised IOP was 48.9 (SD: 65.5) days. Causes included pupil block from air, swollen grafts, and corticosteroid response. Surgical intervention to lower IOP was required in 3 cases (6.8%). In multivariate analyses, the use of Olopatadine 0.1% or cyclosporine eye drops before DALK (OR = 14.51, 95% CI = 1.43-147.23) and use of topical prednisolone acetate 1% compared with dexamethasone 0.1% post DALK (OR = 4.79, 95% CI = 0.73-31.52) were associated with higher rates of elevated IOP post DALK. At 5 years post DALK, 3 of 71 cases (4.48%) developed de novo glaucomatous field defects, and 1 case with pre-existing glaucoma had progression of glaucomatous field defect. CONCLUSIONS DALK was associated with a significant incidence of transiently elevated IOP postoperatively, but had a low incidence of de novo glaucoma at 5 years in our study. Risk factors for raised IOP post DALK included the use of topical prednisolone acetate 1% compared with dexamethasone 0.1%, and the use of Olopatadine 0.1% or any concentration of cyclosporine eye drops prior to DALK.
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Affiliation(s)
| | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hla M Htoon
- Singapore Eye Research Institute, Singapore; Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore
| | - Donald T Tan
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tina T Wong
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Abstract
Background To evaluate the observed prevalence and the optic nerve head (ONH) characteristics of normal tension glaucoma (NTG)-suspect eyes in branch retinal vein occulusion (BRVO) eyes in Korean population. Methods This was a retrospective observational study. We investigated 445 BRVO eyes that were diagnosed in the retina clinic of Samsung Medical Center between March 2005 and December 2011. The observed prevalence of NTG-suspect in BRVO eyes was evaluated compared to the previous population based study. In addition, NTG-suspect cases in BRVO were divided into three groups based on the characteristics of optic disc morphology. Results In 445 BRVO eyes, 30 eyes were excluded from the present study. In 415 BRVO eyes, 4.3% (18 eyes) (95% confident interval [CI], 2.4–6.3%) were diagnosed with suspect glaucoma and this is not significantly different from the result in the general Korean population (P = 0.09). We classified the NTG-suspect eyes into three groups such as disc rim notching and thinning type (Group 1; 55.6%), optic cup-sited hemorrhage type (Group 2; 16.7%) and disc rim thinning and pallor type (Group 3; 27.8%). NTG-suspect in the fellow eye were only found in group 1 (80%) and group 2 (67%), but not in group 3 (P = 0.01). Conclusions BRVO and glaucoma seem to have no common vascular pathogenesis in consideration of the prevalence of NTG-suspect in BRVO eyes compared to general Korean population.
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Affiliation(s)
- Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doo Ri Eo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taek Kwan Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Hoon Shin
- Department of Ophthalmology, Busan National University Hospital, Busan National University School of Medicine, Busan, Republic of Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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Abstract
OBJECTIVES To explore (1) the national trend in population-adjusted prescription rates for glaucoma and ocular hypertension (OHT) in England and (2) any geographical variation in glaucoma/OHT prescribing trends and its association with established risk factors for primary open-angle glaucoma (POAG) at the population level. DESIGN Observational ecological study. SETTING Primary care in England 2008-2012. PARTICIPANTS All patients who received 1 or more of the 37 778 660 glaucoma/OHT prescription items between 2008 and 2012. PRIMARY AND SECONDARY OUTCOME MEASURE METHODS Glaucoma/OHT prescription statistics for England and its constituent primary care trusts (PCTs) between 2008 and 2012 were divided by annual population estimates to give prescription rates per 100 000 population aged ≥40 years. To examine regional differences, prescription rates and the change in prescription rates between 2008 and 2012 for PCTs were separately entered into multivariable linear regression models with the population proportion aged ≥60 years; the proportion of males; the proportion of West African Diaspora (WAD) ethnicity; PCT funding per capita; Index of Multiple Deprivation 2010 score and its domains. RESULTS Between 2008 and 2012, glaucoma/OHT prescriptions increased from 28 029 to 31 309 items per 100 000 population aged ≥40 years. Between PCTs, nearly a quarter of the variation in prescription rates in 2008 and 2012 could be attributed to age, WAD ethnicity and male gender. The change in prescription rates between 2008 and 2012 was only modestly correlated with age (p=0.003, β=0.234), and income deprivation (p=0.035, β=-0.168). CONCLUSIONS Increased population-adjusted glaucoma/OHT prescription rates in the study period were likely due to increased detection of POAG and OHT cases at risk of POAG. Between PCTs, regional variation in overall prescription rates was partly attributable to demographic risk factors for POAG, although the change in prescription rates was only modestly correlated with the same risk factors, suggesting potential variation in practice.
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Affiliation(s)
- Jacob S Heng
- The Solomon H Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Imperial College London Faculty of Medicine, London, UK
| | - Richard Wormald
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Peng Tee Khaw
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Wang YE, Kakigi C, Barbosa D, Porco T, Chen R, Wang S, Li Y, Singh K, Pasquale LR, Lin SC. Oral Contraceptive Use and Prevalence of Self-Reported Glaucoma or Ocular Hypertension in the United States. Ophthalmology 2016; 123:729-36. [PMID: 26948305 PMCID: PMC4857187 DOI: 10.1016/j.ophtha.2015.11.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/25/2015] [Accepted: 11/29/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To investigate the association between oral contraceptive (OC) use and glaucoma prevalence in the United States. DESIGN Cross-sectional study. PARTICIPANTS A total of 3406 female participants, aged 40 years or older, from the 2005 to 2008 National Health and Nutrition Examination Survey, who reported a presence or absence of glaucoma or ocular hypertension completed both the vision and the reproductive health questionnaires and underwent eye examinations. METHODS Multivariate regression analysis was used to assess the correlation between OC use and self-reported glaucoma or ocular hypertension (n = 231 cases), controlling for potential confounders, including age, ethnicity, systemic comorbidities such as hypertension and stroke, ocular diseases such as cataract and diabetic retinopathy, and reproductive health factors, including age at menopause, age at menarche, history of hormone replacement therapy, and gynecological surgical history. MAIN OUTCOME MEASURES The outcome variable was self-reported glaucoma or ocular hypertension. RESULTS After adjusting for confounders, those with ≥3 years of OC use had greater odds (odds ratio, 1.94; 95% confidence interval, 1.22-3.07) of self-reported glaucoma or ocular hypertension. Other factors associated with higher glaucoma or ocular hypertension prevalence included older age, African American race, and later age at menarche. CONCLUSIONS Oral contraceptive use may be associated with increased risk of self-reported glaucoma or ocular hypertension.
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Affiliation(s)
- Ye Elaine Wang
- Department of Ophthalmology, University of California, San Francisco, California; Department of Ophthalmology, Harbor-UCLA Medical Center, Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - Caitlin Kakigi
- Department of Ophthalmology, University of California, San Francisco, California
| | - Diego Barbosa
- Department of Ophthalmology, University of California, San Francisco, California
| | - Travis Porco
- Department of Ophthalmology, University of California, San Francisco, California
| | - Rebecca Chen
- Department of Ophthalmology, University of California, San Francisco, California; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sophia Wang
- Department of Ophthalmology, University of California, San Francisco, California; Kellogg Eye Institute, University of Michigan, Ann Arbor, Michigan
| | - Yingjie Li
- Department of Ophthalmology, University of California, San Francisco, California; Third Hospital of Nanchang University Medical School, Nanchang, Jiangxi Province, People's Republic of China P.R
| | - Kuldev Singh
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California
| | - Louis R Pasquale
- Massachusetts Eye and Ear Infirmary, Glaucoma Service, Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shan C Lin
- Department of Ophthalmology, University of California, San Francisco, California.
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Affiliation(s)
- Giacomo Strapazzon
- EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy (G.S.)Department of Neurology and Psychiatry, Sapienza University, Rome, Italy (M.F.)Department of Neurology, General Hospital of Bolzano, Bolzano, Italy (M.F.)Department of Neurology, General Hospital of Merano, Merano, Italy (F.B., P.L.)
| | - Marika Falla
- EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy (G.S.)Department of Neurology and Psychiatry, Sapienza University, Rome, Italy (M.F.)Department of Neurology, General Hospital of Bolzano, Bolzano, Italy (M.F.)Department of Neurology, General Hospital of Merano, Merano, Italy (F.B., P.L.)
| | - Francesco Brigo
- EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy (G.S.)Department of Neurology and Psychiatry, Sapienza University, Rome, Italy (M.F.)Department of Neurology, General Hospital of Bolzano, Bolzano, Italy (M.F.)Department of Neurology, General Hospital of Merano, Merano, Italy (F.B., P.L.)
| | - Piergiorgio Lochner
- EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy (G.S.)Department of Neurology and Psychiatry, Sapienza University, Rome, Italy (M.F.)Department of Neurology, General Hospital of Bolzano, Bolzano, Italy (M.F.)Department of Neurology, General Hospital of Merano, Merano, Italy (F.B., P.L.)
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Kanaan NC, Lipman GS, Constance BB, Holck PS, Preuss JF, Williams SR. Reply. J Ultrasound Med 2016; 35:458-459. [PMID: 26795049 DOI: 10.7863/ultra.15.11073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Nicholas C Kanaan
- University of Utah, Salt Lake City, Utah USA (N.C.K.)Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.)Tacoma General Hospital, Tacoma, Washington USA (B.B.C.)University of Hawaii, Honolulu, Hawaii USA (P.S.H.)Royal Perth Hospital, Perth Western Australia, Australia (J.F.P.)
| | - Grant S Lipman
- University of Utah, Salt Lake City, Utah USA (N.C.K.)Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.)Tacoma General Hospital, Tacoma, Washington USA (B.B.C.)University of Hawaii, Honolulu, Hawaii USA (P.S.H.)Royal Perth Hospital, Perth Western Australia, Australia (J.F.P.)
| | - Benjamin B Constance
- University of Utah, Salt Lake City, Utah USA (N.C.K.)Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.)Tacoma General Hospital, Tacoma, Washington USA (B.B.C.)University of Hawaii, Honolulu, Hawaii USA (P.S.H.)Royal Perth Hospital, Perth Western Australia, Australia (J.F.P.)
| | - Peter S Holck
- University of Utah, Salt Lake City, Utah USA (N.C.K.)Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.)Tacoma General Hospital, Tacoma, Washington USA (B.B.C.)University of Hawaii, Honolulu, Hawaii USA (P.S.H.)Royal Perth Hospital, Perth Western Australia, Australia (J.F.P.)
| | - James F Preuss
- University of Utah, Salt Lake City, Utah USA (N.C.K.)Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.)Tacoma General Hospital, Tacoma, Washington USA (B.B.C.)University of Hawaii, Honolulu, Hawaii USA (P.S.H.)Royal Perth Hospital, Perth Western Australia, Australia (J.F.P.)
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Affiliation(s)
- Gaurav Sikri
- Department of Physiology, Armed Forces Medical College, Wanowarie, Pune, Maharashtra, India
| | - Krishan Singh
- Department of Physiology, Armed Forces Medical College, Wanowarie, Pune, Maharashtra, India
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Kanaan NC, Lipman GS, Constance BB, Holck PS, Preuss JF, Williams SR. Reply. J Ultrasound Med 2016; 35:456-457. [PMID: 26795047 DOI: 10.7863/ultra.15.10050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Nicholas C Kanaan
- University of Utah, Salt Lake City, Utah USA (N.C.K.)Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.)Tacoma General Hospital, Tacoma, Washington USA (B.B.C.)University of Hawaii, Honolulu, Hawaii USA (P.S.H.)Royal Perth Hospital, Perth, Western Australia, Australia (J.F.P.)
| | - Grant S Lipman
- University of Utah, Salt Lake City, Utah USA (N.C.K.)Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.)Tacoma General Hospital, Tacoma, Washington USA (B.B.C.)University of Hawaii, Honolulu, Hawaii USA (P.S.H.)Royal Perth Hospital, Perth, Western Australia, Australia (J.F.P.)
| | - Benjamin B Constance
- University of Utah, Salt Lake City, Utah USA (N.C.K.)Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.)Tacoma General Hospital, Tacoma, Washington USA (B.B.C.)University of Hawaii, Honolulu, Hawaii USA (P.S.H.)Royal Perth Hospital, Perth, Western Australia, Australia (J.F.P.)
| | - Peter S Holck
- University of Utah, Salt Lake City, Utah USA (N.C.K.)Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.)Tacoma General Hospital, Tacoma, Washington USA (B.B.C.)University of Hawaii, Honolulu, Hawaii USA (P.S.H.)Royal Perth Hospital, Perth, Western Australia, Australia (J.F.P.)
| | - James F Preuss
- University of Utah, Salt Lake City, Utah USA (N.C.K.)Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.)Tacoma General Hospital, Tacoma, Washington USA (B.B.C.)University of Hawaii, Honolulu, Hawaii USA (P.S.H.)Royal Perth Hospital, Perth, Western Australia, Australia (J.F.P.)
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Ibraheem WA, Ibraheem AB, Tjani AM, Oladejo S, Adepoju S, Folohunso B. Tear Film Functions and Intraocular Pressure Changes in Pregnancy. Afr J Reprod Health 2015; 19:118-122. [PMID: 27337861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Pregnancy related ocular changes are diverse with varied clinical outcome. In a cross-sectional, descriptive case control study, we evaluated tear film functions and intraocular pressure during pregnancy and compared the results with non-pregnant women. A total of 270 participants including 165 healthy pregnant women and 105 non-pregnant who were free from systemic and pre-pregnancy eye diseases were investigated. Snellen's chart, fluorescein dye, No 41 Whatman filter paper, Perkin's tonometer were employed to assess visual acuity, tear break up time (TBUT), Schirmer's test (ST), intraocular pressure (IOP) on all subjects. The mean values for IOP (mmHg), TBUT (seconds) and Schirmer's reading (mm) were: 13.24 ± 2.18, 25.05 ± 9.30, 37.03 ± 17.06 and 14.24 ± 2.66, 22.10 ± 10.81, 50.13 ± 19.10 for cases and controls respectively. Schirmer's reading (SR) was significantly lower among pregnant women. Only age had a statistically significant association with the measured parameters. Our study revealed reduced SR during pregnancy. We suggest routine ocular assessment for pregnant women to forestall deleterious sequelae of dry eye.
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Koçak N, Arslan N, Karti O, Tokgoz Y, Ozturk T, Gunenç U, Kaynak S. Evaluation of the intraocular pressure in obese adolescents. Minerva Pediatr 2015; 67:413-418. [PMID: 26377780] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM The aim of this study was to evaluate the intraocular pressure (IOP) levels of children with normal and high Body Mass Index (BMI) and to find out the potential correlation between glaucoma and obesity. METHODS Thirty obese and thirty healty children were enrolled in this study. Physical examinations and anthropometric measurements of all patients and controls were performed. Obesity was defined as a BMI exceeding the 95th percentile for the patients according to age and sex. All participants were underwent a complete eye examination. The results of these measurements were considered for statistical analysis. RESULTS Mean age was 13.5±2.1 years in obese group and 13.3±2.0 years in control group. Mean BMIs were 28.1±3.9 kg/m2 and 19.7±1.2 kg/m2 in obese and control groups, respectively. No significant difference was found in mean IOP levels of both right and left eyes between two groups (P=0.837 and P=0.755, respectively). There was no significant difference in cup/disc ratios of each eyes and mean central corneal thickness of both right and left eyes between obese patients and controls. In visual field analysis, no statistically significant difference in mean false negativeness and mean false positiveness were found between two groups. There were not also any significant correlations in both mean deviation of each eyes (P=0.78 and P=0.94, respectively) and pattern standart deviation of right and left eyes (P=0.89 and P=0.90, respectively) between obese cases and controls. CONCLUSION In this study, there were no significant difference in IOP measurements, central corneal thicknesses, cup/disc ratios and visual field parameters between obese and normal children. No significant correlation was found between obesity and glaucoma or elevated IOP in children.
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Affiliation(s)
- N Koçak
- Department of Ophthalmology, Dokuz Eylul, University Faculty of Medicine, Izmir, Turkey -
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Benitez-del-Castillo Sanchez J, Morion-Grande M, Marco-Garcia MC, Parron-Carreño T. Epidemiology of pseudoexfoliation syndrome: Demystifying legends and looking to the future. Arch Soc Esp Oftalmol 2015; 90:455-457. [PMID: 26248817 DOI: 10.1016/j.oftal.2015.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/14/2015] [Accepted: 07/01/2015] [Indexed: 06/04/2023]
Affiliation(s)
| | - M Morion-Grande
- Servicio de Oftalmología, Agencia Pública Empresarial Sanitaria Hospital de Poniente, El Ejido, Almería, España
| | - M C Marco-Garcia
- Unidad de Gestión Clínica Ejido Sur, Distrito Sanitario Poniente de Almería, El Ejido, Almería, España
| | - T Parron-Carreño
- Departamento de Enfermería, Fisioterapia y Medicina, Universidad de Almeria, Almeria, España
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Kanaan NC, Lipman GS, Constance BB, Holck PS, Preuss JF, Williams SR. Optic Nerve Sheath Diameter Increase on Ascent to High Altitude: Correlation With Acute Mountain Sickness. J Ultrasound Med 2015; 34:1677-1682. [PMID: 26269295 DOI: 10.7863/ultra.15.14.10060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 10/22/2014] [Accepted: 12/16/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Elevated optic nerve sheath diameter on sonography is known to correlate with increased intracranial pressure and is observed in acute mountain sickness. This study aimed to determine whether optic nerve sheath diameter changes on ascent to high altitude are associated with acute mountain sickness incidence. METHODS Eighty-six healthy adults enrolled at 1240 m (4100 ft), drove to 3545 m (11,700 ft) and then hiked to and slept at 3810 m (12,500 ft). Lake Louise Questionnaire scores and optic nerve sheath diameter measurements were taken before, the evening of, and the morning after ascent. RESULTS The incidence of acute mountain sickness was 55.8%, with a mean Lake Louise Questionnaire score ± SD of 3.81 ± 2.5. The mean maximum optic nerve sheath diameter increased on ascent from 5.58 ± 0.79 to 6.13 ± 0.73 mm, a difference of 0.91 ± 0.55 mm (P = .09). Optic nerve sheath diameter increased at high altitude regardless of acute mountain sickness diagnosis; however, compared to baseline values, we observed a significant increase in diameter only in those with a diagnosis of acute mountain sickness (0.57 ± 0.77 versus 0.21 ± 0.76 mm; P = .04). This change from baseline, or Δ optic nerve sheath diameter, was associated with twice the odds of developing acute mountain sickness (95% confidence interval, 1.08-3.93). CONCLUSIONS The mean optic nerve sheath diameter increased on ascent to high altitude compared to baseline values, but not to a statistically significant degree. The magnitude of the observed Δ optic nerve sheath diameter was positively associated with acute mountain sickness diagnosis. No such significant association was found between acute mountain sickness and diameter elevation above standard cutoff values, limiting the utility of sonography as a diagnostic tool.
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Affiliation(s)
- Nicholas C Kanaan
- University of Utah, Salt Lake City, Utah USA (N.C.K.); Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.); Tacoma General Hospital, Tacoma, Washington USA (B.B.C.); University of Hawaii, Honolulu, Hawaii USA (P.S.H.); and Royal Perth Hospital, Perth, Western Australia, Australia (J.F.P.).
| | - Grant S Lipman
- University of Utah, Salt Lake City, Utah USA (N.C.K.); Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.); Tacoma General Hospital, Tacoma, Washington USA (B.B.C.); University of Hawaii, Honolulu, Hawaii USA (P.S.H.); and Royal Perth Hospital, Perth, Western Australia, Australia (J.F.P.)
| | - Benjamin B Constance
- University of Utah, Salt Lake City, Utah USA (N.C.K.); Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.); Tacoma General Hospital, Tacoma, Washington USA (B.B.C.); University of Hawaii, Honolulu, Hawaii USA (P.S.H.); and Royal Perth Hospital, Perth, Western Australia, Australia (J.F.P.)
| | - Peter S Holck
- University of Utah, Salt Lake City, Utah USA (N.C.K.); Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.); Tacoma General Hospital, Tacoma, Washington USA (B.B.C.); University of Hawaii, Honolulu, Hawaii USA (P.S.H.); and Royal Perth Hospital, Perth, Western Australia, Australia (J.F.P.)
| | - James F Preuss
- University of Utah, Salt Lake City, Utah USA (N.C.K.); Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.); Tacoma General Hospital, Tacoma, Washington USA (B.B.C.); University of Hawaii, Honolulu, Hawaii USA (P.S.H.); and Royal Perth Hospital, Perth, Western Australia, Australia (J.F.P.)
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Kang JH, Wiggs JL, Pasquale LR. Relation between time spent outdoors and exfoliation glaucoma or exfoliation glaucoma suspect. Am J Ophthalmol 2014; 158:605-14.e1. [PMID: 24857689 DOI: 10.1016/j.ajo.2014.05.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 02/02/2014] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the relation between time spent outdoors at various life periods and risk of exfoliation glaucoma or exfoliation glaucoma suspect. DESIGN Retrospective cohort study in the United States. METHODS Participants (49 033 women in the Nurses Health Study and 20 066 men in the Health Professionals Follow-up Study) were 60+ years old, were free of glaucoma and cataract, reported eye examinations, and completed questions about time spent outdoors in direct sunlight at midday at 3 life periods: high school to age 24 years, age 25-35 years, and age 36-59 years (asked in 2006 in women and 2008 in men). Participants were followed biennially with mailed questionnaires from 1980 women/1986 men to 2010. Incident cases (223 women and 38 men) were confirmed with medical records. Cohort-specific multivariable-adjusted rate ratios from Cox proportional hazards models were estimated and pooled with meta-analysis. RESULTS Although no association was observed with greater time spent outdoors in the ages of 25-35 or ages 36-59 years, the pooled multivariable-adjusted rate ratios for ≥11 hours per week spent outdoors in high school to age 24 years compared with ≤5 hours per week was 2.00 (95% confidence interval = 1.30, 3.08; P for linear trend = .001). In women, this association was stronger in those who resided in the southern geographic tier in young adulthood (P for interaction = .07). CONCLUSIONS Greater time spent outdoors in young adulthood was associated with risk of exfoliation glaucoma or exfoliation glaucoma suspect, supporting an etiologic role of early exposures to climatic factors.
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Affiliation(s)
- Jae H Kang
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts.
| | - Janey L Wiggs
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Louis R Pasquale
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
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Wang L, Liu J, Lu T. Clinical analysis of early and mid-late elevated intraocular pressure after silicone oil injection. Eye Sci 2014; 29:85-89. [PMID: 26011957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To discuss the incidence and clinical features of early and mid-late elevated intraocular pressure after pars plana vitrectomy and silicone oil injection, and to evaluate the clinical management of eyes with secondary glaucoma. METHODS This was an observational consecutive case series of 691 eyes in 679 patients who were treated with pars plana vitrectomy and silicone injection. The diagnostic criteria of early elevated intraocular pressure after silicone oil injection was ≥ 21 mmHg two weeks after surgery, while mid-late elevated intraocular pressure was ≥ 21 mmHg after two weeks. The incidence and clinical management of elevated intraocular pressure were analyzed. RESULTS In total, 211 of 691 eyes (30.54%) developed elevated intraocular pressure two weeks after pars plana vitrecto my and silicone injection. Of the 211 eyes, 101 eyes (47.87%) had ocular inflammation, 64 eyes (30.33%) showed hyphema, 35 eyes (16.59%) had silicone oil in the anterior chamber, 6 eyes (2.84% ) had excess silicone oil injected, and 5 eyes (2.37%) had rubeosis irides. Eighty three of 691 eyes (12.01%) developed elevated intraocular pressure after two weeks. Of these 83 eyes, 25 eyes (30.12%) had rubeosis irides, 16 eyes (19.27%) had issues related to topic steroid therapy, 13 eyes (15.66%) had a papillary block, silicone oil in the anterior chamber, 10 eyes (12.05%) had a silicone emulsion, 10 eyes (12.05%) had peripheral anterior synchiae, and 9 eyes (10.84%) had silicone oil in the anterior chamber. All eyes with elevated intraocular pressure were treated with antiglaucoma medications and surgeries. CONCLUSION The reasons for elevated intraocular pressure differed between early and mid-late after pars plana vitrectomy and silicone oil injection. The elevated intraocular pressure can be controlled effectively by immediate diagnosis and proper treatment with medicine and operation.
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Ernest PJG, Busch MJWM, Webers CAB, Beckers HJM, Hendrikse F, Prins MH, Schouten JSAG. Prevalence of end-of-life visual impairment in patients followed for glaucoma. Acta Ophthalmol 2013; 91:738-43. [PMID: 23279740 DOI: 10.1111/j.1755-3768.2012.02555.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the prevalence of end-of-life visual impairment in patients followed for glaucoma. METHODS Data of 122 patients followed for glaucoma who had died between July 2008 and July 2010 and who had visited the ophthalmology outpatient department of a large non-academic Dutch hospital were collected from the medical files. Sixty-one patients had open-angle glaucoma (OAG), and 61 patients were suspect for glaucoma or had ocular hypertension (OHT). Visual impairment was defined as a mean deviation value <-15 dB or a Snellen visual acuity <0.3 (20/60) of the better eye. We determined the number of patients with visual impairment on the last patient visit before death and investigated its main explanations. RESULTS Overall, the mean age at death was 81.8 years after a mean follow-up period of 9.2 years. Seventy-three per cent of all patients had their last visit in the year preceding death. In OAG, 16 patients (26%) had an end-of-life visual impairment. In nine patients (15%), this was caused by glaucoma. Eight of them had substantial visual loss at the initial visit. Six (10%) impaired OAG cases were mainly explained by ocular comorbidity, and there was an equal contribution of comorbidity and glaucoma in one case. Five glaucoma suspects or patients with OHT (8%) were visually impaired at death and these were all caused by ocular comorbidity. CONCLUSION The prevalence of end-of-life visual impairment is considerable in patients with OAG. Substantial visual loss at baseline is an important contributing factor. In glaucoma suspects or patients with OHT, the prevalence is lower and can be attributed to ocular comorbidity.
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Affiliation(s)
- Paul J G Ernest
- University Eye Clinic Maastricht, Maastricht, the NetherlandsDepartment of Epidemiology, Maastricht University, Maastricht, the NetherlandsCatharina Ziekenhuis Eindhoven, Department of Ophthalmology, Eindhoven, the Netherlands
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Renard JP, Rouland JF, Bron A, Sellem E, Nordmann JP, Baudouin C, Denis P, Villain M, Chaine G, Colin J, de Pouvourville G, Pinchinat S, Moore N, Estephan M, Delcourt C. Nutritional, lifestyle and environmental factors in ocular hypertension and primary open-angle glaucoma: an exploratory case-control study. Acta Ophthalmol 2013; 91:505-13. [PMID: 22394398 DOI: 10.1111/j.1755-3768.2011.02356.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [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] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate known and potential risk factors, including nutritional, lifestyle and environmental factors, differentiating patients with high-tension primary open-angle glaucoma (POAG) from control subjects with ocular hypertension (OHT). METHODS In 2006-2007, 111 French ophthalmologists prospectively enrolled 339 cases of POAG and 339 age-matched controls with OHT. After a clinical examination with assessment of ocular risk factors, the ophthalmologist filled, during face-to-face interview, a detailed questionnaire developed by nutritionists and epidemiologist on lifestyle and environmental risk factors, including socio-demographic variables, dietary habits related to omega-3 fatty acids intake, smoking and alcohol drinking and professional exposure to pesticides and other chemicals. Associations of POAG with risk factors were estimated using conditional logistic regression, with adjustment for age, gender and duration of disease. RESULTS In the final multivariate model, by comparison with OHT, POAG was significantly associated with more frequent use of pesticides during the professional life [OR = 2.65, 95% confidence interval (CI): 1.04-6.78, p = 0.04] and with low consumption of fatty fish (OR = 2.14, 95% CI: 1.10-4.17, p = 0.02) and walnuts (OR = 2.02, 95% CI: 1.18-3.47, p = 0.01). POAG was also associated with higher frequency of heavy smoking (40 pack-years or more, OR = 3.93, 95% CI: 1.12-13.80, p = 0.03) but not with moderate (20-40 pack-years) and light smoking (<20 pack-years). CONCLUSIONS These exploratory observations suggest a protective effect of omega-3 fatty acids and a deleterious effect of heavy smoking and professional exposure to pesticides in POAG. This will need to be confirmed in future studies.
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Affiliation(s)
- Jean-Paul Renard
- Hôpital du Val de Grâce, Service d'ophtalmologie, Paris, France.
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Segal O, Ferencz JR, Cohen P, Nemet AY, Nesher R. Persistent elevation of intraocular pressure following intravitreal injection of bevacizumab. Isr Med Assoc J 2013; 15:352-355. [PMID: 23943979] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The number of patients treated with intravitreal injections has increased significantly over the past few years, mainly following the introduction of anti-vascular endothelial growth factor antibody intraocular drugs. Bevacizumab is mostly used in this group of medications. OBJECTIVES To describe persistent elevation of intraocular pressure (IOP) following intravitreal injection of bevacizumab. METHODS We reviewed consecutive cases of persistent IOP elevation after intravitreal bevacizumab injection for exudative age-related macular degeneration (AMD). A total of 424 patients (528 eyes) met the inclusion criteria and received 1796 intravitreal injections of bevacizumab. Persistent IOP elevation was found in 19 eyes (3.6%, 19/528) of 18 patients (4.2%, 18/424) with IOP elevated 30-70 mmHg 3-30 days after injection. RESULTS Mean IOP was 42.6 mmHg (range 30-70); IOP elevations occurred after an average of 7.8 injections of bevacizumab (range 3-13). Injected eyes (19/528) had a significantly higher incidence of elevated IOP than uninjected eyes (fellow eyes), 1/328, P < 0.001. CONCLUSIONS Like other anti-vascular endothelial growth factor (VEGF) substances reported in a few recent studies, intravitreal injection of bevacizumab for neovascular AMD may be associated with persistent IOP elevation. Providers should be aware that significant IOP elevation might occur after repeated treatments.
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Affiliation(s)
- Ori Segal
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
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Hoehn R, Mirshahi A, Hoffmann EM, Kottler UB, Wild PS, Laubert-Reh D, Pfeiffer N. Distribution of intraocular pressure and its association with ocular features and cardiovascular risk factors: the Gutenberg Health Study. Ophthalmology 2013; 120:961-8. [PMID: 23399374 DOI: 10.1016/j.ophtha.2012.10.031] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [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: 12/02/2011] [Revised: 08/28/2012] [Accepted: 10/23/2012] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To describe the distribution of intraocular pressure (IOP) and its association with ocular features and cardiovascular risk factors in an adult European cohort. DESIGN Population-based, cross-sectional study. PARTICIPANTS This analysis was based on a Gutenberg Health Study (GHS) cohort that included 4335 eligible enrollees from among 5000 subjects who participated in the survey from 2007 through 2008. The age range was 35 to 74 years at enrollment. METHODS Participants underwent a standardized protocol with a comprehensive questionnaire; ophthalmic examination including slit-lamp biomicroscopy, noncontact tonometry, fundus photography, central corneal thickness measurement, and visual field testing; and a thorough general examination focused on cardiovascular parameters, psychological evaluation, and laboratory tests, including genetic analysis. MAIN OUTCOME MEASURES Mean and reference interval of IOP stratified by age, gender, and eye. RESULTS Mean ± standard deviation (SD) IOP was 14.0 ± 2.6 mmHg in both eyes, 13.9 ± 2.7 mmHg in right eyes, and 14.0 ± 2.7 mmHg in left eyes. Mean ± SD IOP in men (n = 2216) and in women (n = 2119) was 14.1 ± 2.7 mmHg and 13.9 ± 2.5 mmHg with an intersex difference (P = 0.009). Positive univariate associations with higher IOP were detected for brown iris color, central corneal thickness, hypertension, diabetes, smoking, obesity, dyslipidemia, body mass index, weight, hip size (women only), waist circumference, and waist-to-hip ratio. Multivariate testing revealed male gender, central corneal thickness, brown iris color, hypertension, smoking, and waist-to-hip ratio to be correlated with higher IOP. In women, age correlated negatively with IOP in the multivariate analysis. CONCLUSIONS Intraocular pressure distribution in this cohort yielded a lower mean IOP than in similar white study populations. Increasing age in women correlated with lower IOP. Association analyses with several systemic characteristics revealed that cardiovascular risk factors correlated with higher IOP. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- René Hoehn
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
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Pakdel F, Samimagham H, Shafaroodi A, Sheikhvatan M. Changes of serum calcium, phosphorus, and parathyroid hormone concentrations and ocular findings among patients undergoing hemodialysis. Saudi J Kidney Dis Transpl 2011; 22:1142-1148. [PMID: 22089771] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
There are various reports of ocular abnormalities in metabolic disorders. This study was done with the aim to investigate the relationships between the amounts of serum calcium, phosphorus, and parathyroid hormone concentrations and ocular findings in patients undergoing hemodialysis. Fifty eight patients with end stage renal failure undergoing hemodialysis were randomly selected and enrolled in this prospective study. Demographic data, history of diabetes mellitus and hypertension, and duration of hemodialysis were recorded. Serum calcium, phosphorus, alkaline phosphatase (ALP), and parathyroid hormone (PTH) concentrations were measured. Also, blood urea nitrogen (BUN) and weight of the patient was measured just before and three minutes after the hemodialysis. Patients also underwent a complete ocular examination including visual acuity, intraocular pressure (IOP), biomicroscopic examination, and fundoscopy. In univariate analysis, adverse relationships were found between the ocular hypertension and ALP concentration (P = 0.017) and also between the visual acuity and phosphorus concentration (P = 0.033). However, in multivariate regression analysis and with regard to the patients' characteristics and medical history in a multivariate model, no relationships were found between ocular findings and serum calcium, phosphorus, ALP, and PTH concentrations. No relationships were found between the serum concentrations of calcium, phosphorus, ALP, and PTH and ocular findings in patients with end stage renal failure undergoing hemodialysis.
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Affiliation(s)
- Farzad Pakdel
- Department of Nephrology, Hormozgan University of Medical Sciences, Bandarabbas, Iran
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Wang D, Huang W, Li Y, Zheng Y, Foster PJ, Congdon N, He M. Intraocular pressure, central corneal thickness, and glaucoma in chinese adults: the liwan eye study. Am J Ophthalmol 2011; 152:454-462.e1. [PMID: 21679915 DOI: 10.1016/j.ajo.2011.03.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [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: 10/03/2010] [Revised: 03/03/2011] [Accepted: 03/08/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE To describe the distribution of central corneal thickness (CCT), intraocular pressure (IOP), and their determinants and association with glaucoma in Chinese adults. DESIGN Population-based cross-sectional study. METHODS Chinese adults aged 50 years and older were identified using cluster random sampling in Liwan District, Guangzhou. CCT (both optical [OCCT] and ultrasound [UCCT]), intraocular pressure (by Tonopen, IOP), refractive error (by autorefractor, RE), radius of corneal curvature (RCC), axial length (AL), and body mass index (BMI) were measured, and history of hypertension and diabetes (DM) was collected by questionnaire. Right eye data were analyzed. RESULTS The mean values of OCCT, UCCT, and IOP were 512 ± 29.0 μm, 542 ± 31.4 μm, and 15.2 ± 3.1 mm Hg, respectively. In multiple regression models, CCT declined with age (P < .001) and increased with greater RCC (P < .001) and DM (P = .037). IOP was positively associated with greater CCT (P < .001), BMI (P < .001), and hypertension (P < .001). All 25 persons with open-angle glaucoma had IOP <21 mm Hg. CCT did not differ significantly between persons with and without open- or closed-angle glaucoma. Among 65 persons with ocular hypertension (IOP >97.5th percentile), CCT (555 ± 29 μm) was significantly (P = .01) higher than for normal persons. CONCLUSIONS The distributions of CCT and IOP in this study are similar to that for other Chinese populations, though IOP was lower than for European populations, possibly due to lower BMI and blood pressure. Glaucoma with IOP <21 mm Hg is common in this population. We found no association between glaucoma and CCT, though power (0.3) for this analysis was low.
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Affiliation(s)
- Dandan Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yuetao Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yingfeng Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Paul J Foster
- National Biomedical Research Centre for Ophthalmology, Institute of Ophthalmology, University College London and Moorfields Eye Hospital, London, United Kingdom
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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Healey PR, Lee AJ, Aung T, Wong TY, Mitchell P. Diagnostic accuracy of the Heidelberg Retina Tomograph for glaucoma a population-based assessment. Ophthalmology 2010; 117:1667-73. [PMID: 20816247 DOI: 10.1016/j.ophtha.2010.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [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: 04/25/2009] [Revised: 07/06/2010] [Accepted: 07/06/2010] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the Heidelberg Retina Tomograph II (HRTII; Heidelberg Engineering, Heidelberg, Germany) as a screening tool for open-angle glaucoma (OAG) in an older population. DESIGN Population-based, cross-sectional study. PARTICIPANTS Participants from the 10-year follow-up Blue Mountains Eye Study (n = 1952; 75.6% of survivors). METHODS Participants underwent optic nerve head imaging performed using the HRTII; OAG was diagnosed independently from optic disc photographs and Humphrey 24-2 visual fields. MAIN OUTCOME MEASURES The Moorfields Regression Analysis (MRA) was applied to scans using the default results of "normal," borderline," and "outside normal limits." Outcome classification was at the person level and used data from both eyes. RESULTS Mean age was 73.7 years. The HRT scans could be acquired in 1644 participants, 95.9% of those fully examined; 87.4% of scans having a topography standard deviation (TSD) < or =40 microm. Larger TSD was associated with older age and OAG. The MRA sensitivity was 64.1%, specificity 85.7%, positive predictive value 21%, and negative predictive value 97.6% for detecting OAG. Including borderline results improved sensitivity (87.0%) but specificity dropped to 70.6%. Significant predictors of abnormal MRA included OAG (odds ratio [OR], 7.70; 95% confidence interval [CI] 4.79-12.35), age (OR, 1.05; 95% CI, 1.03-1.07), TSD (OR, 1.01; 95% CI, 1.003-1.020) and disc size (OR, 3.2; 95% CI, 2.31-4.49). Diagnostic accuracy was improved by restricting TSD <40 microm. Further TSD restriction improved specificity at the expense of sensitivity. As disc size increased, specificity fell whereas sensitivity, OAG prevalence, and the proportion testing positive rose. Glaucoma prevalence, positive predictive value, and the proportion testing positive increased, but specificity fell with increasing age. Sensitivity also fell between youngest and oldest groups. Diagnostic performance improved for visual field mean deviation < -4.0 dB. Single eye analyses overestimated specificity and underestimated sensitivity compared with using data from both eyes. CONCLUSIONS Diagnostic test evaluation studies of HRTII using single eye analyses or restrictive selection overestimate test accuracy compared with this population-based study. Although the specificity of the MRA was inadequate for use as a glaucoma screening test, the HRTII performed relatively well in an unselected older population with acceptable quality scans in most eyes.
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Affiliation(s)
- Paul R Healey
- Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Sydney, NSW, Australia.
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Griffin BA, Elliott MN, Coleman AL, Cheng EM. Incorporating mortality risk into estimates of 5-year glaucoma risk. Am J Ophthalmol 2009; 148:925-31.e7. [PMID: 19800612 DOI: 10.1016/j.ajo.2009.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 10/29/2008] [Revised: 07/07/2009] [Accepted: 07/10/2009] [Indexed: 11/18/2022]
Abstract
PURPOSE To incorporate mortality risk, a potentially important factor to consider when deciding whether to initiate therapy for ocular hypertensives, into estimates of 5-year glaucoma risk. DESIGN Comparison study of estimates of glaucoma risk that do and do not account for mortality risk. METHODS We computed 5-year risk of glaucoma for a set of hypothetical glaucoma suspects. We then determined their 5-year risk of death using the Charlson index, which is based on age and comorbidity, and computed mortality-adjusted 5-year risk that the individual will develop glaucoma before death. RESULTS Accounting for mortality risk reduces the risk of developing glaucoma in one's lifetime. For example, a 75-year-old patient with an unadjusted 5-year glaucoma risk of 51.0% can have mortality-adjusted 5-year glaucoma risks of 41.8% (18% relative risk reduction) or 20.2% (60% relative risk reduction) assuming the patient has a Charlson comorbidity score of 1 or 3, respectively. CONCLUSIONS Shortened life expectancy reduces 5-year risk of developing glaucoma. Thus, mortality risk is another factor clinicians should consider when deciding whether to initiate treatment of glaucoma suspects.
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Abstract
PURPOSE Primarily to determine the prevalence of various types of glaucoma and ocular hypertension in Wroclaw inhabitants aged 40-79 years. The second aim of the study was to determine the number of undiagnosed glaucoma cases in this population. METHODS A representative group of the Wroclaw population (4853 people aged from 40 to 79 years) was recruited by a proportional simple random sampling selection with stratification. All participants underwent the first, screening-stage examination, which included a medical history interview, intraocular pressure (IOP) measurement, anterior chamber depth assessment by the Van Herrick technique, and optic nerve head (ONH) assessment by means of indirect ophthalmoscopy (Volk's lens), confocal scanning laser ophthalmoscopy with a Heidelberg Retinal Tomograph (HRT) and scanning laser polarimetry by the GDx Nerve Fiber Analyzer (GDx). The second stage, in glaucoma-suspect patients only, included best corrected visual acuity, static perimetry, 24-hour monitoring of IOP, gonioscopy, and full eye examination with mydriasis. Glaucoma was diagnosed by the presence of any two of the following: characteristic morphological changes in the optic disc, glaucomatous visual field abnormalities, and intraocular pressure greater than 21 mmHg. RESULTS The overall prevalence of glaucoma was 1.6% (79 subjects). The prevalence increased with age from 0.4% in subjects belonging to the age group 40-49 years to 4.6% in people aged between 70 and 79 years. The prevalence of definite primary open-angle glaucoma was 1.0% (49 subjects). Normal-pressure glaucoma was diagnosed in 13 subjects (0.3%). Ocular hypertension was diagnosed in 92 subjects (1.9%). CONCLUSION The prevalence of the different types of glaucoma was similar to that found in other white populations. Among the subjects examined, 79 had various forms of glaucoma and 71% of them had not previously been diagnosed. Undiagnosed glaucoma is a serious public health problem in Poland.
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Stefan C, Dumitrica DM, Dragomir L, Cristea I, Sapundgieva A. [Ocular hypertension--follow up or treatment?]. Oftalmologia 2009; 53:23-25. [PMID: 19697835] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Ocular hypertension is an increase in the pressure in the eyes that is above the range considered normal with no detectable changes in vision or damage to the structure of your eyes. The term is used to distinguish people with elevated pressure from those with glaucoma, but not all people with ocular hypertension will develop this disease. However, there is an increased risk of glaucoma among those with ocular hypertension, so regular comprehensive eye examinations are essential to the overall eye health.
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Affiliation(s)
- C Stefan
- Sectia Clinica de Oftalmologie, Spitalul Clinic de Urgenta Militar Central
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Pauli AM, Bentley E, Diehl KA, Miller PE. Effects of the application of neck pressure by a collar or harness on intraocular pressure in dogs. J Am Anim Hosp Assoc 2007; 42:207-11. [PMID: 16611932 DOI: 10.5326/0420207] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The effect on intraocular pressure (IOP) from dogs pulling against a collar or a harness was evaluated in 51 eyes of 26 dogs. The force each dog generated while pulling against a collar or a harness was measured. Intraocular pressure measurements were obtained during application of corresponding pressures via collars or harnesses. Intraocular pressure increased significantly from baseline when pressure was applied via a collar but not via a harness. Based on the results of the study, dogs with weak or thin corneas, glaucoma, or conditions for which an increase in IOP could be harmful should wear a harness instead of a collar, especially during exercise or activity.
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Affiliation(s)
- Amy M Pauli
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
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Pasquale LR, Dolgitser M, Wentzloff JN, Stern LS, Doyle JJ, Chiang TH, Walt JG. Health care charges for patients with ocular hypertension or primary open-angle glaucoma. Ophthalmology 2007; 115:633-638.e4. [PMID: 17716736 DOI: 10.1016/j.ophtha.2007.04.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 04/10/2007] [Accepted: 04/16/2007] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To determine the total and condition-related direct health care charges of patients with ocular hypertension (OH) or primary open-angle glaucoma (POAG) and identify factors that affect these charges. DESIGN Retrospective cohort study. PARTICIPANTS Patients with OH (n = 36 767) and POAG (n = 72 412) with > or =1 year of continuous enrollment during calendar years 1998 through 2005 in a nationally representative, multimanaged health plan database (PharMetrics). METHODS First year total health care and condition-related charges were calculated. Subsequently multivariate linear regression models determined the impact of ophthalmic condition (OH or POAG), age, index year, gender, geographic region, payer mix, product type, treatment with glaucoma medication, ocular comorbidities, and systemic comorbidities on these charges. MAIN OUTCOME MEASURES Per-person per year first-year total health care and ocular condition-related charges in United States dollars, adjusted for multiple covariates. RESULTS Patients with POAG had significantly higher adjusted total and condition-related health care charges during the first year of follow-up than patients with OH in multivariable analysis ($2070 vs. $1990, P<0.0001 and $556 vs. $322 P<0.0001, respectively). Females and older patients had higher total health care charges compared with males and younger patients ($586 or 28.3% more; P<0.0001 and $27 per year or 0.8% per year more; P<0.0001, respectively). However, neither gender nor age were strong determinants of condition-related charges (P = 0.13 and P = 0.052, respectively). Index year, region, payer, and product types significantly dictated both total and disease-related charges. Patients with ocular comorbid conditions, including cataracts, cataract surgery, diabetic retinopathy, and blindness, had significantly higher total and condition-related health care charges than patients without these conditions (P<0.0001). CONCLUSION Total and condition-related health care charges are considerable for patients with OH and POAG. These data identify several factors that dictate these charges.
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Affiliation(s)
- Louis R Pasquale
- Glaucoma Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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Behrouzi Z, Rabei HM, Azizi F, Daftarian N, Mehrabi Y, Ardeshiri M, Mohammadpour M. Prevalence of Open-angle Glaucoma, Glaucoma Suspect, and Ocular Hypertension in Thyroid-related Immune Orbitopathy. J Glaucoma 2007; 16:358-62. [PMID: 17570998 DOI: 10.1097/ijg.0b013e31802e644b] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the prevalence of open-angle glaucoma (OAG), glaucoma suspects (GS), and ocular hypertension (OHT) in patients with thyroid-related immune orbitopathy (TRIO) and compare it with a control group. PATIENTS AND METHODS In this cross-sectional analytic study, 233 eyes of 117 patients with TRIO (case group) and 240 eyes of 120 normal age and sex-matched individuals (control group) underwent complete ocular examinations. Grave orbitopathy (GO) was diagnosed by clinical examinations with the help of an endocrinologist and para clinic tests. Controls were selected among apparently healthy individuals with no history of previous orbitopathy or thyroid diseases. RESULTS Prevalence of OAG and OHT was 2.5% and 8.5% in the case group, respectively. In contrast, OAG was detected in only 2 eyes (0.8%) of the control group and there were no instances of GS or OHT in the control group. Although the prevalence of OAG and GS were higher in cases than controls, this difference was not statistically significant. However, OHT was more common in cases (P<0.01). Ten eyes in the case group (4.3%) developed compressive optic neuropathy (CON); high intraocular pressure was detected in 5 of them (2.1%). All cases of OAG and GS in the case group were classified as stage 3 or higher of No symptoms or signs, Only signs no symptoms, Soft tissue, Proptosis, Extraocular muscle, Cornea, Sight loss. Active GO was only more prevalent in patients with OHT (P<0.001). CONCLUSIONS The prevalence of OHT was higher in cases with GO than age and sex-matched controls. Ophthalmologic examinations including intraocular pressure measurement (and if needed automated visual fields) should be regularly performed in patients with GO particularly in higher stages and those with active disease.
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Affiliation(s)
- Zohreh Behrouzi
- Department of Ophthalmology, Imam Hossein Hospital, Ophthalmic Research Center, Tehran, Iran
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Abstract
AIM To determine the prevalence and clinical characteristics of the inflammatory ocular hypertension syndrome (IOHS) in patients with uveitis and serological evidence of syphilis. METHODS A retrospective, observational case review of 39 consecutive patients with uveitis and serological evidence of syphilis was carried out between January 1977 and December 2001. Other causes of uveitis were excluded. The prevalence and clinical characteristics of IOHS among patients with uveitis and serological evidence of syphilis were documented. IOHS was defined as an increase in intraocular pressure (IOP) of more than 21 mm Hg that began at the onset of acute, recurrent, or chronic anterior chamber inflammation and reversed promptly with appropriate anti-inflammatory or antimicrobial treatment. RESULTS Of the 39 patients with uveitis and serological evidence of syphilis, eight eyes from seven patients (18%) presented with IOHS, a significantly higher prevalence than in the uveitis population at large (2.3%; p<0.001). Best-corrected visual acuity varied from 20/20 to 20/200, with a median of 20/40, and three of the eight eyes (37.5%) had granulomatous features, including large keratic precipitates and, in two eyes, Koeppe nodules. Intraocular pressure varied from 23 to 51 mm Hg, with a mean of 36 and a median of 34. One patient had bilateral IOHS. CONCLUSIONS Syphilitic uveitis should be included in the differential diagnosis of IOHS along with more commonly recognised causes.
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Affiliation(s)
- S Reddy
- Francis I Proctor Foundation, UCSF, San Francisco, California, USA
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Abstract
PURPOSE To study how many of the patients with treated glaucoma or ocular hypertension go blind during their lifetime and which factors are associated with blindness. PATIENTS The data on 106 consecutive patients who had died between 1991 and 2002 was retrospectively evaluated. At diagnosis 39 patients had primary open-angle glaucoma, 27 had exfoliation glaucoma, and 40 had ocular hypertension. METHODS Clinical records and causes of death were reviewed. Visual disability at the last visit before death was evaluated. Outcome measures were visual handicap and blindness based on visual acuity and/or visual fields. RESULTS At the last visit, 17 patients [16%, 95% confidence interval (CI) 9-23] were visually handicapped. Thirteen patients (14%) were bilaterally blind. Glaucoma was the cause of blindness in one or both eyes in 16 patients (15%, 95% CI 8-22) and in both eyes in 6 patients (6%, 95% CI 1-10). In the analysis of only 1 eye of each patient, the cumulative incidence of glaucoma-caused blindness was 6% (95% CI 2-11) at 5 years, 9% (95% CI 4-15) at 10 years, and 15% (95% CI 9-23) at 15 years. An advanced stage of glaucoma at diagnosis, fluctuation in intraocular pressure during treatment, the presence of exfoliation syndrome, and poor patient compliance increased the occurrence of blindness. Positive family history of glaucoma and vascular causes of death had no effect on visual outcome. CONCLUSIONS Glaucoma-caused blindness was associated with an advanced stage of glaucoma at diagnosis, fluctuation of intraocular pressure during treatment, the presence of exfoliation syndrome, and poor patient compliance. The risk of going blind from glaucoma in both eyes was 6%.
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Affiliation(s)
- Eva Forsman
- Population Genetics Unit, Folkhälsan Institute of Genetics, University of Helsinki, Helsinki, Finland.
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