Known for its unique cross-disciplinary investigative programs and clinical excellence,the scientists and clinicians at the Hamilton Glaucoma Center of the University of California,San Diego seek to en-
Glaucoma is a multifactorial eye disorder that can cause vision loss and irreversible blindness,affecting individ uals aged 40 to 80 yea rs worldwide.Due to the aging population,it is expected that the number of peopl...Glaucoma is a multifactorial eye disorder that can cause vision loss and irreversible blindness,affecting individ uals aged 40 to 80 yea rs worldwide.Due to the aging population,it is expected that the number of people affected by glaucoma will surpass 111 million by 2040 as the disease becomes more prevalent.Glaucoma primarily contributes to optic nerve axon loss and the progressive degeneration of retinal ganglion cells (RGCs),subsequently leading to vision impairment.展开更多
AIM: To determine the discriminating performance of the macular ganglion cell-inner plexiform layer(GCIPL) parameters between all the consecutive stages of glaucoma(from healthy to moderate-to-severe glaucoma), and to...AIM: To determine the discriminating performance of the macular ganglion cell-inner plexiform layer(GCIPL) parameters between all the consecutive stages of glaucoma(from healthy to moderate-to-severe glaucoma), and to compare it with the discriminating performances of the peripapillary retinal nerve fiber layer(RNFL) parameters and optic nerve head(ONH) parameters.METHODS: Totally 147 eyes(40 healthy, 40 glaucoma suspects, 40 early glaucoma, and 27 moderate-to-severe glaucoma) of 133 subjects were included. Optical coherence tomography(OCT) was obtained using Cirrus HD-OCT 5000. The diagnostic performances of GC-IPL, RNFL, and ONH parameters were evaluated by determining the area under the curve(AUC) of the receiver operating characteristics. RESULTS: All GC-IPL parameters discriminated glaucoma suspect patients from subjects with healthy eyes and moderate-to-severe glaucoma from early glaucoma patients(P<0.017, for all). Also, minimum, inferotemporal and inferonasal GC-IPL parameters discriminated early glaucoma patients from glaucoma suspects, whereas no RNFL or ONH parameter could discriminate between the two. The best parameters to discriminate glaucoma suspects from subjects with healthy eyes were superonasal GC-IPL, superior RNFL and average c/d ratio(AUC=0.746, 0.810 and 0.746, respectively). Discriminating performances of all the parameters for early glaucoma vs glaucoma suspect comparison were lower than that of the other consecutive group comparisons, with the bestGC-IPL parameters being minimum and inferotemporal(AUC=0.669 and 0.662, respectively). Moreover, minimum GC-IPL, average RNFL, and rim area(AUC=0.900, 0.858, 0.768, respectively) were the best parameters for discriminating moderate-to-severe glaucoma patients from early glaucoma patients.CONCLUSION: GC-IPL parameters can discriminate glaucoma suspect patients from subjects with healthy eyes, and also all the consecutive stages of glaucoma from each other(from glaucoma suspect to moderate-tosevere glaucoma). Further, the discriminating performance of GC-IPL thicknesses is comparable to that.展开更多
AIM：To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve（AGV） implantation. METHODS： Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation se...AIM：To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve（AGV） implantation. METHODS： Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation separately were included in this retrospective chart review.Main outcome measures were surgical failure and complications.Failure was defined as intraocular pressure（IOP） 〉21 mm Hg or 〈5 mm Hg on two consecutive visits after 3mo,reoperation for glaucoma,or loss of light perception.Eyes that had not failed were considered as complete success if they did not required supplemental medical therapy.RESULTS： A total of 64 eyes from 57 patients were included： 31 eyes in the Ex-PRESS group and 33 eyes in the AGV group.The mean follow-up time was 2.6 ±1.1y and 3.3±1.6y,respectively.Patients in the AGV group had significantly higher baseline mean IOP（P =0.005）,lower baseline mean visual acuity（VA）（P =0.02）,and higher proportion of patients with history of previous trabeculectomy（P 〈0.0001）.Crude failure rates were 16.1%,n =5/31 in the Ex-PRESS group and 24.2%,n =8/33 in the AGV group.The cumulative proportion of failure was similar between the groups,P =0.696.The proportion of eyes that experienced postoperative complications was32.3% in the Ex-PRESS group and 60.1% in the AGV group（P =0.0229）.CONCLUSION： Trabeculectomy with Ex-PRESS implant and AGV implantation had comparable failure rates.The AGV group had more post-operative complications,but also included more complex cases with higher baselinemean IOP,worse baseline mean VA,and more previous glaucoma surgeries.Therefore,the results are limited to the cohort included in this study.展开更多
AIM： To evaluate the use of short-duration transient visual evoked potentials（VEP） and color reflectivity discretization analysis（CORDA） in glaucomatous eyes,eyes suspected of having glaucoma,and healthy eyes.MET...AIM： To evaluate the use of short-duration transient visual evoked potentials（VEP） and color reflectivity discretization analysis（CORDA） in glaucomatous eyes,eyes suspected of having glaucoma,and healthy eyes.METHODS： The study included 136 eyes from 136 subjects： 49 eyes with glaucoma,45 glaucoma suspect eyes,and 42 healthy eyes.Subjects underwent Humphrey visual field（VF） testing,VEP testing,as well as peripapillary retinal nerve fiber layer optical coherence tomography imaging studies with post-acquisition CORDA applied.Statistical analysis was performed using means and ranges,ANOVA,post-hoc comparisons using Turkey＇s adjustment,Fisher＇s Exact test,area under the curve,and Spearman correlation coefficients.RESULTS： Parameters from VEP and CORDA correlated significantly with VF mean deviation（MD）（P〈0.05）.In distinguishing glaucomatous eyes from controls,VEP demonstrated area under the curve（AUC） values of 0.64-0.75 for amplitude and 0.67-0.81 for latency.The CORDA HR1 parameter was highly discriminative for glaucomatous eyes vs controls（AUC=0.94）.CONCLUSION： Significant correlations are found between MD and parameters of short-duration transient VEP and CORDA,diagnostic modalities which warrant further consideration in identifying glaucoma characteristics.展开更多
AIM:To evaluate aspects of cognition impacted by individuals with and without normal tension glaucoma.METHODS:Fifty normal tension glaucoma(NTG)and 50 control patients≥50 y of age were recruited from the UCSF Departm...AIM:To evaluate aspects of cognition impacted by individuals with and without normal tension glaucoma.METHODS:Fifty normal tension glaucoma(NTG)and 50 control patients≥50 y of age were recruited from the UCSF Department of Ophthalmology.Demographic data and glaucoma parameters were extracted from electronic medical records for both groups.Tests of executive function[Executive Abilities:Measures and Instruments for Neurobehavioral Evaluation and Research(EXAMINER)]and learning and memory[California Verbal Learning Test–Second Edition(CVLT-II)]were administered to both NTG and controls.Race,handedness,best-corrected visual acuity,maximum intraocular pressure,optic nerve cup-todisc ratio,visual field and optic nerve optical coherence tomography parameters,and a measure of general health(Charlson Comorbidity Index)were compared between NTG and controls as well as within NTG subgroups.Multivariate linear regression was used to compare group performances on the EXAMINER battery and CVLT-II while controlling for age,sex,and years of education.RESULTS:NTG and controls were comparable with respect to age,sex,race,education,handedness,and the Charlson Comorbidity Index(P>0.05 for all).Performance on the EXAMINER composite score and the CVLT-II did not differ between NTG and controls(P>0.05 for both).CONCLUSION:This is the first prospective study in which the cognitive function of subject with NTG were evaluated using a comprehensive,computerized neurocognitive battery.Subjects with NTG do not perform worse than unaffected controls on tests of executive function,learning,and memor y.Results do not suppor t the hypothesis that individuals with NTG are at higher risk for cognitive dysfunction and/or dementia.展开更多
AIM: To report short-term outcomes of mitomycin C-augmented excisional bleb revision with capsulectomy(ERC) after Ahmed glaucoma valve(AGV) failure.METHODS: Patients who underwent ERC procedures between January 2017 a...AIM: To report short-term outcomes of mitomycin C-augmented excisional bleb revision with capsulectomy(ERC) after Ahmed glaucoma valve(AGV) failure.METHODS: Patients who underwent ERC procedures between January 2017 and December 2019 with a minimum follow-up of 6mo were evaluated retrospectively for indications of AGV and AGV implantation to ERC interval.The number of anti-glaucoma medications(AGMs),intraocular pressure(IOP) and best corrected visual acuity(BCVA) were recorded at baseline, 1, 7, 30, 90, and 180d.Intra-and postoperative complications were also recorded.Positive outcome was defined as IOP≤21 mm Hg with or without AGMs.RESULTS: Fourteen eyes [14 patients, median age 69.5y, interquartile range(IQR) 61.3-80] were included.Pseudoexfoliative glaucoma(n=5, 36%) was the most common form of glaucoma. The median AGV implantation to ERC interval was 8.8mo(IQR 3.91-43.67). At 6mo, the median number of AGMs decreased from 3.0(IQR 3.0-4.0)to 2.0(IQR 1.5-3), the median IOP decreased from 26 mm Hg(IQR 22-29) to 16.5 mm Hg(IQR 13.75-20) and there was no significant change in BCVA. The success rate at 6mo was 92.9%. The Kaplan-Meier cumulative probability of survival was 93%, 79%, 64%, and 64% at 1wk, and 1,3, and 6mo, respectively. No intraoperative complications were identified. Postoperative complications were identified in 5 eyes(36%), which were resolved spontaneously during the first week following ERC.CONCLUSION: ERC has a high success rate for shortterm management of AGV failure. A longer follow-up study is required to determine long-term cumulative failure rates.展开更多
Dear Sir,Previous reports have illustrated reversible structural changes in optic disc cupping,the lamina cribrosa,and the retinal nerve fiber layer(RNFL)following glaucoma surgery[1-3].However,few studies have assess...Dear Sir,Previous reports have illustrated reversible structural changes in optic disc cupping,the lamina cribrosa,and the retinal nerve fiber layer(RNFL)following glaucoma surgery[1-3].However,few studies have assessed changes in macular thickness following such intervention.Our aim was to investigate the impact of intraocular pressure(IOP)reduction after glaucoma surgery on total macular thickness展开更多
AIM: To describe a newly-recognized entity, illustrated by five cases of glaucoma in whom trauma to the head, but not the eye, resulted in marked, transient elevation of intraocular pressure (IOP). METHODS: Retrospect...AIM: To describe a newly-recognized entity, illustrated by five cases of glaucoma in whom trauma to the head, but not the eye, resulted in marked, transient elevation of intraocular pressure (IOP). METHODS: Retrospective case series. Chart review. RESULTS: All five cases had a diagnosis of primary open-angle glaucoma prior to the experience of trauma to the head. All cases had an unusual elevation of IOP (around 70 percent) for days to weeks following the trauma, after which the IOP fell to pre-accident levels. No cause other than the trauma could be determined. CONCLUSION: The relationship between head trauma and elevation of IOP appears real.展开更多
Primary angle-closure glaucoma(PACG)is a subtype of glaucoma that affects 16 million people worldwide,of whom4 million are bilaterally blind.This prevalence of PACG is expected to increase to 21 million cases by 2020,...Primary angle-closure glaucoma(PACG)is a subtype of glaucoma that affects 16 million people worldwide,of whom4 million are bilaterally blind.This prevalence of PACG is expected to increase to 21 million cases by 2020,and it is expected that 5.3 million people will become展开更多
AIM:To validate the ability of the Heidelberg Edge Perimeter(HEP)in detecting glaucomatous visual field(VF)defects compared to the Octopus Visual Field(OVF)Analyzer and to determine the test-retest repeatability of bo...AIM:To validate the ability of the Heidelberg Edge Perimeter(HEP)in detecting glaucomatous visual field(VF)defects compared to the Octopus Visual Field(OVF)Analyzer and to determine the test-retest repeatability of both modalities.METHODS:This prospective,cross-sectional study was conducted at Wills Eye Hospital,Philadelphia,PA.Glaucoma subjects and unaffected controls underwent VF testing using HEP standard automated perimetry(SAP)Ⅲ30-2 Adaptive Staircase Thresholding Algorithm(ASTA)FAST protocol and OVF G-TOP white-on-white strategy.Testing order was randomized.Pearson's correlation coefficient was calculated for both mean deviation(MD)and pattern standard deviation/square root of loss of variance(PSD/s LV).Receiver operating characteristic(ROC)curves were used to determine the diagnostic abilities of both modalities.Glaucoma subjects returned for repeat testing and intraclass correlation coefficients(ICCs)were calculated to assess test-retest repeatability.RESULTS:Seventy-nine subjects with glaucoma and 36 unaffected controls were enrolled.HEP and OVF were significantly correlated for both MD(r=-0.84;P<0.01)and PSD/s LV(r=0.79;P<0.01).Areas under the ROC curves(AUCs)were also comparable between HEP and OVF for both MD(0.74 and 0.79,respectively;P=0.26)and PSD/sL V(0.74 and 0.82;P=0.08).ICC was high for both HEP(0.96 for MD,0.95 for PSD/s LV)and OVF(0.82 and 0.88,respectively).Mean test duration(min)was significantly shorter for OVF(2.63)compared to HEP(5.15;P<0.01).CONCLUSION:HEP and OVF show strong correlation for both MD and PSD/s LV,and have similar validity for detecting glaucoma.The test-retest repeatability is high for both HEP and OVF,however the average testing duration of HEP is significantly longer than that of OVF.展开更多
Schools are an important avenue to tackle the rising prevalence of uncorrected refractive error among children.School-based vision programs are an innovative approach of vision care delivery in the urban school settin...Schools are an important avenue to tackle the rising prevalence of uncorrected refractive error among children.School-based vision programs are an innovative approach of vision care delivery in the urban school setting in the United States.These programs are effective in improving vision outcomes and advancing health equity,especially among the disadvantaged school districts.While most school-based vision programs provide vision screening,eye examinations,and eyeglasses prescription to students directly in schools,different mechanisms and models have been reported.In this paper,we describe two large-scale school-based vision programs,Vision for Baltimore and Helen Keller International’s United States Vision Program,representing national and regional efforts to partner with local communities in improving access to pediatric vision care.These programs also serve as data collection platforms and provide evidence to inform public health policy and guide best practice.Collectively,these two programs showed that one in three students failed vision screening.The prevalence of uncorrected refractive error was high and the demand for eyeglasses was great among those who failed vision screening.While most of the students’uncorrected refractive errors could be addressed in the school setting,one in seven needed additional eye care.We found that schools with more socioeconomically disadvantaged students had greater needs of school-based vision program services.We hope this knowledge helps to maximize the impact of school-based vision programs and promote a system that ensures better health outcomes for all children.展开更多
AIM：To describe a novel technique of creating a landing strip within the trabecular meshwork to guide trabecular micro-bypass stent（iStent） implantation in patients who underwent phacoemulsification.METHODS：Thirty...AIM：To describe a novel technique of creating a landing strip within the trabecular meshwork to guide trabecular micro-bypass stent（iStent） implantation in patients who underwent phacoemulsification.METHODS：Thirty-four eyes from 30 patients who underwent i Stent implantation after phacoemulsification from May 2014 to February 2015 were included in our retrospective study. All iStents were implanted via the ＂landing strip＂ technique. A 25-gauge microvitreoretinal blade was used to bisect the trabecular meshwork to less than 1 clock-hour, effectively creating a landing strip. The iStent applicator was pressed along the landing strip and then the stent was released into the trabecular meshwork. RESULTS：Of the 34 eyes with iStent implantation, 27（79.4%） eyes had primary open-angle glaucoma, 6（17.6%） eyes had pseudoexfoliation glaucoma, and 1（2.9%） eye had ocular hypertension. At 6-month follow-up（n=17）, the mean number of hypotensive medications decreased from 2.2±1.2 at baseline to 0.8±1.3（P=0.05） and mean intraocular pressure decreased from 19.7±4.1 mm Hg at baseline to 16.7±2.1 mm Hg（P=0.58）. Two eyes（5.9%） required subsequent trabeculectomy. CONCLUSION：The ＂landing strip＂ technique appears to be an effective way to assist with iS tent implantation.展开更多
Oxidative stress and cyclic adenosine 3′,5′-monophosphate(cAMP)/protein kinase A(PKA)pathway in the optic nerve head astrocytes:Glaucoma is a leading cause of blindness worldwide in individuals 60 years of age and o...Oxidative stress and cyclic adenosine 3′,5′-monophosphate(cAMP)/protein kinase A(PKA)pathway in the optic nerve head astrocytes:Glaucoma is a leading cause of blindness worldwide in individuals 60 years of age and older.Despite the widely appreciated disease relevance of structural and functional abnormalities of astrocyte in the optic nerve head(ONH)that is associated with retinal ganglion cell(RGC)axon degeneration,the molecular mechanisms underlying astrocyte dysfunction in glaucomatous ONH degeneration are poorly understood.Oxidative stress is strongly linked to glaucoma pathogenesis,and astrocytes are the responsible cell type that is mostly related to oxidative stress and glaucomatous ONH degeneration.展开更多
AIM:To evaluate the safety and efficacy of posterior scleral application(a modified technique)of an antimetabolite mitomycin C-soaked sponge in trabeculectomy for patients with glaucoma.METHODS:This retrospective stud...AIM:To evaluate the safety and efficacy of posterior scleral application(a modified technique)of an antimetabolite mitomycin C-soaked sponge in trabeculectomy for patients with glaucoma.METHODS:This retrospective study included 101 patients(115 eyes)with glaucoma(aged 12–83y)who underwent trabeculectomy using a modified mitomycin C-soaked sponge placement method.A piece of 3.5×10 mm2 sponge was placed vertically and posteriorly with the long side perpendicular to the limbus.The mitomycin C concentration and exposure time were 0.2–0.5 mg/m L and 1–5min,respectively.Intraocular pressure,bestcorrected visual acuity,and hypotensive medications were recorded at baseline and at the final visit.Complications,interventions required,and bleb morphology were recorded postoperatively.The primary outcome was trabeculectomy safety,including complications and bleb morphology;the secondary outcome was the trabeculectomy success rate.RESULTS:At the final follow-up[median 28mo,range 7–67mo and interquartile range(IQR)13mo],the qualified(cumulative)success rate was 93.0%and the complete success rate was 60.0%.No bleb-related complications were observed.The mean height,extent,and vascularity grades were 0.6±0.9,1.1±0.4,and 2.4±0.9,respectively.All Seidel tests were negative.The mean posteriority grade was 0.8±0.4.CONCLUSION:Trabeculectomy with the long side of a mitomycin C-soaked sponge placed perpendicular to the corneal limbus is safe and effective.展开更多
Purpose: To evaluate the correlations between office- hour intraocular pressures (IOP) and peak nocturnal IOP in healthy and glaucomatous eyes. Design: Retrospective review of laboratory records. Methods: We reviewed ...Purpose: To evaluate the correlations between office- hour intraocular pressures (IOP) and peak nocturnal IOP in healthy and glaucomatous eyes. Design: Retrospective review of laboratory records. Methods: We reviewed 24- hour data of IOP collected from 33 younger healthy subjects (aged 18 to 25 years), 35 older healthy subjects (aged40 to 74 years), and 35 untreated older glaucoma patients (aged40 to 79 years) housed in a sleep laboratory. Measurements of IOP were taken every 2 hours using a pneumatonometer in the sitting and supine positions during the diurnal/wake period (7 am to 11 pm) and in the supine position during the nocturnal/sleep period. Correlations between average sitting or supine IOP in the right eye between 9:30 am and 3:30 pm (office hours) and peak right eye IOP during the nocturnal hours were analyzed. Results: The average values of supine IOP during office hours were found to have the strongest correlation with peak nocturnal IOP in older glaucoma subjects (r=.713, P < .001), whereas the correlation was less in older healthy subjects (r =.523, P< .01) and was absent in younger healthy subjects (r=.224, P=.21). The correlation between average sitting IOP values during office hours and peak nocturnal IOP was also strong in older glaucoma subjects (r=.601, P< .001) and moderate in older healthy subjects (r=.412, P< .05), but absent in younger healthy subjects (r=- .077, P=.672). Conclusion: Using a modification of the diurnal IOP curve, the magnitude of peak nocturnal IOP in untreated glaucoma patients can be estimated during routine office visits. Supine IOP measurements estimate peak nocturnal IOP better than sitting measurements. This estimation may provide the clinician with valuable information regarding the nocturnal IOP peak in glaucoma patients.展开更多
PURPOSE: To investigate the association between patterns of visual field (VF) loss and retinal nerve fiber layer (RNFL) thickness measurements. DESIGN: Observational cross-sectional study. METHODS: One hundred twenty-...PURPOSE: To investigate the association between patterns of visual field (VF) loss and retinal nerve fiber layer (RNFL) thickness measurements. DESIGN: Observational cross-sectional study. METHODS: One hundred twenty-one glaucoma patients and 65 healthy subjects from the Diagnostic Innovations in Glaucoma Study (DIGS) were included. All glaucoma patients had repeatable abnormal VFs and scanning laser polarimetry (SLP) RNFL thickness measurements. RNFL measurements were obtained from 16 equal parapapillary sectors. Patterns of VF loss were classified as arcuate,partial arcuate,nasal step,or paracentral in each VF hemifield. Logistic regression analysis was performed to determine which RNFL sectors were associated with each VF pattern. The ability of SLP to discriminate between eyes with different VF patterns and healthy eyes using receiver operating characteristic (ROC) curve analyses also was investigated. RESULTS: VF patterns in the superior hemifield were significantly associated with RNFL sectors in the temporal inferior hemiretina (P < .05). ROC curve areas for discrimination between eyes with differentVF patterns and healthy eyes ranged from 0.85 to 0.95. VF patterns in the inferior hemifield were most strongly associated with temporal superior RNFL sectors (P < .05). ROC curve areas for discrimination between different VF patterns and healthy eyes ranged from 0.73 to 0.98. SLP could discriminate between apparently unaffected VF hemifields in glaucoma eyes and VF hemifields in healthy eyes. CONCLUSIONS: Parapapillary RNFL thickness was topographically related to patterns of VF loss. SLP can differentiate between apparently unaffected VF hemifields in glaucoma eyes and normal VF hemifields in healthy eyes.展开更多
Appropriate treatment for ocular hypertension depends on several factors, including the risk of developing glaucoma Results from recently published clincial studies provide new insight about which ocular hypertensive ...Appropriate treatment for ocular hypertension depends on several factors, including the risk of developing glaucoma Results from recently published clincial studies provide new insight about which ocular hypertensive patients are at particular risk for developing展开更多
文摘Known for its unique cross-disciplinary investigative programs and clinical excellence,the scientists and clinicians at the Hamilton Glaucoma Center of the University of California,San Diego seek to en-
基金supported by the National Institutes of Health grants EY034116 (to WKJ, KYK, and SHC) and AG081037 (to YIM and WKJ)。
文摘Glaucoma is a multifactorial eye disorder that can cause vision loss and irreversible blindness,affecting individ uals aged 40 to 80 yea rs worldwide.Due to the aging population,it is expected that the number of people affected by glaucoma will surpass 111 million by 2040 as the disease becomes more prevalent.Glaucoma primarily contributes to optic nerve axon loss and the progressive degeneration of retinal ganglion cells (RGCs),subsequently leading to vision impairment.
文摘AIM: To determine the discriminating performance of the macular ganglion cell-inner plexiform layer(GCIPL) parameters between all the consecutive stages of glaucoma(from healthy to moderate-to-severe glaucoma), and to compare it with the discriminating performances of the peripapillary retinal nerve fiber layer(RNFL) parameters and optic nerve head(ONH) parameters.METHODS: Totally 147 eyes(40 healthy, 40 glaucoma suspects, 40 early glaucoma, and 27 moderate-to-severe glaucoma) of 133 subjects were included. Optical coherence tomography(OCT) was obtained using Cirrus HD-OCT 5000. The diagnostic performances of GC-IPL, RNFL, and ONH parameters were evaluated by determining the area under the curve(AUC) of the receiver operating characteristics. RESULTS: All GC-IPL parameters discriminated glaucoma suspect patients from subjects with healthy eyes and moderate-to-severe glaucoma from early glaucoma patients(P<0.017, for all). Also, minimum, inferotemporal and inferonasal GC-IPL parameters discriminated early glaucoma patients from glaucoma suspects, whereas no RNFL or ONH parameter could discriminate between the two. The best parameters to discriminate glaucoma suspects from subjects with healthy eyes were superonasal GC-IPL, superior RNFL and average c/d ratio(AUC=0.746, 0.810 and 0.746, respectively). Discriminating performances of all the parameters for early glaucoma vs glaucoma suspect comparison were lower than that of the other consecutive group comparisons, with the bestGC-IPL parameters being minimum and inferotemporal(AUC=0.669 and 0.662, respectively). Moreover, minimum GC-IPL, average RNFL, and rim area(AUC=0.900, 0.858, 0.768, respectively) were the best parameters for discriminating moderate-to-severe glaucoma patients from early glaucoma patients.CONCLUSION: GC-IPL parameters can discriminate glaucoma suspect patients from subjects with healthy eyes, and also all the consecutive stages of glaucoma from each other(from glaucoma suspect to moderate-tosevere glaucoma). Further, the discriminating performance of GC-IPL thicknesses is comparable to that.
文摘AIM：To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve（AGV） implantation. METHODS： Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation separately were included in this retrospective chart review.Main outcome measures were surgical failure and complications.Failure was defined as intraocular pressure（IOP） 〉21 mm Hg or 〈5 mm Hg on two consecutive visits after 3mo,reoperation for glaucoma,or loss of light perception.Eyes that had not failed were considered as complete success if they did not required supplemental medical therapy.RESULTS： A total of 64 eyes from 57 patients were included： 31 eyes in the Ex-PRESS group and 33 eyes in the AGV group.The mean follow-up time was 2.6 ±1.1y and 3.3±1.6y,respectively.Patients in the AGV group had significantly higher baseline mean IOP（P =0.005）,lower baseline mean visual acuity（VA）（P =0.02）,and higher proportion of patients with history of previous trabeculectomy（P 〈0.0001）.Crude failure rates were 16.1%,n =5/31 in the Ex-PRESS group and 24.2%,n =8/33 in the AGV group.The cumulative proportion of failure was similar between the groups,P =0.696.The proportion of eyes that experienced postoperative complications was32.3% in the Ex-PRESS group and 60.1% in the AGV group（P =0.0229）.CONCLUSION： Trabeculectomy with Ex-PRESS implant and AGV implantation had comparable failure rates.The AGV group had more post-operative complications,but also included more complex cases with higher baselinemean IOP,worse baseline mean VA,and more previous glaucoma surgeries.Therefore,the results are limited to the cohort included in this study.
文摘AIM： To evaluate the use of short-duration transient visual evoked potentials（VEP） and color reflectivity discretization analysis（CORDA） in glaucomatous eyes,eyes suspected of having glaucoma,and healthy eyes.METHODS： The study included 136 eyes from 136 subjects： 49 eyes with glaucoma,45 glaucoma suspect eyes,and 42 healthy eyes.Subjects underwent Humphrey visual field（VF） testing,VEP testing,as well as peripapillary retinal nerve fiber layer optical coherence tomography imaging studies with post-acquisition CORDA applied.Statistical analysis was performed using means and ranges,ANOVA,post-hoc comparisons using Turkey＇s adjustment,Fisher＇s Exact test,area under the curve,and Spearman correlation coefficients.RESULTS： Parameters from VEP and CORDA correlated significantly with VF mean deviation（MD）（P〈0.05）.In distinguishing glaucomatous eyes from controls,VEP demonstrated area under the curve（AUC） values of 0.64-0.75 for amplitude and 0.67-0.81 for latency.The CORDA HR1 parameter was highly discriminative for glaucomatous eyes vs controls（AUC=0.94）.CONCLUSION： Significant correlations are found between MD and parameters of short-duration transient VEP and CORDA,diagnostic modalities which warrant further consideration in identifying glaucoma characteristics.
基金Supported by the Core Grant for Vision Research and the Research to Prevent Blindness Unrestricted Grant to the UCSF Department of Ophthalmology(No.NIH-NEI EY002162)。
文摘AIM:To evaluate aspects of cognition impacted by individuals with and without normal tension glaucoma.METHODS:Fifty normal tension glaucoma(NTG)and 50 control patients≥50 y of age were recruited from the UCSF Department of Ophthalmology.Demographic data and glaucoma parameters were extracted from electronic medical records for both groups.Tests of executive function[Executive Abilities:Measures and Instruments for Neurobehavioral Evaluation and Research(EXAMINER)]and learning and memory[California Verbal Learning Test–Second Edition(CVLT-II)]were administered to both NTG and controls.Race,handedness,best-corrected visual acuity,maximum intraocular pressure,optic nerve cup-todisc ratio,visual field and optic nerve optical coherence tomography parameters,and a measure of general health(Charlson Comorbidity Index)were compared between NTG and controls as well as within NTG subgroups.Multivariate linear regression was used to compare group performances on the EXAMINER battery and CVLT-II while controlling for age,sex,and years of education.RESULTS:NTG and controls were comparable with respect to age,sex,race,education,handedness,and the Charlson Comorbidity Index(P>0.05 for all).Performance on the EXAMINER composite score and the CVLT-II did not differ between NTG and controls(P>0.05 for both).CONCLUSION:This is the first prospective study in which the cognitive function of subject with NTG were evaluated using a comprehensive,computerized neurocognitive battery.Subjects with NTG do not perform worse than unaffected controls on tests of executive function,learning,and memor y.Results do not suppor t the hypothesis that individuals with NTG are at higher risk for cognitive dysfunction and/or dementia.
文摘AIM: To report short-term outcomes of mitomycin C-augmented excisional bleb revision with capsulectomy(ERC) after Ahmed glaucoma valve(AGV) failure.METHODS: Patients who underwent ERC procedures between January 2017 and December 2019 with a minimum follow-up of 6mo were evaluated retrospectively for indications of AGV and AGV implantation to ERC interval.The number of anti-glaucoma medications(AGMs),intraocular pressure(IOP) and best corrected visual acuity(BCVA) were recorded at baseline, 1, 7, 30, 90, and 180d.Intra-and postoperative complications were also recorded.Positive outcome was defined as IOP≤21 mm Hg with or without AGMs.RESULTS: Fourteen eyes [14 patients, median age 69.5y, interquartile range(IQR) 61.3-80] were included.Pseudoexfoliative glaucoma(n=5, 36%) was the most common form of glaucoma. The median AGV implantation to ERC interval was 8.8mo(IQR 3.91-43.67). At 6mo, the median number of AGMs decreased from 3.0(IQR 3.0-4.0)to 2.0(IQR 1.5-3), the median IOP decreased from 26 mm Hg(IQR 22-29) to 16.5 mm Hg(IQR 13.75-20) and there was no significant change in BCVA. The success rate at 6mo was 92.9%. The Kaplan-Meier cumulative probability of survival was 93%, 79%, 64%, and 64% at 1wk, and 1,3, and 6mo, respectively. No intraoperative complications were identified. Postoperative complications were identified in 5 eyes(36%), which were resolved spontaneously during the first week following ERC.CONCLUSION: ERC has a high success rate for shortterm management of AGV failure. A longer follow-up study is required to determine long-term cumulative failure rates.
文摘Dear Sir,Previous reports have illustrated reversible structural changes in optic disc cupping,the lamina cribrosa,and the retinal nerve fiber layer(RNFL)following glaucoma surgery[1-3].However,few studies have assessed changes in macular thickness following such intervention.Our aim was to investigate the impact of intraocular pressure(IOP)reduction after glaucoma surgery on total macular thickness
文摘AIM: To describe a newly-recognized entity, illustrated by five cases of glaucoma in whom trauma to the head, but not the eye, resulted in marked, transient elevation of intraocular pressure (IOP). METHODS: Retrospective case series. Chart review. RESULTS: All five cases had a diagnosis of primary open-angle glaucoma prior to the experience of trauma to the head. All cases had an unusual elevation of IOP (around 70 percent) for days to weeks following the trauma, after which the IOP fell to pre-accident levels. No cause other than the trauma could be determined. CONCLUSION: The relationship between head trauma and elevation of IOP appears real.
文摘Primary angle-closure glaucoma(PACG)is a subtype of glaucoma that affects 16 million people worldwide,of whom4 million are bilaterally blind.This prevalence of PACG is expected to increase to 21 million cases by 2020,and it is expected that 5.3 million people will become
基金Supported by Wills Eye Innovation Grant#WEF15064
文摘AIM:To validate the ability of the Heidelberg Edge Perimeter(HEP)in detecting glaucomatous visual field(VF)defects compared to the Octopus Visual Field(OVF)Analyzer and to determine the test-retest repeatability of both modalities.METHODS:This prospective,cross-sectional study was conducted at Wills Eye Hospital,Philadelphia,PA.Glaucoma subjects and unaffected controls underwent VF testing using HEP standard automated perimetry(SAP)Ⅲ30-2 Adaptive Staircase Thresholding Algorithm(ASTA)FAST protocol and OVF G-TOP white-on-white strategy.Testing order was randomized.Pearson's correlation coefficient was calculated for both mean deviation(MD)and pattern standard deviation/square root of loss of variance(PSD/s LV).Receiver operating characteristic(ROC)curves were used to determine the diagnostic abilities of both modalities.Glaucoma subjects returned for repeat testing and intraclass correlation coefficients(ICCs)were calculated to assess test-retest repeatability.RESULTS:Seventy-nine subjects with glaucoma and 36 unaffected controls were enrolled.HEP and OVF were significantly correlated for both MD(r=-0.84;P<0.01)and PSD/s LV(r=0.79;P<0.01).Areas under the ROC curves(AUCs)were also comparable between HEP and OVF for both MD(0.74 and 0.79,respectively;P=0.26)and PSD/sL V(0.74 and 0.82;P=0.08).ICC was high for both HEP(0.96 for MD,0.95 for PSD/s LV)and OVF(0.82 and 0.88,respectively).Mean test duration(min)was significantly shorter for OVF(2.63)compared to HEP(5.15;P<0.01).CONCLUSION:HEP and OVF show strong correlation for both MD and PSD/s LV,and have similar validity for detecting glaucoma.The test-retest repeatability is high for both HEP and OVF,however the average testing duration of HEP is significantly longer than that of OVF.
文摘Schools are an important avenue to tackle the rising prevalence of uncorrected refractive error among children.School-based vision programs are an innovative approach of vision care delivery in the urban school setting in the United States.These programs are effective in improving vision outcomes and advancing health equity,especially among the disadvantaged school districts.While most school-based vision programs provide vision screening,eye examinations,and eyeglasses prescription to students directly in schools,different mechanisms and models have been reported.In this paper,we describe two large-scale school-based vision programs,Vision for Baltimore and Helen Keller International’s United States Vision Program,representing national and regional efforts to partner with local communities in improving access to pediatric vision care.These programs also serve as data collection platforms and provide evidence to inform public health policy and guide best practice.Collectively,these two programs showed that one in three students failed vision screening.The prevalence of uncorrected refractive error was high and the demand for eyeglasses was great among those who failed vision screening.While most of the students’uncorrected refractive errors could be addressed in the school setting,one in seven needed additional eye care.We found that schools with more socioeconomically disadvantaged students had greater needs of school-based vision program services.We hope this knowledge helps to maximize the impact of school-based vision programs and promote a system that ensures better health outcomes for all children.
文摘AIM：To describe a novel technique of creating a landing strip within the trabecular meshwork to guide trabecular micro-bypass stent（iStent） implantation in patients who underwent phacoemulsification.METHODS：Thirty-four eyes from 30 patients who underwent i Stent implantation after phacoemulsification from May 2014 to February 2015 were included in our retrospective study. All iStents were implanted via the ＂landing strip＂ technique. A 25-gauge microvitreoretinal blade was used to bisect the trabecular meshwork to less than 1 clock-hour, effectively creating a landing strip. The iStent applicator was pressed along the landing strip and then the stent was released into the trabecular meshwork. RESULTS：Of the 34 eyes with iStent implantation, 27（79.4%） eyes had primary open-angle glaucoma, 6（17.6%） eyes had pseudoexfoliation glaucoma, and 1（2.9%） eye had ocular hypertension. At 6-month follow-up（n=17）, the mean number of hypotensive medications decreased from 2.2±1.2 at baseline to 0.8±1.3（P=0.05） and mean intraocular pressure decreased from 19.7±4.1 mm Hg at baseline to 16.7±2.1 mm Hg（P=0.58）. Two eyes（5.9%） required subsequent trabeculectomy. CONCLUSION：The ＂landing strip＂ technique appears to be an effective way to assist with iS tent implantation.
文摘Oxidative stress and cyclic adenosine 3′,5′-monophosphate(cAMP)/protein kinase A(PKA)pathway in the optic nerve head astrocytes:Glaucoma is a leading cause of blindness worldwide in individuals 60 years of age and older.Despite the widely appreciated disease relevance of structural and functional abnormalities of astrocyte in the optic nerve head(ONH)that is associated with retinal ganglion cell(RGC)axon degeneration,the molecular mechanisms underlying astrocyte dysfunction in glaucomatous ONH degeneration are poorly understood.Oxidative stress is strongly linked to glaucoma pathogenesis,and astrocytes are the responsible cell type that is mostly related to oxidative stress and glaucomatous ONH degeneration.
基金Supported by the National Natural Science Foundation of China(No.82070955)the Science and Technology Program of Guangzhou(2022),China(No.202201020362)the High-level Hospital Construction Project,Zhongshan Ophthalmic Center,Sun Yat-sen University(No.303020104)。
文摘AIM:To evaluate the safety and efficacy of posterior scleral application(a modified technique)of an antimetabolite mitomycin C-soaked sponge in trabeculectomy for patients with glaucoma.METHODS:This retrospective study included 101 patients(115 eyes)with glaucoma(aged 12–83y)who underwent trabeculectomy using a modified mitomycin C-soaked sponge placement method.A piece of 3.5×10 mm2 sponge was placed vertically and posteriorly with the long side perpendicular to the limbus.The mitomycin C concentration and exposure time were 0.2–0.5 mg/m L and 1–5min,respectively.Intraocular pressure,bestcorrected visual acuity,and hypotensive medications were recorded at baseline and at the final visit.Complications,interventions required,and bleb morphology were recorded postoperatively.The primary outcome was trabeculectomy safety,including complications and bleb morphology;the secondary outcome was the trabeculectomy success rate.RESULTS:At the final follow-up[median 28mo,range 7–67mo and interquartile range(IQR)13mo],the qualified(cumulative)success rate was 93.0%and the complete success rate was 60.0%.No bleb-related complications were observed.The mean height,extent,and vascularity grades were 0.6±0.9,1.1±0.4,and 2.4±0.9,respectively.All Seidel tests were negative.The mean posteriority grade was 0.8±0.4.CONCLUSION:Trabeculectomy with the long side of a mitomycin C-soaked sponge placed perpendicular to the corneal limbus is safe and effective.
文摘Purpose: To evaluate the correlations between office- hour intraocular pressures (IOP) and peak nocturnal IOP in healthy and glaucomatous eyes. Design: Retrospective review of laboratory records. Methods: We reviewed 24- hour data of IOP collected from 33 younger healthy subjects (aged 18 to 25 years), 35 older healthy subjects (aged40 to 74 years), and 35 untreated older glaucoma patients (aged40 to 79 years) housed in a sleep laboratory. Measurements of IOP were taken every 2 hours using a pneumatonometer in the sitting and supine positions during the diurnal/wake period (7 am to 11 pm) and in the supine position during the nocturnal/sleep period. Correlations between average sitting or supine IOP in the right eye between 9:30 am and 3:30 pm (office hours) and peak right eye IOP during the nocturnal hours were analyzed. Results: The average values of supine IOP during office hours were found to have the strongest correlation with peak nocturnal IOP in older glaucoma subjects (r=.713, P < .001), whereas the correlation was less in older healthy subjects (r =.523, P< .01) and was absent in younger healthy subjects (r=.224, P=.21). The correlation between average sitting IOP values during office hours and peak nocturnal IOP was also strong in older glaucoma subjects (r=.601, P< .001) and moderate in older healthy subjects (r=.412, P< .05), but absent in younger healthy subjects (r=- .077, P=.672). Conclusion: Using a modification of the diurnal IOP curve, the magnitude of peak nocturnal IOP in untreated glaucoma patients can be estimated during routine office visits. Supine IOP measurements estimate peak nocturnal IOP better than sitting measurements. This estimation may provide the clinician with valuable information regarding the nocturnal IOP peak in glaucoma patients.
文摘PURPOSE: To investigate the association between patterns of visual field (VF) loss and retinal nerve fiber layer (RNFL) thickness measurements. DESIGN: Observational cross-sectional study. METHODS: One hundred twenty-one glaucoma patients and 65 healthy subjects from the Diagnostic Innovations in Glaucoma Study (DIGS) were included. All glaucoma patients had repeatable abnormal VFs and scanning laser polarimetry (SLP) RNFL thickness measurements. RNFL measurements were obtained from 16 equal parapapillary sectors. Patterns of VF loss were classified as arcuate,partial arcuate,nasal step,or paracentral in each VF hemifield. Logistic regression analysis was performed to determine which RNFL sectors were associated with each VF pattern. The ability of SLP to discriminate between eyes with different VF patterns and healthy eyes using receiver operating characteristic (ROC) curve analyses also was investigated. RESULTS: VF patterns in the superior hemifield were significantly associated with RNFL sectors in the temporal inferior hemiretina (P < .05). ROC curve areas for discrimination between eyes with differentVF patterns and healthy eyes ranged from 0.85 to 0.95. VF patterns in the inferior hemifield were most strongly associated with temporal superior RNFL sectors (P < .05). ROC curve areas for discrimination between different VF patterns and healthy eyes ranged from 0.73 to 0.98. SLP could discriminate between apparently unaffected VF hemifields in glaucoma eyes and VF hemifields in healthy eyes. CONCLUSIONS: Parapapillary RNFL thickness was topographically related to patterns of VF loss. SLP can differentiate between apparently unaffected VF hemifields in glaucoma eyes and normal VF hemifields in healthy eyes.
文摘Appropriate treatment for ocular hypertension depends on several factors, including the risk of developing glaucoma Results from recently published clincial studies provide new insight about which ocular hypertensive patients are at particular risk for developing
