Journal of Glaucoma最新文献

Prcis: Analysis of Centers for Medicare and Medicaid Services (CMS) Physician Payment data found that physician certification year, degree of urbanization, and estimated income by zip code were significant in predicting the proportion of traditional glaucoma procedures performed by each provider in the United States.

Objective: The prevalence of microinvasive glaucoma surgery (MIGS) compared with traditional procedures has been increasing in glaucoma management. It is important to understand whether the uptake of new glaucoma procedures is associated with aspects of the physician practice.

Methods: In this cross-sectional study, data on glaucoma procedure distribution, degree of urbanization, and physician certification in the United States were extracted from the 2019 CMS Physician Payment and American Board of Ophthalmology databases. The distribution of traditional and MIGS procedure numbers for metropolitan versus non-metropolitan providers was visualized with boxplots and statistically compared using Mann-Whitney U tests. We used two-dimensional histograms and regression analyses to assess the relationship between certification year and volume of traditional versus MIGS procedures. A multivariable linear regression model was created using certification year, rural-urban commuting area code, and estimated income by practice zip code to predict the number and proportion of each type of glaucoma procedure.

Results: This study included 2625 providers from the CMS physician payment data who performed only traditional procedures (n = 370), MIGS procedures (n = 1727), or both procedure types (n = 528) in 2019. The median number of MIGS procedures performed by each provider was greater in non-metropolitan areas (31 vs 29, P = 0.015), whereas the proportion of traditional procedures performed by each provider was greater in metropolitan areas (0.24 vs 0.08, P < 0.001). Regression analysis showed a positive relationship between the certification year and the proportion of traditional procedures performed by each provider ( P < 0.001). Multivariable regression models found that certification year, rural-urban commuting area code, and estimated income of practice location were all significant predictors ( P < 0.02) of the proportion of traditional procedures performed by each provider.

Conclusion: In the United States, physicians in metropolitan areas and more recent certification years are more likely to perform a larger proportion of traditional procedures. This finding suggests that the distribution of glaucoma procedure types is related to physician factors such as degree of urbanization and duration of practice. More research is needed to better understand how such differences affect patient access and outcomes.

Prcis: In addition to standard automated perimetry tests, contrast sensitivity (CS) testing and macular analyses may predict changes in the quality of life (QOL) in patients at different stages of glaucoma.

Objective: To examine the relationship between functional and structural tests of visual function and the 25-item National Eye Institute-Visual Function Questionnaire (NEI-VFQ-25) and the 36-item Short Form (SF-36) Health Survey in patients with different stages of glaucoma.

Materials and methods: Standard automated perimetry tests, optical coherence tomography scans, and CS testing were prospectively performed in 160 patients with glaucoma. The Hoddap-Parrish-Anderson staging system was used for glaucoma staging. Health-related QOL questionnaires (NEI-VFQ-25, SF-36) were also administered to all patients.

Results: The study group comprised 29 patients with suspected glaucoma, 104 with mild glaucoma, 15 with moderate glaucoma, and 12 with severe glaucoma. The mean total score of the NEI-VFQ-25 was 88.8 ± 8.2. The SF-36 did not show a significant correlation with the data on functional and structural tests of visual function, whereas the NEI-VFQ-25 showed a low to moderate correlation ( r = 0.212 to -0.492). Vision parameters can explain up to 18.6% of the total score of the NEI-VFQ-25. CS was the only function significantly correlated with glaucoma suspects, whereas, in the early stages, visual acuity was the strongest correlated function with the NEI-VFQ-25 total score ( P = 0.003 and r = 0.551; P = 0.001 and r = 0.343, respectively). The impact of the visual field on vision-related QOL increased in the advanced stages ( P = 0.013, r = 0.688). The macular retinal ganglion cell plus inner plexiform layer thickness remained associated with NEI-VFQ-25 at all stages of glaucoma ( r = 0.335 to 0.802). The NEI-VFQ-25 total score and most of the subscales were correlated with the physical and mental component summary scores of the SF-36 ( r = 0.159 to 0.587).

Conclusion: Visual acuity correlated the most with QOL in patients with glaucoma, as measured with the NEI-VFQ-25 to assess QOL in glaucoma. The impact of visual functions on QOL varies at different stages of glaucoma.

Prcis: This study provides evidence of the long-term efficacy and safety of deep sclerectomy as a successful surgical intervention option in cases with childhood glaucoma.

Objectives: The primary objective was to evaluate the long-term visual acuity outcomes of deep sclerectomy in pediatric glaucoma and identify factors predicting poor prognosis. The secondary objective was to evaluate the long-term success rate of deep sclerectomy in controlling intraocular pressure (IOP).

Methods: A retrospective review was conducted of all pediatric patients who underwent deep sclerectomy at King Abdulaziz University Hospital (KAUH) between 2001 and 2016. We included all patients who had valid visual acuity tests. The preoperative findings and long-term visual and IOP outcomes were analyzed.

Results: A total of 83 eyes of 68 patients were included. The mean (SD) age of participants was 11.1 (4.0) years (range: 5-25 y). The mean age at surgery was 5.9 months, and the mean follow-up period was 10.75 years. The majority of cases (83.1%) were primary congenital glaucoma. Visual acuity was ≥20/40 in 56.6% of cases, ranged between 20/40 and 20/200 in 18.1%, and was ≤20/200 in 25.3% of the operated eyes. Complete success rate (IOP ≤21 mm Hg without medications) after one surgery was achieved in 53 eyes (63.86%). Qualified success rate (IOP ≤21 mm Hg with medications) was achieved in 8 eyes (9.6%), while 22 eyes (26.5%) failed to achieve the target IOP of ≤21 mm Hg or needed additional surgery to achieve it. Nine eyes (10.74%) had postoperative complications.

Conclusion: Deep sclerectomy is a reasonable option for pediatric glaucoma that can provide good long-term visual outcomes and IOP control with a lower risk of surgical complications.

Prcis: In a diverse database ( All of Us ), we report significant dose-response associations between alcohol use frequency and glaucoma, with alcohol use of 4 or more drinks per week associated with significantly increased odds of glaucoma.

Purpose: Current evidence on the association between alcohol use and primary open angle glaucoma (POAG) is mixed. We utilize the diverse All of Us Research Program to further examine this relationship.

Methods: This is a retrospective cohort study using the diverse All of Us Research Program, a nationwide effort by the United States National Institutes of Health to recruit those historically under-represented in biomedical research. Electronic health records and survey data from the All of Us program were analyzed. A randomized 1:4 case/control ratio was utilized for POAG patients and randomly selected control patients. χ 2 , bivariable, and multivariable regression were utilized to examine the associations between alcohol use and POAG.

Results: Of the 3876 POAG patients, 2015 (52%) were female, 1943 (50%) were White, 1152 (30%) were Black, 117 (3%) were Asian, and 584 (15%) were Hispanic. Alcohol use of 4 or more drinks per week was significantly higher in the glaucoma cohort relative to controls (15% vs. 12%, P <0.001). On bivariate analysis, diagnosed alcohol misuse was associated with higher odds of POAG [odds ratio (OR): 1.20, 95% CI: 1.17-1.23, P <0.001]. In multivariable regression, more frequent alcohol use was associated with higher odds of glaucoma; alcohol use with a frequency of 4 or more drinks per week was significantly associated with increased odds of glaucoma (OR: 1.22, 95% CI: 1.03-1.44, P =0.023). This dose-response relationship was also observed and more pronounced for female participants, where alcohol use frequency of monthly or less was already associated with increased odds of glaucoma (OR: 1.21, 95% CI: 1.002-1.46, P =0.048).

Conclusion: In the diverse All of Us database, there was a dose-response relationship between alcohol consumption and POAG risk, which was more pronounced in female participants. Overall, a higher frequency of alcohol consumption was associated with an increased risk of POAG; 4 or more drinks per week significantly was associated with higher glaucoma risk.

Prcis: This research presents the burden and clinical characteristics of NVG in Zhongshan Ophthalmic Center, employing the most extensive sample size and the longest uninterrupted temporal duration so far, which may provide a theoretical reference for the effective prevention and diagnosis of NVG.

Purpose: To summarize the burden and clinical characteristics of neovascular glaucoma (NVG) in a major tertiary care center in China.

Methods: The clinical data of NVG patients in Zhongshan Ophthalmic Center (ZOC) between 2012 and 2021 were collected retrospectively, including their age, sex, the affected eye, best-corrected visual acuity (BCVA), intraocular pressure (IOP), clinical stage and etiology.

Results: In this study, we included 1877 eyes of 1749 patients who developed NVG, with a 2.01:1 ratio of male to female. Their mean age was 53.14±16.69 years and those aged 41-70 years (65.2%) were most affected. Monocular patients were more predominant in most of them (92.7%), while 7.3% were binocular and 1667 eyes (88.8%) were at the angle closure stage. The BCVA and IOP were 2.42±0.70 logMAR and 38.6±12.2 mm Hg, respectively. Over the decade, the number of NVG patients and the proportion of NVG patients among glaucoma patients showed an increasing trend, with annual percentage changes (APCs) of 9.1% (95% CI: 5.0%-13.3%, P =0.001) and 4.8% (95% CI: 2.2%-7.4%, P =0.003), respectively. The top 3 primary conditions were diabetic retinopathy (DR), retinal vein occlusion (RVO), and retinal detachment (RD). Moreover, the APCs for the constituent ratio of DR and RVO were 4.4% (95% CI: 0.5%-8.4%, P =0.031) and -4.6% (95% CI: -8.4% to -0.7%, P =0.028), respectively. However, the first and second causes of NVG in minors (below 18 years old) were Coat's disease and ocular tumors, followed by RD and RVO in third place. The top cause of NVG in patients aged 65 years and older was RVO.

Conclusions: The burden of NVG is increasing, emphasizing the need to improve preventive strategies focusing on primary diseases such as DR, RVO, and RD, particularly the increasing proportion of DR cases and the previously underemphasized RD patients, while also highlighting the differences in primary diseases across different age groups.

Purpose: Evaluate the relationship between CYP3A4 phenotype, the gene encoding the enzyme that metabolizes exogenous steroids, and the rate of steroid-induced intraocular pressure (IOP) response.

Materials and methods: Lymphocyte-derived DNA sequencing of CYP3A4 from 10073 patients was completed using the PGRN-Seq assay. Subjects with CYP3A4 intermediate metabolizer or slower phenotypes were identified and compared with controls matched by age, race, and sex. All subjects had at least 3 eye exams with at least an exam while on topical/systemic/local steroid in any body location except the eye. Patients with pre-existing glaucoma or glaucoma suspects were excluded.

Results: Of the 10,073 patients, there were 63 patients who had CYP3A4 poor or intermediate metabolizer phenotype. Of the 63 patients, 22 had documented steroid use. Fifty-nine percent (13/22) of patients with CYP3A4 poor/intermediate metabolizer had a steroid-induced IOP response of 3 mm Hg or more, significantly higher compared with 23% (5/22) of matched controls ( P =0.031). Although more poor/intermediate metabolizers were steroid responders, the average IOP elevation in steroid responders in both groups was similar (5.0±2.5 mm Hg in CYP3A4 poor/intermediate metabolizers compared with 4.1±2.1 mm Hg in controls, P =0.327). Family history of glaucoma was similar in both groups (7/22 vs. 8/22, P =1.0).

Conclusion: Reduced CYP3A4 phenotypes may help identify patients at a higher risk of steroid-induced IOP elevation.

Prcis: Perspectives and practice patterns regarding perioperative anticoagulation management and minimally invasive glaucoma surgery were queried among surgeons of American Glaucoma Society. Management varied based on surgeon preference and the type of procedure performed.

Purpose: The purpose of this study was to characterize anticoagulation and antiplatelet practice patterns for minimally invasive glaucoma surgery (MIGS) in the perioperative period.

Materials and methods: This was a survey of surgeons of American Glaucoma Society (AGS) about anticoagulation decision-making for their most performed MIGS procedures.

Results: A total of 103 surgeons completed the survey, with 43.6% in an academic setting, 49.5% in a private practice setting, and 6.8% in a mixed practice. Median MIGS per month was 10 [interquartile range (IQR) 20-5]. The 2 most performed MIGS were trabecular meshwork (TM) bypass with either device implantation (24.9%) or tissue excision (40.0%). Half of the respondents (50.5%) deferred to the primary care physician about anticoagulation most/all the time. Most (59.3%) managed anticoagulation differently for MIGS compared with trabeculectomy and tube implantation. Respondents reported an average of 1.3 (SD 2.5) bleeding complications related to anticoagulation and MIGS in the last year. Bleeding risk perception depended upon the type of surgery (e.g., 74.0% reported no/mild concern regarding surgeries involving TM bypass with device implantation vs. 48.0% reported high concern for TM bypass with tissue excision). Respondents stopped blood thinners at the highest rates for procedures enhancing aqueous outflow through the subconjunctival space and stopped least frequently for iStent implantation. Antiplatelets were held for a longer duration than anticoagulants before surgery, and most resumed both agents within 1-4 days after surgery.

Conclusions: Anticoagulation management is highly varied, and this study may help to inform practice guidelines and optimize surgical outcomes by elucidating surgeon perspectives toward MIGS and anticoagulation management.

Prcis: The screening program using imo strongly correlates with 10-2 standard automated perimetry in detecting central visual field defects in early glaucoma, highlighting its potential as a valuable tool for efficient screening and severity quantification.

Purpose: To investigate the correlation between abnormalities within the central 10 degrees of the screening program using imo, a portable head-mounted perimeter, and 10-2 standard automated perimetry in early-stage glaucoma with central visual field defects.

Methods: This retrospective study included early glaucoma with (26 eyes) and without (38 eyes) central visual field defects. The correlation between the numbers of abnormal points within the central 10 degrees of the imo screening program and those in the probability plot of 10-2, and mean total deviation and pattern deviation, were analyzed.

Results: The imo screening program demonstrated sensitivity (80%) and specificity (98.7%) in detecting abnormalities, with a 91.6% agreement rate of 10-2. The mean number of anomalies in the 10-2 plot (pattern deviation) with P <1% was 0.85, 7.75, and 9.69 (95% CI: 0.18-1.51, 5.38-10.1, and 6.89-12.5, respectively) for no, 1, and 2 anomalies in the imo screening program, respectively. The number of anomalies with P <1% was significantly higher when the imo screening program detected 1 anomaly versus none ( P <0.01) and 2 versus 1 ( P <0.05). Mean total deviation values were -1.15, -7.5, and -15.2 (95% CI: -2.32 to 0.03, -11.21 to -3.78, and -19.7 to -10.6, respectively), while mean pattern deviation values were -1.57, -9.0, and -16.0 (95% CI: -2.57 to -0.57, -12.5 to -5.49, and -21.4 to -10.7, respectively), for no, 1, and 2 anomalies in the imo screening program, respectively.

Conclusions: The imo portable head-mounted perimeter was found to correlate with 10-2 standard automated perimetry in glaucoma patients with central visual field defects and has the potential to shorten visual field testing times.

Prcis: Alterations in the PTEN-induced kinase 1 (PINK)-mediated mitophagy pathway play an important role in pseudoexfoliation syndrome (PEX) disease.

Purpose: PEX is a condition in which aberrant fibrillary protein builds up in various components of the eye and other extraocular tissues. In this study, we aim to investigate the functionality of intracellular auto-degradative machinery-especially mitophagy-and related genes and proteins in PEX.

Materials and methods: Anterior lens capsules were obtained from cataract patients with and without PEX to constitute the PEX group and age-matched controls during microincision cataract surgery. PINK1-mediated mitophagy markers were evaluated on the transcriptional and translational level via reverse transcriptionquantitative polymerase chain reaction and immunohistochemistry analysis, respectively.

Results: The lens epithelial cells of PEX patients were characterized by significantly higher PINK1 gene expression compared with that of the controls ( P <0.05). In terms of intensity of staining of expressed proteins, PINK1 ( P <0.05), Parkin ( P <0.01), and microtubule-associated protein 1A/1B-light chain 3 B ( P <0.01) were all statistically higher in PEX, compared with the controls.

Conclusion: Altered auto-degradative response-specifically mitophagy-is a component of increased oxidative stress in PEX patients. The role of this mechanism in emerging complications warrants further research.

Prcis: Hypobaric hypoxia, the major environmental factor at high altitudes, has been observed to induce pupil miosis and widening of the anterior chamber angle. This environment may be safe for individuals with narrow angle and deserves further study.

Purpose: This study aimed to quantify anterior chamber biometric parameters before and after acute short-term, effortless exposure to hypobaric hypoxia (HH) in healthy lowlanders using swept-source anterior segment optical coherence tomography (SS AS-OCT).

Methods: This prospective study included 25 healthy young lowlanders (50 eyes) who underwent SS AS-OCT measurements and intraocular pressure (IOP) assessments under baseline sea-level conditions (T1). They were then passively exposed to simulated 4000 m above sea level for 3 hours and underwent acute mountain sickness (AMS) symptoms evaluation and IOP measurement after 2 hours exposure to HH (T2). Repeat SS AS-OCT measurements and IOP assessments were taken within 15 minutes after leaving the hypobaric chamber (T3). Anterior segment parameters including anterior chamber depth (ACD), lens vault (LV), angle opening distance (AOD500), trabecular-iris space area (TISA500), angle recess area (ARA500) at 500 μm from the scleral spur, iris curvature (IC), iris volume (IV), pupil diameter (PD), and central corneal thickness (CCT) were obtained through SS AS-OCT. These repeated measurements were compared using linear mixed model analysis.

Results: In comparison to the sea level, both IOP (16.4±3.4 vs. 14.9±2.4 mm Hg, P =0.029) and PD (5.36±0.77 vs. 4.78±0.89 mm, P =0.001) significantly decreased after exposure to HH. Significant post-HH changes [mean difference (95% CI)] were observed in AOD500 [0.129 (0.006, 0.252), P =0.04], TISA500 [0.059 (0.008, 0.11), P =0.025], ARA500 [0.074 (0.008, 0.141), P =0.029], IV [1.623 (0.092, 3.154), P =0.038], and IC [-0.073 (-0.146, 0.001), P =0.047], whereas CCT, ACD, and LV remained stable. After adjusting for age, post-HH variations in AOD500 (Beta=0.553, 95% CI: 0.001, 1.105, P =0.048) and TISA500 (Beta=0.256, 95% CI: 0.02, 0.492, P =0.034) were associated with decreased IC but were not related to lowered arterial oxygen pressure or IV increase per millimeter of pupil miosis (IV/PD). These differences in anterior segment parameters were neither correlated with differences in IOP nor AMS.

Conclusions: After short-term, effortless exposure to hypobaric hypoxia, pupil miosis occurred with widening of the anterior chamber angle and decreased IC. These changes in anterior chamber angle parameters were associated with decreased IC but did not correlate with the post-hypobaric variations in IV/PD, IOP, or AMS.