Journal of Glaucoma最新文献

Prcis: Higher neighborhood-level poverty is associated with greater odds of missing a free eye disease screening appointment, underscoring the importance of community-based interventions to address upstream social determinants of health.

Purpose: To investigate the association between neighborhood-level characteristics and attendance for a free eye disease screening.

Methods: The MI-SIGHT program is conducted in 2 community clinics in Southeastern Michigan. Participant-level demographics were extracted from electronic health records. Neighborhood-level characteristics, including Area Deprivation Index (ADI), median household income (HHI), percent of households with >30% rent burden, percent of households without vehicles, percent of households in subsidized housing, and energy burden, were obtained from the Wisconsin Neighborhood Atlas and the United States census. Logistic regression was used to model the probability of clinic visit attendance, which was the main outcome measure.

Results: One thousand four hundred thirty-one participants were scheduled for screening appointments between July 2020 and November 2021, with a no-show rate of 23%. Individuals lived an average of 7.7 miles from each clinic (SD=8.1) and in neighborhoods with a mean ADI of 6.8 (SD=3.2, 1-10 scale, where 10 is the most deprived). After adjusting for age, sex, race, and ethnicity, participants from neighborhoods with higher deprivation were more likely to have missed clinic visits. For example, there was an 8% higher odds of missed clinic visits for every 1-point increase in ADI (odds ratio, OR=1.08, P =0.020) and an 18% higher odds of a missed visit with every 10% increase in households without a vehicle (OR=1.18, P =0.013).

Conclusions: Higher neighborhood-level poverty was associated with greater odds of missing a free eye disease screening appointment after adjusting for individual characteristics. Increased neighborhood-level resources are likely needed to bolster engagement in preventive eye care.

Prcis: There were statistically significant differences across multiple socioeconomic characteristics and self-reported barriers to care among primary glaucoma patients with severity staging data versus those missing this data in the NIH All of Us database.

Purpose: To characterize missing data among glaucoma patients within All of Us .

Materials and methods: We used diagnosis codes to define cohorts of primary glaucoma patients with and without severity staging specified. Descriptive analyses were conducted by presence of disease severity stage. Analysis of missing data was conducted using a set intersection plot and the Little Test of Missing Completely at Random. T tests were performed to evaluate differences.

Results: Of 2982 participants, 1714 (57%) did not have glaucoma severity stage specified, and 11 of 23 analyzed variables had missing data. The Little Test indicated data was not missing completely at random ( P <0.001). Significant differences existed between the 2 cohorts with respect to age, age of first glaucoma diagnosis, gender, ethnicity, education, income, insurance, history of glaucoma surgery and medication use, and answers regarding the ability to afford eyeglasses and having seen an eye care provider in the last 12 months (all P- values ≤0.01).

Conclusion: There were significant differences between glaucoma participants with glaucoma severity stage specified versus those with unstaged disease across multiple socioeconomic characteristics and self-reported barriers to care. Glaucoma severity staging data was not missing completely at random. The unstaged cohort included higher rates of multiple underrepresented communities, which may potentially contribute to bias in ophthalmology research as participants from vulnerable populations may be disproportionately excluded from electronic health records or claims data studies where diagnosis codes with severity/staging levels are used to examine risk factors for disease, progression, and treatment efficacy.

Prcis: Femtosecond laser-assisted cataract surgery (FLACS) leads to an increase in intraocular pressure (IOP) during the procedure and subsequent IOP reduction after surgery, with greater magnitude in eyes with higher preoperative IOP.

Purpose: To evaluate the effect of FLACS using the LDVZ8 laser on IOP during and after surgery, and to compare the IOP-lowering effect of FLACS and conventional phacoemulsification cataract surgery (CPCS).

Patients and methods: This prospective cohort study enrolled 395 healthy eyes (395 patients) scheduled for FLACS (n=245) and CPCS (n=150). FLACS was performed using the LDVZ8 laser. During FLACS, IOP was assessed before and immediately after docking. IOP reduction during a 6-month postoperative period was evaluated following FLACS and CPCS. Multivariate analyses were performed.

Results: The mean IOP increase after docking was 2.3±4.1 mm Hg ( P <0.0001); the maximum increase was 17.6 mm Hg, peak of 38 mm Hg. Sixty-one eyes (25.1%) demonstrated an increase of ≥5 mm Hg and 10 (3.7%) showed an increase of ≥10 mm Hg; predocking IOP was associated with an IOP increase of ≥5 mm Hg ( P =0.029). IOP reduction over 6 months postsurgery was similar for FLACS and CPCS ( P >0.05), -1.33±3.12 mm Hg for FLACS ( P <0.001) and -1.4±2.87 mm Hg for CPCS ( P <0.001). Preoperative IOP correlated statistically significantly with IOP reduction in both FLACS (β -0.742, P <0.001) and CPCS (β -0.743, P <0.001).

Conclusions: Although the LDVZ8 laser procedure causes an increase in IOP in some healthy eyes, a subsequent decrease in IOP is observed after FLACS. The IOP-lowering effect of FLACS is similar to CPCS and tends to be more pronounced in eyes with higher preoperative IOP. Eyes with higher preoperative IOP are prone to IOP elevation during FLACS, a critical consideration for glaucoma patients.

Prcis: The genetic risk score (GRS) of genetic variants associated with intraocular pressure (IOP) elevation, but not those associated with optic nerve vulnerability, was associated with a history of glaucoma surgery in Japanese patients with primary open angle glaucoma (POAG).

Objective: To investigate genetic variants associated with a history of glaucoma surgery in Japanese patients with POAG.

Methods: Japanese patients with POAG (n = 468), including normal tension glaucoma (n = 246) and high tension glaucoma (n = 222), and control subjects (n = 246) were genotyped for 22 genetic variants predisposing to POAG, which can be classified into those associated with IOP elevation (IOP-related genetic variants) and optic nerve vulnerability independent of IOP (optic nerve-related genetic variants). The unweighted and weighted GRSs of 17 IOP-related, 5 optic nerve-related, and all 22 genetic variants were calculated, and the association between the GRS and a history of glaucoma surgery was evaluated.

Results: There was a significant association (odds ratio 1.13 per unweighted GRS, 95% CI: 1.03 to 1.24, P = 0.0093) between IOP-related unweighted GRS and a history of glaucoma surgery. A significant association (odds ratio 1.09 per 0.1 weighted GRS, 95% CI: 1.04 to 1.14, P = 0.00022) was also found between IOP-related weighted GRS and a history of glaucoma surgery. The IOP-related GRS was positively correlated with the need for glaucoma surgery. The mean of IOP-related unweighted and weighted GRS in patients with POAG with a history of glaucoma surgery were significantly higher ( P = 0.013 and P = 0.00031, respectively) than those in patients with POAG without a history of glaucoma surgery.

Conclusions: IOP-related, but not optic nerve-related, genetic variants were associated with a history of glaucoma surgery in Japanese patients with POAG. These results indicate that IOP elevation induced by IOP-related genetic variants rather than optic nerve vulnerability induced by optic nerve-related genetic variants may play an important role in requiring glaucoma surgery.

Prcis: The lamina cribrosa microvasculature reduction was associated with the posterior deformation of lamina cribrosa, as well as the functional deterioration, in all spectrums of open-angle glaucoma.

Purpose: To investigate the factors associated with the lamina cribrosa vessel density (LCVD) determined via swept-source optical coherence tomography angiography (SS-OCTA).

Materials and methods: The optic nerve head (ONH) scan was obtained using SS-OCTA (PLEX Elite 9000; Carl Zeiss Meditec, Inc., Dublin, CA, USA). The lamina cribrosa curvature index (LCCI) was assessed using seven horizontal B-scan images across the ONH. The LCVD was calculated from the segmented layer at the level of lamina cribrosa (LC). Primary open angle glaucoma (POAG) eyes were categorized into two groups according to the visual field mean deviation (VF MD) (mild to moderate [≥ -12 dB] and advanced [< -12 dB]). The factors associated with the LCVD were evaluated using linear regression analysis.

Results: A total of 127 POAG and 43 healthy eyes were included. POAG eyes showed significantly thinner circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell inner plexiform layer (mGCIPL), lower LCVD, and greater LCCI compared to healthy eyes (all P<0.05). In the mild to moderate group, lower LCVD was associated with worse VF MD, thinner cpRNFL and mGCIPL, and greater LCCI (all P<0.05). In the advanced group, the LCVD was associated with VF MD and LCCI (both P<0.05). A greater LCVD was correlated with a greater LCCI in the healthy group (P =0.045).

Conclusions: Reduced LCVD was associated with an increased LCCI in all spectrums of POAG. LC deformation may affect the ONH microvasculature in glaucoma.

Prcis: Trabeculectomy increases tissue blood flow superior and temporal in the optic nerve head. Improvement of tissue blood flow superior and temporal in the optic nerve could be an indicator of the effectiveness of glaucoma treatment.

Purpose: To investigate changes in tissue blood flow at the optic nerve head before and after trabeculectomy.

Methods: This prospective study included 53 eyes who underwent trabeculectomy. The mean blur rate of the tissue area (MT) was determined using laser speckle flowgraphy (LSFG) preoperatively and 1 and 3 months postoperatively. MT, LSFG waveform parameters (blowout score [BOS] and resistivity index [RI]), intraocular pressure (IOP), and ocular perfusion pressure (OPP) were analyzed preoperatively and at 3 months postoperatively.

Results: Postoperatively, IOP decreased (17.9±6.0 to 9.2±3.4 mmHg) and OPP increased (43.3±9.2 to 52.1±6.4 mmHg). As previously described, BOS increased (73.5±8.3 to 76.7±6.5; P<0.001) with an inverse correlation to IOP and in proportion with OPP; RI decreased (0.40±0.1 to 0.35±0.08; P<0.001) with an inverse correlation to OPP and in proportion to IOP. However, we found that MT increased significantly after surgery (7.9±2.2 to 8.8±2.2 AU; P=0.002) without significant association between MT and IOP or OPP. In the four quadrants of the optic nerve head (ONH), BOS significantly increased, while RI significantly decreased after surgery in all quadrants. On the other hand, MT significantly increased in the superior and temporal quadrants only.

Conclusions: Blood flow increases in the superior and temporal of optic nerve head.

Precis: Second trabeculectomy and glaucoma drainage device implantation offer similar success rates for juvenile open angle glaucoma after initial trabeculectomy failure. However, second trabeculectomies required fewer medications. A quarter of patients in both groups required a third operation after 2.5±2.3 years.

Purpose: To compare outcomes between second trabeculectomy surgery versus glaucoma drainage device (GDD) insertion in juvenile open-angle glaucoma (JOAG) patients after primary trabeculectomy failure.

Method: A retrospective review was performed on all JOAG patients who underwent a second glaucoma surgery after primary trabeculectomy failure across two tertiary hospitals in Bangkok, Thailand between 2009 and 2020. Demographics, intraoperative reports, and clinical findings were collected. The primary outcomes were complete and qualified success rates at 5 years; secondary outcomes included differences in intraocular pressures and number of glaucoma medications post-operatively.

Results: Fifty-two eyes of 38 patients underwent a second glaucoma surgery after primary trabeculectomy: 30 had a second trabeculectomy, 17 received a GDD (10 valved, 7 non-valved), and 5 underwent cyclophotocoagulation. Prior to surgery, there were no significant differences except in mean refractive error. Average follow-up length was 66.9±53.7 months. Qualified success rates were 81.5% and 63.2% at 3 and 5 years (complete success: 55.6% and 42.1%) for the second trabeculectomy group and 80.0% and 70.0% (complete success: 53.3% and 50.0%) for the GDD group, respectively. There were no significant differences in group success or IOP post-operatively. The GDD group required more medications at 5 years (1.3±1.9 vs. 2.3±1.5, P=0.03). Two cases of tube exposure in the GDD group resulted in implant removal. About a quarter of patients in both groups required a third operation after 2.5±2.3 years.

Conclusion: Both second trabeculectomy and GDD insertion are effective treatments for JOAG after trabeculectomy failure. Second trabeculectomy required fewer medications for IOP control.

Precis: Younger patient age (coefficient: 0.10, P=0.04) and greater peak IOP during follow-up (coefficient: -0.14, P=0.03), but not baseline optical microangiography parameters, were significantly associated with a faster rate of RNFL loss in mild-moderate PACG.

Purpose: To evaluate the association between optical microangiography (OMAG) measurements and progressive retinal nerve fiber layer (RNFL) loss in primary angle-closure glaucoma (PACG).

Methods: In a prospective study, 45 eyes of 30 PACG patients (86 hemifields) with mild to moderate functional damage were longitudinally studied for at least 2 years and with a minimum of 3 optical coherence tomography (OCT) examinations. OMAG imaging was performed at the baseline visit. Effect of clinical parameters (age, gender, presence of systemic diseases, central corneal thickness, mean, peak and fluctuation of intraocular pressure during follow-up), baseline hemifield mean deviation (MD) and baseline OMAG (quadrant peripapillary and macular perfusion density [PD]) on the rate of RNFL change was evaluated using linear mixed models.

Results: Average (±SD) hemifield MD, RNFL thickness, peripapillary PD and macular PD of the analyzed quadrants at baseline were -6.0±3.4 dB, 89±21 µm, 40.1±3.5% and 29.6±10.3%, respectively. Rate of quadrant RNFL change was -2.5±1.7 µm/year. Multivariate mixed models showed that younger patient age (coefficient: 0.10, P=0.04) and higher peak IOP during follow-up (coefficient: -0.14, P=0.03) were significantly associated with a faster rate of RNFL loss.

Conclusions: Younger patient age and greater peak IOP during follow-up were significantly associated with a faster rate of RNFL loss in PACG patients with mild to moderate severity of functional damage. None of the OMAG parameters at baseline were associated with RNFL thinning suggesting a limited role of OCTA imaging in predicting structural progression in mild-moderate PACG.

Prcis: Automated optic nerve head hemoglobin measurements through change overtime in the Globin Individual Pointer (GIP) index, provided by the Laguna ONhE software, can be useful to evaluate structural progression in glaucoma.

Purpose: To assess the performance of automated optic nerve head hemoglobin measurements (ONH Hb) for detection of structural progression in glaucoma patients using event analysis.

Patients and methods: Treated glaucoma patients were included in this cross-sectional study. Two experienced examiners classified patients into progressors and non-progressors (controls) based on serial color retinographies (CR). Progressors were then subdivided in structural changes of the neuroretinal rim (NR) or retinal nerve fiber layer (RNFL). Globin individual pointer (GIP) index, derived from ONH Hb measurements, was calculated for each CR using the Laguna ONhE software. Differences in GIP values, ​​between baseline and last visit CRs, were used to assess structural progression. Sensitivity at a fixed specificity (50%; median GIP difference in controls) and areas under receiver operating characteristic curves (AUROC) were calculated.

Results: Eight-seven eyes (35 progressors and 52 controls) from 64 patients were enrolled. Mean GIP reduction overtime was greater in progressors (-13.0±18.6) than controls (-2.9±10.4; P=0.001). In progressors, mean GIP reduction was greater in patients with NR changes (-19.6±19.5) than RNFL changes (-3.1±12.1; P=0.008). GIP difference correctly identified 69% of the progressors (AUROC: 0.66), being 76% of these progressions related to NR changes (AUROC: 0.76) and 57% to RNFL changes (AUROC: 0.52).

Conclusions: The GIP index, based on automated ONH Hb measurements demonstrated good sensitivity to differentiate progressors from controls, especially in cases in which progression was documented trough structural NR changes. Using only two CRs and event analysis, GIP changes overtime can be a useful screening tool to evaluate structural progression.