Journal of Glaucoma最新文献

Prcis: Based on a large administrative database of German claims data, our study provides current estimates of the prevalence and incidence of primary open angle glaucoma (POAG) in Germany and describes selected outcomes for prevalent patients with POAG.

Purpose: To estimate the prevalence and incidence of POAG in Germany, to describe the patient population in terms of comorbidity burden, routine care, and overall healthcare resource utilization (HCRU) and associated costs, and to describe treatment patterns over time in patients undergoing relevant laser procedures.

Materials and methods: Based on anonymized German claims data, we carried out a retrospective, noninterventional study covering calendar years 2016-2021.

Results: For the adult German population (≥18 y), we estimated a POAG 1-year prevalence of 1.70% and a 1-year incidence of 0.17% in 2018; both increased with age, peaking in 80- to 89-year-olds. Prevalence and incidence were lower in 2020 (1.65% and 0.16%, respectively), the first year of the SARS-CoV-2 pandemic. Most patients solely received topical treatment. Most surgically treated patients underwent laser trabeculoplasty, followed by laser iridotomy, trabeculectomy, and filtration operations with implant. In patients undergoing laser trabeculoplasty, the treatment regimen was nearly unchanged in the second year after, compared with 2 years before the procedure. Multimorbidity was commonly observed; 75.5% of patients had arterial hypertension and 50.0% had disorders of lipoprotein metabolism and other lipidemias, compared with 60.1% and 39.2%, respectively, in an age- and sex-matched control sample.

Conclusions: Our study provides insights into epidemiology and routine care of POAG in Germany and HCRU in prevalent patients. There was little change in treatment regimens in patients who underwent laser trabeculoplasty, 2 years after the procedure. Most patients were multimorbid highlighting the need for comprehensive care.

Prcis: Targeted glaucoma screening strategies performed within retail care-based clinics and Federally Qualified Health Centers (FQHCs) uncover a high prevalence of glaucoma.

Objective: To summarize the glaucoma detection and maintenance programs that utilize existing health care infrastructure to promote up-scalable programs.

Methods: Health care infrastructure that already exists may facilitate glaucoma detection. This infrastructure includes retail-based optometry practices and FQHC. Persons who are at risk for glaucoma are disproportionately represented within the patient populations served by much of this infrastructure, thus suggesting that it could be useful for deploying glaucoma screening programs. Glaucoma screening within FQHCs reveals a very high prevalence of glaucoma and related disease in the patients seeking care at these facilities.

Results: These telemetric-based care delivery programs have a high patient acceptance. A simulated telemedicine program modeled after a telemedicine program based in Walmart Vision Centers for the diagnosis of glaucoma indicated that there was moderate diagnostic agreement between an ophthalmologist's telemedicine diagnosis and an ophthalmologist's in-person diagnosis. There was also moderate agreement between an optometrist's telemedicine diagnosis and the ophthalmologist's in-person diagnosis.

Conclusion: Telemetric care delivery programs that capitalize on existing infrastructure within a retail-based care setting or FQHCs may provide a promising setting to cost-effectively screen for glaucoma and other eye diseases that are potentially expandable nationwide.

Purpose: To introduce a discussion of glaucoma screening.

Methods/results: Glaucoma screening faces challenges, including not satisfying important ethical principles for medical screening.

Conclusions: Approaches that would better provide care for glaucoma patients include eliminating the loss of follow-up and identifying glaucoma among family members of known glaucoma patients.

Prcis: Optical coherence tomography (OCT) and optic disc photography present valuable but distinct capabilities for glaucoma screening.

Objective: This review article examines the strengths and limitations of OCT and optic disc photography in glaucoma screening.

Methods: A comprehensive literature review was conducted, focusing on the accuracy, feasibility, cost-effectiveness, and technological advancements in OCT and optic disc photography for glaucoma screening.

Results: OCT is highly accurate and reproducible but faces limitations due to its cost and less portable nature, making widespread screening challenging. In contrast, optic disc photos are more accessible and cost-effective but are hindered by subjective interpretation and inconsistent grading reliability. A critical challenge in glaucoma screening is achieving a high PPV, particularly given the low prevalence of the disease, which can lead to a significant number of false positives. The advent of artificial intelligence (AI) and deep learning models shows potential in improving the diagnostic accuracy of optic disc photos by automating the detection of glaucomatous optic neuropathy and reducing subjectivity. However, the effectiveness of these AI models hinges on the quality of training data. Using subjective gradings as training data, will carry the limitations of human assessment into the AI system, leading to potential inaccuracies. Conversely, training AI models using objective data from OCT, such as retinal nerve fiber layer thickness, may offer a promising direction.

Conclusion: Both OCT and optic disc photography present valuable but distinct capabilities for glaucoma screening. An approach integrating AI technology might be key in optimizing these methods for effective, large-scale screening programs.

Prcis: Recommendations for glaucoma screening vary significantly from organization to organization, and while worldwide screening is currently not recommended, there is support in many organizations for screening at-risk subgroups of the general population.

Objective: To summarize and compare current glaucoma screening protocols of major national and international, governmental, and non-governmental organizations.

Methods: A general review of the major medical, and more specifically ophthalmic, organizations within North America, South America, Europe, Asia, and Africa was undertaken. Protocols from recent international and regional meetings were reviewed and summarized and a comparative analysis was employed to highlight differences between national and regional policies.

Results: In general, it was found that worldwide screening for glaucoma is currently of limited clinical utility and unlikely to be cost-effective. However, a more targeted approach is recommended by some major organizations, including the American Academy of Ophthalmology, the Pan-American Association of Ophthalmology, and the International Council of Ophthalmology in conjunction with a group of prominent ophthalmologists based in Sub-Saharan Africa recommend a targeted approach to screening specific populations that are deemed to be at higher risk of developing glaucoma.

Conclusion: General population screening for glaucoma has been adopted as a recommendation by only a few organizations and only in specific situations. It is the screening of high-risk populations that has been demonstrated to be not only clinically useful in diagnosing and treating larger proportions of the general population benefiting from a higher positive-predictive value for screening protocols in these groups but also cost-effective. Further research is needed to create cost-effective protocols to successfully screen these high-risk populations for glaucoma using methods that are sufficiently sensitive and specific.

Prcis: As additional glaucoma genes are identified and classified, polygenic risk scores will be refined, facilitating early diagnosis and treatment. Ensuring genetic research is equitable to prevent glaucoma blindness worldwide is crucial.

Purpose: To review the progress in glaucoma genetics over the past 25 years, including the identification of genes with varying contributions to the disease and the development of polygenic risk scores.

Methods/results: Over the last 2 and a half decades, glaucoma genetics has evolved from identifying genes with Mendelian inheritance patterns, such as myocilin and CYP1B1, to the discovery of hundreds of genes associated with the disease. Polygenic risk scores have been developed, primarily based on research in Northern European populations, and efforts to refine these scores are ongoing. However, there is a question regarding their applicability to other ethnic groups, especially those at higher risk of primary open angle glaucoma, like individuals of African ancestry. Glaucoma is highly heritable and family history can be used for cascade clinical screening programs, but these will not be feasible in all populations. Thus, cascade genetic testing using well-established genes such as myocilin may help improve glaucoma diagnosis. In addition, ongoing investigations seek to identify pathogenic genetic variants within genes like myocilin.

Conclusions: The expanding availability of genetic testing for various diseases and early access to genetic risk information necessitates further research to determine when and how to act on specific genetic results. Polygenic risk scores involving multiple genes with subtle effects will require continuous refinement to improve clinical utility. This is crucial for effectively interpreting an individual's risk of developing glaucoma and preventing blindness.

Prcis: This survey highlights a deficiency in gonioscopy practices across the UK, particularly in the utilization of indentation gonioscopy and training of junior ophthalmologists. Recommendations include standardizing practice and enhancing training opportunities to improve patient care.

Background: Gonioscopy is an important general skill learnt and practised by all grades of ophthalmologists. The aim of this study is to discover the general attitude, perception and practice of gonioscopy among ophthalmologists in the UK.

Methods: A National gonioscopy survey was carried out by utilising an anonymous electronic questionnaire of 18 questions. The questionnaire was electronically distributed online, using the survey tool, Microsoft 2016 'MS Forms' to all grades of ophthalmologists in the UK.

Results: A total of 146 responses were analysed. Overall, 89% of the participants felt 'comfortable in performing slit lamp gonioscopy' but only 38% of junior trainees (ophthalmic specialist trainees years 1-3) felt comfortable in gonioscopy. Only 13% of the junior trainees felt they had adequate training in performing gonioscopy compared with 68% of the total respondents. Surprisingly, the majority of consultants (58%) did not 'strongly agree' to being confident in assessing the angle and its configuration on gonioscopy. The most commonly used gonioscopic lens in this survey was the Zeiss four-mirror gonio lens, but only 38% of participants performed indentation gonioscopy routinely. The majority of the participants utilised the modified Shaffer's classification for gonioscopy. Fewer than expected numbers performed gonioscopy routinely for new glaucoma patients.

Conclusion: This survey suggests that gonioscopy is not being performed according to the UK national recommendations and few ophthalmologists perform indentation gonioscopy. Additional gonioscopy training in the curriculum may be helpful.