首页 > 最新文献

Ophthalmology. Glaucoma最新文献

英文 中文
Celebrating the 40th Anniversary of the American Glaucoma Society: Yesterday, Today, and Tomorrow
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ogla.2024.12.003
Carla J. Siegfried MD, Gregory L. Skuta MD
{"title":"Celebrating the 40th Anniversary of the American Glaucoma Society: Yesterday, Today, and Tomorrow","authors":"Carla J. Siegfried MD, Gregory L. Skuta MD","doi":"10.1016/j.ogla.2024.12.003","DOIUrl":"10.1016/j.ogla.2024.12.003","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 1","pages":"Pages 1-3"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Glaucoma Surgery SOS: Emergency Department Utilization Greater among Younger and First-Time Surgical Patients with Glaucoma 青光眼手术 SOS:年轻和首次接受青光眼手术的患者使用急诊科的比例更高。
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ogla.2024.09.001
Andrew W. Gross MD, Sahil Aggarwal MD, Jay K. Rathinavelu MD, Sandra S. Stinnett DrPH, Leon W. Herndon MD

Purpose

To describe the frequency, findings, and interventions of patients’ emergency department (ED) visits after all types of glaucoma surgery

Design

Retrospective cohort study

Subjects

All surgical patients with glaucoma between 2013 and 2021

Methods

This single institution study collected demographics, surgery type, and surgical parameters for each patient. Subsequently, for those visiting the ED within 50 days of surgery, data were collected on reason for visit, findings, and ophthalmic intervention. Logistic regression models were used to determine the odds of ED visits based on multiple risk factors.

Main Outcome Measures

Postoperative presentation to ED

Results

Among 9155 surgeries in 5505 patients, 5.7% had ED visits within 50 days, with 46.3% having ocular complaints. Patients with ocular diagnoses presented earlier than those without (P < 0.001). Patients who presented to the ED with an ocular diagnosis were found to be significantly younger than those who did not present (62.2 ± 18.6 vs. 65.4 ± 18.0 years old, P < 0.028). Furthermore, white patients were more likely than Black patients to present with an ocular diagnosis compared to a nonocular diagnosis (odds ratio [OR]: 2.64; 95% confidence interval [CI], 1.67–4.18; P < 0.001). Patients undergoing their first glaucoma surgery had a much higher chance of presenting to the ED compared to patients who had undergone more than one surgery (OR: 3.75; 95% CI, 2.74–5.14; P < 0.001). Those who underwent traditional surgeries were more likely than patients with trabecular meshwork bypass stent to present to the ED with an ocular diagnosis (OR: 3.02; 95% CI, 1.29–7.08; P = 0.011). Filtering surgeries and glaucoma drainage device (GDD) revisions exhibited more vision-threatening conditions than GDDs (P = 0.037 and P = 0.010 respectively). Ophthalmology consultation was sought for 88.0% of ocular diagnoses. Most received medical therapy (71.0%), primarily intraocular pressure-lowering drops.

Conclusion

Emergency department visits after glaucoma surgery are infrequent, yet more often seen in younger patients or those undergoing their first glaucoma surgery. Trabecular meshwork bypass stent, but not trabecular meshwork excision and/or Schlemm canal dilation, were less likely to present to the ED than traditional surgeries. Filtering surgeries and tube revisions presented more often with visual threatening conditions.

Financial Disclosures

The author(s) have no proprietary or commercial interest in any materials discussed in this article.
目的:描述各种类型青光眼手术后患者急诊就诊的频率、结果和干预措施 设计:回顾性队列研究 对象:2013 年至 2021 年期间的所有青光眼手术患者 方法:这一单机构研究收集了每位患者的人口统计学特征、手术类型和手术参数:2013 年至 2021 年期间的所有青光眼手术患者 方法:这项单一机构研究收集了每位患者的人口统计学特征、手术类型和手术参数。随后,对于手术后 50 天内到急诊科就诊的患者,收集其就诊原因、检查结果和眼科干预措施的数据。使用逻辑回归模型确定基于多种风险因素的急诊科就诊几率:结果:在 5505 名患者的 9155 例手术中,5.7% 的患者在 50 天内到过急诊室,其中 46.3% 的患者有眼部不适。有眼部诊断的患者比没有眼部诊断的患者更早就诊(P < 0.001)。在急诊室就诊并确诊为眼部疾病的患者明显比未确诊的患者年轻(62.2 ± 18.6 岁 vs 65.4 ± 18.0 岁,p < 0.028)。此外,与非眼科诊断相比,白人患者更有可能出现眼科诊断(OR 2.64,95% CI 1.67-4.18,p):青光眼手术后的急诊就诊并不常见,但更多见于年轻患者或首次接受青光眼手术的患者。与传统手术相比,小梁网切除术和/或Schlemm's管扩张术(TME/SCD)更不容易导致急诊室就诊。滤过手术和人工晶体管翻修手术更常见于视力受到威胁的情况。
{"title":"Glaucoma Surgery SOS: Emergency Department Utilization Greater among Younger and First-Time Surgical Patients with Glaucoma","authors":"Andrew W. Gross MD,&nbsp;Sahil Aggarwal MD,&nbsp;Jay K. Rathinavelu MD,&nbsp;Sandra S. Stinnett DrPH,&nbsp;Leon W. Herndon MD","doi":"10.1016/j.ogla.2024.09.001","DOIUrl":"10.1016/j.ogla.2024.09.001","url":null,"abstract":"<div><h3>Purpose</h3><div>To describe the frequency, findings, and interventions of patients’ emergency department (ED) visits after all types of glaucoma surgery</div></div><div><h3>Design</h3><div>Retrospective cohort study</div></div><div><h3>Subjects</h3><div>All surgical patients with glaucoma between 2013 and 2021</div></div><div><h3>Methods</h3><div>This single institution study collected demographics, surgery type, and surgical parameters for each patient. Subsequently, for those visiting the ED within 50 days of surgery, data were collected on reason for visit, findings, and ophthalmic intervention. Logistic regression models were used to determine the odds of ED visits based on multiple risk factors.</div></div><div><h3>Main Outcome Measures</h3><div>Postoperative presentation to ED</div></div><div><h3>Results</h3><div>Among 9155 surgeries in 5505 patients, 5.7% had ED visits within 50 days, with 46.3% having ocular complaints. Patients with ocular diagnoses presented earlier than those without (<em>P</em> &lt; 0.001). Patients who presented to the ED with an ocular diagnosis were found to be significantly younger than those who did not present (62.2 ± 18.6 vs. 65.4 ± 18.0 years old, <em>P</em> &lt; 0.028). Furthermore, white patients were more likely than Black patients to present with an ocular diagnosis compared to a nonocular diagnosis (odds ratio [OR]: 2.64; 95% confidence interval [CI], 1.67–4.18; <em>P</em> &lt; 0.001). Patients undergoing their first glaucoma surgery had a much higher chance of presenting to the ED compared to patients who had undergone more than one surgery (OR: 3.75; 95% CI, 2.74–5.14; <em>P</em> &lt; 0.001). Those who underwent traditional surgeries were more likely than patients with trabecular meshwork bypass stent to present to the ED with an ocular diagnosis (OR: 3.02; 95% CI, 1.29–7.08; <em>P</em> = 0.011). Filtering surgeries and glaucoma drainage device (GDD) revisions exhibited more vision-threatening conditions than GDDs (<em>P</em> = 0.037 and <em>P</em> = 0.010 respectively). Ophthalmology consultation was sought for 88.0% of ocular diagnoses. Most received medical therapy (71.0%), primarily intraocular pressure-lowering drops.</div></div><div><h3>Conclusion</h3><div>Emergency department visits after glaucoma surgery are infrequent, yet more often seen in younger patients or those undergoing their first glaucoma surgery. Trabecular meshwork bypass stent, but not trabecular meshwork excision and/or Schlemm canal dilation, were less likely to present to the ED than traditional surgeries. Filtering surgeries and tube revisions presented more often with visual threatening conditions.</div></div><div><h3>Financial Disclosures</h3><div>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 1","pages":"Pages 37-45"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Gap Analysis of Glaucoma Examination Concept Representations within Standard Systemized Nomenclature of Medicine – Clinical Terms 标准 SNOMED 临床术语中青光眼检查概念表述的差距分析。
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ogla.2024.08.001
Shahin Hallaj MD , Anthony P. Khawaja PhD, FRCOphth , Ian A.S. Rodrigues FRCOphth , Michael V. Boland MD, PhD , Eric N. Brown MD, PhD , Aiyin Chen MD , Brian C. Stagg MD, MS , Joshua D. Stein MD, MS , Catherine Q. Sun MD , Anne-Laure Mahe-Cook MBBS, BS , Swarup S. Swaminathan MD , Sophia Y. Wang MD, MS , Benjamin Y. Xu MD, PhD , Robert N. Weinreb MD , Sally L. Baxter MD, MSc

Objective/Purpose

Standardization of eye care data is important for clinical interoperability and research. We aimed to address gaps in the representations of glaucoma examination concepts within Systemized Nomenclature of Medicine – Clinical Terms (SNOMED-CT), the preferred terminology of the American Academy of Ophthalmology.

Design

Study of data elements.

Methods

Structured eye examination data fields from 2 electronic health records (EHR) systems (Epic Systems and Medisoft) were compared against existing SNOMED-CT codes for concepts representing glaucoma examination findings. Glaucoma specialists from multiple institutions were surveyed to identify high-priority gaps in representation, which were discussed among the SNOMED International Eye Care Clinical Reference Group. Proposals for new codes to address the gaps were formulated and submitted for inclusion in SNOMED-CT.

Main Outcome Measures

Gaps in SNOMED-CT glaucoma examination concept representations.

Results

We identified several gaps in SNOMED-CT regarding glaucoma examination concepts. A survey of glaucoma specialists identified high-priority data elements within the categories of tonometry and gonioscopy. For tonometry, there was consensus that we need to define new codes related to maximum intraocular pressure (IOP) and target IOP and delineate all methods of measuring IOP. These new codes were proposed and successfully added to SNOMED-CT for future use. Regarding gonioscopy, the current terminology did not include the ability to denote the gonioscopic grading system used (e.g., Shaffer or Spaeth), degree of angle pigmentation, iris configuration (except for plateau iris), and iris approach. There was also no ability to specify eye laterality or angle quadrant for gonioscopic findings. We proposed a framework for representing gonioscopic findings as observable entities in SNOMED-CT.

Conclusion

There are existing gaps in the standardized representation of findings related to tonometry and gonioscopy within SNOMED-CT. These are important areas for evaluating clinical outcomes and enabling secondary use of EHR data for glaucoma research. This international multi-institutional collaborative process enabled identification of gaps, prioritization, and development of data standards to address these gaps. Addressing these gaps and augmenting SNOMED-CT coverage of glaucoma examination findings could enhance clinical documentation and future research efforts related to glaucoma.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的:眼科数据的标准化对于临床互操作性和研究非常重要。我们的目标是解决美国眼科学会首选术语--系统化医学术语-临床术语(SNOMED-CT)中青光眼检查概念表述方面的差距:设计:数据元素研究:将两个电子健康记录(EHR)系统(Epic Systems 和 Medisoft)中的结构化眼科检查数据字段与现有的 SNOMED-CT 代码进行比较,以确定代表青光眼检查结果的概念3。对来自多个机构的青光眼专家进行了调查,以确定在表示方面存在的高度优先差距,并在 SNOMED 国际眼科临床参考组中进行了讨论。针对这些差距提出了新的代码建议,并提交给 SNOMED-CT 列入:SNOMED-CT中青光眼检查概念表述的空白 结果:我们在SNOMED-CT中发现了几个有关青光眼检查概念的空白。通过对青光眼专家的调查,确定了眼压测量和眼底检查类别中的高优先级数据元素。在眼压测量方面,专家们一致认为我们需要定义与最高眼压 (IOP) 和目标 IOP 相关的新代码,并界定所有测量 IOP 的方法。我们提出了这些新代码,并成功将其添加到 SNOMED-CT 中,以供今后使用。关于眼底镜检查,目前的术语不包括所使用的眼底镜分级系统(如 Shaffer 或 Spaeth)、角膜色素沉着程度、虹膜结构(高原虹膜除外)和虹膜方法。此外,也无法为眼底检查结果指定眼球偏侧或角膜象限。我们提出了一个框架,用于在 SNOMED-CT 中将眼底检查结果表示为可观察实体:讨论:SNOMED-CT 在标准化表示眼压测量和眼底检查结果方面存在空白。这些都是评估临床结果和将电子病历数据二次用于青光眼研究的重要领域。这一国际性、多机构的合作过程有助于找出差距、确定优先次序并制定数据标准以弥补这些差距:结论:弥补这些不足并扩大 SNOMED-CT 对青光眼检查结果的覆盖范围,可以加强临床记录和与青光眼相关的未来研究工作。
{"title":"Gap Analysis of Glaucoma Examination Concept Representations within Standard Systemized Nomenclature of Medicine – Clinical Terms","authors":"Shahin Hallaj MD ,&nbsp;Anthony P. Khawaja PhD, FRCOphth ,&nbsp;Ian A.S. Rodrigues FRCOphth ,&nbsp;Michael V. Boland MD, PhD ,&nbsp;Eric N. Brown MD, PhD ,&nbsp;Aiyin Chen MD ,&nbsp;Brian C. Stagg MD, MS ,&nbsp;Joshua D. Stein MD, MS ,&nbsp;Catherine Q. Sun MD ,&nbsp;Anne-Laure Mahe-Cook MBBS, BS ,&nbsp;Swarup S. Swaminathan MD ,&nbsp;Sophia Y. Wang MD, MS ,&nbsp;Benjamin Y. Xu MD, PhD ,&nbsp;Robert N. Weinreb MD ,&nbsp;Sally L. Baxter MD, MSc","doi":"10.1016/j.ogla.2024.08.001","DOIUrl":"10.1016/j.ogla.2024.08.001","url":null,"abstract":"<div><h3>Objective/Purpose</h3><div>Standardization of eye care data is important for clinical interoperability and research. We aimed to address gaps in the representations of glaucoma examination concepts within Systemized Nomenclature of Medicine – Clinical Terms (SNOMED-CT), the preferred terminology of the American Academy of Ophthalmology.</div></div><div><h3>Design</h3><div>Study of data elements.</div></div><div><h3>Methods</h3><div>Structured eye examination data fields from 2 electronic health records (EHR) systems (Epic Systems and Medisoft) were compared against existing SNOMED-CT codes for concepts representing glaucoma examination findings. Glaucoma specialists from multiple institutions were surveyed to identify high-priority gaps in representation, which were discussed among the SNOMED International Eye Care Clinical Reference Group. Proposals for new codes to address the gaps were formulated and submitted for inclusion in SNOMED-CT.</div></div><div><h3>Main Outcome Measures</h3><div>Gaps in SNOMED-CT glaucoma examination concept representations.</div></div><div><h3>Results</h3><div>We identified several gaps in SNOMED-CT regarding glaucoma examination concepts. A survey of glaucoma specialists identified high-priority data elements within the categories of tonometry and gonioscopy. For tonometry, there was consensus that we need to define new codes related to maximum intraocular pressure (IOP) and target IOP and delineate all methods of measuring IOP. These new codes were proposed and successfully added to SNOMED-CT for future use. Regarding gonioscopy, the current terminology did not include the ability to denote the gonioscopic grading system used (e.g., Shaffer or Spaeth), degree of angle pigmentation, iris configuration (except for plateau iris), and iris approach. There was also no ability to specify eye laterality or angle quadrant for gonioscopic findings. We proposed a framework for representing gonioscopic findings as observable entities in SNOMED-CT.</div></div><div><h3>Conclusion</h3><div>There are existing gaps in the standardized representation of findings related to tonometry and gonioscopy within SNOMED-CT. These are important areas for evaluating clinical outcomes and enabling secondary use of EHR data for glaucoma research. This international multi-institutional collaborative process enabled identification of gaps, prioritization, and development of data standards to address these gaps. Addressing these gaps and augmenting SNOMED-CT coverage of glaucoma examination findings could enhance clinical documentation and future research efforts related to glaucoma.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 1","pages":"Pages 83-91"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diagnostic Performance of the Offline Medios Artificial Intelligence for Glaucoma Detection in a Rural Tele-Ophthalmology Setting 离线 Medios 人工智能(AI)在农村远程眼科环境中检测青光眼的诊断性能。
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ogla.2024.09.002
Swati Upadhyaya MD , Divya Parthasarathy Rao MS , Srinivasan Kavitha MS , Shonraj Ballae Ganeshrao PhD , Kalpa Negiloni PhD , Shreya Bhandary BOpt , Florian M. Savoy MSc , Rengaraj Venkatesh MD
<div><h3>Purpose</h3><div>This study assesses the diagnostic efficacy of offline Medios Artificial Intelligence (AI) glaucoma software in a primary eye care setting, using nonmydriatic fundus images from Remidio's Fundus-on-Phone (FOP NM-10). Artificial intelligence results were compared with tele-ophthalmologists' diagnoses and with a glaucoma specialist's assessment for those participants referred to a tertiary eye care hospital.</div></div><div><h3>Design</h3><div>Prospective cross-sectional study</div></div><div><h3>Participants</h3><div>Three hundred three participants from 6 satellite vision centers of a tertiary eye hospital.</div></div><div><h3>Methods</h3><div>At the vision center, participants underwent comprehensive eye evaluations, including clinical history, visual acuity measurement, slit lamp examination, intraocular pressure measurement, and fundus photography using the FOP NM-10 camera. Medios AI-Glaucoma software analyzed 42-degree disc-centric fundus images, categorizing them as normal, glaucoma, or suspect. Tele-ophthalmologists who were glaucoma fellows with a minimum of 3 years of ophthalmology and 1 year of glaucoma fellowship training, masked to artificial intelligence (AI) results, remotely diagnosed subjects based on the history and disc appearance. All participants labeled as disc suspects or glaucoma by AI or tele-ophthalmologists underwent further comprehensive glaucoma evaluation at the base hospital, including clinical examination, Humphrey visual field analysis, and OCT. Artificial intelligence and tele-ophthalmologist diagnoses were then compared with a glaucoma specialist's diagnosis.</div></div><div><h3>Main Outcome Measures</h3><div>Sensitivity and specificity of Medios AI.</div></div><div><h3>Results</h3><div>Out of 303 participants, 299 with at least one eye of sufficient image quality were included in the study. The remaining 4 participants did not have sufficient image quality in both eyes. Medios AI identified 39 participants (13%) with referable glaucoma. The AI exhibited a sensitivity of 0.91 (95% confidence interval [CI]: 0.71–0.99) and specificity of 0.93 (95% CI: 0.89–0.96) in detecting referable glaucoma (definite perimetric glaucoma) when compared to tele-ophthalmologist. The agreement between AI and the glaucoma specialist was 80.3%, surpassing the 55.3% agreement between the tele-ophthalmologist and the glaucoma specialist amongst those participants who were referred to the base hospital. Both AI and the tele-ophthalmologist relied on fundus photos for diagnoses, whereas the glaucoma specialist's assessments at the base hospital were aided by additional tools such as Humphrey visual field analysis and OCT. Furthermore, AI had fewer false positive referrals (2 out of 10) compared to the tele-ophthalmologist (9 out of 10).</div></div><div><h3>Conclusions</h3><div>Medios offline AI exhibited promising sensitivity and specificity in detecting referable glaucoma from remote vision centers in southern I
目的:本研究评估了离线Medios人工智能(AI)青光眼软件在初级眼科医疗环境中的诊断效果,该软件使用了Remidio公司的手机眼底图像(FOP NM-10)。将人工智能结果与远程眼科医生的诊断结果以及转诊至三级眼科医院的青光眼专家的评估结果进行比较:设计:前瞻性横断面研究 参与者:一家三级眼科医院的 6 家卫星视力中心的 303 名参与者 方法:在视力中心,参与者接受全面的眼部评估,包括临床病史、视力测量、裂隙灯检查、眼压测量以及使用 FOP NM-10 相机进行眼底摄影。Medios AI-Glaucoma软件对42度盘心眼底图像进行分析,将其分为正常、青光眼或可疑三类。远程眼科医生是青光眼研究员,至少接受过 3 年的眼科培训和 1 年的青光眼研究培训,他们对人工智能结果进行了屏蔽,根据病史和椎间盘外观对受试者进行远程诊断。所有被人工智能或远程眼科医生诊断为眼底椎间盘可疑或青光眼的受试者都在基地医院接受了进一步的青光眼综合评估,包括临床检查、汉弗莱视野分析(HFA)和光学相干断层扫描(OCT)。然后将人工智能和远程眼科医生的诊断与青光眼专家的诊断进行比较:结果:在 303 名参与者中,有 299 名参与者至少有一只眼睛的图像质量达到了要求。其余 4 名参与者双眼图像质量均不达标。Medios AI 发现 39 名参与者(13%)患有可转诊的青光眼。与远程眼科医生相比,人工智能在检测可转诊青光眼(明确的周边性青光眼)方面的灵敏度为 0.91(95% CI:0.71 - 0.99),特异性为 0.93(95% CI:0.89 - 0.96)。在转诊到基地医院的参与者中,人工智能与青光眼专科医生的一致率为 80.3%,超过了远程眼科医生与青光眼专科医生 55.3% 的一致率。人工智能和远程眼科医生都依赖眼底照片进行诊断,而青光眼专科医生在基地医院的评估则借助了 HFA 和 OCT 等其他工具。此外,与远程眼科医生(10 次中有 9 次)相比,人工智能的误诊率较低(10 次中有 2 次):结论:与远程眼科医生相比,离线人工智能在检测印度南部偏远地区视力中心的可转诊青光眼方面表现出良好的灵敏度和特异性。对于可转诊的青光眼患者,离线人工智能与青光眼专家的诊断也显示出更好的一致性。
{"title":"Diagnostic Performance of the Offline Medios Artificial Intelligence for Glaucoma Detection in a Rural Tele-Ophthalmology Setting","authors":"Swati Upadhyaya MD ,&nbsp;Divya Parthasarathy Rao MS ,&nbsp;Srinivasan Kavitha MS ,&nbsp;Shonraj Ballae Ganeshrao PhD ,&nbsp;Kalpa Negiloni PhD ,&nbsp;Shreya Bhandary BOpt ,&nbsp;Florian M. Savoy MSc ,&nbsp;Rengaraj Venkatesh MD","doi":"10.1016/j.ogla.2024.09.002","DOIUrl":"10.1016/j.ogla.2024.09.002","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;This study assesses the diagnostic efficacy of offline Medios Artificial Intelligence (AI) glaucoma software in a primary eye care setting, using nonmydriatic fundus images from Remidio's Fundus-on-Phone (FOP NM-10). Artificial intelligence results were compared with tele-ophthalmologists' diagnoses and with a glaucoma specialist's assessment for those participants referred to a tertiary eye care hospital.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Prospective cross-sectional study&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Three hundred three participants from 6 satellite vision centers of a tertiary eye hospital.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;At the vision center, participants underwent comprehensive eye evaluations, including clinical history, visual acuity measurement, slit lamp examination, intraocular pressure measurement, and fundus photography using the FOP NM-10 camera. Medios AI-Glaucoma software analyzed 42-degree disc-centric fundus images, categorizing them as normal, glaucoma, or suspect. Tele-ophthalmologists who were glaucoma fellows with a minimum of 3 years of ophthalmology and 1 year of glaucoma fellowship training, masked to artificial intelligence (AI) results, remotely diagnosed subjects based on the history and disc appearance. All participants labeled as disc suspects or glaucoma by AI or tele-ophthalmologists underwent further comprehensive glaucoma evaluation at the base hospital, including clinical examination, Humphrey visual field analysis, and OCT. Artificial intelligence and tele-ophthalmologist diagnoses were then compared with a glaucoma specialist's diagnosis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Sensitivity and specificity of Medios AI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Out of 303 participants, 299 with at least one eye of sufficient image quality were included in the study. The remaining 4 participants did not have sufficient image quality in both eyes. Medios AI identified 39 participants (13%) with referable glaucoma. The AI exhibited a sensitivity of 0.91 (95% confidence interval [CI]: 0.71–0.99) and specificity of 0.93 (95% CI: 0.89–0.96) in detecting referable glaucoma (definite perimetric glaucoma) when compared to tele-ophthalmologist. The agreement between AI and the glaucoma specialist was 80.3%, surpassing the 55.3% agreement between the tele-ophthalmologist and the glaucoma specialist amongst those participants who were referred to the base hospital. Both AI and the tele-ophthalmologist relied on fundus photos for diagnoses, whereas the glaucoma specialist's assessments at the base hospital were aided by additional tools such as Humphrey visual field analysis and OCT. Furthermore, AI had fewer false positive referrals (2 out of 10) compared to the tele-ophthalmologist (9 out of 10).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Medios offline AI exhibited promising sensitivity and specificity in detecting referable glaucoma from remote vision centers in southern I","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 1","pages":"Pages 28-36"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ophthalmological Examination and Imaging Features that Better Predict Risk of Angle Closure in Siblings 能更好地预测兄弟姐妹发生闭角症风险的眼科检查和成像特征。
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ogla.2024.09.003
Shwetha Mudalegundi BS , Aleksandra Mihailovic ScM , Louay Almidani MD, MSc , Elizabeth C. Ciociola MD , Nazlee Zebardast MD, MS , Sharmila Rajendrababu MD , Mohideen Abdul Kader MD , Ganesh V. Raman MD , Venkatesh Rengaraj MD , Kavitha Srinivasan MD , Pradeep Y. Ramulu MD, PhD

Objective

Characteristics of individuals with angle closure may be useful in targeted screening of family members. Here, we assess if findings gathered during examination and imaging of patients with a known angle-closure diagnosis (probands) could better determine the risk of angle closure in the patients’ siblings.

Design

Cross-sectional study of patients with known angle closure and their siblings.

Participants

South Indian patients (probands) 30 years and older with open angles, primary angle-closure suspect (PACS), or primary angle closure/primary angle-closure glaucoma (PAC/PACG) and a biological sibling age 30 years or older (n = 292 proband/sibling pairs).

Methods

Demographic data, relevant ocular history, and a comprehensive ophthalmic examination with anterior segment OCT (AS-OCT) were obtained. Three clinically relevant models were created to analyze the contribution of specific proband factors in predicting sibling angle-closure diagnosis, using demographic (age, sex), ocular examination (gonioscopy, optic nerve examination, visual acuity, intraocular pressure), and AS-OCT features to improve prediction beyond proband diagnosis alone evaluated by log likelihood ratio testing and statistical comparison of receiver operating characteristics (ROCs).

Main Outcome Measures

Sibling angle-closure diagnostic accuracy.

Results

Demographic and ocular examination metrics did not improve the prediction of sibling angle closure for all 3 outcomes (sibling diagnosis: (1) PACS/PAC/PACG vs. OA, (2) PAC/PACG vs. PACS/OA, and (3) PAC/PACG vs. PACS), adding no model improvement when compared to diagnosis alone. Models adding AS-OCT metrics to the prior model including proband diagnosis, demographics, and ocular examination measures led to significantly improved prediction of 2 of the 3 angle-closure outcomes. Specifically, improvement was noted via likelihood ratio testing for prediction of PAC/PACG vs. PACS/OA (P = 0.01) or PAC/PACG vs. PACS (P = 0.001). For all 3 angle-closure outcomes, ROC comparisons demonstrated significant improvement in area under the curve (AUC) between the 3 models predicting sibling outcomes, demonstrating an increase in AUC with each successive nested model across all 3 sibling angle-closure outcomes.

Conclusions

Structural features of eyes with angle closure may assist in stratifying the risk of angle closure in patients’ siblings. Further studies should consider evaluating this approach to achieve more targeted screenings.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的:闭角患者的特征可能有助于对家庭成员进行有针对性的筛查。在此,我们将评估在对已确诊为闭角症的患者(探明者)进行检查和成像时收集的结果是否能更好地确定患者兄弟姐妹患闭角症的风险:设计:对已知角膜闭合患者及其兄弟姐妹进行横断面研究:参与者和对照组:30岁及以上患有开角型青光眼、疑似原发性闭角型青光眼(PACS)或原发性闭角型青光眼/原发性闭角型青光眼(PAC/PACG)的南印度患者(原发性患者)及其30岁及以上的亲生兄弟姐妹(原发性患者/兄弟姐妹对数为292对):方法:获取人口统计学数据、相关眼科病史以及通过前眼底光学相干断层扫描(ASOCT)进行的全面眼科检查。通过对数似然比检验和接受者操作特征(ROC)的统计比较,建立了三个临床相关模型,分析特定原发因素在预测同胞闭角诊断中的作用,利用人口统计学(年龄、性别)、眼部检查(眼底镜检查、视神经检查、视力、眼压[IOP])和ASOCT特征来提高预测效果,从而超越单纯的原发诊断:主要结果测量:兄弟姐妹闭角诊断准确率:结果:人口统计学和眼部检查指标并未改善所有三种结果(同胞诊断:(1) PACS/PAC/PACG vs OA;(2) PAC/PACG vs PACS/OA;(3) PAC/PACG vs PACS)的同胞角膜闭合预测,与单纯诊断相比,未增加任何模型改进。将 ASOCT 指标添加到包括原发性诊断、人口统计学和眼科检查指标在内的先验模型中,可显著改善对 3 个闭角结果中 2 个结果的预测。具体来说,通过似然比检验,PAC/PACG vs PACS/OA(P=0.01)或 PAC/PACG vs PACS(P=0.001)的预测结果均有所改善。对于所有 3 个闭角结果,ROC 比较显示,预测同胞结果的 3 个模型之间的 AUC 有显著改善,在所有 3 个同胞闭角结果中,每个连续嵌套模型的 AUC 都有所提高:结论:角膜闭合患者眼球的结构特征可能有助于对患者兄弟姐妹的角膜闭合风险进行分层。进一步的研究应考虑评估这种方法,以实现更有针对性的筛查。
{"title":"Ophthalmological Examination and Imaging Features that Better Predict Risk of Angle Closure in Siblings","authors":"Shwetha Mudalegundi BS ,&nbsp;Aleksandra Mihailovic ScM ,&nbsp;Louay Almidani MD, MSc ,&nbsp;Elizabeth C. Ciociola MD ,&nbsp;Nazlee Zebardast MD, MS ,&nbsp;Sharmila Rajendrababu MD ,&nbsp;Mohideen Abdul Kader MD ,&nbsp;Ganesh V. Raman MD ,&nbsp;Venkatesh Rengaraj MD ,&nbsp;Kavitha Srinivasan MD ,&nbsp;Pradeep Y. Ramulu MD, PhD","doi":"10.1016/j.ogla.2024.09.003","DOIUrl":"10.1016/j.ogla.2024.09.003","url":null,"abstract":"<div><h3>Objective</h3><div>Characteristics of individuals with angle closure may be useful in targeted screening of family members. Here, we assess if findings gathered during examination and imaging of patients with a known angle-closure diagnosis (probands) could better determine the risk of angle closure in the patients’ siblings.</div></div><div><h3>Design</h3><div>Cross-sectional study of patients with known angle closure and their siblings.</div></div><div><h3>Participants</h3><div>South Indian patients (probands) 30 years and older with open angles, primary angle-closure suspect (PACS), or primary angle closure/primary angle-closure glaucoma (PAC/PACG) and a biological sibling age 30 years or older (<em>n</em> = 292 proband/sibling pairs).</div></div><div><h3>Methods</h3><div>Demographic data, relevant ocular history, and a comprehensive ophthalmic examination with anterior segment OCT (AS-OCT) were obtained. Three clinically relevant models were created to analyze the contribution of specific proband factors in predicting sibling angle-closure diagnosis, using demographic (age, sex), ocular examination (gonioscopy, optic nerve examination, visual acuity, intraocular pressure), and AS-OCT features to improve prediction beyond proband diagnosis alone evaluated by log likelihood ratio testing and statistical comparison of receiver operating characteristics (ROCs).</div></div><div><h3>Main Outcome Measures</h3><div>Sibling angle-closure diagnostic accuracy.</div></div><div><h3>Results</h3><div>Demographic and ocular examination metrics did not improve the prediction of sibling angle closure for all 3 outcomes (sibling diagnosis: (1) PACS/PAC/PACG vs. OA, (2) PAC/PACG vs. PACS/OA, and (3) PAC/PACG vs. PACS), adding no model improvement when compared to diagnosis alone. Models adding AS-OCT metrics to the prior model including proband diagnosis, demographics, and ocular examination measures led to significantly improved prediction of 2 of the 3 angle-closure outcomes. Specifically, improvement was noted via likelihood ratio testing for prediction of PAC/PACG vs. PACS/OA (<em>P</em> = 0.01) or PAC/PACG vs. PACS (<em>P</em> = 0.001). For all 3 angle-closure outcomes, ROC comparisons demonstrated significant improvement in area under the curve (AUC) between the 3 models predicting sibling outcomes, demonstrating an increase in AUC with each successive nested model across all 3 sibling angle-closure outcomes.</div></div><div><h3>Conclusions</h3><div>Structural features of eyes with angle closure may assist in stratifying the risk of angle closure in patients’ siblings. Further studies should consider evaluating this approach to achieve more targeted screenings.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 1","pages":"Pages 12-21"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Characterizing Longitudinal Changes in Fear of Falling and Quality of Life in Patients with Varying Levels of Visual Field Damage 描述不同程度视野损伤患者对跌倒的恐惧和生活质量的纵向变化。
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ogla.2024.08.008
Louay Almidani MD, MSc , Aleksandra Mihailovic ScM , Zhuochen Yuan BS , Chhavi Saini MD, MPH , Pradeep Y. Ramulu MD, PhD

Purpose

To investigate the relationship between baseline visual field (VF) severity and rates of visual field loss with changes in quality of life (QoL) and fear of falling (FoF) in adults with glaucoma.

Methods

Prospective cohort study, including participants from the Falls In Glaucoma Study. Quality of life and FoF were assessed annually using the Glaucoma Quality of Life-15 Questionnaire, and the University of Illinois at Chicago FoF Questionnaire, respectively, with higher Rasch-analyzed scores (in logits) indicating better QoL and greater FoF. Mean deviation (MD) values of each eye were collected, with better-eye MD taken as the primary exposure. Change rates in better-eye MD, QoL, and FoF were computed using linear regression. Separate regression models were employed to explore the relationship between baseline better-eye MD and its rate of change with rates of change in QoL and FoF.

Results

The mean (standard deviation) rate of change in better-eye MD was −0.08 dB/year (0.5), rate of QoL change was −0.08 logits/year (0.4), and rate of FoF change was 0.16 logits/year (0.7). At baseline, better-eye MD (per dB worse) was significantly associated with worse baseline QoL (β = −0.10 logits [95% confidence interval [CI]: −0.13, −0.08]) and greater FoF (β = 0.06 logits [95% CI: 0.01, 0.10]). Baseline better-eye MD was associated with no significant change in QoL ( −0.004 logits/year, 95% CI: −0.02, 0.01) or FoF (–0.0001 logits/year, 95% CI: −0.02, 0.02) over time. Change rates in better-eye MD showed significant associations with faster increases in FoF over time (β = 0.26 logits/year [95% CI: 0.06, 0.45]; per dB loss/year), but not with changes in QoL (P = 0.79).

Conclusions

Patients with glaucoma generally showed worsening of QoL and FoF over time, though the degree of change was modest and not related to the degree of damage at baseline. Faster rates of better-eye MD change alone were associated with faster increases in FoF. Further studies are needed to evaluate the reasons (visual and nonvisual) for changes in QoL and functionality over time and find ways in which QoL and mobility can be improved for those with VF damage.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的:研究成人青光眼患者的基线视野(VF)严重程度和视野丧失率与生活质量(QoL)和跌倒恐惧(FoF)变化之间的关系:前瞻性队列研究,包括青光眼跌倒研究的参与者。每年分别使用青光眼生活质量-15(GQL-15)问卷和伊利诺伊大学芝加哥分校跌倒恐惧问卷对青光眼患者的生活质量和跌倒恐惧进行评估,Rasch分析得分越高(对数),表示青光眼患者的生活质量越好,跌倒恐惧越严重。收集了每只眼睛的平均偏差(MD)值,其中较好眼睛的 MD 值为主要暴露值。使用线性回归法计算较好眼睛 MD、QoL 和 FoF 的变化率。采用不同的回归模型来探讨基线双眼MD及其变化率与QoL和FoF变化率之间的关系:结果:平均(标清)双眼MD变化率为-0.08 dB/年(0.5),QoL变化率为-0.08 logits/年(0.4),FoF变化率为0.16 logits/年(0.7)。基线时,较好视力的 MD(每 dB 差)与较差的基线 QoL(β = -0.10 logits [95% CI: -0.13, -0.08])和较大的 FoF(β = 0.06 logits [95% CI: 0.01, 0.10])显著相关。随着时间的推移,基线较好视力MD与QoL(-0.004 logits/年,95% CI:-0.01,0.02)或FoF(-0.0001 logits/年,95% CI:-0.02,0.02)无明显变化。随着时间的推移,好眼MD的变化率与FoF的快速增长有显著关联(β=0.26 logits/年[95% CI:0.06,0.45];每分贝损失/年),但与QoL的变化无关(P=0.79):结论:随着时间的推移,青光眼患者的 QoL 和 FoF 普遍恶化,但变化程度不大,且与基线受损程度无关。单是较好眼压变化的速度较快,就与较快的FoF增长有关。还需要进一步的研究来评估随时间推移生活质量和功能发生变化的原因(视觉和非视觉),并找到改善视网膜纤维损伤患者生活质量和活动能力的方法。
{"title":"Characterizing Longitudinal Changes in Fear of Falling and Quality of Life in Patients with Varying Levels of Visual Field Damage","authors":"Louay Almidani MD, MSc ,&nbsp;Aleksandra Mihailovic ScM ,&nbsp;Zhuochen Yuan BS ,&nbsp;Chhavi Saini MD, MPH ,&nbsp;Pradeep Y. Ramulu MD, PhD","doi":"10.1016/j.ogla.2024.08.008","DOIUrl":"10.1016/j.ogla.2024.08.008","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the relationship between baseline visual field (VF) severity and rates of visual field loss with changes in quality of life (QoL) and fear of falling (FoF) in adults with glaucoma.</div></div><div><h3>Methods</h3><div>Prospective cohort study, including participants from the Falls In Glaucoma Study. Quality of life and FoF were assessed annually using the Glaucoma Quality of Life-15 Questionnaire, and the University of Illinois at Chicago FoF Questionnaire, respectively, with higher Rasch-analyzed scores (in logits) indicating better QoL and greater FoF. Mean deviation (MD) values of each eye were collected, with better-eye MD taken as the primary exposure. Change rates in better-eye MD, QoL, and FoF were computed using linear regression. Separate regression models were employed to explore the relationship between baseline better-eye MD and its rate of change with rates of change in QoL and FoF.</div></div><div><h3>Results</h3><div>The mean (standard deviation) rate of change in better-eye MD was −0.08 dB/year (0.5), rate of QoL change was −0.08 logits/year (0.4), and rate of FoF change was 0.16 logits/year (0.7). At baseline, better-eye MD (per dB worse) was significantly associated with worse baseline QoL (β = −0.10 logits [95% confidence interval [CI]: −0.13, −0.08]) and greater FoF (β = 0.06 logits [95% CI: 0.01, 0.10]). Baseline better-eye MD was associated with no significant change in QoL ( −0.004 logits/year, 95% CI: −0.02, 0.01) or FoF (–0.0001 logits/year, 95% CI: −0.02, 0.02) over time. Change rates in better-eye MD showed significant associations with faster increases in FoF over time (β = 0.26 logits/year [95% CI: 0.06, 0.45]; per dB loss/year), but not with changes in QoL (<em>P</em> = 0.79).</div></div><div><h3>Conclusions</h3><div>Patients with glaucoma generally showed worsening of QoL and FoF over time, though the degree of change was modest and not related to the degree of damage at baseline. Faster rates of better-eye MD change alone were associated with faster increases in FoF. Further studies are needed to evaluate the reasons (visual and nonvisual) for changes in QoL and functionality over time and find ways in which QoL and mobility can be improved for those with VF damage.</div></div><div><h3>Financial Disclosures</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 1","pages":"Pages 63-72"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Relationships between Frailty and the Risk of Glaucoma in Middle-aged and Older Adults 中老年人体弱与青光眼风险之间的关系。
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ogla.2024.09.006
Jianqi Chen MD , Xu Cao MD, PhD , Xiaohua Zhuo OD , Xuhao Chen MD, PhD , Yuyao Ling MD , Yuwen Wen MD , Guitong Ye MD , Yuan Zhang MD , Jinan Zhan MD , Hongmei Tan MD, PhD , Yingting Zhu MD, PhD , Yehong Zhuo MD, PhD
<div><h3>Purpose</h3><div>Increased frailty in older individuals increases health risks, but its relationship with glaucoma, the leading cause of irreversible blindness in middle-aged and older adults, is unclear. We investigated the association between frailty and glaucoma in a large-scale representative sample and explored possible causal relationships.</div></div><div><h3>Design</h3><div>Combined cross-sectional and Mendelian randomization (MR) study.</div></div><div><h3>Participants</h3><div>In the cross-sectional analysis, we included 5744 participants of the US National Health and Nutrition Examination Surveys 2005 to 2008 ≥ 40 years of age. For the MR analysis, frailty genome-wide association study (GWAS) data were sourced from a UK Biobank and TwinGen meta-analysis, and GWAS data on glaucoma subtypes were derived from FinnGen.</div></div><div><h3>Methods</h3><div>According to the 49-item frailty index, we classified participants into nonfrail (≤ 0.10), prefrail (0.10−0.21), and frail (> 0.21) groups. Using survey-weighted logistic regression models adjusted for multiple covariates, we explored the association between frailty and glaucoma. We further assessed causation using MR.</div></div><div><h3>Main Outcome Measures</h3><div>The associations between different levels of frailty (nonfrail, prefrail, and frail) and glaucoma, as well as causal relationships between genetically predicted frailty and various subtypes of glaucoma (primary open-angle glaucoma [POAG], primary angle-closure glaucoma [PACG], normotensive glaucoma [NTG], exfoliation glaucoma, and suspected glaucoma).</div></div><div><h3>Results</h3><div>After adjusting for covariates, higher frailty levels were significantly associated with glaucoma in frail individuals (odds ratio [OR] = 1.83, 95% confidence interval [CI] = 1.05–3.19, <em>P</em> = 0.036) but not prefrail (OR = 1.90, 95% CI = 0.99–3.64, <em>P</em> = 0.052). The association was significantly stronger among male participants (<em>P</em> interaction = 0.042). The variation in the association between frailty and glaucoma did not reach statistical significance across age groups (<em>P</em> interaction = 0.575) or race groups (<em>P</em> interaction = 0.092). Mendelian randomization revealed that genetically predicted frailty was linked to greater risks for POAG (OR = 1.67, 95% CI = 1.24–2.25, <em>P</em> = 0.001), PACG (OR = 2.78, 95% CI = 1.48–5.20, <em>P</em> = 0.001), exfoliation glaucoma (OR = 1.70, 95% CI = 1.18–2.43, <em>P</em> = 0.004), and suspected glaucoma (OR = 1.74, 95% CI = 1.30–2.34, <em>P</em> < 0.001) but not for NTG (OR = 1.01, 95% CI = 0.61–1.68, <em>P</em> = 0.956).</div></div><div><h3>Conclusions</h3><div>Our study revealed an association between frailty and increased glaucoma risk and emphasized the significance of glaucoma screening in frail individuals. Targeted health-care strategies can help prevent or delay irreversible blindness among middle-aged and older adults.</div></div><div><h3>Fin
目的:老年人体弱增加了健康风险,但其与青光眼(中老年人不可逆性失明的主要原因)的关系尚不清楚。我们在大规模代表性样本中调查了虚弱与青光眼之间的关系,并探讨了可能的因果关系:设计:横断面和孟德尔随机(MR)相结合的研究:在横断面分析中,我们纳入了 2005-2008 年美国国家健康与营养调查中年龄≥40 岁的 5744 名参与者。在MR分析中,虚弱全基因组关联研究(GWAS)数据来自英国生物库和TwinGen荟萃分析,青光眼亚型的GWAS数据来自FinnGen:根据 49 项虚弱指数,我们将参与者分为非虚弱组(≤0.10)、虚弱前组(0.10-0.21)和虚弱组(>0.21)。我们使用调查加权逻辑回归模型,并对多个协变量进行了调整,从而探讨了体弱与青光眼之间的关系。我们使用 MR 进一步评估了因果关系:不同程度的虚弱(非虚弱、虚弱前和虚弱)与青光眼之间的关系,以及遗传预测的虚弱与各种亚型青光眼(原发性开角型青光眼、原发性闭角型青光眼、正常血压型青光眼、剥脱性青光眼和疑似青光眼)之间的因果关系:在对协变量进行调整后,体弱者较高的体弱程度与青光眼显著相关(几率比[OR]=1.83,95%置信区间[CI]=1.05-3.19,P=0.036),但与先天体弱者无关(OR=1.90,95%置信区间[CI]=0.99-3.64,P=0.052)。男性参与者的相关性明显更强(P交互作用=0.042)。不同年龄组(P交互作用=0.575)或不同种族组(P交互作用=0.092)的虚弱与青光眼之间的关联差异未达到统计学意义。MR 显示,遗传预测的虚弱与原发性开角型青光眼(OR=1.67,95% CI=1.24-2.25,P=0.001)、原发性闭角型青光眼(OR=2.78,95% CI=1.48-5.20,P=0.001)、剥脱性青光眼(OR=1.70,95% CI=1.18-2.43,P=0.004)和疑似青光眼(OR=1.74,95% CI=1.30-2.34,PC结论:我们的研究揭示了体弱与青光眼风险增加之间的关系,并强调了对体弱者进行青光眼筛查的重要性。有针对性的医疗保健策略有助于预防或延缓中老年人不可逆转的失明。
{"title":"Relationships between Frailty and the Risk of Glaucoma in Middle-aged and Older Adults","authors":"Jianqi Chen MD ,&nbsp;Xu Cao MD, PhD ,&nbsp;Xiaohua Zhuo OD ,&nbsp;Xuhao Chen MD, PhD ,&nbsp;Yuyao Ling MD ,&nbsp;Yuwen Wen MD ,&nbsp;Guitong Ye MD ,&nbsp;Yuan Zhang MD ,&nbsp;Jinan Zhan MD ,&nbsp;Hongmei Tan MD, PhD ,&nbsp;Yingting Zhu MD, PhD ,&nbsp;Yehong Zhuo MD, PhD","doi":"10.1016/j.ogla.2024.09.006","DOIUrl":"10.1016/j.ogla.2024.09.006","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;Increased frailty in older individuals increases health risks, but its relationship with glaucoma, the leading cause of irreversible blindness in middle-aged and older adults, is unclear. We investigated the association between frailty and glaucoma in a large-scale representative sample and explored possible causal relationships.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Combined cross-sectional and Mendelian randomization (MR) study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;In the cross-sectional analysis, we included 5744 participants of the US National Health and Nutrition Examination Surveys 2005 to 2008 ≥ 40 years of age. For the MR analysis, frailty genome-wide association study (GWAS) data were sourced from a UK Biobank and TwinGen meta-analysis, and GWAS data on glaucoma subtypes were derived from FinnGen.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;According to the 49-item frailty index, we classified participants into nonfrail (≤ 0.10), prefrail (0.10−0.21), and frail (&gt; 0.21) groups. Using survey-weighted logistic regression models adjusted for multiple covariates, we explored the association between frailty and glaucoma. We further assessed causation using MR.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;The associations between different levels of frailty (nonfrail, prefrail, and frail) and glaucoma, as well as causal relationships between genetically predicted frailty and various subtypes of glaucoma (primary open-angle glaucoma [POAG], primary angle-closure glaucoma [PACG], normotensive glaucoma [NTG], exfoliation glaucoma, and suspected glaucoma).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;After adjusting for covariates, higher frailty levels were significantly associated with glaucoma in frail individuals (odds ratio [OR] = 1.83, 95% confidence interval [CI] = 1.05–3.19, &lt;em&gt;P&lt;/em&gt; = 0.036) but not prefrail (OR = 1.90, 95% CI = 0.99–3.64, &lt;em&gt;P&lt;/em&gt; = 0.052). The association was significantly stronger among male participants (&lt;em&gt;P&lt;/em&gt; interaction = 0.042). The variation in the association between frailty and glaucoma did not reach statistical significance across age groups (&lt;em&gt;P&lt;/em&gt; interaction = 0.575) or race groups (&lt;em&gt;P&lt;/em&gt; interaction = 0.092). Mendelian randomization revealed that genetically predicted frailty was linked to greater risks for POAG (OR = 1.67, 95% CI = 1.24–2.25, &lt;em&gt;P&lt;/em&gt; = 0.001), PACG (OR = 2.78, 95% CI = 1.48–5.20, &lt;em&gt;P&lt;/em&gt; = 0.001), exfoliation glaucoma (OR = 1.70, 95% CI = 1.18–2.43, &lt;em&gt;P&lt;/em&gt; = 0.004), and suspected glaucoma (OR = 1.74, 95% CI = 1.30–2.34, &lt;em&gt;P&lt;/em&gt; &lt; 0.001) but not for NTG (OR = 1.01, 95% CI = 0.61–1.68, &lt;em&gt;P&lt;/em&gt; = 0.956).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Our study revealed an association between frailty and increased glaucoma risk and emphasized the significance of glaucoma screening in frail individuals. Targeted health-care strategies can help prevent or delay irreversible blindness among middle-aged and older adults.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Fin","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 1","pages":"Pages 73-82"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Tibial Bone Keratoprosthesis: Seeing into the Third Decade 胫骨角膜移植术:见证第三个十年
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ogla.2024.10.003
Dinukie-Chantal Perera BS , James Chodosh MD, MPH , Teresa C. Chen MD
{"title":"Tibial Bone Keratoprosthesis: Seeing into the Third Decade","authors":"Dinukie-Chantal Perera BS ,&nbsp;James Chodosh MD, MPH ,&nbsp;Teresa C. Chen MD","doi":"10.1016/j.ogla.2024.10.003","DOIUrl":"10.1016/j.ogla.2024.10.003","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 1","pages":"Page e2"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Manometric Intraocular Pressure Reduction with Negative Pressure Using Ocular Pressure Adjusting Pump Goggles 使用眼压调节泵护目镜以负压方式降低人工眼压
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ogla.2024.09.005
Katherine S. Peters MD , Enrico Brambilla ME , Tanner Ferguson MD , Brent Kramer MD , Daniel Terveen MD , John Berdahl MD

Objective

The ocular pressure adjusting pump is a novel noninvasive and nonpharmacological intraocular pressure (IOP)-lowering device consisting of goggles attached to a negative pressure (NP) pump. This study aimed to determine the effect of NP in ocular pressure adjusting pump goggles on IOP using continuous direct manometry.

Design

Prospective, single-arm, single center, basic physiological research trial.

Subjects

Adult patients undergoing cataract surgery.

Methods

Direct manometry was performed via an anterior chamber cannula attached to an IOP sensor. This was placed just prior to each subject’s previously scheduled cataract surgery. Intraocular pressure was continuously monitored every 0.5 seconds through the following sequence of 30 seconds each: baseline IOP measurement, NP –10 mmHg, NP off, NP –20 mmHg, and NP off.

Main Outcome Measures

Intraocular pressure response to application of NP.

Results

All 17 subjects had a dose-dependent reduction in IOP, with a mean IOP decrease from 16.9 to 11.3 (33%) with –10 mmHg of NP and from 15.7 to 7.7 (51%) mmHg with –20 mmHg of NP. Intraocular pressure returned to baseline for each cycle when NP was discontinued. There were no patients with increased IOP.

Conclusions

Negative pressure with the ocular pressure adjusting pump results in a consistent dose-dependent reduction in IOP, with return to baseline IOP when NP is discontinued.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的:眼压调节泵是一种新型、非侵入性、非药物性降低眼压(IOP)装置,由连接负压(NP)泵的护目镜组成。本研究旨在通过连续直接测压法确定眼压调节泵护目镜中的负压对眼压的影响:前瞻性、单臂、单中心、基础生理研究试验:研究对象:接受白内障手术的成年患者:方法:直接测压是通过连接到眼压传感器的前房插管进行的。传感器在每位受试者预定的白内障手术前放置。每隔 0.5 秒对眼压进行一次连续监测,每次 30 秒:测量基线眼压、负压 -10 mmHg、负压关闭、负压 -20 mmHg 和负压关闭:结果:结果:所有 17 名受试者的眼压均呈剂量依赖性降低,负压为 -10 mmHg 时,平均眼压从 16.9 mmHg 降至 11.3 mmHg(33%),负压为 -20 mmHg 时,平均眼压从 15.7 mmHg 降至 7.7 mmHg(51%)。停用 NP 后,每个周期的眼压都恢复到基线水平。没有患者的眼压升高:结论:使用眼压调节泵进行负压治疗可持续降低眼压,并在停用 NP 后恢复到基线眼压。
{"title":"Manometric Intraocular Pressure Reduction with Negative Pressure Using Ocular Pressure Adjusting Pump Goggles","authors":"Katherine S. Peters MD ,&nbsp;Enrico Brambilla ME ,&nbsp;Tanner Ferguson MD ,&nbsp;Brent Kramer MD ,&nbsp;Daniel Terveen MD ,&nbsp;John Berdahl MD","doi":"10.1016/j.ogla.2024.09.005","DOIUrl":"10.1016/j.ogla.2024.09.005","url":null,"abstract":"<div><h3>Objective</h3><div>The ocular pressure adjusting pump is a novel noninvasive and nonpharmacological intraocular pressure (IOP)-lowering device consisting of goggles attached to a negative pressure (NP) pump. This study aimed to determine the effect of NP in ocular pressure adjusting pump goggles on IOP using continuous direct manometry.</div></div><div><h3>Design</h3><div>Prospective, single-arm, single center, basic physiological research trial.</div></div><div><h3>Subjects</h3><div>Adult patients undergoing cataract surgery.</div></div><div><h3>Methods</h3><div>Direct manometry was performed via an anterior chamber cannula attached to an IOP sensor. This was placed just prior to each subject’s previously scheduled cataract surgery. Intraocular pressure was continuously monitored every 0.5 seconds through the following sequence of 30 seconds each: baseline IOP measurement, NP –10 mmHg, NP off, NP –20 mmHg, and NP off.</div></div><div><h3>Main Outcome Measures</h3><div>Intraocular pressure response to application of NP.</div></div><div><h3>Results</h3><div>All 17 subjects had a dose-dependent reduction in IOP, with a mean IOP decrease from 16.9 to 11.3 (33%) with –10 mmHg of NP and from 15.7 to 7.7 (51%) mmHg with –20 mmHg of NP. Intraocular pressure returned to baseline for each cycle when NP was discontinued. There were no patients with increased IOP.</div></div><div><h3>Conclusions</h3><div>Negative pressure with the ocular pressure adjusting pump results in a consistent dose-dependent reduction in IOP, with return to baseline IOP when NP is discontinued.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 1","pages":"Pages 22-27"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Visualizing the Void: 3-Dimensional Insights into Optic Disc Pit 虚空可视化:视盘凹陷的三维透视。
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.ogla.2024.07.005
Kanishk Singh MS, Sagarika Snehi DNB, FAICO, Rajesh Pattebahadur MS
{"title":"Visualizing the Void: 3-Dimensional Insights into Optic Disc Pit","authors":"Kanishk Singh MS,&nbsp;Sagarika Snehi DNB, FAICO,&nbsp;Rajesh Pattebahadur MS","doi":"10.1016/j.ogla.2024.07.005","DOIUrl":"10.1016/j.ogla.2024.07.005","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 1","pages":"Page e1"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Ophthalmology. Glaucoma
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1