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Frontloading SITA-Faster Can Increase Frequency and Reliability of Visual Field Testing at Minimal Time Cost 更快地加载SITA可以以最小的时间成本提高视野测试的频率和可靠性。
IF 2.9 Q2 Medicine
Ophthalmology. Glaucoma
Pub Date : 2023-09-01 DOI: 10.1016/j.ogla.2023.03.006
Jeremy C.K. Tan MD, FRANZCO , Michael Kalloniatis PhD , Jack Phu PhD

Purpose

To report the outcomes of frontloaded visual field (VF) testing (2 tests per eye on the same visit) over 2 longitudinal, consecutive visits using SITA-Faster (SFR) in terms of global indices, reliability metrics, and test duration.

Design

Prospective longitudinal study.

Subjects

A total of 902 eyes of 463 subjects with normal, suspect, or manifest glaucoma.

Methods

Two intravisit SFR VF tests (T1 and T2) per eye at an initial (Ti) and follow-up (Tf) visit.

Main Outcome Measures

Intra- and intervisit global indices, reliability metrics, and test durations.

Results

The mean age of the subjects was 63.6 years, and 58.3% were male. Seven hundred ninety eyes (87.4%) had a diagnosis of glaucoma or glaucoma suspicion. The mean duration between visits was 265.0 (standard deviation 98.8) days. In total, 3608 VF tests were analyzed, with the correlation of mean deviation (MD) values of the frontloaded tests at each visit high (T1/T2 MD correlation at initial visit r = 0.83, root mean squared error [RMSE] = 1.26, follow-up visit r = 0.83, RMSE = 1.25, P < 0.0001) and greater than the correlation of MD between visits (Ti1/Tf1 MD correlation r = 0.72, RMSE = 1.31). There was a significant intra-visit decrease in rates of abnormally high sensitivity in the glaucoma hemifield test (3.2% vs. 1.6%, P = 0.0023) and rates of unreliable test results (15.4% vs. 9.2%, P = 0.002) from T1 to T2 in both visits, with a corresponding significant decrease in MD (–1.28 dB vs. –1.68 dB, P < 0.0001) and VF index (P = 0.03). The mean duration of each SFR test was 132.6 (SD 27.2) seconds.

Conclusions

Frontloading VFs using SFR produced sets of repeatable perimetric data with significant improvement of reliability indices from the first to second test. This may help increase testing frequency at minimal time cost to meet recommended guidelines and for evaluating patients prone to high variability.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

目的：报告使用SITA Faster（SFR）进行的2次纵向连续访视的前负荷视野（VF）测试（同一次访视每只眼睛2次测试）的结果，包括全局指数、可靠性指标和测试持续时间。设计：前瞻性纵向研究。受试者：463名受试者中的902只眼睛患有正常、可疑或明显的青光眼。方法：在初次（Ti）和随访（Tf）访视时，每只眼睛进行两次访视内SFR VF测试（T1和T2）。主要结果指标：访视内和访视间全球指数、可靠性指标和测试持续时间。结果：受试者的平均年龄为63.6岁，其中58.3%为男性。790眼（87.4%）被诊断为青光眼或怀疑青光眼。两次就诊的平均持续时间为265.0天（标准差98.8）。总共分析了3608次VF测试，每次访视时前负荷测试的平均偏差（MD）值的相关性较高（初次访视时T1/T2 MD相关性r=0.83，均方根误差[RMSE]=1.26，随访访视时r=0.83、均方根误差=1.25，P<0.0001），并且大于访视之间MD的相关性（Ti1/Tf1 MD相关性r=0.72，均方根值=1.31）在两次访视中，从T1到T2，青光眼半视野测试的异常高灵敏度（3.2%对1.6%，P=0.0023）和不可靠测试结果的发生率（15.4%对9.2%，P=0.002），MD（-1.28dB对-1.68dB，P<0.0001）和VF指数（P=0.003）相应显著下降。每次SFR测试的平均持续时间为132.6（SD 27.2）秒。结论：使用SFR的前负荷VFs产生了一组可重复的周长数据，从第一次测试到第二次测试的可靠性指标显著提高。这可能有助于以最小的时间成本增加检测频率，以满足推荐指南的要求，并用于评估易发生高度变异的患者。财务披露：作者对本文中讨论的任何材料都没有所有权或商业利益。
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引用次数: 2
Choroidal Effusions after Glaucoma Drainage Implant Surgery 青光眼引流植入术后脉络膜渗出
IF 2.9 Q2 Medicine
Ophthalmology. Glaucoma
Pub Date : 2023-09-01 DOI: 10.1016/j.ogla.2023.03.002
Stephanie Ying AB , Sara J. Coulon MD , Alcina K. Lidder MD , Mary Labowsky MD , Christopher P. Cheng AB , Kateki Vinod MD , Paul A. Sidoti MD , Joseph F. Panarelli MD

Objective

To report the incidence of patients who developed choroidal effusions after glaucoma drainage implant (GDI) surgery and determine risk factors for and outcomes of surgical intervention.

Design

Retrospective case series.

Subjects

Medical records of 605 patients who underwent GDI surgery from January 1, 2017 to June 7, 2021 at New York University Langone Health and New York Eye and Ear Infirmary of Mount Sinai were reviewed.

Methods

Preoperative, intraoperative, and postoperative clinical data were obtained. Multivariate logistic regression evaluated the factors associated with the need for surgical intervention. Patient records were analyzed for effusion resolution, intraocular pressure (IOP), visual acuity (VA), and complications across treatment modalities.

Main Outcome Measures

Incidence of choroidal effusion development and need for surgical intervention.

Results

Choroidal effusions developed in 110 (18%) patients (110 eyes). Surgical intervention to drain the effusion or ligate the implant tube was performed in 19 (17%) patients. The average time to surgical intervention was 47.6 days. Among patients who developed postoperative effusions, risk factors for requiring surgical intervention included history of selective laser trabeculoplasty (SLT) (P = 0.004; odds ratio [OR], 14.4), prior GDI surgery (P = 0.04; OR 8.7), 350-mm2 Baerveldt glaucoma implant placement (P = 0.05; OR, 4.8), and anterior chamber shallowing (AC; P < 0.001; OR, 25.1) in the presence of effusions. The subgroup that required multiple surgeries for effusion resolution had a significantly lower mean IOP at the most recent follow-up compared with those who received medical management only (P < 0.001). A higher percentage of patients who required surgical intervention lost VA at the most recent follow-up compared with patients whose effusions resolved with conservative management (i.e., medical management, AC viscoelastic injection).

Conclusions

Choroidal effusions after GDI surgery resolved with conservative management in most patients. A history of SLT or GDI placement, implantation of a BGI-350, and the presence of a shallow chamber were risk factors for surgical intervention. Although interventions, such as surgical drainage are at times necessary, a better understanding of their impacts can help guide postoperative decisions. The risks and benefits of these procedures must be carefully considered in these high-risk eyes.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的报告青光眼引流植入术（GDI）后并发脉络膜积液的患者发生率，并确定手术干预的危险因素和结果。设计回顾性病例系列。受试者回顾了2017年1月1日至2021年6月7日在纽约大学朗格尼健康中心和西奈山纽约眼耳医院接受GDI手术的605名患者的医疗记录。方法收集术前、术中、术后临床资料。多因素logistic回归评估了与手术干预需求相关的因素。分析患者记录中的积液消退、眼压（IOP）、视力（VA）和各种治疗方式的并发症。主要结果测量脉络膜积液的发生率和手术干预的必要性。结果110例（18%）患者（110眼）出现脉络膜积液。19名（17%）患者进行了引流积液或结扎植入管的手术干预。手术干预的平均时间为47.6天。在术后出现积液的患者中，需要手术干预的风险因素包括选择性激光小梁成形术（SLT）史（P=0.004；比值比[OR]，14.4）、既往GDI手术史（P=0.04；OR 8.7）、350-mm2 Baerveldt青光眼植入术史（P=0.05；OR，4.8），以及前房变浅（AC；P<；0.001；OR，25.1）。与仅接受药物治疗的患者相比，需要多次手术才能解决积液的亚组在最近的随访中的平均IOP显著较低（P<；0.001）。与采用保守治疗解决积液的患者相比较，需要手术干预的患者在最近的访问中失去VA的比例更高（即医疗管理，AC粘弹性注射）。结论GDI手术后的脉络膜积液在大多数患者中通过保守治疗得以解决。SLT或GDI植入史、BGI-350植入史和浅腔的存在是手术干预的风险因素。尽管手术引流等干预措施有时是必要的，但更好地了解其影响有助于指导术后决策。在这些高危人群眼中，必须仔细考虑这些手术的风险和益处。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。
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引用次数: 1
Comparison of Perimetric Outcomes from a Tablet Perimeter, Smart Visual Function Analyzer, and Humphrey Field Analyzer 平板电脑周长计、智能视觉功能分析仪和Humphrey视野分析仪的周长结果比较。
IF 2.9 Q2 Medicine
Ophthalmology. Glaucoma
Pub Date : 2023-09-01 DOI: 10.1016/j.ogla.2023.03.001
Joyce Kang BA , Sofia De Arrigunaga MD, MPH , Sandra E. Freeman BA , Yan Zhao MS , Michael Lin MD , Daniel L. Liebman MD , Ana M. Roldan MD , Julia A. Kim BS , Dolly S. Chang MD, PhD , David S. Friedman MD, PhD , Tobias Elze PhD

Purpose

The tablet-based Melbourne Rapid Fields (MRF) visual field (VF) test and the IMOvifa Smart Visual Function Analyzer (SVFA) are portable perimeters that may allow for at-home monitoring and more frequent testing. We compared tablet and SVFA results with outputs from the Humphrey Field Analyzer (HFA) 24-2 Swedish Interactive Threshold Algorithm Standard program.

Design

Observational cross-sectional study.

Subjects

Adult participants with a diagnosis of glaucoma, suspected glaucoma, or ocular hypertension seen in the Massachusetts Eye and Ear glaucoma clinic were enrolled. All participants were reliable and experienced HFA testers.

Methods

Participants were tested with the SVFA and HFA. The study staff also trained participants on the MRF tablet with instructions to take weekly tests at home for 3 months. Visual field results from the 3 devices were compared.

Main Outcome Measures

Mean deviation (MD), pattern standard deviation (PSD), reliability parameters, and point sensitivity.

Results

Overall, 79 participants (133 eyes) with a mean age of 61 ± 13 years (range, 26–79 years) were included; 59% of the participants were female, and the mean HFA MD was −2.7 ± 3.9 dB. The global indices of MD and PSD did not significantly vary between HFA and the 2 novel devices, except that the tablet VF reported a 0.6 dB higher PSD compared with HFA. However, tablet and SVFA sensitivities significantly differed from those of the HFA at 36 and 39 locations, respectively, out of 52 locations. Relative to HFA, the tablet overestimated light sensitivity in the nasal field while underestimating the temporal field. The SVFA generally underestimated light sensitivity, but its results were more similar to HFA results compared with the tablet.

Conclusions

Although average MD values from the 2 novel devices suggest that they provide similar results to the HFA, point-by-point comparisons highlight notable deviations. Differences in specific point sensitivity values were significant, especially between the tablet and the other 2 devices. These differences may in part be explained by differences in the devices' normative databases as well as how MD is calculated. However, the tablet had substantial differences based on location, indicating that the tablet design itself may be responsible for differences in local sensitivities.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的：基于平板电脑的Melbourne Rapid Fields（MRF）视野（VF）测试和IMOvifa智能视觉功能分析仪（SVFA）是便携式周界，可以在家进行监测和更频繁的测试。我们将平板电脑和SVFA结果与Humphrey Field Analyzer（HFA）24-2瑞典交互式阈值算法标准程序的输出进行了比较。设计：观察性横断面研究。受试者：在马萨诸塞州眼耳青光眼诊所就诊的诊断为青光眼、疑似青光眼或高眼压的成年参与者被纳入研究。所有参与者都是可靠且经验丰富的HFA测试人员。方法：采用SVFA和HFA对受试者进行测试。研究人员还对参与者进行了MRF平板电脑培训，并指示他们在家进行为期3个月的每周测试。比较了三种装置的视野结果。主要结果指标：平均偏差（MD）、模式标准偏差（PSD）、可靠性参数和点敏感性。结果：共有79名参与者（133眼），平均年龄61±13岁（26-79岁）；59%的参与者是女性，平均HFA-MD为-2.7±3.9 dB。MD和PSD的总体指数在HFA和2种新型设备之间没有显著变化，只是片剂VF报告的PSD比HFA高0.6dB。然而，在52个位置中，片剂和SVFA的敏感性分别在36个和39个位置与HFA显著不同。相对于HFA，该片剂高估了鼻野的感光度，而低估了时域。SVFA通常低估了感光度，但与片剂相比，其结果与HFA结果更相似。结论：尽管两种新型装置的平均MD值表明它们提供了与HFA相似的结果，但逐点比较突出了显著的偏差。特定点灵敏度值的差异非常显著，尤其是在片剂和其他2种设备之间。这些差异可以部分解释为设备标准数据库的差异以及MD的计算方式。然而，该片剂在位置上存在显著差异，这表明片剂设计本身可能是局部敏感性差异的原因。财务披露：专有或商业披露可在本文末尾的脚注和披露中找到。
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引用次数: 2
Forecasting Risk of Future Rapid Glaucoma Worsening Using Early Visual Field, OCT, and Clinical Data 利用早期视野、OCT和临床数据预测未来快速青光眼恶化的风险。
IF 2.9 Q2 Medicine
Ophthalmology. Glaucoma
Pub Date : 2023-09-01 DOI: 10.1016/j.ogla.2023.03.005
Patrick Herbert , Kaihua Hou , Chris Bradley PhD , Greg Hager PhD , Michael V. Boland MD, PhD , Pradeep Ramulu MD, PhD , Mathias Unberath PhD , Jithin Yohannan MD, MPH

Purpose

To assess whether we can forecast future rapid visual field (VF) worsening using deep learning models (DLMs) trained on early VF, OCT, and clinical data.

Design

A retrospective cohort study.

Subjects

In total, 4536 eyes from 2962 patients. Overall, 263 (5.80%) eyes underwent rapid VF worsening (mean deviation slope less than −1 dB/year across all VFs).

Methods

We included eyes that met the following criteria: (1) followed for glaucoma or suspect status; (2) had at least 5 longitudinal reliable VFs (VF1, VF2, VF3, VF4, and VF5); and (3) had 1 reliable baseline OCT scan (OCT1) and 1 set of baseline clinical measurements (clinical1) at the time of VF1. We designed a DLM to forecast future rapid VF worsening. The input consisted of spatially oriented total deviation values from VF1 (including or not including VF2 and VF3 in some models) and retinal nerve fiber layer thickness values from the baseline OCT. We passed this VF/OCT stack into a vision transformer feature extractor, the output of which was concatenated with baseline clinical data before putting it through a linear classifier to predict the eye’s risk of rapid VF worsening across the 5 VFs. We compared the performance of models with differing inputs by computing area under the curve (AUC) in the test set. Specifically, we trained models with the following inputs: (1) model V: VF1; (2) VC: VF1+ Clinical1; (3) VO: VF1+ OCT1; (4) VOC: VF1+ Clinical1+ OCT1; (5) V2: VF1 + VF2; (6) V2OC: VF1 + VF2 + Clinical1 + OCT1; (7) V3: VF1 + VF2 + VF3; and (8) V3OC: VF1 + VF2 + VF3 + Clinical1 + OCT1.

Main Outcome Measures

The AUC of DLMs when forecasting rapidly worsening eyes.

Results

Model V3OC best forecasted rapid worsening with an AUC (95% confidence interval [CI]) of 0.87 (0.77–0.97). Remaining models in descending order of performance and their respective AUC (95% CI) were as follows: (1) model V3 (0.84 [0.74–0.95]), (2) model V2OC (0.81 [0.70–0.92]), (3) model V2 (0.81 [0.70–0.82]), (4) model VOC (0.77 [0.65–0.88]), (5) model VO (0.75 [0.64–0.88]), (6) model VC (0.75 [0.63–0.87]), and (7) model V (0.74 [0.62–0.86]).

Conclusions

Deep learning models can forecast future rapid glaucoma worsening with modest to high performance when trained using data from early in the disease course. Including baseline data from multiple modalit

目的：评估我们是否可以使用根据早期VF、OCT和临床数据训练的深度学习模型（DLM）来预测未来快速视野（VF）的恶化。设计：一项回顾性队列研究。受试者：2962名患者共4536只眼睛。总的来说，263眼（5.80%）的VF快速恶化（所有VF的平均偏差斜率小于-1dB/年）。方法：我们纳入符合以下标准的眼睛：（1）随访青光眼或可疑状态；（2） 具有至少5个纵向可靠VF（VF1、VF2、VF3、VF4和VF5）；以及（3）在VF1时具有1个可靠的基线OCT扫描（OCT1）和1组基线临床测量（临床1）。我们设计了一个DLM来预测未来VF的快速恶化。输入包括与VF1（在一些模型中包括或不包括VF2和VF3）的空间定向总偏差值和与基线OCT的视网膜神经纤维层厚度值。我们将该VF/OCT堆栈传递到视觉变换器特征提取器中，在将其通过线性分类器以预测眼睛在5个VF中快速VF恶化的风险之前，将其输出与基线临床数据连接。我们通过计算测试集中的曲线下面积（AUC）来比较具有不同输入的模型的性能。具体来说，我们用以下输入训练模型：（1）模型V:VF1；（2） VC:VF1+临床1；（3） VO:VF1+OCT1；（4） VOC：VF1+临床1+OCT1；（5） V2:VF1+VF2；（6） V2OC:VF1+VF2+Clinical1+OCT1；（7） V3:VF1+VF2+VF3；和（8）V3OC:VF1+VF2+VF3+Clinical1+OCT1。主要结果指标：预测快速恶化眼睛时DLM的AUC。结果：模型V3OC的AUC（95%置信区间[CI]）为0.87（0.77-0.97，（6）VC模型（0.75[0.63-0.87]）和（7）V模型（0.74[0.62-0.86]）。结论：当使用病程早期的数据进行训练时，深度学习模型可以预测未来青光眼的快速恶化，并具有适度到高的性能。包括来自多种模式的基线数据和随后的就诊，除了单独使用心室颤动数据外，还能提高性能。财务披露：专有或商业披露可在本文末尾的脚注和披露中找到。
{"title":"Forecasting Risk of Future Rapid Glaucoma Worsening Using Early Visual Field, OCT, and Clinical Data","authors":"Patrick Herbert ,&nbsp;Kaihua Hou ,&nbsp;Chris Bradley PhD ,&nbsp;Greg Hager PhD ,&nbsp;Michael V. Boland MD, PhD ,&nbsp;Pradeep Ramulu MD, PhD ,&nbsp;Mathias Unberath PhD ,&nbsp;Jithin Yohannan MD, MPH","doi":"10.1016/j.ogla.2023.03.005","DOIUrl":"10.1016/j.ogla.2023.03.005","url":null,"abstract":"<div><h3>Purpose</h3><p>To assess whether we can forecast future rapid visual field (VF) worsening using deep learning models (DLMs) trained on early VF, OCT, and clinical data.</p></div><div><h3>Design</h3><p>A retrospective cohort study.</p></div><div><h3>Subjects</h3><p>In total, 4536 eyes from 2962 patients. Overall, 263 (5.80%) eyes underwent rapid VF worsening (mean deviation slope less than <span><math><mrow><mo>−</mo></mrow></math></span>1 dB/year across all VFs).</p></div><div><h3>Methods</h3><p>We included eyes that met the following criteria: (1) followed for glaucoma or suspect status; (2) had at least 5 longitudinal reliable VFs (VF<sub>1</sub>, VF<sub>2</sub>, VF<sub>3</sub>, VF<sub>4</sub>, and VF<sub>5</sub>); and (3) had 1 reliable baseline OCT scan (OCT<sub>1</sub>) and 1 set of baseline clinical measurements (clinical<sub>1</sub>) at the time of VF<sub>1</sub>. We designed a DLM to forecast future rapid VF worsening. The input consisted of spatially oriented total deviation values from VF<sub>1</sub> (including or not including VF<sub>2</sub> and VF<sub>3</sub><span> in some models) and retinal nerve fiber layer thickness values from the baseline OCT. We passed this VF/OCT stack into a vision transformer feature extractor, the output of which was concatenated with baseline clinical data before putting it through a linear classifier to predict the eye’s risk of rapid VF worsening across the 5 VFs. We compared the performance of models with differing inputs by computing area under the curve (AUC) in the test set. Specifically, we trained models with the following inputs: (1) model V: VF</span><sub>1</sub>; (2) VC: VF<sub>1</sub>+ Clinical<sub>1</sub>; (3) VO: VF<sub>1</sub>+ OCT<sub>1</sub>; (4) VOC: VF<sub>1</sub>+ Clinical<sub>1</sub>+ OCT<sub>1</sub>; (5) V<sub>2</sub>: VF<sub>1</sub> + VF<sub>2</sub>; (6) V<sub>2</sub>OC: VF<sub>1</sub> + VF<sub>2</sub> + Clinical<sub>1</sub> + OCT<sub>1</sub>; (7) V<sub>3</sub>: VF<sub>1</sub> + VF<sub>2</sub> + VF<sub>3</sub>; and (8) V<sub>3</sub>OC: VF<sub>1</sub> + VF<sub>2</sub> + VF<sub>3</sub> + Clinical<sub>1</sub> + OCT<sub>1</sub>.</p></div><div><h3>Main Outcome Measures</h3><p>The AUC of DLMs when forecasting rapidly worsening eyes.</p></div><div><h3>Results</h3><p>Model V<sub>3</sub>OC best forecasted rapid worsening with an AUC (95% confidence interval [CI]) of 0.87 (0.77–0.97). Remaining models in descending order of performance and their respective AUC (95% CI) were as follows: (1) model V<sub>3</sub> (0.84 [0.74–0.95]), (2) model V<sub>2</sub>OC (0.81 [0.70–0.92]), (3) model V<sub>2</sub> (0.81 [0.70–0.82]), (4) model VOC (0.77 [0.65–0.88]), (5) model VO (0.75 [0.64–0.88]), (6) model VC (0.75 [0.63–0.87]), and (7) model V (0.74 [0.62–0.86]).</p></div><div><h3>Conclusions</h3><p>Deep learning models can forecast future rapid glaucoma worsening with modest to high performance when trained using data from early in the disease course. Including baseline data from multiple modalit","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10509314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9389058","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: 3
The Journal Receives Its Initial Impact Factor 《华尔街日报》收到了最初的影响因素。
IF 2.9 Q2 Medicine
Ophthalmology. Glaucoma
Pub Date : 2023-09-01 DOI: 10.1016/j.ogla.2023.07.008
Henry D. Jampel MD, MHS, May B. Piotrowski MA
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引用次数: 0
Evaluating Measurement Properties of Patient-Reported Outcome Measures in Glaucoma 评估青光眼患者报告结果测量的测量特性
IF 2.9 Q2 Medicine
Ophthalmology. Glaucoma
Pub Date : 2023-09-01 DOI: 10.1016/j.ogla.2023.04.007
Anastasiya Vinokurtseva MD , Matthew P. Quinn MD, PhD , Mandy Wai BSc , Victoria Leung BMSc , Monali Malvankar-Mehta PhD , Cindy M.L. Hutnik MD, PhD

Topic

The purpose of the current study was to systematically identify and evaluate existing patient-reported outcome measures (PROMs) for clinical glaucoma practice.

Clinical Relevance

Understanding and incorporating patient preferences into decision-making is now recognized as critical for optimal resource allocation, especially in technologically advancing areas, such as minimally invasive surgeries. Patient-reported outcome measures are instruments designed to evaluate the health outcomes that are most important to patients. Despite their recognized importance, especially in the era of patient-centered care, their routine use in clinical settings remains low.

Methods

A systematic literature search was conducted in 6 databases (EMBASE, MEDLINE, PsycINFO, Scopus, BIOSIS, and Web of Science) from the date of inception. Studies were included in the qualitative review if they reported measurement properties of PROMs in adult patients with glaucoma. COnsensus-based Standards for the selection of health Measurement INstruments guidelines were used to assess the included PROMs. The study protocol is registered with PROSPERO (registration number: CRD42020176064).

Results

The literature search yielded 2661 records. After deduplication, 1259 studies entered level 1 screening, and based on title and abstract review, 164 records proceeded to full-text screening. In 48 included studies, 70 instrument reports discuss 43 distinct instruments in 3 major categories: glaucoma-specific, vision-specific, and general health-related quality of life. Most used measures were glaucoma-specific (Glaucoma Quality of Life [GQL] and Glaucoma Symptom Scale [GSS]) and vision-specific (National Eye Institute Visual Function Questionnaire [NEI VFQ-25]). All 3 have sufficient validity (especially construct), with GQL and GSS having sufficient internal consistency, cross-cultural validity, and reliability, with reports suggesting high methodological quality.

Conclusion

The GQL, GSS, and NEI VFQ-25 are the 3 most used questionnaires in a research setting, having considerable validation in a patient population with glaucoma. Limited reports on interpretability, responsiveness, and feasibility in all 43 identified instruments make identifying a single optimal questionnaire for clinical use challenging and highlight the need for further studies.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

主题当前研究的目的是系统地识别和评估临床青光眼实践中现有的患者报告结果测量（PROM）。临床相关性了解患者偏好并将其纳入决策现在被认为是优化资源分配的关键，尤其是在技术进步的领域，如微创手术。患者报告的结果测量是旨在评估对患者最重要的健康结果的工具。尽管它们具有公认的重要性，尤其是在以患者为中心的护理时代，但它们在临床环境中的常规使用率仍然很低。方法从创建之日起，在EMBASE、MEDLINE、PsycINFO、Scopus、BIOSIS和Web of Science 6个数据库中进行系统的文献检索。如果研究报告了成年青光眼患者PROM的测量特性，则将其纳入定性审查。基于康森索斯的健康测量仪器选择标准指南用于评估纳入的PROM。研究方案已在PROSPERO注册（注册号：CRD42020176064）。结果文献检索得到2661条记录。重复数据消除后，1259项研究进入1级筛选，根据标题和摘要审查，164项记录进入全文筛选。在48项纳入的研究中，70份仪器报告讨论了3大类43种不同的仪器：青光眼特异性、视力特异性和一般健康相关生活质量。最常用的测量方法是青光眼特异性（青光眼生活质量[GQL]和青光眼症状量表[GSS]）和视力特异性（国家眼科研究所视觉功能问卷[NEI VFQ-25]）。所有3项都具有足够的有效性（尤其是结构），GQL和GSS具有足够的内部一致性、跨文化有效性和可靠性，报告表明方法论质量很高。结论GQL、GSS和NEI VFQ-25是研究环境中使用最多的三种问卷，在青光眼患者群体中具有相当大的验证性。关于所有43种已确定仪器的可解释性、响应性和可行性的有限报告，使得确定一份用于临床的最佳问卷具有挑战性，并强调了进一步研究的必要性。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。
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引用次数: 0
Ab Externo SIBS Microshunt with Mitomycin C for Open-Angle Glaucoma Ab-Externo-SIBS联合丝裂霉素C微搜寻治疗开角型青光眼
IF 2.9 Q2 Medicine
Ophthalmology. Glaucoma
Pub Date : 2023-09-01 DOI: 10.1016/j.ogla.2023.04.002
James J. Armstrong MD, PhD , Ticiana De Francesco MD , Jenny Ma MD , Matthew B. Schlenker MD, MSc , Iqbal Ike K. Ahmed MD

Purpose

To determine the effectiveness, risk factors for surgical failure, and adverse events in a large cohort of patients receiving stand-alone ab externo poly(styrene-block-isobutylene-block-styrene) (SIBS) microshunt implantation with mitomycin C (MMC) over 3 years of follow-up.

Design

Retrospective, interventional case series.

Participants

Glaucomatous eyes on maximally tolerated medical therapy with no previous subconjunctival glaucoma surgery.

Methods

Records of eyes that underwent ab externo SIBS microshunt with MMC between July 2015 and November 2017 were reviewed. Data from all follow-up visits were utilized and included intraocular pressure (IOP), medication use, postoperative interventions, complications, and reoperations.

Main Outcome Measures

The primary outcome was proportion of eyes at 3 years with (1) no 2 consecutive IOPs > 17 mmHg (or < 6 mmHg with > 2 lines of vision loss from baseline); (2) ≥ 20% reduction from baseline IOP; and (3) using no glaucoma medications (complete success). Secondary outcomes included 14 and 21 mmHg upper IOP thresholds with and without ≥ 20% IOP reduction from baseline, qualified success (with glaucoma medications), risk factors for failure, median IOP/medications, postoperative interventions, complications, and reoperations.

Results

One hundred fifty-two eyes from 135 patients were included. Complete and qualified success was achieved in 55.6% and 74.8% of eyes, respectively. Time to first glaucoma medication use was a median of 16.9 (interquartile range [IQR], 12.1–34.1) months; however, 59.4% of eyes remained medication free at 3 years. Significant risk factors for failure included receiving < 0.4 mg/ml of MMC (adjusted hazard ratio [HR], 2.42; 95% confidence interval [CI], 1.44–4.05) and baseline IOP < 21 mmHg (adjusted HR, 1.79; 95% CI, 1.03–3.13). The most common complications were choroidal detachment, hyphema, and anterior chamber shallowing, occurring in 7%, 5%, and 5% of eyes, respectively. The needling rate was 15.1%, with significantly higher frequency for baseline IOP > 21 mmHg (HR, 3.21; 95% CI, 1.38–7.48). Revisions occurred in 7% of eyes and reoperations in 2.6%. Eyes receiving < 0.4 mg/ml of MMC underwent more revisions (odds ratio, 4.9; 95% CI, 1.3–18.3).

Conclusions

Three-year follow-up data from this large cohort continues to support promising rates of qualified and complete success, with decreased medication burden postoperatively and few postoperative complications and interventions. Comparisons to other filtering surgeries will further facilitate integration of the SIBS microshunt into the surgical treatment paradigm.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的确定在3年随访期内接受单独体外多聚苯乙烯-异丁烯-嵌段苯乙烯（SIBS）微搜寻植入丝裂霉素C（MMC）的大型患者队列中手术失败的有效性、危险因素和不良事件。设计回顾性介入性病例系列。参与者青光眼眼接受最大耐受性药物治疗，既往无结膜下青光眼手术。方法回顾2015年7月至2017年11月间用MMC进行体外SIBS显微手术的病例记录。利用了所有随访的数据，包括眼压（IOP）、药物使用、术后干预、并发症和再次手术。主要结果测量主要结果是在3年时有（1）没有2个连续IOP>；17mmHg（或＜6mmHg，与基线相比视力损失＞2行）；（2） 与基线IOP相比降低≥20%；和（3）不使用青光眼药物（完全成功）。次要结果包括14和21 mmHg的眼压上限阈值，与基线相比眼压降低或不降低≥20%，合格的成功率（使用青光眼药物），失败的风险因素，中位眼压/药物，术后干预，并发症和再次手术。结果135例患者152只眼。成功率分别为55.6%和74.8%。首次使用青光眼药物的时间中位数为16.9个月（四分位间距[IQR]，12.1-34.1）；然而，59.4%的眼睛在3年时仍然没有药物。失败的重要风险因素包括接收<；0.4 mg/ml MMC（调整后的危险比[HR]，2.42；95%置信区间[CI]，1.44–4.05）和基线IOP<；21 mmHg（校正HR，1.79；95%CI，1.03–3.13）。最常见的并发症是脉络膜脱离、前房积血和前房变浅，分别发生在7%、5%和5%的眼睛中。针刺率为15.1%，基线IOP>；21毫米汞柱（HR，3.21；95%CI，1.38-7.48）。7%的眼睛出现矫正，2.6%的眼睛再次手术；0.4 mg/ml MMC进行了更多的翻修（比值比，4.9；95%可信区间，1.3-18.3）。结论来自这一大型队列的三年随访数据继续支持有希望的合格和完全成功率，术后药物负担减轻，术后并发症和干预少。与其他过滤手术的比较将进一步促进将SIBS微搜寻整合到手术治疗模式中。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。
{"title":"Ab Externo SIBS Microshunt with Mitomycin C for Open-Angle Glaucoma","authors":"James J. Armstrong MD, PhD ,&nbsp;Ticiana De Francesco MD ,&nbsp;Jenny Ma MD ,&nbsp;Matthew B. Schlenker MD, MSc ,&nbsp;Iqbal Ike K. Ahmed MD","doi":"10.1016/j.ogla.2023.04.002","DOIUrl":"https://doi.org/10.1016/j.ogla.2023.04.002","url":null,"abstract":"<div><h3>Purpose</h3><p>To determine the effectiveness, risk factors for surgical failure, and adverse events in a large cohort of patients receiving stand-alone ab externo poly(styrene-block-isobutylene-block-styrene) (SIBS) microshunt implantation with mitomycin C (MMC) over 3 years of follow-up.</p></div><div><h3>Design</h3><p>Retrospective, interventional case series.</p></div><div><h3>Participants</h3><p>Glaucomatous eyes on maximally tolerated medical therapy with no previous subconjunctival glaucoma surgery.</p></div><div><h3>Methods</h3><p>Records of eyes that underwent ab externo SIBS microshunt with MMC between July 2015 and November 2017 were reviewed. Data from all follow-up visits were utilized and included intraocular pressure (IOP), medication use, postoperative interventions, complications, and reoperations.</p></div><div><h3>Main Outcome Measures</h3><p>The primary outcome was proportion of eyes at 3 years with (1) no 2 consecutive IOPs &gt; 17 mmHg (or &lt; 6 mmHg with &gt; 2 lines of vision loss from baseline); (2) ≥ 20% reduction from baseline IOP; and (3) using no glaucoma medications (complete success). Secondary outcomes included 14 and 21 mmHg upper IOP thresholds with and without ≥ 20% IOP reduction from baseline, qualified success (with glaucoma medications), risk factors for failure, median IOP/medications, postoperative interventions, complications, and reoperations.</p></div><div><h3>Results</h3><p>One hundred fifty-two eyes from 135 patients were included. Complete and qualified success was achieved in 55.6% and 74.8% of eyes, respectively. Time to first glaucoma medication use was a median of 16.9 (interquartile range [IQR], 12.1–34.1) months; however, 59.4% of eyes remained medication free at 3 years. Significant risk factors for failure included receiving &lt; 0.4 mg/ml of MMC (adjusted hazard ratio [HR], 2.42; 95% confidence interval [CI], 1.44–4.05) and baseline IOP &lt; 21 mmHg (adjusted HR, 1.79; 95% CI, 1.03–3.13). The most common complications were choroidal detachment, hyphema, and anterior chamber shallowing, occurring in 7%, 5%, and 5% of eyes, respectively. The needling rate was 15.1%, with significantly higher frequency for baseline IOP &gt; 21 mmHg (HR, 3.21; 95% CI, 1.38–7.48). Revisions occurred in 7% of eyes and reoperations in 2.6%. Eyes receiving &lt; 0.4 mg/ml of MMC underwent more revisions (odds ratio, 4.9; 95% CI, 1.3–18.3).</p></div><div><h3>Conclusions</h3><p>Three-year follow-up data from this large cohort continues to support promising rates of qualified and complete success, with decreased medication burden postoperatively and few postoperative complications and interventions. Comparisons to other filtering surgeries will further facilitate integration of the SIBS microshunt into the surgical treatment paradigm.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49807042","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: 2
Comparing the Effectiveness of Phacoemulsification + Endoscopic Cyclophotocoagulation Laser versus Phacoemulsification Alone for the Treatment of Primary Open Angle Glaucoma in Patients with Cataract (CONCEPT) 超声乳化+内镜激光循环光凝与单纯超声乳化治疗白内障原发性开角型青光眼的疗效比较
IF 2.9 Q2 Medicine
Ophthalmology. Glaucoma
Pub Date : 2023-09-01 DOI: 10.1016/j.ogla.2023.03.004
Tom Sherman FRCOphth , Ian A.S. Rodrigues FRCOphth , Saurabh Goyal FRCS, FRCOphth , Pouya Alaghband MD, FRCOphth , Philip Bloom FRCS, FRCOphth , Keith Barton MD, FRCS , Hari Jayaram PhD, FRCOphth , Mohammed Abu-Bakra FRCOphth , Melody Ni PhD , Kin Sheng Lim MD, FRCOphth

Objective

To describe the methodology of the Comparing the Effectiveness of Phacoemulsification + Endoscopic Cyclophotocoagulation Laser and Phacoemulsification Alone for the Treatment of Primary Open Angle Glaucoma in Patients with Cataract (CONCEPT) study, a randomized controlled trial.

Design

Double-masked, randomized controlled trial.

Subjects, Participants, and/or Controls

Participants will be recruited from 5 United Kingdom–based centers. One hundred and sixty eyes with a diagnosis of primary open-angle glaucoma and visually significant cataract will be included. Eighty eyes will be randomized to undergo cataract surgery alone and eighty to undergo cataract surgery with endoscopic cyclophotocoagulation (ECP).

Methods

The baseline diurnal washout intraocular pressure (IOP) will be measured. The participants will be randomized to undergo cataract surgery alone or cataract surgery with ECP upon completion of uncomplicated cataract surgery. At the 1- and 2-year post surgery follow-up visits, the measurements of washout diurnal IOP will be repeated.

Main Outcome Measures

Diurnal washout IOP, use of glaucoma medications, and adverse events.

Conclusions

We described the methodology of the first randomized controlled trial comparing cataract surgery alone with cataract surgery combined with ECP in the context of patients with primary open-angle glaucoma and symptomatic cataract.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的描述比较超声乳化+内窥镜激光和超声乳化单独治疗白内障患者原发性开角型青光眼的疗效的方法（CONCEPT）研究，一项随机对照试验。设计双盲随机对照试验。受试者、参与者和/或对照参与者将从5个英国中心招募。160只被诊断为原发性开角型青光眼和视力显著白内障的眼睛将被包括在内。80只眼睛将随机接受白内障单独手术，80只眼睛接受白内障内窥镜睫状体光凝术（ECP）。方法测量基线昼夜冲洗眼压（IOP）。参与者将被随机分为单独接受白内障手术或在完成简单白内障手术后接受ECP白内障手术。在术后1年和2年的随访中，将重复测量冲洗日眼压。主要疗效指标日间冲洗眼压、青光眼药物的使用和不良事件。结论我们描述了第一项随机对照试验的方法，该试验在原发性开角型青光眼和症状性白内障患者中比较了单独白内障手术和白内障手术联合ECP。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。
{"title":"Comparing the Effectiveness of Phacoemulsification + Endoscopic Cyclophotocoagulation Laser versus Phacoemulsification Alone for the Treatment of Primary Open Angle Glaucoma in Patients with Cataract (CONCEPT)","authors":"Tom Sherman FRCOphth ,&nbsp;Ian A.S. Rodrigues FRCOphth ,&nbsp;Saurabh Goyal FRCS, FRCOphth ,&nbsp;Pouya Alaghband MD, FRCOphth ,&nbsp;Philip Bloom FRCS, FRCOphth ,&nbsp;Keith Barton MD, FRCS ,&nbsp;Hari Jayaram PhD, FRCOphth ,&nbsp;Mohammed Abu-Bakra FRCOphth ,&nbsp;Melody Ni PhD ,&nbsp;Kin Sheng Lim MD, FRCOphth","doi":"10.1016/j.ogla.2023.03.004","DOIUrl":"https://doi.org/10.1016/j.ogla.2023.03.004","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the methodology of the Comparing the Effectiveness of Phacoemulsification + Endoscopic Cyclophotocoagulation Laser and Phacoemulsification Alone for the Treatment of Primary Open Angle Glaucoma in Patients with Cataract (CONCEPT) study, a randomized controlled trial.</p></div><div><h3>Design</h3><p>Double-masked, randomized controlled trial.</p></div><div><h3>Subjects, Participants, and/or Controls</h3><p>Participants will be recruited from 5 United Kingdom–based centers. One hundred and sixty eyes with a diagnosis of primary open-angle glaucoma and visually significant cataract will be included. Eighty eyes will be randomized to undergo cataract surgery alone and eighty to undergo cataract surgery with endoscopic cyclophotocoagulation (ECP).</p></div><div><h3>Methods</h3><p>The baseline diurnal washout intraocular pressure (IOP) will be measured. The participants will be randomized to undergo cataract surgery alone or cataract surgery with ECP upon completion of uncomplicated cataract surgery. At the 1- and 2-year post surgery follow-up visits, the measurements of washout diurnal IOP will be repeated.</p></div><div><h3>Main Outcome Measures</h3><p>Diurnal washout IOP, use of glaucoma medications, and adverse events.</p></div><div><h3>Conclusions</h3><p>We described the methodology of the first randomized controlled trial comparing cataract surgery alone with cataract surgery combined with ECP in the context of patients with primary open-angle glaucoma and symptomatic cataract.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49807021","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
A Surgical Technique for Same-quadrant Ahmed-to-Baerveldt Exchange 同象限Ahmed至Baerveldt交换的手术技术。
IF 2.9 Q2 Medicine
Ophthalmology. Glaucoma
Pub Date : 2023-09-01 DOI: 10.1016/j.ogla.2023.05.004
Inae J. Kim MD, Jacob A. Kanter MD, Mary Qiu MD
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引用次数: 2
Intraocular Pressure and Rates of Macular Thinning in Glaucoma 青光眼的眼压和黄斑变薄率。
IF 2.9 Q2 Medicine
Ophthalmology. Glaucoma
Pub Date : 2023-09-01 DOI: 10.1016/j.ogla.2023.03.008
Abia Ahmed BSc , Alessandro A. Jammal MD, PhD , Tais Estrela MD , Samuel I. Berchuck PhD , Felipe A. Medeiros MD, PhD

Purpose

To evaluate the effect of intraocular pressure (IOP) on the rates of macular thickness (ganglion cell layer [GCL] and ganglion cell–inner plexiform layer [GCIPL]) change over time measured by spectral-domain (SD) OCT.

Design

Retrospective cohort study.

Participants

Overall, 451 eyes of 256 patients with primary open-angle glaucoma.

Methods

Data were extracted from the Duke Ophthalmic Registry, a database of electronic medical records of patients observed under routine clinical care at the Duke Eye Center, and satellite clinics. All records from patients with a minimum of 6 months of follow-up and at least 2 good-quality Spectralis SD-OCT macula scans were included. Linear mixed models were used to investigate the relationship between average IOP during follow-up and rates of GCL and GCIPL thickness change over time.

Main Outcome Measures

The effect of IOP on the rates of GCL and GCIPL thickness loss measured by SD-OCT.

Results

Eyes had a mean follow-up of 1.8 ± 1.3 years, ranging from 0.5 to 10.2 years. The average rate of change for GCL thickness was −0.220 μm/year (95% confidence interval [CI], −0.268 to −0.172 μm/year) and for GCIPL thickness was −0.231 μm/year (95% CI, −0.302 to −0.160 μm/year). Each 1-mmHg higher mean IOP during follow-up was associated with an additional loss of −0.021 μm/year of GCL thickness (P = 0.001) and −0.032 μm/year of GCIPL thickness (P = 0.001) after adjusting for potentially confounding factors, such as baseline age, disease severity, sex, race, central corneal thickness, and follow-up time.

Conclusions

Higher IOP was significantly associated with faster rates of GCL and GCIPL loss over time measured by SD-OCT, even during relatively short follow-up times. These findings support the use of SD-OCT GCL and GCIPL thickness measurements as structural biomarkers for the evaluation of the efficacy of IOP-lowering therapies in slowing down the progression of glaucoma.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的：评估眼压（IOP）对通过光谱域（SD）OCT测量的黄斑厚度（神经节细胞层[GCL]和神经节细胞内丛状层[GCIPL]）随时间变化率的影响。设计：回顾性队列研究。参与者：256名原发性开角型青光眼患者共451眼。方法：数据来自杜克眼科登记处，这是一个在杜克眼科中心常规临床护理下观察到的患者的电子医疗记录数据库，以及卫星诊所。纳入了至少6个月随访和至少2次高质量Spectralis SD-OCT黄斑扫描的患者的所有记录。使用线性混合模型来研究随访期间的平均IOP与GCL和GCIPL厚度随时间变化率之间的关系。主要结果指标：通过SD-OCT测量IOP对GCL和GCIPL厚度损失率的影响。结果：眼睛的平均随访时间为1.8±1.3年，从0.5年到10.2年不等。GCL厚度的平均变化率为-0.220μm/年（95%置信区间[CI]，-0.268至-0.172μm/年），GCIPL厚度的变化率为-0.131μm/年，95%置信区间为-0.302至-0.160μm/年。随访期间平均IOP每升高1mmHg，在校正潜在的混杂因素（如基线年龄、疾病严重程度、性别、种族、中央角膜厚度和随访时间）后，GCL厚度就会额外损失-0.021μm/年（P=0.001）和-0.032μm/年的GCIPL厚度（P=0.000）。结论：随着时间的推移，即使在相对较短的随访时间内，SD-OCT测量的IOP越高，GCL和GCIPL损失的速度越快，也会显著相关。这些发现支持使用SD-OCT GCL和GCIPL厚度测量作为结构生物标志物来评估降低眼压疗法在减缓青光眼进展方面的疗效。财务披露：专有或商业披露可在本文末尾的脚注和披露中找到。
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