Pub Date : 2024-07-01DOI: 10.1016/j.ogla.2024.03.007
Purpose
To investigate sectoral differences in the relationship between intraocular pressure (IOP) dynamics during dark-room prone testing (DRPT) and visual field (VF) defect progression in primary open-angle glaucoma (POAG) patients.
Design
Retrospective, longitudinal study.
Participants
This retrospective study included 116 eyes of 84 POAG patients who underwent DRPT and had at least 5 reliable VF tests conducted over a more than 2-year follow-up period. We excluded eyes with mean deviation worse than −20 dB or a history of intraocular surgery or laser treatment.
Methods
Average total deviation (TD) was calculated in the superior, central, and inferior sectors of the Humphrey 24-2 or 30-2 program. During DRPT, IOP was measured in the sitting position, and after 60 minutes in the prone position in a dark room, IOP was measured again. The relationship between IOP change during DRPT, IOP after DRPT, and TD slope in each quadrant was analyzed with a linear mixed-effects model, adjusting for other potential confounding factors.
Main Outcome Measures
Total deviation slope in each quadrant, IOP change during DRPT, and IOP after DRPT.
Results
Intraocular pressure after DRPT and IOP change during DRPT were 18.16 ± 3.42 mmHg and 4.92 ± 3.12 mmHg, respectively. Superior TD slope was significantly associated with both IOP after DRPT (β = −0.28, P = 0.003) and IOP change during DRPT (β = −0.21, P = 0.029), while central (β = −0.05, P = 0.595; β = −0.05; P = 0.622) and inferior (β = 0.05, P = 0.611; β = 0.01, P = 0.938) TD slopes were not.
Conclusion
Dark-room prone testing might be a useful test to predict the risk of superior VF defect progression in eyes with POAG.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
{"title":"Sector-specific Association of Intraocular Pressure Dynamics in Dark-room Prone Testing and Visual Field Defect Progression in Glaucoma","authors":"","doi":"10.1016/j.ogla.2024.03.007","DOIUrl":"10.1016/j.ogla.2024.03.007","url":null,"abstract":"<div><h3>Purpose</h3><p>To investigate sectoral differences in the relationship between intraocular pressure (IOP) dynamics during dark-room prone testing (DRPT) and visual field (VF) defect progression in primary open-angle glaucoma (POAG) patients.</p></div><div><h3>Design</h3><p>Retrospective, longitudinal study.</p></div><div><h3>Participants</h3><p>This retrospective study included 116 eyes of 84 POAG patients who underwent DRPT and had at least 5 reliable VF tests conducted over a more than 2-year follow-up period. We excluded eyes with mean deviation worse than −20 dB or a history of intraocular surgery or laser treatment.</p></div><div><h3>Methods</h3><p>Average total deviation (TD) was calculated in the superior, central, and inferior sectors of the Humphrey 24-2 or 30-2 program. During DRPT, IOP was measured in the sitting position, and after 60 minutes in the prone position in a dark room, IOP was measured again. The relationship between IOP change during DRPT, IOP after DRPT, and TD slope in each quadrant was analyzed with a linear mixed-effects model, adjusting for other potential confounding factors.</p></div><div><h3>Main Outcome Measures</h3><p>Total deviation slope in each quadrant, IOP change during DRPT, and IOP after DRPT.</p></div><div><h3>Results</h3><p>Intraocular pressure after DRPT and IOP change during DRPT were 18.16 ± 3.42 mmHg and 4.92 ± 3.12 mmHg, respectively. Superior TD slope was significantly associated with both IOP after DRPT (β = −0.28, <em>P</em> = 0.003) and IOP change during DRPT (β = −0.21, <em>P</em> = 0.029), while central (β = −0.05, <em>P</em> = 0.595; β = −0.05; <em>P</em> = 0.622) and inferior (β = 0.05, <em>P</em> = 0.611; β = 0.01, <em>P</em> = 0.938) TD slopes were not.</p></div><div><h3>Conclusion</h3><p>Dark-room prone testing might be a useful test to predict the risk of superior VF defect progression in eyes with POAG.</p></div><div><h3>Financial Disclosure(s)</h3><p>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 4","pages":"Pages 372-379"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589419624000620/pdfft?md5=9a68924a8975a470c2e550eb9f76f1ba&pid=1-s2.0-S2589419624000620-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140330426","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}
Pub Date : 2024-07-01DOI: 10.1016/j.ogla.2024.03.008
Purpose
To determine the associations between social vulnerability index (SVI) and baseline severity, worsening, and variability of glaucoma, as assessed by visual field (VF) and OCT.
Design
Retrospective longitudinal cohort study.
Participants
Adults with glaucoma or glaucoma suspect status in 1 or both eyes. Visual fields were derived from 7897 eyes from 4482 patients, while OCTs were derived from 6271 eyes from 3976 patients. All eyes had a minimum of 5 tests over follow-up using either the Humphrey Field Analyzer or the Cirrus HD-OCT.
Methods
Social vulnerability index, which measures neighborhood-level environmental factors, was linked to patients' addresses at the census tract level. Rates of change in mean deviation (MD) and retinal nerve fiber layer (RNFL) thickness were computed using linear regression. The slope of the regression line was used to assess worsening, while the standard deviation of residuals was used as a measure of variability. Multivariable linear mixed-effects models were used to investigate the impact of SVI on baseline, worsening, and variability in both MD and RNFL. We further explored the interaction effect of mean intraocular pressure (IOP) and SVI on worsening in MD and RNFL.
Main Outcome Measures
Glaucoma severity defined based on baseline MD and RNFL thickness. Worsening defined as MD and RNFL slope. Variability defined as the standard deviation of the residuals obtained from MD and RNFL slopes.
Results
Increased (worse) SVI was significantly associated with worse baseline MD (β = −1.07 dB, 95% confidence interval [CI]: [−1.54, −0.60]), thicker baseline RNFL (β = 2.46 μm, 95% CI: [0.75, 4.17]), greater rates of RNFL loss (β = −0.12 μm, 95% CI: [−0.23, −0.02]), and greater VF variability (β = 0.16 dB, 95% CI: [0.07, 0.24]). Having worse SVI was associated with worse RNFL loss with increases in IOP (βinteraction = −0.07, 95% CI: [−0.12, −0.02]).
Conclusions
Increased SVI score is associated with worse functional (VF) loss at baseline, higher rates of structural (OCT) worsening over time, higher VF variability, and a greater effect of IOP on RNFL loss. Further studies are needed to enhance our understanding of these relationships and establish their cause.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"The Impact of Social Vulnerability on Structural and Functional Glaucoma Severity, Worsening, and Variability","authors":"","doi":"10.1016/j.ogla.2024.03.008","DOIUrl":"10.1016/j.ogla.2024.03.008","url":null,"abstract":"<div><h3>Purpose</h3><p>To determine the associations between social vulnerability index (SVI) and baseline severity, worsening, and variability of glaucoma, as assessed by visual field (VF) and OCT.</p></div><div><h3>Design</h3><p>Retrospective longitudinal cohort study.</p></div><div><h3>Participants</h3><p>Adults with glaucoma or glaucoma suspect status in 1 or both eyes. Visual fields were derived from 7897 eyes from 4482 patients, while OCTs were derived from 6271 eyes from 3976 patients. All eyes had a minimum of 5 tests over follow-up using either the Humphrey Field Analyzer or the Cirrus HD-OCT.</p></div><div><h3>Methods</h3><p>Social vulnerability index, which measures neighborhood-level environmental factors, was linked to patients' addresses at the census tract level. Rates of change in mean deviation (MD) and retinal nerve fiber layer (RNFL) thickness were computed using linear regression. The slope of the regression line was used to assess worsening, while the standard deviation of residuals was used as a measure of variability. Multivariable linear mixed-effects models were used to investigate the impact of SVI on baseline, worsening, and variability in both MD and RNFL. We further explored the interaction effect of mean intraocular pressure (IOP) and SVI on worsening in MD and RNFL.</p></div><div><h3>Main Outcome Measures</h3><p>Glaucoma severity defined based on baseline MD and RNFL thickness. Worsening defined as MD and RNFL slope. Variability defined as the standard deviation of the residuals obtained from MD and RNFL slopes.</p></div><div><h3>Results</h3><p>Increased (worse) SVI was significantly associated with worse baseline MD (β = −1.07 dB, 95% confidence interval [CI]: [−1.54, −0.60]), thicker baseline RNFL (β = 2.46 μm, 95% CI: [0.75, 4.17]), greater rates of RNFL loss (β = −0.12 μm, 95% CI: [−0.23, −0.02]), and greater VF variability (β = 0.16 dB, 95% CI: [0.07, 0.24]). Having worse SVI was associated with worse RNFL loss with increases in IOP (β<sub>interaction</sub> = −0.07, 95% CI: [−0.12, −0.02]).</p></div><div><h3>Conclusions</h3><p>Increased SVI score is associated with worse functional (VF) loss at baseline, higher rates of structural (OCT) worsening over time, higher VF variability, and a greater effect of IOP on RNFL loss. Further studies are needed to enhance our understanding of these relationships and establish their cause.</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":"7 4","pages":"Pages 380-390"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140773480","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}
Pub Date : 2024-07-01DOI: 10.1016/j.ogla.2024.03.003
Objective
Angle-based minimally invasive glaucoma surgery (ab-MIGS) has grown substantially, although long-term efficacy is poorly understood. We analyze ab-MIGS effectiveness with and without preceding laser trabeculoplasty (LTP).
Design
Retrospective cohort study.
Subjects
Eyes undergoing ab-MIGS (Canaloplasty, Goniotomy, Trabectome, and iStent) with and without prior laser trabeculoplasty (< 2 years preceding MIGS) were identified in the IRIS® Registry (Intelligent Research in Sight) 2013 to 2018.
Methods
Propensity score matching (PSM) was undertaken to define the following 4 cohorts: (1) standalone ab-MIGS, no prior LTP vs. (2) standalone ab-MIGS, with prior LTP; and (3) ab-MIGS + phacoemulsification, no prior LTP vs. (4) ab-MIGS + phacoemulsification, with prior LTP.
Main Outcome Measures
Failure was defined as subsequent glaucoma reoperation after ab-MIGS (either MIGS or traditional glaucoma surgery). Time-to-event outcome and incidence rates were calculated using survival analysis, and adjusted hazard ratios (aHRs) were generated using multivariate Cox proportional hazards models. Medication data were not available for analysis.
Results
A total of 164 965 unique MIGS procedures were performed, from 2013 to 2018. After PSM, we identified 954 eyes undergoing standalone ab-MIGS and 7522 undergoing ab-MIGS + phacoemulsification. For eyes undergoing standalone ab-MIGS, those with prior LTP (n = 477) were more likely to undergo reoperation vs. those without LTP (n = 477) at 6 and 12 months. In multivariable models, those with prior LTP were more likely to undergo reoperation over the 36-month period vs. those without prior LTP (aHR, 1.53; CI, 1.15–2.04; P = 0.004). For eyes undergoing ab-MIGS + phacoemulsification, those with prior LTP (n = 3761) were more likely to undergo reoperation vs. those without LTP (n = 3761) at 12, 24, and 36 months. In multivariable models, those with prior LTP were more likely to undergo reoperation over the 36-month period vs. those without prior LTP (aHR, 1.53 CI, 1.15–2.04; P = 0.004).
Conclusions
Prior LTP may be associated with a higher chance of subsequent glaucoma surgery following ab-MIGS, either with or without concurrent phacoemulsification. These findings have important implications for understanding who may benefit most from ab-MIGS, and for guiding patient and surgeon treatment expectations.
Financial Disclosures
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Effectiveness of Angle-Based Minimally Invasive Glaucoma Surgery after Laser Trabeculoplasty","authors":"","doi":"10.1016/j.ogla.2024.03.003","DOIUrl":"10.1016/j.ogla.2024.03.003","url":null,"abstract":"<div><h3>Objective</h3><p>Angle-based minimally invasive glaucoma surgery (ab-MIGS) has grown substantially, although long-term efficacy is poorly understood. We analyze ab-MIGS effectiveness with and without preceding laser trabeculoplasty (LTP).</p></div><div><h3>Design</h3><p>Retrospective cohort study.</p></div><div><h3>Subjects</h3><p>Eyes undergoing ab-MIGS (Canaloplasty, Goniotomy, Trabectome, and iStent) with and without prior laser trabeculoplasty (< 2 years preceding MIGS) were identified in the IRIS® Registry (Intelligent Research in Sight) 2013 to 2018.</p></div><div><h3>Methods</h3><p>Propensity score matching (PSM) was undertaken to define the following 4 cohorts: (1) standalone ab-MIGS, no prior LTP vs. (2) standalone ab-MIGS, with prior LTP; and (3) ab-MIGS + phacoemulsification, no prior LTP vs. (4) ab-MIGS + phacoemulsification, with prior LTP.</p></div><div><h3>Main Outcome Measures</h3><p>Failure was defined as subsequent glaucoma reoperation after ab-MIGS (either MIGS or traditional glaucoma surgery). Time-to-event outcome and incidence rates were calculated using survival analysis, and adjusted hazard ratios (aHRs) were generated using multivariate Cox proportional hazards models. Medication data were not available for analysis.</p></div><div><h3>Results</h3><p>A total of 164 965 unique MIGS procedures were performed, from 2013 to 2018. After PSM, we identified 954 eyes undergoing standalone ab-MIGS and 7522 undergoing ab-MIGS + phacoemulsification. For eyes undergoing standalone ab-MIGS, those with prior LTP (n = 477) were more likely to undergo reoperation vs. those without LTP (n = 477) at 6 and 12 months. In multivariable models, those with prior LTP were more likely to undergo reoperation over the 36-month period vs. those without prior LTP (aHR, 1.53; CI, 1.15–2.04; <em>P</em> = 0.004). For eyes undergoing ab-MIGS + phacoemulsification, those with prior LTP (n = 3761) were more likely to undergo reoperation vs. those without LTP (n = 3761) at 12, 24, and 36 months. In multivariable models, those with prior LTP were more likely to undergo reoperation over the 36-month period vs. those without prior LTP (aHR, 1.53 CI, 1.15–2.04; <em>P</em> = 0.004).</p></div><div><h3>Conclusions</h3><p>Prior LTP may be associated with a higher chance of subsequent glaucoma surgery following ab-MIGS, either with or without concurrent phacoemulsification. These findings have important implications for understanding who may benefit most from ab-MIGS, and for guiding patient and surgeon treatment expectations.</p></div><div><h3>Financial Disclosures</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":"7 4","pages":"Pages 335-344"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140190400","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}
Pub Date : 2024-07-01DOI: 10.1016/j.ogla.2024.01.007
Purpose
Glaucoma patients may be considered to have normal vision as long as each point of visual space is perceived by at least 1 eye, that is, with an intact binocular visual field (VF). We aimed to investigate the effect of nonoverlapping VF defects on vision-related quality of life (VR-QoL) in glaucoma.
Design
Cross-sectional study.
Subjects and Controls
Two hundred sixty-nine glaucoma patients and 113 controls.
Methods
We evaluated VR-QoL of glaucoma patients (n = 269) and controls (n = 113) using 4 different questionnaires (National Eye Institute visual function questionnaire [NEI-VFQ-25], NEI-VFQ neuro-ophthalmology supplement, Glaucoma Quality of Life-15, and a luminance-specific questionnaire). We defined “differential VF” (DVF) as a measure of location-specific differences in the VFs of both eyes. Within the group of glaucoma patients, we analyzed the relationship between different aspects of VR-QoL and DVF using ordinal multiple regression analysis. Analyses were adjusted for age, sex, integrated VF (IVF; an estimate of the binocular VF from the monocular VFs), and higher visual acuity of both eyes, and corrected for multiple hypothesis testing.
Main Outcome Measures
Vision-related quality of life.
Results
Glaucoma patients had lower VR-QoL than controls. Among the glaucoma patients, DVF was significantly associated with general vision (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.54–0.89), peripheral vision (OR, 0.68; 95% CI, 0.54–0.86), walking on uneven ground (OR, 0.73; 95% CI, 0.58–0.93), crossing the street (OR, 0.61; 95% CI, 0.46–0.83), seeing other road users coming from the side (OR, 0.67; 95% CI, 0.52–0.85), cycling during the day (OR, 0.64; 95% CI, 0.46–0.89) and seeing outside on a sunny day (OR, 0.73; 95% CI, 0.57–0.94). In general, IVF was a stronger predictor of VR-QoL than DVF.
Conclusions
Nonoverlapping VF defects affect VR-QoL. Although IVF is strongly associated with VR-QoL, basing clinical decisions only on IVF leads to overlooking vision problems that patients may have.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
{"title":"Effect of Nonoverlapping Visual Field Defects on Vision-related Quality of Life in Glaucoma","authors":"","doi":"10.1016/j.ogla.2024.01.007","DOIUrl":"10.1016/j.ogla.2024.01.007","url":null,"abstract":"<div><h3>Purpose</h3><p>Glaucoma patients may be considered to have normal vision as long as each point of visual space is perceived by at least 1 eye, that is, with an intact binocular visual field (VF). We aimed to investigate the effect of nonoverlapping VF defects on vision-related quality of life (VR-QoL) in glaucoma.</p></div><div><h3>Design</h3><p>Cross-sectional study.</p></div><div><h3>Subjects and Controls</h3><p>Two hundred sixty-nine glaucoma patients and 113 controls.</p></div><div><h3>Methods</h3><p>We evaluated VR-QoL of glaucoma patients (n = 269) and controls (n = 113) using 4 different questionnaires (National Eye Institute visual function questionnaire [NEI-VFQ-25], NEI-VFQ neuro-ophthalmology supplement, Glaucoma Quality of Life-15, and a luminance-specific questionnaire). We defined “differential VF” (DVF) as a measure of location-specific differences in the VFs of both eyes. Within the group of glaucoma patients, we analyzed the relationship between different aspects of VR-QoL and DVF using ordinal multiple regression analysis. Analyses were adjusted for age, sex, integrated VF (IVF; an estimate of the binocular VF from the monocular VFs), and higher visual acuity of both eyes, and corrected for multiple hypothesis testing.</p></div><div><h3>Main Outcome Measures</h3><p>Vision-related quality of life.</p></div><div><h3>Results</h3><p>Glaucoma patients had lower VR-QoL than controls. Among the glaucoma patients, DVF was significantly associated with general vision (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.54–0.89), peripheral vision (OR, 0.68; 95% CI, 0.54–0.86), walking on uneven ground (OR, 0.73; 95% CI, 0.58–0.93), crossing the street (OR, 0.61; 95% CI, 0.46–0.83), seeing other road users coming from the side (OR, 0.67; 95% CI, 0.52–0.85), cycling during the day (OR, 0.64; 95% CI, 0.46–0.89) and seeing outside on a sunny day (OR, 0.73; 95% CI, 0.57–0.94). In general, IVF was a stronger predictor of VR-QoL than DVF.</p></div><div><h3>Conclusions</h3><p>Nonoverlapping VF defects affect VR-QoL. Although IVF is strongly associated with VR-QoL, basing clinical decisions only on IVF leads to overlooking vision problems that patients may have.</p></div><div><h3>Financial Disclosure(s)</h3><p>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 4","pages":"Pages 401-409"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589419624000267/pdfft?md5=2f20d1a493da181defe82dc8a9af4f1c&pid=1-s2.0-S2589419624000267-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139682032","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}
Pub Date : 2024-07-01DOI: 10.1016/j.ogla.2024.02.009
Topic
To identify patient-reported outcome measures (PROMs) that have been used in children and adolescents with glaucoma and to evaluate their methodologic quality.
Clinical relevance
Childhood glaucoma impairs vision and quality of life (QoL) throughout all stages of life. Thus, a PROM needs to cover many different age groups and topics. Various instruments have been used to evaluate patient-reported outcomes (PROs) in patients with childhood glaucoma, however, it is unclear which PROM has the highest methodologic quality and complies best with the needs of patients with childhood glaucoma.
Methods
A systematic literature review was performed searching MEDLINE (PubMed), the Cochrane Library, Web of Science, and PsycINFO (EBSCO). We included peer-reviewed full-text articles of the past 10 years in English, German, or Spanish language that reported PROMs in children with glaucoma. The study selection and methodologic quality assessment of the identified PROMs was performed by 2 independent reviewers using a 7-point checklist. The content was mapped onto the World Health Organization International Classification of Functioning, Disability and Health. The systematic review was prospectively registered in PROSPERO (ID CRD42022353936).
Results
The search strategy retrieved 3295 matches. A total of 2901 studies were screened, and 11 relevant articles were identified using 10 different instruments. The instruments addressed functional visual ability, vision-related QoL, health-related QoL, and life satisfaction. Six instruments were applicable for the use in children. Seven of the questionnaires received the highest number of positive ratings (5/7). None of the instruments considered the views of patients with childhood glaucoma during their development.
Conclusion
This systematic review provides a descriptive catalog of vision-specific and generic health PRO instruments that have been used in childhood glaucoma cohorts. An instrument specifically developed for childhood glaucoma is lacking which might result in missing important factors, such as permanent treatment with eye drops, repeated surgeries, and heritability of the disease, when investigating the QoL in children with glaucoma.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Systematic Review of Instruments for the Assessment of Patient-Reported Outcomes and Quality of Life in Patients with Childhood Glaucoma","authors":"","doi":"10.1016/j.ogla.2024.02.009","DOIUrl":"10.1016/j.ogla.2024.02.009","url":null,"abstract":"<div><h3>Topic</h3><p>To identify patient-reported outcome measures (PROMs) that have been used in children and adolescents with glaucoma and to evaluate their methodologic quality.</p></div><div><h3>Clinical relevance</h3><p>Childhood glaucoma impairs vision and quality of life (QoL) throughout all stages of life. Thus, a PROM needs to cover many different age groups and topics. Various instruments have been used to evaluate patient-reported outcomes (PROs) in patients with childhood glaucoma, however, it is unclear which PROM has the highest methodologic quality and complies best with the needs of patients with childhood glaucoma.</p></div><div><h3>Methods</h3><p>A systematic literature review was performed searching MEDLINE (PubMed), the Cochrane Library, Web of Science, and PsycINFO (EBSCO). We included peer-reviewed full-text articles of the past 10 years in English, German, or Spanish language that reported PROMs in children with glaucoma. The study selection and methodologic quality assessment of the identified PROMs was performed by 2 independent reviewers using a 7-point checklist. The content was mapped onto the World Health Organization International Classification of Functioning, Disability and Health. The systematic review was prospectively registered in PROSPERO (ID CRD42022353936).</p></div><div><h3>Results</h3><p>The search strategy retrieved 3295 matches. A total of 2901 studies were screened, and 11 relevant articles were identified using 10 different instruments. The instruments addressed functional visual ability, vision-related QoL, health-related QoL, and life satisfaction. Six instruments were applicable for the use in children. Seven of the questionnaires received the highest number of positive ratings (5/7). None of the instruments considered the views of patients with childhood glaucoma during their development.</p></div><div><h3>Conclusion</h3><p>This systematic review provides a descriptive catalog of vision-specific and generic health PRO instruments that have been used in childhood glaucoma cohorts. An instrument specifically developed for childhood glaucoma is lacking which might result in missing important factors, such as permanent treatment with eye drops, repeated surgeries, and heritability of the disease, when investigating the QoL in children with glaucoma.</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":"7 4","pages":"Pages 391-400"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S258941962400036X/pdfft?md5=480f6cc723a0d2f9151c94bb010be6c1&pid=1-s2.0-S258941962400036X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139998350","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}
Pub Date : 2024-07-01DOI: 10.1016/j.ogla.2024.01.008
<div><h3>Objective</h3><p>To investigate the association of psychosocial factors with health self-management behaviors and beliefs among patients with primary open-angle glaucoma (POAG).</p></div><div><h3>Design</h3><p>Prospective cross-sectional cohort study.</p></div><div><h3>Participants</h3><p>Patients (n = 202) with mild, moderate, or advanced bilateral POAG.</p></div><div><h3>Methods</h3><p>Patients (N = 1164) were identified from electronic medical records at a single academic medical center. Letters soliciting participation were mailed to 591 randomly selected potential participants. Psychometric measures and a social determinants of health questionnaire were administered by phone to 202 study participants.</p></div><div><h3>Main Outcome Measures</h3><p>The National Eye Institute Visual Function Questionnaire-8 (NEI-VFQ), the Multidimensional Health Locus of Control (MHLC), the Perceived Medical Condition Self-Management Scale-4, the Patient Health Questionnaire-9 (PHQ), the Patient Activation Measure-13 (PAM), a health literacy question, and a social determinants of health questionnaire.</p></div><div><h3>Results</h3><p>For each increase in level of POAG severity, there was a decrease in mean NEI-VFQ score (<em>P</em> < 0.001). For each unit increase in NEI-VFQ item 1, self-rated vision, mean PAM score increased (<em>R</em><sup>2</sup> = 5.3%; <em>P</em> = 0.001; 95% confidence interval [CI], 0.077–0.276). For each unit increase in “Internal” on the MHLC, mean PAM score increased (<em>R</em><sup>2</sup> = 19.3%; 95% CI, 0.649–1.166; <em>P</em> < 0.001). For each unit increase in “Doctors” on the MHLC, mean PAM score increased (<em>R</em><sup>2</sup> = 11.0%; 95% CI, 1.555–3.606; <em>P</em> < 0.001). For each unit increase in “Chance” on the MHLC, mean PAM score decreased (<em>R</em><sup>2</sup> = 2.6%; 95% CI, −0.664 to −0.051; <em>P</em> = 0.023). On multivariate analysis, adjusting for age, sex and race, for each unit increase in PHQ, mean PAM score decreased (95% CI, 0.061–1.35; <em>P</em> = 0.032); for each unit increase in MHLC “Doctors”, mean PAM score increased (95% CI, −1.448 to 3.453; <em>P</em> < 0.001); for each unit increase in MHLC “Internal”, mean PAM score increased (95% CI, 0.639–1.137; <em>P</em> < 0.001); for each unit increase in MHLC “Chance”, mean PAM score decreased (95% CI, −0.685 to −0.098; <em>P</em> = 0.009).</p></div><div><h3>Conclusions</h3><p>We identified modifiable behavioral factors that could increase patients’ self-perceived ability and confidence to manage their own eye care. Locus of control (MHLC), level of depression (PHQ), and self-rated functional vision (NEI-VFQ) were each associated with patient behaviors, attitudes, and beliefs needed for health self-management (activation, assessed by the PAM) and may be important determinants of adherence behaviors. Targeting change in patients’ care beliefs and behaviors may improve activation and treatment outcomes.</p></div><div><h3>Financial
{"title":"Association of Psychosocial Factors with Activation Among Patients with Glaucoma","authors":"","doi":"10.1016/j.ogla.2024.01.008","DOIUrl":"10.1016/j.ogla.2024.01.008","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the association of psychosocial factors with health self-management behaviors and beliefs among patients with primary open-angle glaucoma (POAG).</p></div><div><h3>Design</h3><p>Prospective cross-sectional cohort study.</p></div><div><h3>Participants</h3><p>Patients (n = 202) with mild, moderate, or advanced bilateral POAG.</p></div><div><h3>Methods</h3><p>Patients (N = 1164) were identified from electronic medical records at a single academic medical center. Letters soliciting participation were mailed to 591 randomly selected potential participants. Psychometric measures and a social determinants of health questionnaire were administered by phone to 202 study participants.</p></div><div><h3>Main Outcome Measures</h3><p>The National Eye Institute Visual Function Questionnaire-8 (NEI-VFQ), the Multidimensional Health Locus of Control (MHLC), the Perceived Medical Condition Self-Management Scale-4, the Patient Health Questionnaire-9 (PHQ), the Patient Activation Measure-13 (PAM), a health literacy question, and a social determinants of health questionnaire.</p></div><div><h3>Results</h3><p>For each increase in level of POAG severity, there was a decrease in mean NEI-VFQ score (<em>P</em> < 0.001). For each unit increase in NEI-VFQ item 1, self-rated vision, mean PAM score increased (<em>R</em><sup>2</sup> = 5.3%; <em>P</em> = 0.001; 95% confidence interval [CI], 0.077–0.276). For each unit increase in “Internal” on the MHLC, mean PAM score increased (<em>R</em><sup>2</sup> = 19.3%; 95% CI, 0.649–1.166; <em>P</em> < 0.001). For each unit increase in “Doctors” on the MHLC, mean PAM score increased (<em>R</em><sup>2</sup> = 11.0%; 95% CI, 1.555–3.606; <em>P</em> < 0.001). For each unit increase in “Chance” on the MHLC, mean PAM score decreased (<em>R</em><sup>2</sup> = 2.6%; 95% CI, −0.664 to −0.051; <em>P</em> = 0.023). On multivariate analysis, adjusting for age, sex and race, for each unit increase in PHQ, mean PAM score decreased (95% CI, 0.061–1.35; <em>P</em> = 0.032); for each unit increase in MHLC “Doctors”, mean PAM score increased (95% CI, −1.448 to 3.453; <em>P</em> < 0.001); for each unit increase in MHLC “Internal”, mean PAM score increased (95% CI, 0.639–1.137; <em>P</em> < 0.001); for each unit increase in MHLC “Chance”, mean PAM score decreased (95% CI, −0.685 to −0.098; <em>P</em> = 0.009).</p></div><div><h3>Conclusions</h3><p>We identified modifiable behavioral factors that could increase patients’ self-perceived ability and confidence to manage their own eye care. Locus of control (MHLC), level of depression (PHQ), and self-rated functional vision (NEI-VFQ) were each associated with patient behaviors, attitudes, and beliefs needed for health self-management (activation, assessed by the PAM) and may be important determinants of adherence behaviors. Targeting change in patients’ care beliefs and behaviors may improve activation and treatment outcomes.</p></div><div><h3>Financial","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 4","pages":"Pages 410-417"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139698946","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}
Pub Date : 2024-07-01DOI: 10.1016/j.ogla.2024.02.002
{"title":"Bridging the Digital Divide: Ensuring Equity in At-Home Glaucoma Monitoring","authors":"","doi":"10.1016/j.ogla.2024.02.002","DOIUrl":"10.1016/j.ogla.2024.02.002","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 4","pages":"Pages 323-325"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140295394","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}
Pub Date : 2024-05-01DOI: 10.1016/j.ogla.2023.11.005
Ernesto Sabogal BS, BA, Zoë Ingram BS, Nino Odishelidze MD, Hani El Helwe MD, Henisk K. Falah BS, Jonathan Trzcinski BS, Nathan Hall MS, David Solá-Del Valle MD
Purpose
To compare trabeculectomy with mitomycin C (trab-MMC) and XEN45 Gel Stent placed ab externo with open conjunctiva (XGS AEO) with or without cataract surgery in patients with glaucoma.
Design
Nonrandomized, retrospective, comparative study.
Subjects
A total of 204 eyes from 204 glaucoma patients who received XGS AEO or underwent trab-MMC with or without cataract surgery between July 2018 and August 2021 at Massachusetts Eye and Ear.
Methods
Visits from 204 patient charts were reviewed after either trab-MMC or XGS AEO from 2018 to 2021 from a level 3 triage center.
One hundred fifty-seven patients underwent trab-MMC and 47 underwent XGS AEO. Groups had similar baseline intraocular pressure (IOP) and medications (meds). Intraocular pressure and meds decreased similarly at 1.5 years (11.2 mmHg vs. 7.4 mmHg, P = 0.62; 2.9 vs. 2.8 meds, P = 0.92, respectively for trab-MMC and XGS AEO). Success was defined as IOP reduction ≥ 20% with 5 mmHg ≤ IOP ≤ 18 mmHg for 2 consecutive visits. Complete success (CS) did not allow meds; qualified success (QS) allowed for ≤ baseline meds. When IOP fluctuations in the first 60 days were not counted as failures, CS was 43% for trab-MMC, about 8.5% higher than for XGS AEO (P < 0.01). Qualified success was similar between the groups (65%–67%). Procedure time was shorter for XGS AEO than trab-MMC (44 vs. 63 minutes, P < 0.01).
Conclusions
XEN45 Gel Stent AEO may provide similar benefits to trab-MMC, especially for patients who tolerate some meds, with shorter procedure times.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Comparing Outcomes of Trabeculotomy with Mitomycin C to 45-μm Gelatin Stent Placed Ab Externo with Open Conjunctiva","authors":"Ernesto Sabogal BS, BA, Zoë Ingram BS, Nino Odishelidze MD, Hani El Helwe MD, Henisk K. Falah BS, Jonathan Trzcinski BS, Nathan Hall MS, David Solá-Del Valle MD","doi":"10.1016/j.ogla.2023.11.005","DOIUrl":"10.1016/j.ogla.2023.11.005","url":null,"abstract":"<div><h3>Purpose</h3><p>To compare trabeculectomy with mitomycin C (trab-MMC) and XEN45 Gel Stent placed ab externo with open conjunctiva (XGS AEO) with or without cataract surgery in patients with glaucoma.</p></div><div><h3>Design</h3><p>Nonrandomized, retrospective, comparative study.</p></div><div><h3>Subjects</h3><p>A total of 204 eyes from 204 glaucoma patients who received XGS AEO or underwent trab-MMC with or without cataract surgery between July 2018 and August 2021 at Massachusetts Eye and Ear.</p></div><div><h3>Methods</h3><p>Visits from 204 patient charts were reviewed after either trab-MMC or XGS AEO from 2018 to 2021 from a level 3 triage center.</p></div><div><h3>Main Outcome Measures</h3><p>Intraocular pressure (IOP), medication burden, Kaplan–Meier success rates, 5-fluorouracil impact, and complications.</p></div><div><h3>Results</h3><p>One hundred fifty-seven patients underwent trab-MMC and 47 underwent XGS AEO. Groups had similar baseline intraocular pressure (IOP) and medications (meds). Intraocular pressure and meds decreased similarly at 1.5 years (11.2 mmHg vs. 7.4 mmHg, <em>P</em> = 0.62; 2.9 vs. 2.8 meds, <em>P</em> = 0.92, respectively for trab-MMC and XGS AEO). Success was defined as IOP reduction ≥ 20% with 5 mmHg ≤ IOP ≤ 18 mmHg for 2 consecutive visits. Complete success (CS) did not allow meds; qualified success (QS) allowed for ≤ baseline meds. When IOP fluctuations in the first 60 days were not counted as failures, CS was 43% for trab-MMC, about 8.5% higher than for XGS AEO (<em>P</em> < 0.01). Qualified success was similar between the groups (65%–67%). Procedure time was shorter for XGS AEO than trab-MMC (44 vs. 63 minutes, <em>P</em> < 0.01).</p></div><div><h3>Conclusions</h3><p>XEN45 Gel Stent AEO may provide similar benefits to trab-MMC, especially for patients who tolerate some meds, with shorter procedure times.</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":"7 3","pages":"Pages 232-241"},"PeriodicalIF":2.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589419623002107/pdfft?md5=e3c17f9c1144db37f437f7d12d615f62&pid=1-s2.0-S2589419623002107-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500275","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}
Pub Date : 2024-05-01DOI: 10.1016/j.ogla.2023.12.004
Victoria Vought BA , Rita Vought BA , Ava Herzog , Miriam M. Habiel MD
Purpose
Patients utilize online physician reviews to decide between and rate ophthalmologists. Sentiment analysis allows for better understanding of patient experiences. In this study, Valence Aware Dictionary sEntiment Reasoner (VADER) and word frequency analysis of glaucoma specialist Healthgrades reviews were used to determine factors prioritized by patients.
Design
Retrospective cross-sectional analysis.
Participants
N/A.
Methods
Written reviews and Star ratings of glaucoma specialists listed under the Physicians Payments Sunshine Acts were obtained, and demographic information was collected. Valence Aware Dictionary sEntiment Reasoner produced Negative, Neutral, Positive, and Compound scores of reviews, and these were stratified by demographic variables. Word frequency review was applied to determine popular words and phrases.
Main Outcome Measures
Star ratings, VADER Compound score of written reviews, and highest word frequencies.
Results
A total of 203 glaucoma specialists and 3531 written reviews were assessed. Glaucoma specialists had an average of 4.26/5 stars, with a mean of 30 ratings per physician on Healthgrades. Most physicians (86%) had overall Positive written reviews (VADER = 0.74), indicating high patient satisfaction. Specialists who were women or had fewer years of practice had higher Compound and Star scores than their respective male and senior counterparts, with statistical significance observed between junior and senior physician Stars (P < 0.001). Repeated words pertaining to the surgery, staff, wait times, and questions were common overall and among the most positive and most negative reviews.
Conclusions
Glaucoma specialist patients value nonclinical factors, such as appointment setting and nonphysician health-care staff members, in their written reviews. Thus, factors beyond clinical outcomes are influential in the overall patient experience and should be considered to improve health-care delivery. These results can also advise ophthalmologists on factors that patients prioritize when evaluating physicians, which influences the decisions of other patients seeking glaucoma care.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
{"title":"Application of Patient Sentiment Analysis to Evaluate Glaucoma Care","authors":"Victoria Vought BA , Rita Vought BA , Ava Herzog , Miriam M. Habiel MD","doi":"10.1016/j.ogla.2023.12.004","DOIUrl":"10.1016/j.ogla.2023.12.004","url":null,"abstract":"<div><h3>Purpose</h3><p>Patients utilize online physician reviews to decide between and rate ophthalmologists. Sentiment analysis allows for better understanding of patient experiences. In this study, Valence Aware Dictionary sEntiment Reasoner (VADER) and word frequency analysis of glaucoma specialist Healthgrades reviews were used to determine factors prioritized by patients.</p></div><div><h3>Design</h3><p>Retrospective cross-sectional analysis.</p></div><div><h3>Participants</h3><p>N/A.</p></div><div><h3>Methods</h3><p>Written reviews and Star ratings of glaucoma specialists listed under the Physicians Payments Sunshine Acts were obtained, and demographic information was collected. Valence Aware Dictionary sEntiment Reasoner produced Negative, Neutral, Positive, and Compound scores of reviews, and these were stratified by demographic variables. Word frequency review was applied to determine popular words and phrases.</p></div><div><h3>Main Outcome Measures</h3><p>Star ratings, VADER Compound score of written reviews, and highest word frequencies.</p></div><div><h3>Results</h3><p>A total of 203 glaucoma specialists and 3531 written reviews were assessed. Glaucoma specialists had an average of 4.26/5 stars, with a mean of 30 ratings per physician on Healthgrades. Most physicians (86%) had overall Positive written reviews (VADER = 0.74), indicating high patient satisfaction. Specialists who were women or had fewer years of practice had higher Compound and Star scores than their respective male and senior counterparts, with statistical significance observed between junior and senior physician Stars (<em>P</em> < 0.001). Repeated words pertaining to the surgery, staff, wait times, and questions were common overall and among the most positive and most negative reviews.</p></div><div><h3>Conclusions</h3><p>Glaucoma specialist patients value nonclinical factors, such as appointment setting and nonphysician health-care staff members, in their written reviews. Thus, factors beyond clinical outcomes are influential in the overall patient experience and should be considered to improve health-care delivery. These results can also advise ophthalmologists on factors that patients prioritize when evaluating physicians, which influences the decisions of other patients seeking glaucoma care.</p></div><div><h3>Financial Disclosure(s)</h3><p>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 3","pages":"Pages 316-322"},"PeriodicalIF":2.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138813977","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}
Pub Date : 2024-05-01DOI: 10.1016/j.ogla.2024.01.004
Jeannette Y. Stallworth MD , Natan Hekmatjah BS , Yinxi Yu MS , Julius T. Oatts MD , Gui-Shuang Ying MD, PhD , Ying Han MD, PhD
Purpose
To assess the effect of lens status and cataract surgery on glaucoma drainage device (GDD) efficacy.
Design
Retrospective cohort study.
Participants
Two hundred and forty-three eyes of 216 patients that underwent GDD implantation with 1 follow-up visit within 3 years postoperatively. Exclusion criteria included GDD combined with other ophthalmic procedures. 90%–94% of GDDs were Ahmed implants; 83%–90% had adjunctive mitomycin-C.
Methods
Outcomes were compared between phakic eyes (group A), eyes phakic at time of implantation but subsequently underwent cataract surgery within 3 years (group B), and pseudophakic eyes (group C). Outcomes were measured at 1, 3, 6, 12, 24, and 36 months after tube shunt implantation. Multivariable regression models were performed, adjusting for baseline characteristics.
Main Outcome Measures
Intraocular pressure (IOP) after GDD implantation. Secondary outcomes included change in visual acuity (VA), number of glaucoma eye drops, and rate of failure, defined as additional glaucoma surgery, vision decrease to no light perception, or IOP persistently ≤ 5 mmHg or > 21 mmHg or not reduced from baseline by 20%.
Results
There were 65 eyes in group A, 52 in group B, and 126 in group C. Within group B, cataract surgery was performed at a mean of 1.3 ± 0.7 years after GDD implantation. There were no statistically significant differences in mean IOP or medications between the 3 groups at all time points up to 3 years postoperatively. Significant improvement in VA was noted in groups A and B compared to group C at 6 months, 1 year, and 2 years after implantation; however, by postoperative year 3, change in VA was similar across groups. There were no significant differences in the failure rate amongst groups (P = 0.68). IOP and medications up to 12 months after cataract surgery were similar compared to preoperative baseline. Group B had significantly more short-term (P = 0.02) and long-term (P < 0.001) postoperative complications than groups A or C, driven primarily by hypotony.
Conclusions
There were no differences in IOP, glaucoma medications, or rate of failure 3 years after GDD implantation based on lens status or after undergoing subsequent cataract surgery. These results may inform the management of patients with co-existing glaucoma and cataract.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
{"title":"Effect of Lens Status on the Outcomes of Glaucoma Drainage Device Implantation","authors":"Jeannette Y. Stallworth MD , Natan Hekmatjah BS , Yinxi Yu MS , Julius T. Oatts MD , Gui-Shuang Ying MD, PhD , Ying Han MD, PhD","doi":"10.1016/j.ogla.2024.01.004","DOIUrl":"10.1016/j.ogla.2024.01.004","url":null,"abstract":"<div><h3>Purpose</h3><p>To assess the effect of lens status and cataract surgery on glaucoma drainage device (GDD) efficacy.</p></div><div><h3>Design</h3><p>Retrospective cohort study.</p></div><div><h3>Participants</h3><p>Two hundred and forty-three eyes of 216 patients that underwent GDD implantation with <span><math><mrow><mo>≥</mo></mrow></math></span>1 follow-up visit within 3 years postoperatively. Exclusion criteria included GDD combined with other ophthalmic procedures. 90%–94% of GDDs were Ahmed implants; 83%–90% had adjunctive mitomycin-C.</p></div><div><h3>Methods</h3><p>Outcomes were compared between phakic eyes (group A), eyes phakic at time of implantation but subsequently underwent cataract surgery within 3 years (group B), and pseudophakic eyes (group C). Outcomes were measured at 1, 3, 6, 12, 24, and 36 months after tube shunt implantation. Multivariable regression models were performed, adjusting for baseline characteristics.</p></div><div><h3>Main Outcome Measures</h3><p>Intraocular pressure (IOP) after GDD implantation. Secondary outcomes included change in visual acuity (VA), number of glaucoma eye drops, and rate of failure, defined as additional glaucoma surgery, vision decrease to no light perception, or IOP persistently ≤ 5 mmHg or > 21 mmHg or not reduced from baseline by 20%.</p></div><div><h3>Results</h3><p>There were 65 eyes in group A, 52 in group B, and 126 in group C. Within group B, cataract surgery was performed at a mean of 1.3 ± 0.7 years after GDD implantation. There were no statistically significant differences in mean IOP or medications between the 3 groups at all time points up to 3 years postoperatively. Significant improvement in VA was noted in groups A and B compared to group C at 6 months, 1 year, and 2 years after implantation; however, by postoperative year 3, change in VA was similar across groups. There were no significant differences in the failure rate amongst groups (<em>P</em> = 0.68). IOP and medications up to 12 months after cataract surgery were similar compared to preoperative baseline. Group B had significantly more short-term (<em>P</em> = 0.02) and long-term (<em>P</em> < 0.001) postoperative complications than groups A or C, driven primarily by hypotony.</p></div><div><h3>Conclusions</h3><p>There were no differences in IOP, glaucoma medications, or rate of failure 3 years after GDD implantation based on lens status or after undergoing subsequent cataract surgery. These results may inform the management of patients with co-existing glaucoma and cataract.</p></div><div><h3>Financial Disclosure(s)</h3><p>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 3","pages":"Pages 242-250"},"PeriodicalIF":2.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139567655","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}
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