Purpose: To evaluate clinical and sociodemographic factors associated with selecting treatments in glaucoma patients with rapid visual field (VF) progression.
Design: Retrospective cohort study.
Participants: A total of 2782 eyes from 1812 adults with 5 or more 24-2 VFs over 5 years and at least 1 OCT scan at baseline.
Methods: Rapid progressors were defined by mean deviation (MD) slopes worse than -1 decibels (dB)/year. Demographic (age, gender, race), clinical (intraocular pressure [IOP], VF metrics, OCT measures), and socioeconomic (Social Vulnerability Index [SVI]) variables were collected. Patients were categorized based on the most intensive treatment received in the first 7 years: medical management, minimally invasive procedures (e.g., minimally invasive glaucoma surgery or laser), or aggressive procedures (e.g., filtering surgery or external ciliodestruction). Multinomial regression was performed to identify demographic, clinical, and socioeconomic factors associated with treatment intensity.
Main outcome measures: Odds of treatment selection based on rapid VF progression.
Results: Rapid progressors had significantly higher odds of receiving aggressive procedures (odds ratio [OR], 6.96, 95% confidence interval [CI], 2.61-18.55, P < 0.001), yet only 23% of rapid progressors underwent aggressive procedures in the first 7 years. In a sample of rapid progressors who were managed with medical treatment alone, we found that 85% were conservatively managed due to clinician decision-making rather than patient preference. Worse MD, smaller rim area, and higher initial IOP were associated with more aggressive intervention. Functional decline (MD slope) was not associated with treatment selection in rapid progressors. We also found that higher (worse) SVI was associated with a reduced likelihood of receiving minimally invasive procedures among rapid progressors (OR, 0.06, 95% CI, 0.00-0.78, P = 0.032).
Conclusions: Although rapid progression was a strong predictor of aggressive procedures, fewer than 1 in 4 patients underwent aggressive IOP-lowering interventions in the first 7 years. Rate of functional decline did not play a role in treatment selection within rapid progressors. Rapidly progressing patients in areas of higher socioeconomic vulnerability were also less likely to receive less-invasive procedures. Better integrating rates of functional decline and addressing socioeconomic barriers may help optimize care for patients with rapidly progressing glaucoma.
Financial disclosure(s): Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article.
Purpose: We examined the extent to which adopting healthy lifestyle behaviors could offset high genetic risk for progression to advanced age-related macular degeneration (AAMD) to address concerns of family members of affected patients.
Design: Prospective, longitudinal analysis.
Participants: Eyes with early or intermediate age-related macular degeneration (AMD) at baseline were defined based on the Age-Related Eye Disease Study severity scale. High genetic risk was defined as the third tertile of a genetic risk score (GRS) for progression, adjusted for age, race, and sex.
Methods: Information on lifestyle behaviors was obtained from baseline risk and food frequency questionnaires. Risk-inducing and health-promoting lifestyle profiles were defined based on dichotomous categorizations of smoking, body mass index (BMI), dietary caloric intake, and consumption of green leafy vegetables and fish, in never and ever smokers. Cox proportional hazard ratios (HRs), relative risks, and population attributable risks (PARs) were calculated, adjusting for inter-eye correlation, demographic factors, macular status, and family history of AMD.
Main outcome measures: Progression to AAMD and subtypes geographic atrophy (GA) and neovascular (NV) was confirmed at 2 consecutive visits over 5 years follow-up.
Results: Among 898 high genetic risk eyes, 207 eyes progressed to AAMD (23%). Among never smokers, a high-risk-inducing lifestyle profile conferred a 3-fold increased incidence of AAMD compared with an ideal health-promoting profile (hazard ratio [HR], 3.3; confidence interval [CI], 1.8-6.4), P < 0.001). In ever smokers, a high-risk-inducing profile was independently associated with a 5-fold increased incidence of AAMD (HR, 5.3; CI, 2.3-11.9; P < 0.001). Stronger effects of lifestyle behaviors were seen for GA compared with NV. Estimated PARs suggested that adopting an ideal health-promoting profile could prevent 56% of incident AAMD in never smokers and 60% in ever smokers.
Conclusions: Unhealthy behaviors increased incidence of AAMD by 3- to 5-fold among a highly genetically susceptible population, and 56% to 60% of AAMD incidence was due to modifiable factors: smoking, high BMI, high caloric intake, and low intake of foods rich in lutein-zeaxanthin and omega-3 fatty acids. Results underscore the importance of lifestyle interventions in high genetic risk populations, such as patients with a high GRS, to reduce progression from early or intermediate AMD to advanced vision-threatening stages.
Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.
Purpose: To compare the efficacy of a stepwise extension treatment (SET) protocol and a pro re nata (PRN) regimen of intense pulsed light (IPL) therapy with warm compresses for meibomian gland dysfunction (MGD).
Design: A prospective, comparative study.
Participants: Participants with meibomian gland expressibility (MGE) or meibum quality (MQ) grade 2 or higher.
Methods: All participants initially received 4 IPL sessions at 4-week intervals. In the SET group, intervals were extended or shortened by 2 weeks based on clinical response. In the PRN group, re-treatment was performed only when predefined criteria were met. Re-treatment was indicated if the Ocular Surface Disease Index (OSDI) was ≥23 or increased from the prior visit, along with MGE or MQ ≥2. A linear mixed-effects model (LMM) was used for analysis.
Main outcome measures: The primary outcome measures were the longitudinal changes in the Ocular Surface Disease Index (OSDI), meibomian gland expressibility (MGE), and meibum quality (MQ). The total number of IPL sessions administered from baseline to 24 months was assessed as a secondary outcome.
Results: Among 412 participants, 308 (74.8 %) completed the study. Mean changes in OSDI, MGE, and MQ from baseline to 24 months were -16.0, -0.8, and -0.9 in the SET group and -15.3, -0.7, and -0.8 in the PRN group, respectively (all P > 0.05). In patients with baseline MGE or MQ grade ≤2, both protocols effectively reduced scores to below 1.5. In patients with MGE grade 3, the SET group demonstrated greater improvement (P < 0.01), and episodic exacerbations were observed in the PRN group. The mean number of IPL sessions over 24 months was 14.8 ± 4.2 (median 13.0) in the SET group and 10.0 ± 6.4 (median 8.0) in the PRN group (P < 0.01).
Conclusions: Both SET and PRN regimens led to symptomatic and functional improvement in MGD. Patients with mild-to-moderate MGD responded well to either regimen. In severe MGD, the SET protocol may provide more stable long-term control, suggesting the importance of individualized treatment approaches.
Financial disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Topic: To evaluate whether pars plana vitrectomy (PPV) increases the risk of ocular hypertension (OHT) and glaucoma, with particular focus on lens status as a risk modifier.
Clinical relevance: Ocular hypertension and glaucoma are major complications that can threaten vision and require lifelong management. Although PPV is a standard treatment for vitreoretinal disease, concerns exist about its long-term effects on intraocular pressure and glaucoma, particularly in pseudophakic eyes, where the natural lens barrier is absent. No clear quantitative synthesis currently informs risk stratification in this context.
Methods: The protocol for this systematic review and meta-analysis was prospectively registered in International Prospective Register of Systematic Reviews (CRD42024541683), and data reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies were randomized or nonrandomized comparative studies reporting OHT or glaucoma after PPV in adults. We last searched Ovid MEDLINE, Ovid EMBASE, and Web of Science on May 25, 2024. Two reviewers independently conducted screening, data extraction, and Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) risk of bias assessment. Meta-analyses were performed using generalized linear mixed-effects models. Publication bias and heterogeneity were assessed. The ROBINS-I tool was used to assess the risk of bias in nonrandomized studies, and the certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluation. Numbers needed to treat for harm (NNTH) were calculated using standard formulas as recommended in the Cochrane Handbook to enhance the clinical interpretability of the results.
Results: Forty-one observational studies (54 006 patients, 54 021 eyes) were included. The pooled absolute risk was 5.6% (95% confidence interval [CI]: 3.1-9.9; I2 = 94.6%; low certainty) for post-PPV OHT, and 3.9% (95% CI: 2.0-7.2; I2 = 94.4%; low certainty). Pseudophakic eyes had a threefold higher odds of OHT compared to phakic eyes (odds ratio [OR], 3.2; 95% CI: 1.4-9.9; I2 = 75.1%; NNTH, 8; very low certainty) and nearly 12-fold higher odds of glaucoma (OR, 11.8; 95% CI: 4.2-33.6; I2 = 0%; NNTH, 10; moderate certainty).
Conclusion: Pars plana vitrectomy is associated with clinically meaningful risk of OHT and glaucoma, especially in pseudophakic eyes. Despite limitations from nonrandomized data and heterogeneity, these findings highlight lens status as a key modifier of post-PPV risk and support tailored surgical planning and postoperative monitoring.
Financial disclosures: The author(s) have no proprietary or commercial interest in any materials discussed in this article.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：