Ophthalmology. Glaucoma最新文献

Purpose: This study compared the agreement between the Humphrey Field Analyzer (HFA) SITA Fast strategy and a novel virtual reality head-mounted visual perimetry device (VisuALL) in patients with glaucoma.

Design: This is prospective observational study.

Participants: This study was conducted on 62 eyes of 39 glaucoma subjects.

Methods: All participants had visual field (VF) testing with the VisuALL AVAFAST strategy and the HFA (24-2, Swedish Interactive Threshold Algorithm FAST). The mean sensitivity of the whole VF and each quadrant was compared between both machines. Additionally, the pattern deviation plot was analyzed to compare the agreement of both devices to detect localized VF defects.

Main outcome measures: Correlation and agreement between the mean sensitivity of the fast strategies from VisuALL and HFA.

Results: The global mean sensitivity of the VisuALL and the HFA correlated significantly (r = 0.60; P < 0.001) and was in agreement (r = 0.73; P < 0.001). The detection of VF defects in all quadrants was also moderately correlated and in agreement. Participants overwhelmingly preferred the VisuALL over the conventional (80%).

Conclusions: Although the mean sensitivity and ability to detect localized VF defects of the VisuALL were correlated and in agreement with the HFA, this was only moderate. This indicates that the VisuALL AVAFast strategy must be used with caution.

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

Purpose: To investigate the agreement between the ICare HOME tonometer and the Goldmann Applanation Tonometer (GAT) in assessing the peak intraocular pressure (IOP) during the water-drinking test (WDT).

Design: Prospective cross-sectional study.

Subjects: Seventy-nine eyes of 41 open-angle glaucoma patients were included in the study.

Methods: All of the included patients underwent a training session provided by ophthalmologist specialists to use the ICare HOME tonometer. Then the IOP was first measured with the GAT (AT900; Haag-Streit) by a trained physician, immediately followed by ICare HOME tonometer (TA022, ICare Oy) measurement by the patient. Four measurements were taken with each device with 15-minute differences as established by the WDT.

Main outcome measures: The agreement and degree of correlation of the peak IOP by both tonometers were assessed.

Results: The agreement between the ICare HOME and GAT was high during the WDT: the intraclass correlation coefficient (r) between the 2 methods from basal to 45 minutes: 0.94 (P < 0.001), at basal: 0.91 (P < 0.001), at 15 minutes: 0.94 (P < 0.001), at 30 minutes: 0.94 (P < 0.001), at 45 minutes: 0.95 (P < 0.001), and for peak IOP: 0.94 (P < 0.001). There was no significant difference between peak IOP with the GAT and ICare HOME (18.3 ± 4.6 [10-33] and 18.5 ± 5.0 [0-33], respectively, P = 0.533), nor between the delta of fluctuation between basal and peak IOP with the GAT and ICare HOME (3.96 ± 3.22 and 4.54 ± 3.92, P = 0.054).

Conclusions: Our study demonstrated a high agreement between the ICare HOME and the GAT during the WDT in a clinical environment with supervision.

Financial disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

Purpose: Perimetry is a critical tool for the diagnosis and monitoring of glaucomatous visual field defects. The Humphrey Field Analyzer (HFA) is a large, relatively expensive device that does not normally allow for examination outside of the clinic, and it can be ergonomically difficult to tolerate for some patients. The present study compared the novel Smart System Virtual Reality (SSVR) perimetric headset test to that of the HFA in a group of patients with glaucoma.

Design: Prospective comparative study.

Subjects: Seventy-two eyes from 36 patients with glaucoma recruited at the University of Iowa Hospitals and Clinics.

Methods: Patients completed both HFA and SSVR visual field tests on the same day, with the order of tests randomized. After completing both visual field tests, subjects completed a survey regarding their subjective experience using each perimeter. Visual fields were analyzed using a linear mixed model to assess differences between devices accounting for intereye correlation and Bland-Altman analysis.

Main outcome measures: Primary outcome measures included mean deviation (MD), pattern standard deviation (PSD), and test duration.

Results: No statistically significant difference in MD was observed between the SSVR (-7.17 ± 6.36 dB) and HFA (-6.88 ± 6.78 dB; P = 0.859). Statistically significant differences in PSD were observed between the SSVR (4.26 ± 2.37 dB) and HFA (6.38 ± 4.51 dB; P < 0.001) and test duration (323.44 ± 72.27 seconds and 372.20 ± 61.44 seconds, respectively; P < 0.001). Subjectively, the SSVR was the preferred perimeter by 88.5% of patients.

Conclusions: The SSVR headset is a novel visual field testing device that produces similar results to the HFA with a shorter testing duration. The SSVR was the preferred perimeter by the majority of patients. Future study is required to determine if the SSVR can identify visual field progression.

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

Purpose: To evaluate the risk of incidence rates of uveitis among patients starting topical glaucoma therapy.

Design: Retrospective database study utilizing the Sight Outcomes Research Collaborative (SOURCE) Ophthalmology Data Repository.

Participants: Adult glaucoma patients who were recently started on topical glaucoma therapy.

Methods: Using data from 10 health systems contributing data to the SOURCE data repository, we identified all adult glaucoma patients who had been newly started on a topical glaucoma medication (prostaglandin analogs [PGAs], beta-blockers [BBs], alpha agonists [AAs], and carbonic anhydrase inhibitors [CAIs]). Patients with pre-existing documentation of uveitis were excluded.

Main outcome measures: Incidence of uveitis within 3 months of initiating therapy with different topical glaucoma medications.

Results: We included 67 517 patients who were newly prescribed a topical glaucoma medication. The mean age of the patients was 67.3 ± 13.2 years and ∼59% were females. A total of 567 patients (0.87%) developed uveitis within 3 months of initiating the therapy. The incidence of uveitis was 0.32%, 1.95%, 1.63%, and 1.68% for users of PGAs, BBs, AAs, and CAIs, respectively. After adjusting for sociodemographic factors, individuals using topical BBs, AAs, and CAIs had significantly higher odds of developing uveitis versus those using PGAs (P < 0.001 for all comparisons).

Conclusions: The use of PGAs was not associated with higher odds of developing uveitis compared with other classes of topical glaucoma medications.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Topic: The systematic review and meta-analysis consolidates the extant body of evidence comparing reliability and agreement between transpalpebral tonometers (TTs) and Goldmann applanation tonometer (GAT).

Clinical relevance: With a global prevalence of 3.54 percent, glaucoma stands as the second leading cause of preventable blindness. Projections indicate a rise to 111 million cases by 2040. Existing literature presents inconsistent findings while comparing TT and GAT. The derivation of summary estimates assessing their agreement holds significance, given TT's multifaceted applicability in clinical, community, and home settings.

Methods: Systematic review was conducted using PubMed, Cochrane Library, and Google Scholar from January 2000 to December 2022. Two reviewers independently evaluated, enumerated, and extracted studies and data based on eligibility criteria. The Quality Assessment for Diagnostic Accuracy Studies checklist was used to assess study quality. The summary measures were pooled using the random-effects model as mean difference (MD), and 95% limits of agreement (LoA). We assessed heterogeneity using the I² statistic. The study protocol was registered with the International Prospective Register of Systematic Reviews (CRD42022321693).

Results: A total of 26 methods comparison studies (3577 eyes) were included in the meta-analysis. The overall random-effects MD (TT - GAT) and standard deviation (SD) for intraocular pressure (IOP) were -0.70 ± 4.32 mmHg (95% LoA: -8.74 to 7.33 mmHg). In the subgroup analysis based on index test devices used, Easyton showed the lowest MD, SD, (-0.29 ± 2.35 mmHg), and 95% LoA (-4.90 to 4.32 mmHg). In the univariate meta-regression model, we found that, on average, studies examining normal eyes reported a statistically significant lower MD of 2.67 mmHg (95% confidence interval: 0.27-5.07 mmHg; P = 0.03) between TT and GAT, compared to studies that assessed eyes with mixed ocular condition.

Conclusion: In the current meta-analysis, we found a small MD in the measured IOP between the 2 tonometers. However, given the high heterogeneity and a wider LoA, it is not advisable to use TT interchangeably with GAT.

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

Purpose: To test the hypothesis that a summary index derived from the central 12 points of the 24-2 visual field (12-point mean deviation [MD12]) could provide complementary information to that provided by the 24-2 visual field (VF) mean deviation (24-2 MD).

Design: Longitudinal observational study.

Participants: One hundred twenty-five eyes (125 patients) with central damage or moderate to severe glaucoma from the Advanced Glaucoma Progression Study with ≥ 4 pairs of 10-2 and 24-2 Swedish Interactive Thresholding Algorithm standard VFs.

Methods: Baseline 10-2 and 24-2 VF dates were within 6 months, and the remaining pairs of VF tests were done in the same session. The MD12 index was calculated by averaging total deviation values from the central 12 points of 24-2 VF. Simple linear regression of MD against time was used to estimate 24-2 MD, 10-2 MD, and MD12 rates of change (RoC). Progression at the final follow-up visit was defined as a RoC < 0 dB/year with P < 0.05 for any summary index with confirmation.

Main outcome measures: Proportion of progressing eyes based on 24-2 MD, 10-2 MD, and MD12 RoC.

Results: The average (standard deviation) baseline 24-2 and 10-2 MD were -9.0 ± 6.2 and -8.5 ± 5.4 dB, respectively. The mean follow-up time was 5.7 (±1.6) years. The three summary indices were highly correlated at baseline: r = 0.62 (95% confidence interval: 0.52-0.74) between 10-2 MD and 24-2 MD, 0.84 (95% confidence interval: 0.78-0.90) between MD12 and 24-2 MD, and 0.86 (95% confidence interval: 0.80-0.92) between 10-2 MD and MD12. The corresponding correlations between RoC were weaker: r = 0.41 (95% confidence interval: 0.37-0.45), 0.80 (95% confidence interval: 0.78-0.82), and 0.49 (95% confidence interval: 0.45-0.53). Glaucoma progression was detected in 29 (23.2%), 22 (17.6%), and 23 eyes (18.4%) based on the 24-2, 10-2, and MD12 RoC, respectively; 7 eyes (9.6%) exhibited progression based on MD12 RoC and not with 24-2 MD; only 3 of these eyes progressed according to 10-2.

Conclusions: MD12 RoC and detection rates have a low level of agreement with those of 10-2 and hence do not replace the need for 10-2 VF MD to monitor central damage.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Purpose: State laws on early eyedrop refills, implemented to help patients obtain their medications when they run out early, have many inconsistencies possibly impacting their efficacy and functionality. This study sought to examine different state laws and elucidate unique features and commonalities that may influence their effectiveness.

Design: A review of all state legislation to date regarding early eyedrop refills was performed.

Participants: All 50 states were included, with an in-depth review of the 33 states that had early eyedrop refill legislation.

Methods: The law database Nexis Uni (formerly LexisNexis) and each state's individual law code site were used to identify relevant laws (or proposed legislation) using keywords such as "eyedrop," "eye," "refill," and "early." Political data based on the year these laws were passed were obtained from the National Governor's Association and National Conference of State Legislatures. These data were aggregated and analyzed using descriptive statistics.

Main outcome measures: State law wording was analyzed for percentage of dosage period passed, days passed, and other requirements.

Results: Of the 33 states with early eyedrop refill laws, 14 were only days based, 8 were only percentage based, 4 had both, 4 had neither percentage nor days criteria, and 3 had neither but cited Centers for Medicare and Medicaid Services guidelines. These laws were passed between 2009 and 2023, with a notable increase from 2014 to 2018, rising from 10 to 29 states. Regionally, the Northeast had the highest adoption rate (88%), followed by the West (77%), the South (56%), and the Midwest (50%). Political climates varied: 14 states had Republican control, 2 had Democratic control, and 17 had mixed party control. Of the 17 states without an early eyedrop refill law 4 attempted passage but were not put into law for various reasons with the other 13 not appearing to have had any attempts at law passage.

Conclusions: State laws providing coverage for early eyedrop refills vary in terms of verbiage and requirements necessary to obtain a covered early eyedrop refill. Region, political climate, and year appear to play minor roles in early eyedrop refill verbiage and passage.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.