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Shah SN, Zhou S, Sanvicente C, Burkemper B, Apolo G, Li C, Li S, Liu L, Lum F, Moghimi S, Xu B. Prevalence and Risk Factors of Blindness Among Primary Angle Closure Glaucoma Patients in the United States: An IRIS Registry Analysis. Am J Ophthalmol 2024; 259:131-140. [PMID: 37944688 PMCID: PMC10922147 DOI: 10.1016/j.ajo.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To assess the prevalence and risk factors of blindness among patients newly diagnosed with primary angle closure glaucoma (PACG) in the United States. DESIGN Retrospective cross-sectional study. METHODS Eligible patients from the American Academy of Ophthalmology (AAO) Intelligent Research in Sight (IRIS) Registry had newly diagnosed PACG, defined as: 1) observable during a 24-month lookback period from index date of PACG diagnosis; 2) no history of eye drops, laser, or cataract surgery unless preceded by a diagnosis of anatomical narrow angle (ANA); and 3) no history of glaucoma surgery. Logistic regression models were developed to identify risk factors for any (one or both eyes) or bilateral (both eyes) blindness (visual acuity ≤20/200) at first diagnosis of PACG. RESULTS Among 43,901 eligible patients, overall prevalence of any and bilateral blindness were 11.5% and 1.8%, respectively. Black and Hispanic patients were at higher risk of any (odds ratios [ORs] 1.42 and 1.21, respectively; P < .001) and bilateral (ORs 2.04 and 1.53, respectively; P < .001) blindness compared with non-Hispanic White patients adjusted for ocular comorbidities. Age <50 or >80 years, male sex, Medicaid or Medicare insurance product, and Southern or Western practice region also conferred a higher risk of blindness (OR > 1.28; P ≤ .01). CONCLUSIONS Blindness affects 1 of 9 patients with newly diagnosed PACG in the IRIS Registry. Black and Hispanic patients and Medicaid and Medicare recipients are at significantly higher risk. These findings highlight the severe ocular morbidity among patients with PACG and the need for improved disease awareness and detection methods.
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Affiliation(s)
- Sona N Shah
- From the Roski Eye Institute (S.N.S., S.Z., B.B., G.A., B.X.), Department of Ophthalmology, University of Southern California, Los Angeles, California, USA
| | - Sarah Zhou
- From the Roski Eye Institute (S.N.S., S.Z., B.B., G.A., B.X.), Department of Ophthalmology, University of Southern California, Los Angeles, California, USA
| | - Carina Sanvicente
- Harvey & Bernice Jones Eye Institute (C.S.), University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Bruce Burkemper
- From the Roski Eye Institute (S.N.S., S.Z., B.B., G.A., B.X.), Department of Ophthalmology, University of Southern California, Los Angeles, California, USA
| | - Galo Apolo
- From the Roski Eye Institute (S.N.S., S.Z., B.B., G.A., B.X.), Department of Ophthalmology, University of Southern California, Los Angeles, California, USA
| | - Charles Li
- American Academy of Ophthalmology (C.L., S.L., L.L., F.L.), San Francisco, California, USA
| | - Siying Li
- American Academy of Ophthalmology (C.L., S.L., L.L., F.L.), San Francisco, California, USA
| | - Lynn Liu
- American Academy of Ophthalmology (C.L., S.L., L.L., F.L.), San Francisco, California, USA
| | - Flora Lum
- American Academy of Ophthalmology (C.L., S.L., L.L., F.L.), San Francisco, California, USA
| | - Sasan Moghimi
- Hamilton Glaucoma Center (S.M.), Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Benjamin Xu
- From the Roski Eye Institute (S.N.S., S.Z., B.B., G.A., B.X.), Department of Ophthalmology, University of Southern California, Los Angeles, California, USA.
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Lee JH, Yoo K, Lung K, Apolo G, Toy B, Sanvicente C, Xu B. Patterns and Disparities in Recorded Gonioscopy During Initial Glaucoma Evaluations in the United States. Am J Ophthalmol 2024; 264:90-98. [PMID: 38423202 DOI: 10.1016/j.ajo.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To assess patterns in gonioscopy during initial glaucoma evaluations in the United States. DESIGN Retrospective, case-control study. METHODS Patients undergoing initial glaucoma evaluation between 2009-2020 were identified in the Optum Clinformatics DataMart. Initial evaluation was defined as follows: (1) glaucoma suspect, anatomical narrow angle (ANA), or primary/secondary glaucoma diagnosed by an ophthalmologist; (2) continuously observable during a 36-month lookback period; (3) no history of glaucoma medications, laser, or surgical procedures; and (4) optical coherence tomography (OCT) or visual field performed within 6 months of initial diagnosis. Logistic regression models were developed to identify factors associated with no record of gonioscopy based on Current Procedural Terminology (CPT) codes. RESULTS Among 198,995 patients, 20.4% and 29.5% had recorded gonioscopy on the day of diagnosis or within 6 months, respectively. On multivariable analysis, odds of recorded gonioscopy within 6 months of initial evaluation was lower (P < .001) among non-Hispanic Whites (OR=0.84) but similar for Blacks (OR=1.02) and Hispanics (OR=0.96) compared with Asians. Age ≥60 years (OR<0.82), pseudophakia/aphakia (OR=0.58), or residence outside of the Northeast region (OR=0.66-0.84) conferred lower odds of recorded gonioscopy (P < .001). Angle closure glaucoma (OR=0.85), secondary glaucoma (OR=0.31), or open angle glaucoma/suspect (OR=0.12/0.24, respectively) patients were less likely to have recorded gonioscopy compared to ANA patients (P < .01). CONCLUSIONS More than 70% patients undergoing initial glaucoma evaluation in the United States do not have a record of gonioscopy, especially elderly, non-Hispanic White, and pseudophakic patients in non-Northeast regions. This pattern does not conform to current practice guidelines and could contribute to misdiagnosed disease and suboptimal outcomes.
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Affiliation(s)
- Jun Hui Lee
- From the Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California (J.H.L., G.A., B.T., B.X.), Los Angeles, California
| | - Kristy Yoo
- Keck School of Medicine at the University of Southern California (K.Y.), Los Angeles, California
| | - Khristina Lung
- Schaeffer Center for Health Policy and Economics, University of Southern California (K.I.), Los Angeles, California
| | - Galo Apolo
- From the Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California (J.H.L., G.A., B.T., B.X.), Los Angeles, California
| | - Brian Toy
- From the Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California (J.H.L., G.A., B.T., B.X.), Los Angeles, California
| | - Carina Sanvicente
- Harvey & Bernice Jones Eye Institute, University of Arkansas for Medical Sciences (C.S.), Little Rock, Arkansas, USA
| | - Benjamin Xu
- From the Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California (J.H.L., G.A., B.T., B.X.), Los Angeles, California.
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Filippopoulos T, Danias J, Karmiris E, Mégevand GS, Rhee DJ, Gazzard G, Topouzis F, Xu B. Rethinking Prophylactic Laser Peripheral Iridotomy in Primary Angle-Closure Suspects: A Review. Ophthalmol Glaucoma 2023; 6:657-667. [PMID: 37321374 DOI: 10.1016/j.ogla.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE To examine the generalizability, discuss limitations, and critically appraise recommendations on the management of primary angle-closure suspects (PACSs) that emerged as a result of recent randomized clinical trials challenging the widely accepted clinical practice of offering laser peripheral iridotomy (LPI) to PACS patients. To synthetize findings from these and other studies. DESIGN Narrative review. SUBJECTS Patients classified as PACS. METHODS The Zhongshan Angle-Closure Prevention (ZAP)-Trial and the Singapore Asymptomatic Narrow Angle Laser Iridotomy Study (ANA-LIS) along with accompanying publications were reviewed. Epidemiologic studies reporting on the prevalence of primary angle-closure glaucoma and other precursor forms of the disease were also analyzed along with publications reporting on the natural course of the disease or studies reporting on outcomes after prophylactic LPI. MAIN OUTCOME MEASURES Incidence of progression to more severe forms of angle closure. RESULTS Patients recruited in recent randomized clinical trials are asymptomatic, do not have cataracts, may be younger, and have, on average, deeper anterior chambers depth compared with patients treated with LPI in clinics. CONCLUSIONS The ZAP-Trial and ANA-LIS clearly represent the best available data on PACS management, additional parameters however may need to be considered when physicians face patients in clinic. PACS patients encountered at tertiary referral centers may represent more advanced cases with respect to ocular biometric parameters and may be at higher risk for disease progression compared with those recruited through population-based screening. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | - John Danias
- Department of Ophthalmology at SUNY Downstate Health Sciences University, New York, New York
| | | | | | - Douglas J Rhee
- University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Gus Gazzard
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; Institute of Ophthalmology, University College London, United Kingdom
| | - Fotis Topouzis
- First Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Benjamin Xu
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
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Espinoza G, Iglesias K, Parra JC, Rodriguez-Una I, Serrano-Gomez S, Prada AM, Galvis V. Agreement and Reproducibility of Anterior Chamber Angle Measurements between CASIA2 Built-In Software and Human Graders. J Clin Med 2023; 12:6381. [PMID: 37835024 PMCID: PMC10573880 DOI: 10.3390/jcm12196381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023] Open
Abstract
PURPOSE This study evaluated the agreement and reproducibility of ACA measurements obtained using the built-in software of the CASIA2 (Version 3G.1) and the measurements derived from expert clinicians. METHODS Healthy volunteers underwent ophthalmological evaluation and AS-OCT examination. ACA measurements derived from automated and manual SS location were obtained using the CASIA2 automated software and clinician identification, respectively. The intraobserver, interobserver reproducibility, CASIA2-human grader reproducibility and CASIA2 repeatability were assessed using intraclass correlation coefficients (ICCs). RESULTS The study examined 58 eyes of 30 participants. The CASIA2 software showed excellent repeatability for all ACA parameters (ICC > 0.84). Intraobserver, interobserver, and CASIA2-human grader reproducibility were also excellent (ICC > 0.87). Interobserver agreement was high, except for nasal TISA500, differing between observers 1 and 2 (p < 0.05). The agreement between CASIA2 measurements and human graders was high, except for nasal TISA500, where observer 1 values were smaller (p < 0.05). CONCLUSION The CASIA2 built-in software reliably measures ACA parameters in healthy individuals, demonstrating high consistency. Although a small difference was observed in nasal TISA500 measurements, interobserver and CASIA2-human grader reproducibility remained excellent. Automated SS detection has the potential to facilitate evaluation and monitoring of primary angle closure disease.
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Affiliation(s)
- Gustavo Espinoza
- Centro Oftalmológico Virgilio Galvis, Floridablanca 681004, Santander, Colombia
- Fundación Oftalmológica de Santander, Floridablanca 681004, Santander, Colombia
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga 680002, Santander, Colombia
| | - Katheriene Iglesias
- Fundación Oftalmológica de Santander, Floridablanca 681004, Santander, Colombia
| | - Juan C. Parra
- Fundación Oftalmológica de Santander, Floridablanca 681004, Santander, Colombia
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga 680002, Santander, Colombia
| | - Ignacio Rodriguez-Una
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain;
| | - Sergio Serrano-Gomez
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga 680002, Santander, Colombia
| | - Angelica M. Prada
- Centro Oftalmológico Virgilio Galvis, Floridablanca 681004, Santander, Colombia
- Fundación Oftalmológica de Santander, Floridablanca 681004, Santander, Colombia
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga 680002, Santander, Colombia
| | - Virgilio Galvis
- Centro Oftalmológico Virgilio Galvis, Floridablanca 681004, Santander, Colombia
- Fundación Oftalmológica de Santander, Floridablanca 681004, Santander, Colombia
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga 680002, Santander, Colombia
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Azuara-Blanco A. Use of Biometric Data After Laser Peripheral Iridotomy-Individualized Monitoring Strategy for Angle Closure Progression. JAMA Ophthalmol 2023; 141:524. [PMID: 37103917 DOI: 10.1001/jamaophthalmol.2023.1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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