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KhalafAllah MT, Zangwill LM, Proudfoot J, Walker E, Girkin CA, Fazio MA, Weinreb RN, Bowd C, Moghimi S, De Moraes CG, Liebmann JM, Racette L. Racial Differences in Diagnostic Accuracy of Retinal Nerve Fiber Layer Thickness in Primary Open-Angle Glaucoma. Am J Ophthalmol 2024; 259:7-14. [PMID: 38708401 PMCID: PMC11068369 DOI: 10.1016/j.ajo.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Purpose To evaluate the diagnostic accuracy of retinal nerve fiber layer thickness (RNFLT) by spectral-domain optical coherence tomography (OCT) in primary open-angle glaucoma (POAG) in eyes of African (AD) and European descent (ED). Design Comparative diagnostic accuracy analysis by race. Participants 379 healthy eyes (125 AD and 254 ED) and 442 glaucomatous eyes (226 AD and 216 ED) from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Methods Spectralis (Heidelberg Engineering GmbH) and Cirrus (Carl Zeiss Meditec) OCT scans were taken within one year from each other. Main Outcome Measures Diagnostic accuracy of RNFLT measurements. Results Diagnostic accuracy for Spectralis-RNFLT was significantly lower in eyes of AD compared to those of ED (area under the receiver operating curve [AUROC]: 0.85 and 0.91, respectively, P=0.04). Results for Cirrus-RNFLT were similar but did not reach statistical significance (AUROC: 0.86 and 0.90 in AD and ED, respectively, P =0.33). Adjustments for age, central corneal thickness, axial length, disc area, visual field mean deviation, and intraocular pressure yielded similar results. Conclusions OCT-RNFLT has lower diagnostic accuracy in eyes of AD compared to those of ED. This finding was generally robust across two OCT instruments and remained after adjustment for many potential confounders. Further studies are needed to explore the potential sources of this difference.
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Affiliation(s)
- Mahmoud T. KhalafAllah
- Vision Science Graduate Program, The University of Alabama at Birmingham, Birmingham, USA
- Department of Ophthalmology, Menoufia University, Shebin Elkom, Egypt
| | - Linda M. Zangwill
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, USA
| | - James Proudfoot
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, USA
| | - Evan Walker
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, USA
| | - Christopher A. Girkin
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, USA
| | - Massimo A. Fazio
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, USA
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, USA
| | - Christopher Bowd
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, USA
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, USA
| | - C. Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, NY, USA
| | - Jeffrey M. Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, NY, USA
| | - Lyne Racette
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, USA
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Kastner A, Stuart KV, Montesano G, De Moraes CG, Kang JH, Wiggs JL, Pasquale LR, Hysi P, Chua SYL, Patel PJ, Foster PJ, Khaw PT, Khawaja AP. Calcium Channel Blocker Use and Associated Glaucoma and Related Traits Among UK Biobank Participants. JAMA Ophthalmol 2023; 141:956-964. [PMID: 37676684 PMCID: PMC10485742 DOI: 10.1001/jamaophthalmol.2023.3877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/10/2023] [Indexed: 09/08/2023]
Abstract
Importance Calcium channel blocker (CCB) use has been associated with an increased risk of glaucoma in exploratory studies. Objective To examine the association of systemic CCB use with glaucoma and related traits among UK Biobank participants. Design, Setting, and Participants This population-based cross-sectional study included UK Biobank participants with complete data (2006-2010) for analysis of glaucoma status, intraocular pressure (IOP), and optical coherence tomography (OCT)-derived inner retinal layer thicknesses. Data analysis was conducted in January 2023. Exposure Calcium channel blocker use was assessed in a baseline touchscreen questionnaire and confirmed during an interview led by a trained nurse. Main Outcomes and Measures The primary outcome measures included glaucoma status, corneal-compensated IOP, and 2 OCT-derived inner retinal thickness parameters (macular retinal nerve fiber layer [mRNFL] and macular ganglion cell-inner plexiform layer [mGCIPL] thicknesses). We performed logistic regression and linear regression analyses to test for associations with glaucoma status and IOP and OCT-derived inner retinal thickness parameters, respectively. Results This study included 427 480 adults. Their median age was 58 (IQR, 50-63) years, and more than half (54.1%) were women. There were 33 175 CCB users (7.8%). Participants who had complete data for glaucoma status (n = 427 480), IOP (n = 97 100), and OCT-derived inner retinal layer thicknesses (n = 41 023) were eligible for respective analyses. After adjustment for key sociodemographic, medical, anthropometric, and lifestyle factors, use of CCBs (but not other antihypertensive agents) was associated with greater odds of glaucoma (odds ratio [OR], 1.39 [95% CI, 1.14 to 1.69]; P = .001). Calcium channel blocker use was also associated with thinner mGCIPL (-0.34 μm [95% CI, -0.54 to -0.15 μm]; P = .001) and mRNFL (-0.16 μm [95% CI, -0.30 to -0.02 μm]; P = .03) thicknesses but not IOP (-0.01 mm Hg [95% CI, -0.09 to 0.07 mm Hg]; P = .84). Conclusions and Relevance In this study, an adverse association between CCB use and glaucoma was observed, with CCB users having, on average, 39% higher odds of glaucoma. Calcium channel blocker use was also associated with thinner mGCIPL and mRNFL thicknesses, providing a structural basis that supports the association with glaucoma. The lack of association of CCB use with IOP suggests that an IOP-independent mechanism of glaucomatous neurodegeneration may be involved. Although a causal relationship has not been established, CCB replacement or withdrawal may be considered should glaucoma progress despite optimal care.
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Affiliation(s)
- Alan Kastner
- National Institute for Health and Care Research Biomedical Research Centre, Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
- Clínica Oftalmológica Pasteur, Santiago, Chile
| | - Kelsey V. Stuart
- National Institute for Health and Care Research Biomedical Research Centre, Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
| | - Giovanni Montesano
- National Institute for Health and Care Research Biomedical Research Centre, Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
- Division of Optometry and Vision Science, City University of London, London, United Kingdom
| | - C. Gustavo De Moraes
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - Jae H. Kang
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Janey L. Wiggs
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Louis R. Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Pirro Hysi
- Department of Ophthalmology, King’s College London, St Thomas’ Hospital, London, United Kingdom
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Sharon Y. L. Chua
- National Institute for Health and Care Research Biomedical Research Centre, Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
| | - Praveen J. Patel
- National Institute for Health and Care Research Biomedical Research Centre, Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
| | - Paul J. Foster
- National Institute for Health and Care Research Biomedical Research Centre, Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
| | - Peng T. Khaw
- National Institute for Health and Care Research Biomedical Research Centre, Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
| | - Anthony P. Khawaja
- National Institute for Health and Care Research Biomedical Research Centre, Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
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Melchior B, De Moraes CG, Paula JS, Cioffi GA, Gordon MO, Kass MA, Liebmann JM. What is the Optimal Frequency of Visual Field Testing to Detect Rapid Progression Among Hypertensive Eyes? J Glaucoma 2023; 32:721-724. [PMID: 37343189 DOI: 10.1097/ijg.0000000000002260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
PRCIS We evaluated 16,351 visual field (VF) tests from Ocular Hypertension Treatment Study (OHTS) database and showed that more frequent testing resulted in a shorter time to detect glaucoma progression, with the best trade-off being the 6-month intervals for high-risk and 12 months for low-risk patients. PURPOSE To investigate the effect of different testing intervals on time to detect visual field progression in eyes with ocular hypertension. METHODS A total of 16,351 reliable 30-2 VF tests from 1575 eyes of the OHTS-1 observation arm with a mean (95% CI) follow-up of 4.8 (4.7-4.8) years were analyzed. Computer simulations (n = 10,000 eyes) based on mean deviation values and the residuals of risk groups (according to their baseline 5 y risk of developing primary open angle glaucoma: low, medium, and high risk) were performed to estimate time to detect progression with testing intervals of 4, 6, 12, and 24 months using linear regression. The time to detect VF progression ( P < 5%) at 80% power was calculated based on the mean deviation slope of -0.42 dB/year. We assessed the time to detect a -3 dB loss as an estimate of clinically meaningful perimetric loss. RESULTS At 80% power, based on the progression of -0.42 dB/year, the best trade-off to detect significant rates of VF change to clinically meaningful perimetric loss in high, medium, and low-risk patients was 6, 6, and 12-month intervals, respectively. CONCLUSION Given the importance of not missing the conversion to glaucoma, the frequency of testing used in OHTS (6 mo) was optimal for the detection of progression in high-risk patients. Low-risk patients could potentially be tested every 12 months to optimize resource utilization.
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Affiliation(s)
- Bruna Melchior
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - C Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center
| | - Jayter S Paula
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - George A Cioffi
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center
| | - Mae O Gordon
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
| | - Michael A Kass
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center
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Hark LA, Horowitz JD, Gorroochurn P, Park L, Wang Q, Diamond DF, Harizman N, Auran JD, Maruri SC, Henriquez DR, Carrion J, Muhire RSM, Kresch YS, Pizzi LT, Jutkowitz E, Sapru S, Sharma T, De Moraes CG, Friedman DS, Liebmann JM, Cioffi GA. Manhattan Vision Screening and Follow-up Study (NYC-SIGHT): Baseline Results and Costs of a Cluster-Randomized Trial. Am J Ophthalmol 2023; 251:12-23. [PMID: 36690289 DOI: 10.1016/j.ajo.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/10/2023] [Accepted: 01/15/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE To describe the 15-month baseline results and costs of the Manhattan Vision Screening and Follow-up Study, which aims to investigate whether innovative community-based eye health screening can improve early detection and management of glaucoma and other eye diseases among high-risk populations. DESIGN 5-year prospective, cluster-randomized controlled trial. METHODS Individuals age 40+ were recruited from public housing buildings in New York City for an eye health screening (visual acuity (VA) with correction, intraocular pressure measurements (IOP), and fundus photography). Participants with VA 20/40 or worse, IOP 23-29 mmHg, or an unreadable fundus image failed the screening and were scheduled for an optometric exam at the same location; those with an abnormal image were referred to ophthalmology. A cost analysis was conducted alongside the study. RESULTS 708 participants were screened; mean age 68.6±11.9 years, female (65.1%), African American (51.8%) and Hispanic (42%). 78.4% (n = 555) failed the eye health screening; 35% (n= 250) had an abnormal image and were also referred to ophthalmology. 308 participants attended the optometric exam; 218 were referred to ophthalmology. Overall, 66.1% were referred to ophthalmology. The cost per participant to deliver the eye health screening and optometric exam was $180.88. The cost per case of eye disease detected was $273.64. CONCLUSIONS This innovative study in public housing developments targeted high-risk populations, provided access to eye-care, and improved early detection of ocular diseases in New York City. The study has identified strategies to overcoming barriers to eye care to reduce eye health disparities.
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Affiliation(s)
- Lisa A Hark
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York.
| | - Jason D Horowitz
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W. 168(th) Street, New York, NY 10032
| | - Lisa Park
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Qing Wang
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Daniel F Diamond
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Noga Harizman
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - James D Auran
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Desiree R Henriquez
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Jailine Carrion
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Remy S Manzi Muhire
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Yocheved S Kresch
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York; Kresge Eye Institute, Wayne State University School of Medicine, 4717 St Antoine, Detroit, MI 48201
| | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University Ernest Mario School of Pharmacy, 160 Frelinghuysen Road, Piscataway, NJ 08854
| | - Eric Jutkowitz
- Department of Health Services, Policy & Practice, Brown University School of Public Health, 21 S. Main Street, Providence, RI 02903
| | - Saloni Sapru
- Westat Public Health and Epidemiology Practice, 1600 Research Blvd., Rockville, MD 20850
| | - Tarun Sharma
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - C Gustavo De Moraes
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - David S Friedman
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Glaucoma Service, 243 Charles Street, Boston, MA 02114
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - George A Cioffi
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
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Melgarejo JD, Eijgen JV, Maestre GE, Al-Aswad LA, Thijs L, Mena LJ, Lee JH, Terwilliger JD, Petitto M, Chávez CA, Brito M, Calmon G, Silva E, Wei DM, Cutsforth E, Keer KV, Gustavo De Moraes C, Vanassche T, Janssens S, Stalmans I, Verhamme P, Staessen JA, Zhang ZY. Open-Angle Glaucomatous Optic Neuropathy Is Related to Dips Rather Than Increases in the Mean Arterial Pressure Over 24-H. Am J Hypertens 2022; 35:703-714. [PMID: 35218651 PMCID: PMC9340631 DOI: 10.1093/ajh/hpac028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/27/2022] [Accepted: 02/25/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Mean arterial pressure (MAP) drives ocular perfusion. Excessive 24-h MAP variability relates to glaucoma, however, whether this is due to dips or increases in the blood pressure (BP) is undocumented. We investigated the association of open-angle glaucoma (OAG) in relation to the 5 largest MAP dips/increases over 24-h, henceforth called dips/blips. METHODS In the Maracaibo Aging Study (MAS), 93 participants aged ≥40 y (women, 87.1%; mean age, 61.9 y) underwent baseline ophthalmological and 24-h ambulatory BP monitoring assessments. OAG was the presence of optic nerve damage and visual field defects. Statistical methods included logistic regression and the generalized R2 statistic. For replication, 48 OAG cases at the Leuven Glaucoma Clinic were matched with 48 controls recruited from Flemish population. RESULTS In the MAS, 26 participants had OAG. OAG compared to non-OAG participants experienced longer and deeper dips (116.5 vs. 102.7 minutes; to 60.3 vs. 66.6 mm Hg; -21.0 vs. -18.0 mm Hg absolute or 0.79 vs. 0.81 relative dip compared to the preceding reading). The adjusted odds ratios associated with dip measures ranged from 2.25 (95% confidence interval [CI], 1.31-4.85; P = 0.009) to 3.39 (95% CI, 1.36-8.46; P = 0.008). On top of covariables and 24-MAP level/variability, the dip measures increased the model performance (P ≤ 0.025). Blips did not associate with OAG. The case-control study replicated the MAS observations. CONCLUSIONS Dips rather than increases in the 24-h MAP level were associated with increased risk for OAG. An ophthalmological examination combined with 24-h BP monitoring might be precautious steps required in normotensive and hypertensive patients at risk of OAG.
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Affiliation(s)
- Jesus D Melgarejo
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Zulia, Venezuela
| | - Jan V Eijgen
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Department of Neurosciences, Research Group Ophthalmology, University of Leuven, Leuven, Belgium
| | - Gladys E Maestre
- Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Zulia, Venezuela
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, Texas, USA
- Institute for Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Harlingen, Texas, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Lama A Al-Aswad
- Department of Ophthalmology, New York University (NYU) Grossman School of Medicine, NYU Langone Health, New York, New York, USA
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Luis J Mena
- Department of Informatics, Universidad Politécnica de Sinaloa, Mazatlán, Mexico
| | - Joseph H Lee
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, G.H. Sergievsky Center, Columbia University Medical Center, New York, New York, USA
- Departments of Epidemiology and Neurology, Columbia University Medical Center, New York, New York, USA
| | - Joseph D Terwilliger
- Department of Genetics and Development, Columbia University, New York, New York, USA
- Department of Psychiatry, G.H. Sergievsky Center, Columbia University, New York, New York, USA
- Division of Medical Genetics, New York State Psychiatric Institute, New York, New York, USA
- Division of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Michele Petitto
- Glaucoma and Retina Units, Eye Clinic of Maracaibo, Maracaibo, Zulia, Venezuela
| | - Carlos A Chávez
- Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Zulia, Venezuela
| | - Miguel Brito
- Instituto Docente de Especialidades Oftalmológicas (IDEO), Maracaibo, Zulia, Venezuela
| | - Gustavo Calmon
- Laboratory of Ambulatory Recordings, Cardiovascular Institute (IECLUZ), University of Zulia, Maracaibo, Zulia, Venezuela
| | - Egle Silva
- Laboratory of Ambulatory Recordings, Cardiovascular Institute (IECLUZ), University of Zulia, Maracaibo, Zulia, Venezuela
| | - Dong-Mei Wei
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Ella Cutsforth
- Biomedical Science Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Karel V Keer
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Department of Neurosciences, Research Group Ophthalmology, University of Leuven, Leuven, Belgium
| | | | - Thomas Vanassche
- Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Stefan Janssens
- Division of Cardiology, Department of Internal Medicine, University Hospitals UZ Leuven, Leuven, Belgium
| | - Ingeborg Stalmans
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Department of Neurosciences, Research Group Ophthalmology, University of Leuven, Leuven, Belgium
| | - Peter Verhamme
- Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jan A Staessen
- Biomedical Science Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
| | - Zhen-Yu Zhang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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Melchior B, Valenzuela IA, De Moraes CG, Paula JS, Fazio MA, Girkin CA, Proudfoot J, Cioffi GA, Weinreb RN, Zangwill LM, Liebmann JM. Glaucomatous Visual Field Progression in the African Descent and Glaucoma Evaluation Study (ADAGES): Eleven Years of Follow-up. Am J Ophthalmol 2022; 239:122-129. [PMID: 35172170 DOI: 10.1016/j.ajo.2022.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/26/2022] [Accepted: 02/02/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To compare the rates of visual field (VF) progression between individuals of Black and White race and to investigate whether treatment effects may help explain differences previously reported between racial groups. DESIGN Multicenter prospective observational cohort study. METHODS Participants were patients in referral tertiary care glaucoma clinics with open angle glaucoma. Eyes were excluded who had <5 VF tests and <2 years of follow-up or any disease that could affect the optic nerve or the VF. The VF mean deviation (MD) slopes over time (dB/y) were calculated with linear regression models. Socioeconomic variables, rates of glaucoma surgery, medications, treated intraocular pressure (IOP), and central corneal thickness (CCT) were investigated. RESULTS A total of 516 eyes were included with a mean (95% CI) follow-up time of 11.0 (range, 10.5-11.5) years and 15.0 (range, 14.1-15.8) visits. Participants of Black race were significantly younger (59.7 vs 66.9 years, P < .01) than those of White race. The mean CCT and socioeconomic variables were similar between Black and White groups (P = 0.20 and P = .56, respectively), as were treatment with topical medications (P = .90) and the rate of VF MD change (-0.24 [-0.31 to -0.17] dB/year vs -0.32 [-0.36 to -0.27], P = .11), despite higher treated mean IOP (14.9 [14.5 to 15.4] vs 14.0 [13.6 to 14.4] mm Hg, P = .03) and fewer trabeculectomies (29.5% vs 50.0%, P < .01) in the Black race group. CONCLUSIONS Rates of VF progression were similar despite higher treated IOP in the Black race group. Mitigation of health access disparities in this study may have equalized previously reported different rates of VF progression between racial groups.
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Villasana GA, Bradley C, Elze T, Myers JS, Pasquale L, De Moraes CG, Wellik S, Boland MV, Ramulu P, Hager G, Unberath M, Yohannan J. Improving Visual Field Forecasting by Correcting for the Effects of Poor Visual Field Reliability. Transl Vis Sci Technol 2022; 11:27. [PMID: 35616923 PMCID: PMC9145029 DOI: 10.1167/tvst.11.5.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 03/30/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to accurately forecast future reliable visual field (VF) mean deviation (MD) values by correcting for poor reliability. Methods Four linear regression techniques (standard, unfiltered, corrected, and weighted) were fit to VF data from 5939 eyes with a final reliable VF. For each eye, all VFs, except the final one, were used to fit the models. Then, the difference between the final VF MD value and each model's estimate for the final VF MD value was used to calculate model error. We aggregated the error for each model across all eyes to compare model performance. The results were further broken down into eye-level reliability subgroups to track performance as reliability levels fluctuate. Results The standard method, used in the Humphrey Field Analyzer (HFA), was the worst performing model with an average residual that was 0.69 dB higher than the average from the unfiltered method, and 0.79 dB higher than that of the weighted and corrected methods. The weighted method was the best performing model, beating the standard model by as much as 1.75 dB in the 40% to 50% eye-level reliability subgroup. However, its average 95% prediction interval was relatively large at 7.67 dB. Conclusions Including all VFs in the trend estimation has more predictive power for future reliable VFs than excluding unreliable VFs. Correcting for VF reliability further improves model accuracy. Translational Relevance The VF correction methods described in this paper may allow clinicians to catch VF worsening at an earlier stage.
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Affiliation(s)
- Gabriel A. Villasana
- Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, USA
| | - Chris Bradley
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tobias Elze
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | | | - Louis Pasquale
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Sarah Wellik
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael V. Boland
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Pradeep Ramulu
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Greg Hager
- Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, USA
| | - Mathias Unberath
- Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, USA
| | - Jithin Yohannan
- Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, USA
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Dagi Glass LR, De Moraes CG, Wright MA, Winn BJ, Chen RWS, Cioffi GA. Ophthalmology Medical Student Directors, Associate Residency Program Directors, and Program Directors: A Benchmarking Study of Work and Life Metrics. Journal of Academic Ophthalmology 2022. [DOI: 10.1055/s-0041-1741460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction During a time of increased interest in physician well-being, this study benchmarks current work life, home life, and burnout scores for ophthalmology medical student directors (MSD), associate program directors (APD), and program directors (PD).
Methods An anonymous cross-sectional survey was disseminated through the Association of University Professors of Ophthalmology (AUPO) listserve, with queries regarding leadership positions, work time allotment, extracurricular activities, family life, and burnout. Answers were analyzed descriptively through Fisher's exact test, Kruskal–Wallis test, and Poisson regression models.
Results Nineteen percent of listed MSD, 15% of APD, and 29% of PD queried responded to the survey. MSD, APD, and PD are statistically similar in terms of work and home life, with the exception of time spent performing administrative tasks for the position. PD spend more time on administrative tasks, and are paid more. All groups score positively on burnout surveys.
Conclusion This benchmarking survey demonstrates that MSD, APD, and PD are intensively involved in both their work and home lives, with a seemingly high correlation of sense of worth both personally and in their careers.
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Affiliation(s)
- Lora R. Dagi Glass
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - C. Gustavo De Moraes
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - Melissa A. Wright
- Center for Teaching and Learning, Columbia University, New York, New York
| | - Bryan J. Winn
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Royce W. S. Chen
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - George A. Cioffi
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
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Haring B, Hovey K, La Monte M, Andrews C, Saquib N, Manson J, Shimbo D, Ritch R, De Moraes CG, Wassertheil-Smoller S. Abstract P188: Blood Pressure Control And Glaucoma Risk In Older Women. Hypertension 2021. [DOI: 10.1161/hyp.78.suppl_1.p188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Individuals with elevated systolic blood pressure (BP) or low diastolic BP, whether or not on antihypertensive treatment, may be at higher risk for developing glaucoma. We aimed to investigate BP levels in relation to risk of incident glaucoma in a large cohort of elderly women.
Methods:
Prospective follow-up of 101,447 postmenopausal women without prior history of glaucoma enrolled in the Women’s Health Initiative Study (WHI). Blood pressure was measured in-clinic at baseline and after 3 years using standardized procedures and average BP was calculated. Antihypertensive medication use was determined by drug inventory at baseline and year 3. Women self-reported incident newly diagnosed glaucoma annually. Hazard ratios (HRs) and 95% confidence intervals (95% CI) were estimated using Cox proportional hazards analyses adjusting for demographic, medical history, and lifestyle covariates.
Results:
During a mean follow-up of 4.7 years, we documented 7,514 glaucoma cases. Among women not on antihypertensive treatment, those with systolic BP ≥140 mmHg or diastolic BP ≥80 mmHg were not at higher risk of developing glaucoma (HR 0.97, 95% CI 0.88-1.08 and HR 1.00 [0.93-1.08], respectively), compared to women with a systolic BP <120 mmHg or a diastolic BP 60-<80 mmHg. Among women on antihypertensive treatment, neither systolic BP ≥140 mmHg nor diastolic BP ≥80 mmHg was associated with an increased risk of glaucoma (HR 0.91 [0.82-1.01] and HR 0.97 [0.90-1.05], respectively). A diastolic BP <60 mmHg was not associated with a higher risk compared to a diastolic BP 60-<80 mmHg.
Conclusions:
BP control is not associated with an increased or decreased glaucoma risk in elderly women.
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Affiliation(s)
| | | | | | | | | | | | | | - Robert Ritch
- New York Eye and Ear Infirmary New York, New York City, NY
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10
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Leshno A, De Moraes CG, Mezad-Koursh D, Belkin M, Singer R, Jaber W, Barkana Y, Skaat A. Glaucoma Publication Trends in Leading General Ophthalmology Journals During the Past Quarter Century: Where Are the Clinical Trials? J Glaucoma 2021; 30:e305-e311. [PMID: 34060510 DOI: 10.1097/ijg.0000000000001800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/27/2020] [Indexed: 11/25/2022]
Abstract
PRCIS During the past quarter century, the rate of glaucoma-related publication in general ophthalmology journals increased due to higher representation in "experimentally oriented" journals. The rate of glaucoma randomized controlled clinical trial (RCT) articles decreased during the same time period. PURPOSE To evaluate trends in rate of glaucoma publications in leading general ophthalmology journals over the past quarter century. MATERIALS AND METHODS Q1 ophthalmology journals Web sites were reviewed. Only journals not limited to certain subspecialty were considered "general" and included in the analysis. In addition we categorized journals orientation as either "clinical" or "experimental." The PubMed search engine was used to collect publications from the selected journals between January 1, 1995 to December 31, 2019. Publications captured by "glaucoma" or "ocular hypertension" filters were considered glaucoma related. The fraction of glaucoma articles out of total number of articles within each year for each journal was calculated. A linear mixed effects model was applied to detect trends in glaucoma publication rates during the study period. RESULTS Eight journals were included: 4 "clinically oriented" and 4 "experimentally oriented." The PubMed search yielded 72,750 publications, of which 9329 (12.8%) considered "glaucoma related." Percentage of glaucoma publications remained stable within "clinically oriented" journals, and significantly increased within "experimentally oriented" journals (annual change of 0.3%, P<0.001). The number of glaucoma-related RCTs decreased significantly in each (annual change of -0.21% and -0.13%, respectively, P<0.05). CONCLUSIONS There has been a significant rise in the rates of glaucoma publications in "experimentally oriented" journals, while their representation in "clinically oriented" journals remained stable over the past quarter century. This change might be due to the increasing efforts to develop more advanced methods for evaluation and treatment in glaucoma, although still unable to address clinical demands. The decrease in glaucoma-related RCT articles might indicate reduced funding for such research.
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Affiliation(s)
- Ari Leshno
- Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center
- Sackler Faculty of Medicine, Tel Aviv University
| | - C Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY
| | - Daphna Mezad-Koursh
- Sackler Faculty of Medicine, Tel Aviv University
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Michael Belkin
- Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center
- Sackler Faculty of Medicine, Tel Aviv University
| | - Reut Singer
- Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center
| | - Wasim Jaber
- Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center
| | - Yaniv Barkana
- Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center
| | - Alon Skaat
- Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center
- Sackler Faculty of Medicine, Tel Aviv University
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Hark LA, Tan CS, Kresch YS, De Moraes CG, Horowitz JD, Park L, Auran JD, Gorroochurn P, Stempel S, Maruri SC, Besagar S, Saaddine JB, Lambert BC, Pizzi LT, Sapru S, Price S, Williams OA, Cioffi GA, Liebmann JM. Manhattan Vision Screening and Follow-Up Study in Vulnerable Populations: 1-Month Feasibility Results. Curr Eye Res 2021; 46:1597-1604. [PMID: 33726583 DOI: 10.1080/02713683.2021.1905000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose/Aim: In the United States, high rates of vision impairment and eye disease disproportionately impact those who lack access to eye care, specifically vulnerable populations. The objective of our study was to test instruments, implement protocols, and collect preliminary data for a larger 5-year study, which aims to improve detection of eye diseases and follow-up eye care in vulnerable populations using community health workers (CHW) and patient navigators. In the study, trained CHWs conducted vision screening and patient navigators scheduled on-site eye exams and arranged appointments for those referred to ophthalmology to improve adherence to follow-up eye care.Materials and Methods: Eligible individuals age 40-and-older were recruited from the Riverstone Senior Center in Upper Manhattan, New York City. Participants underwent on-site vision screening (visual acuity with correction, intraocular pressure measurements, and fundus photography). Individuals who failed the vision screening were scheduled with an on-site optometrist for an eye exam; those with ocular pathologies were referred to an ophthalmologist. Participants were also administered the National Eye Institute Visual Function Questionnaire-8 (NEI-VFQ-8) and Stopping Elderly Accidents, Deaths, and Injuries (STEADI) test by community health workers.Results:Participants (n = 42) were predominantly older adults, with a mean age of 70.0 ± 9.8, female (61.9%), and Hispanic (78.6%). Most individuals (78.6%, n = 33) failed vision screening. Of those who failed, 84.8% (n = 28) attended the on-site eye exam with the optometrist. Ocular diagnoses: refractive error 13/28 (46.4%), glaucoma/glaucoma suspect 9/28 (32.1%), cataract 7/28 (25.0%), retina abnormalities 6/28 (21.4%); 13 people required eyeglasses.Conclusion: This study demonstrates the feasibility of using CHWs and patient navigators for reducing barriers to vision screening and optometrist-based eye exams in vulnerable populations, ultimately improving early detection of eye disease and linking individuals to additional eye care appointments. The full five-year study aims to further examine these outcomes.
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Affiliation(s)
- Lisa A Hark
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Camille S Tan
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Yocheved S Kresch
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - C Gustavo De Moraes
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Jason D Horowitz
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Lisa Park
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - James D Auran
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Stella Stempel
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Sonya Besagar
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Jinan B Saaddine
- Centers for Disease Control and Prevention, Vision Health Initiative, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, USA
| | - Bianca C Lambert
- Department of General Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University, New Brunswick, New Jersey, USA
| | - Saloni Sapru
- Public Health and Epidemiology Practice, Westat, Inc., Rockville, Maryland, USA
| | - Simani Price
- Public Health and Epidemiology Practice, Westat, Inc., Rockville, Maryland, USA
| | - Olajide A Williams
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - George A Cioffi
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
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12
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Shuldiner SR, Boland MV, Ramulu PY, De Moraes CG, Elze T, Myers J, Pasquale L, Wellik S, Yohannan J. Predicting eyes at risk for rapid glaucoma progression based on an initial visual field test using machine learning. PLoS One 2021; 16:e0249856. [PMID: 33861775 PMCID: PMC8051770 DOI: 10.1371/journal.pone.0249856] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/25/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess whether machine learning algorithms (MLA) can predict eyes that will undergo rapid glaucoma progression based on an initial visual field (VF) test. DESIGN Retrospective analysis of longitudinal data. SUBJECTS 175,786 VFs (22,925 initial VFs) from 14,217 patients who completed ≥5 reliable VFs at academic glaucoma centers were included. METHODS Summary measures and reliability metrics from the initial VF and age were used to train MLA designed to predict the likelihood of rapid progression. Additionally, the neural network model was trained with point-wise threshold data in addition to summary measures, reliability metrics and age. 80% of eyes were used for a training set and 20% were used as a test set. MLA test set performance was assessed using the area under the receiver operating curve (AUC). Performance of models trained on initial VF data alone was compared to performance of models trained on data from the first two VFs. MAIN OUTCOME MEASURES Accuracy in predicting future rapid progression defined as MD worsening more than 1 dB/year. RESULTS 1,968 eyes (8.6%) underwent rapid progression. The support vector machine model (AUC 0.72 [95% CI 0.70-0.75]) most accurately predicted rapid progression when trained on initial VF data. Artificial neural network, random forest, logistic regression and naïve Bayes classifiers produced AUC of 0.72, 0.70, 0.69, 0.68 respectively. Models trained on data from the first two VFs performed no better than top models trained on the initial VF alone. Based on the odds ratio (OR) from logistic regression and variable importance plots from the random forest model, older age (OR: 1.41 per 10 year increment [95% CI: 1.34 to 1.08]) and higher pattern standard deviation (OR: 1.31 per 5-dB increment [95% CI: 1.18 to 1.46]) were the variables in the initial VF most strongly associated with rapid progression. CONCLUSIONS MLA can be used to predict eyes at risk for rapid progression with modest accuracy based on an initial VF test. Incorporating additional clinical data to the current model may offer opportunities to predict patients most likely to rapidly progress with even greater accuracy.
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Affiliation(s)
- Scott R. Shuldiner
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Michael V. Boland
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States of America
| | - Pradeep Y. Ramulu
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - C. Gustavo De Moraes
- Department of Ophthalmology, Columbia University Medical Center, New York, NY, United States of America
| | - Tobias Elze
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States of America
| | - Jonathan Myers
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Louis Pasquale
- The Eye and Vision Research Institute of New York Eye and Ear Infirmary at Mount Sinai, Icahn School of Medicine at Mount Sinai School, New York, NY, United States of America
| | - Sarah Wellik
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Jithin Yohannan
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
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Abstract
Identifying progression is of fundamental importance to the management of glaucoma. It is also a challenge. The most sophisticated, and probably the most useful, commercially available clinical tool for identifying progression is the Guided Progression Analysis (GPA), which was initially developed to identify progression using 24-2 visual field tests. More recently, it has been extended to retinal nerve fiber layer (RNFL) and ganglion cell+inner plexiform layer thicknesses measured with optical coherence tomography (OCT). However, the OCT GPA requires a minimum of 3 tests to determine "possible loss (progression)" and a minimum of 4 tests to determine if the patient shows "likely loss (progression)." Thus, it is not designed to answer a fundamental question asked by both the clinician and the patient, namely: Did damage progress since the last visit? Some clinicians use changes in summary statistics, such as global/average circumpapillary RNFL thickness. However, these statistics have poor sensitivity and specificity due to segmentation and alignment errors. Instead of relying on the GPA analysis or summary statistics, one needs to evaluate RNFL and ganglion cell+inner plexiform layer probability maps and circumpapillary OCT B-scan images. In addition, we argue that the clinician can make a better decision about suspected progression between 2 test days by topographically comparing the changes in the different OCT maps and images, in addition to topographically comparing the changes in the visual field with the changes in OCT probability maps.
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Affiliation(s)
- Donald C. Hood
- Department of Psychology, Columbia University, New York City, NY, USA
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - Bruna Melchior
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Emmanouil Tsamis
- Department of Psychology, Columbia University, New York City, NY, USA
| | - Jeffrey M. Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - C. Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
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Hood DC, Thenappan AA, Tsamis E, Liebmann JM, De Moraes CG. An Evaluation of a New 24-2 Metric for Detecting Early Central Glaucomatous Damage. Am J Ophthalmol 2021; 223:119-128. [PMID: 32777374 DOI: 10.1016/j.ajo.2020.07.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE We sought to test the hypothesis that a recently proposed pattern standard deviation (PSD) metric, based upon the 24-2 visual field (VF) test, as well as the PSD of the 10-2 VF, will miss central glaucomatous damage confirmed with an objective structure-function method. DESIGN Cross-sectional study. METHODS A glaucoma (G) group (70 eyes/patients) diagnosed with glaucoma and a 24-2 mean deviation better than -6 dB and a healthy (H) group (45 eyes/patients) had 24-2 and 10-2 VFs and optical coherence tomography (OCT) scans twice within 4 weeks. The PSD(C24-2), based upon the central 12 points of the 24-2, was compared with the PSD(10-2). To evaluate central damage (CD) in G eyes with normal PSD(C24-2) values, a post hoc analysis was combined with a CD reference standard (CD-RS), which was based upon an objective, topographic comparison between abnormal points on the 10-2 VF and OCT probability maps. RESULTS The 115 PSD(C24-2) and PSD(10-2) values were significantly correlated (Spearman correclation coefficient: rho = 0.55; P < .001) and the number of G eyes (19) identified as abnormal by the PSD(C24-2) was not significantly different from the number (22) identified by the PSD(10-2) (P = .15). However, based upon the CD-RS, 44 of 70 G eyes were classified as abnormal. The PSD(C24-2) missed 27 (61%) of these 44 eyes, and the PSD(10-2) missed 23 (52%) of these eyes. Post hoc analysis revealed clear CD in most of these eyes. CONCLUSION Neither the PSD(C24-2) nor the PSD(10-2) metric is good measure of early CD. Instead we recommend a topographic approach based upon OCT probability maps and a 10-2 VF.
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15
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Yamane MLM, Kassotis AS, De Moraes CG, Dagi Glass LR. Correlating Ophthalmology Exposure in Medical School to Applying and Matching Into an Ophthalmology Residency. Acad Med 2020; 95:1770-1776. [PMID: 32324639 DOI: 10.1097/acm.0000000000003448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To correlate ophthalmology curricular exposure in medical school to the number of students who applied and matched into ophthalmology residency programs. Given the high curricular burden placed on medical schools, the authors sought to better characterize existing ophthalmology curricula and to delineate which offerings are closely related to high numbers of students applying and matching into ophthalmology residencies. METHOD The authors reviewed the extent of ophthalmology curricula between 2007 and 2017 via a survey administered in 2018 to all U.S. Association of American Medical Colleges (AAMC)-affiliated medical schools. They obtained residency application and match data with permission from the Association of University Professors of Ophthalmology. The authors compared metrics of ophthalmology exposure with the number of students who applied and matched into ophthalmology during the corresponding year using mixed-effects Poisson regression analysis. RESULTS This study includes 49 U.S. AAMC-affiliated medical schools. When adjusted for the number of applicants per year, the following were significantly (P < .05) associated with matching into an ophthalmology residency: the presence of an ophthalmology department, an ophthalmology residency program, an ophthalmology interest group, ophthalmologists on faculty, ophthalmology content in the preclinical curriculum, preclinical lectures taught by ophthalmologists, and the availability of an optional fourth-year ophthalmology elective. Multivariable analysis indicated both that the presence of an ophthalmology residency program was the only independent predictor of matching into an ophthalmology residency and that the presence of an ophthalmology residency program, ophthalmology content in the preclinical curriculum, and preclinical lectures taught by ophthalmologists are independent predictors for applying. CONCLUSIONS A foundation in ophthalmology is crucial for all physicians, especially those who may encounter patients with eye problems in emergency or primary care settings. However, for those students considering a career in ophthalmology, choosing a medical school with an ophthalmology department and residency program is particularly important.
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Affiliation(s)
- Maya L M Yamane
- M.L.M. Yamane is resident physician, University of Hawaii, and graduate, Columbia University Vagelos College of Physicians & Surgeons, New York, New York
| | - Alexis S Kassotis
- A.S. Kassotis is a medical student, Columbia University Vagelos College of Physicians & Surgeons, New York, New York
| | - C Gustavo De Moraes
- C.G. De Moraes is associate professor and medical director of clinical trials, Department of Ophthalmology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Lora R Dagi Glass
- L.R. Dagi Glass is assistant professor of ophthalmology, Columbia University Medical Center, and attending ophthalmologist, NewYork-Presbyterian Hospital, New York, New York
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Eguia MD, Tsamis E, Zemborain ZZ, Sun A, Percival J, De Moraes CG, Ritch R, Hood DC. Reasons why OCT Global Circumpapillary Retinal Nerve Fiber Layer Thickness is a Poor Measure of Glaucomatous Progression. Transl Vis Sci Technol 2020; 9:22. [PMID: 33150048 PMCID: PMC7585398 DOI: 10.1167/tvst.9.11.22] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/17/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the effects of local defects, segmentation errors, and improper image alignment on the performance of the commonly used optical coherence tomography (OCT) measure of progression, that is the change in global (average) circumpapillary retinal nerve fiber layer (cpRNFL) thickness (ΔG). Methods One hundred fifty eyes suspected of, or with, early glaucoma had OCT circle and cube scans obtained using eye tracking on two occasions at least 1 year apart. Statistical progression was defined by fixed values of ΔG (3-8 um) and quantile regression. For a reference standard, four authors identified 30 eyes as "likely progressed," and 61 eyes that "likely had not progressed" based on OCT reports from both baseline and follow-up tests. Results A ΔG criterion of 4 um had the best accuracy: 77%, with 5 false positive (8.2%) and 16 false negative (53%). A post hoc analysis of circular b-scans and OCT probability maps of these eyes indicated that segmentation errors and local progression accounted for most of these mistakes. Segmentation errors, although less common, were also present in true positives and true negatives. Conclusions Local defects and segmentation errors are the primary reasons for the poor performance of cpRNFL thickness G metric. Because these problems are difficult, if not impossible, to eliminate, the G metric should not be relied on in isolation for detecting glaucomatous progression. Translational Relevance Local defects and segmentation errors are easily identified by viewing OCT circumpapillary images, which should be part of the standard protocol for detecting glaucomatous progression.
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Affiliation(s)
- Melvi D. Eguia
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Emmanouil Tsamis
- Department of Psychology, Columbia University, New York, NY, USA
| | | | - Ashley Sun
- Department of Psychology, Columbia University, New York, NY, USA
| | - Joseph Percival
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - C. Gustavo De Moraes
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Donald C. Hood
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
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17
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Abstract
Glaucoma is typically defined as a progressive optic neuropathy characterized by a specific (arcuate) pattern of visual field (VF) and anatomic changes. Therefore, we should be comparing arcuate patterns of damage seen on VFs with those seen on optical coherence tomography (OCT) maps. Instead, clinicians often use summary metrics such as VF pattern standard deviation, OCT retinal nerve fiber (RNF) global thickness, etc. There are 2 major impediments to topographically comparing patterns of damage on VF and OCT maps. First, until recently, it was not easy to make these comparisons with commercial reports. While recent reports do make it easier to compare VF and OCT maps, they have shortcomings. In particular, the 24-2 VF covers a larger retinal region than the commercial OCT scans, and, further, it is not easy to understand the topographical relationship among the different maps/plots within the current OCT reports. Here we show how a model of RNF bundles can overcome these problems. The second major impediment is the lack of a quantitative, and automated, method for comparing patterns of damage seen on VF and OCT maps. However, it is now possible to objectively and automatically quantify this agreement. Together, the RNF bundle model and the automated structure-function method should improve the power of topographical methods for detecting glaucoma and its progression. This should prove useful in clinical studies and trials, as well as for training and validating artificial intelligence/deep learning approaches for these purposes.
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Affiliation(s)
- Donald C. Hood
- Department of Psychology, Columbia University, New York City, NY, USA
- Department of Ophthalmology, Columbia University Medical Center, New York City, New York, USA
| | - Zane Z. Zemborain
- Department of Psychology, Columbia University, New York City, NY, USA
| | - Emmanouil Tsamis
- Department of Psychology, Columbia University, New York City, NY, USA
| | - C. Gustavo De Moraes
- Department of Ophthalmology, Columbia University Medical Center, New York City, New York, USA
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18
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Shukla AG, De Moraes CG, Cioffi GA, Girkin CA, Weinreb RN, Zangwill LM, Liebmann JM. The Relationship Between Intraocular Pressure and Rates of Central Versus Peripheral Visual Field Progression. J Glaucoma 2020; 29:435-440. [PMID: 32251071 PMCID: PMC7272279 DOI: 10.1097/ijg.0000000000001494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PRECIS In this longitudinal prospective cohort study of open-angle glaucoma patients, intraocular pressure (IOP) parameters (mean, fluctuation, and maximum) had a similar effect on glaucomatous progression in the central and peripheral visual field (VF) regions. PURPOSE To study the effects of IOP on rates of glaucomatous central versus peripheral VF progression. METHODS The African Descent and Glaucoma Evaluation Study (ADAGES) is a longitudinal prospective cohort study that recruited patients from 3 centers. A sample of those with established glaucoma were included in this study. The mean peripheral sensitivity (MPS) and the mean central sensitivity (MCS) were defined based upon the average total deviation of the peripheral and central (10 degrees) points of the 24-2 VF, respectively. Progression was based upon central and peripheral change from linear mixed-effects models. The relationships between VF progression and IOP mean, maximum, and fluctuation as continuous variables were also investigated. Main outcome measures were MPS and MCS progression rates. RESULTS A total of 452 eyes of 344 patients were studied. The mean number of VFs (SD) for each eye was 13.3 (6.4) over 9.1 (3.7) years. The mean baseline MD was -5.1 (3.9) dB and the mean rate of MD change was -0.26 dB/y [95% confidence interval (CI): -0.33 to -0.20, P<0.001]. Mean rates of MPS (-0.27 dB/y, 95% CI: -0.33 to -0.22, P<0.001) and MCS change (-0.26 dB/y, 95% CI: -0.31 to -0.21, P<0.001) were similar (P=0.351). Mean, fluctuation, and maximum IOP were significantly associated with MPS and MCS (all P<0.025). CONCLUSIONS The effect of IOP parameters on VF progression was statistically similar between central and peripheral VF regions.
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Affiliation(s)
- Aakriti G Shukla
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Columbia University Medical Center, Edward S. Harkness Eye Institute, New York, NY
| | - C Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Columbia University Medical Center, Edward S. Harkness Eye Institute, New York, NY
| | - George A Cioffi
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Columbia University Medical Center, Edward S. Harkness Eye Institute, New York, NY
| | | | - Robert N Weinreb
- Department of Ophthalmology, Hamilton Glaucoma Center, University of California-San Diego, San Diego, CA
| | - Linda M Zangwill
- Department of Ophthalmology, Hamilton Glaucoma Center, University of California-San Diego, San Diego, CA
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Columbia University Medical Center, Edward S. Harkness Eye Institute, New York, NY
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19
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Chen RW, Brooks SE, Kresch YS, Sherman S, De Moraes CG, McDaniel DD, Glass LRD, Liebmann JM, Cioffi GA. Rapid Deployment of Teleophthalmology in the COVID-19 Pandemic. Journal of Academic Ophthalmology 2020. [DOI: 10.1055/s-0040-1712176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Royce W. Chen
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York
| | - Steven E. Brooks
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York
| | - Yocheved S. Kresch
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York
| | - Suzanne Sherman
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York
| | - C. Gustavo De Moraes
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York
| | - Dajzsa D. McDaniel
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York
| | - Lora R. Dagi Glass
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York
| | - Jeffrey M. Liebmann
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York
| | - George A. Cioffi
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York
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20
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Lee SH, Joiner DB, Tsamis E, Rajshekhar R, Kim E, De Moraes CG, Ritch R, Hood DC. OCT Circle Scans Can Be Used to Study Many Eyes with Advanced Glaucoma. Ophthalmol Glaucoma 2019; 2:130-135. [PMID: 31850400 DOI: 10.1016/j.ogla.2019.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Purpose To examine the utility of optical coherence tomography (OCT) for studying eyes with advanced glaucoma [i.e., eyes with a 24-2 visual field (VF) mean deviation (MD) worse than -15 dB], we tested the hypothesis that if these eyes had a 10-2 total deviation (TD) map with points better than -8 dB, then the topographically corresponding regions on the circumpapillary retinal nerve fiber layer (cpRNFL) should show a preserved region. Design Evaluation of technology study. Participants 39 eyes from 33 patients (mean: 68.8 ± 9.2 years) with a diagnosis of glaucoma had a 24-2 VF with a MD ≤ -15 dB (mean: -18.94 ± 2.95 dB). All eyes additionally had a 10-2 VF and an averaged OCT circle scan. Methods Each scan was inspected, and preserved cpRNFL regions of the disc associated with the macula (central ±8° were delin eated. Main Outcome Measures The number of eyes with preserved cpRNFL regions and their association with preserved VF locations (i.e. better than -8 dB) shown in the 10-2 VF TD map. Results 38 of the 39 eyes had one or more points on the 10-2 VF with TD values that were better than -8 dB (mean: 25.7 ± 12.6 points). For all 39 eyes, there was a preserved portion of the cpRNFL on the circle scan within the disc region associated with the macula. However, for 3 of these eyes, this region was hypodense and could be a challenge for the clinician to identify. Conclusion OCT scans can be used to assess and potentially follow the preserved regions of cpRNFL associated with the macula in eyes with advanced glaucoma if there is a preserved region on the 10-2 VF better than -8 dB.
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Affiliation(s)
- Seung H Lee
- Department of Psychology, Columbia University, New York, NY
| | - Devon B Joiner
- Department of Psychology, Columbia University, New York, NY
| | | | | | - Eleanor Kim
- Department of Psychology, Columbia University, New York, NY
| | - C Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
| | - Donald C Hood
- Department of Psychology, Columbia University, New York, NY.,Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
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21
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Melgarejo JD, Lee JH, Maestre GE, De Moraes CG. Reply. Ophthalmology 2019; 126:e12-e13. [PMID: 30683182 DOI: 10.1016/j.ophtha.2018.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/23/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jesus D Melgarejo
- Institute for Biological Research, Neuroscience Laboratory, University of Zulia, Maracaibo, Venezuela
| | - Joseph H Lee
- The Taub Institute for Research in Alzheimer's Disease and the Aging Brain and the G.H. Sergievsky Center, Columbia University, New York, New York; Department of Epidemiology, School of Public Health, Columbia University, New York, New York
| | - Gladys E Maestre
- Institute for Biological Research, Neuroscience Laboratory, University of Zulia, Maracaibo, Venezuela; Departments of Neuroscience and Human Genetics, University of Texas Rio Grande Valley School of Medicine, Brownsville, Texas.
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22
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23
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De Moraes CG, Pettito M, Yepez JB, Sakuntabhai A, Simon-Loriere E, Zaidi MB, Prot M, Ruffie C, Kim SS, Allikmets R, Terwilliger JD, Lee JH, Maestre GE. Corrigendum: Optic neuropathy and congenital glaucoma associated with probable Zika virus infection in Venezuelan patients. JMM Case Rep 2018; 5:e005161. [PMID: 30323937 PMCID: PMC6152399 DOI: 10.1099/jmmcr.0.005161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/09/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- C Gustavo De Moraes
- Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA
| | | | | | - Anavaj Sakuntabhai
- Pasteur Institute, Functional Genetics of Infectious Diseases Unit, Paris, France.,CNRS, URA 3012, Paris, France
| | - Etienne Simon-Loriere
- Pasteur Institute, Functional Genetics of Infectious Diseases Unit, Paris, France.,CNRS, URA 3012, Paris, France
| | - Mussaret B Zaidi
- Infectious Diseases Research Laboratory, Hospital General O'Horan, Merida, Mexico.,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Matthieu Prot
- Pasteur Institute, Functional Genetics of Infectious Diseases Unit, Paris, France.,CNRS, URA 3012, Paris, France
| | - Claude Ruffie
- Pasteur Institute, Viral Genomics and Vaccination Unit, Paris, France.,CNRS, URA3015, Paris, France
| | - Susan S Kim
- In-patient Diabetes Unit, St. Peter's Hospital, Albany, NY, USA
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA
| | - Joseph D Terwilliger
- Departments of Psychiatry and Genetics and Development, Columbia University Medical Center, New York, NY, USA.,Sergievsky Center, Columbia University Medical Center, New York, NY, USA.,Division of Medical Genetics, New York State Psychiatric Institute, New York, NY, USA.,Public Health Genomics Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Joseph H Lee
- Sergievsky Center, Columbia University Medical Center, New York, NY, USA.,Taub Institute and Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Gladys E Maestre
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Venezuela.,Department of Biomedical Sciences, Division of Neurosciences, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA.,Department of Human Genetics, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA
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24
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Zaidi MB, De Moraes CG, Petitto M, Yepez JB, Sakuntabhai A, Simon-Loriere E, Prot M, Ruffie C, Kim SS, Allikmets R, Terwilliger JD, Lee JH, Maestre GE. Non-congenital severe ocular complications of Zika virus infection. JMM Case Rep 2018; 5:e005152. [PMID: 30128159 PMCID: PMC6096927 DOI: 10.1099/jmmcr.0.005152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 04/23/2018] [Indexed: 01/03/2023] Open
Affiliation(s)
- Mussaret B. Zaidi
- Infectious Diseases Research Laboratory, Hospital General O'Horan, Merida, Mexico
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - C. Gustavo De Moraes
- Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA
| | | | - Juan B. Yepez
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Anavaj Sakuntabhai
- Functional Genetics of Infectious Diseases Unit, Institut Pasteur, Paris, France, CNRS, UMR2000, Paris, France
- Viral Genomics and Vaccination Unit, Institut Pasteur, Paris, France, CNRS, UMR 3965, Paris, France
| | - Etienne Simon-Loriere
- Functional Genetics of Infectious Diseases Unit, Institut Pasteur, Paris, France, CNRS, UMR2000, Paris, France
- Viral Genomics and Vaccination Unit, Institut Pasteur, Paris, France, CNRS, UMR 3965, Paris, France
| | - Matthieu Prot
- Functional Genetics of Infectious Diseases Unit, Institut Pasteur, Paris, France, CNRS, UMR2000, Paris, France
- Viral Genomics and Vaccination Unit, Institut Pasteur, Paris, France, CNRS, UMR 3965, Paris, France
| | - Claude Ruffie
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Viral Genomics and Vaccination Unit, Institut Pasteur, Paris, France, CNRS, UMR 3965, Paris, France
| | - Susan S. Kim
- In-patient Diabetes Unit, St Peter’s Hospital, Albany, NY, USA
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA
| | - Joseph D. Terwilliger
- Departments of Psychiatry and Genetics and Development, Columbia University Medical Center, New York, NY, USA
- Sergievsky Center, Columbia University Medical Center, New York, NY, USA
- Division of Medical Genetics, New York State Psychiatric Institute, New York, NY, USA
- Public Health Genomics Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Joseph H. Lee
- Sergievsky Center, Columbia University Medical Center, New York, NY, USA
- Taub Institute and Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Gladys E. Maestre
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Venezuela
- Department of Biomedical Sciences, Division of Neurosciences, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA
- Department of Human Genetics, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA
- *Correspondence: Gladys E. Maestre, or
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25
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De Moraes CG, Pettito M, Yepez JB, Sakuntabhai A, Simon-Loriere E, Zaidi MB, Prot M, Ruffie C, Kim SS, Allikmets R, Terwilliger JD, Lee JH, Maestre GE. Optic neuropathy and congenital glaucoma associated with probable Zika virus infection in Venezuelan patients. JMM Case Rep 2018; 5:e005145. [PMID: 29896405 PMCID: PMC5994708 DOI: 10.1099/jmmcr.0.005145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/06/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction Although the current Zika virus (ZIKV) epidemic is a major public health concern, most reports have focused on congenital ZIKV syndrome, its most devastating manifestation. Severe ocular complications associated with ZIKV infections and possible pathogenetic factors are rarely described. Here, we describe three Venezuelan patients who developed severe ocular manifestations following ZIKV infections. We also analyse their serological response to ZIKV and dengue virus (DENV). Case presentation One adult with bilateral optic neuritis, a child of 4 years of age with retrobulbar neuritis [corrected]. and a newborn with bilateral congenital glaucoma had a recent history of an acute exanthematous infection consistent with ZIKV infection. The results of ELISA tests indicated that all patients were seropositive for ZIKV and four DENV serotypes. Conclusion Patients with ZIKV infection can develop severe ocular complications. Anti-DENV antibodies from previous infections could play a role in the pathogenesis of these complications. Well-designed epidemiological studies are urgently needed to measure the risk of ZIKV ocular complications and confirm whether they are associated with the presence of anti-flaviviral antibodies.
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Affiliation(s)
- C Gustavo De Moraes
- Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA
| | | | | | - Anavaj Sakuntabhai
- Pasteur Institute, Functional Genetics of Infectious Diseases Unit, Paris, France.,CNRS, URA 3012, Paris, France
| | - Etienne Simon-Loriere
- Pasteur Institute, Functional Genetics of Infectious Diseases Unit, Paris, France.,CNRS, URA 3012, Paris, France
| | - Mussaret B Zaidi
- Infectious Diseases Research Laboratory, Hospital General O'Horan, Merida, Mexico.,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Matthieu Prot
- Pasteur Institute, Functional Genetics of Infectious Diseases Unit, Paris, France.,CNRS, URA 3012, Paris, France
| | - Claude Ruffie
- Pasteur Institute, Viral Genomics and Vaccination Unit, Paris, France.,CNRS, URA3015, Paris, France
| | - Susan S Kim
- In-patient Diabetes Unit, St. Peter's Hospital, Albany, NY, USA
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA
| | - Joseph D Terwilliger
- Departments of Psychiatry and Genetics and Development, Columbia University Medical Center, New York, NY, USA.,Sergievsky Center, Columbia University Medical Center, New York, NY, USA.,Division of Medical Genetics, New York State Psychiatric Institute, New York, NY, USA.,Public Health Genomics Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Joseph H Lee
- Sergievsky Center, Columbia University Medical Center, New York, NY, USA.,Taub Institute and Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Gladys E Maestre
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Venezuela.,Department of Biomedical Sciences, Division of Neurosciences, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA.,Department of Human Genetics, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA
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26
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De Moraes CG, Hood DC, Thenappan A, Girkin CA, Medeiros FA, Weinreb RN, Zangwill LM, Liebmann JM. 24-2 Visual Fields Miss Central Defects Shown on 10-2 Tests in Glaucoma Suspects, Ocular Hypertensives, and Early Glaucoma. Ophthalmology 2017; 124:1449-1456. [PMID: 28551166 PMCID: PMC5610609 DOI: 10.1016/j.ophtha.2017.04.021] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/13/2017] [Accepted: 04/17/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To investigate the prevalence of visual field defects in glaucomatous eyes, glaucoma suspects, and ocular hypertensives with 24-2 and 10-2 visual fields. DESIGN Prospective, cross-sectional study. PARTICIPANTS Patients with or suspected glaucoma tested with 24-2 and 10-2. Patients were classified into 3 groups on the basis of the presence of glaucomatous optic neuropathy (GON) and 24-2 visual field abnormalities: early glaucoma (GON and abnormal visual field, mean deviation >-6 decibels [dB]), glaucoma suspects (GON and normal visual field), and ocular hypertensives (normal disc, normal visual field, and intraocular pressure >22 mmHg). For the classification of visual field abnormalities, 24-2 and 10-2 tests performed on the same visit were analyzed. MAIN OUTCOME MEASURES Comparison of the prevalence of abnormal 24-2 versus 10-2 visual field results based on cluster criteria in each diagnostic group. RESULTS A total of 775 eyes (497 patients) were evaluated. A total of 364 eyes had early glaucoma, 303 eyes were glaucoma suspects, and 108 eyes were ocular hypertensives. In the glaucoma group, 16 of the 26 eyes (61.5%) classified as normal based on cluster criteria on 24-2 tests were classified as abnormal on 10-2 visual fields. In eyes with suspected glaucoma, 79 of the 200 eyes (39.5%) classified as normal on the 24-2 test were classified as abnormal on 10-2 visual fields. In ocular hypertensive eyes, 28 of the 79 eyes (35.4%) classified as normal on the 24-2 were classified as abnormal on the 10-2. Patients of African descent were more likely to have an abnormal 10-2 result (67.3 vs. 56.8%, P = 0.009). CONCLUSIONS Central visual field damage seen on the 10-2 test is often missed with the 24-2 strategy in all groups. This finding has implications for the diagnosis of glaucoma and classification of severity.
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Affiliation(s)
- C Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York.
| | - Donald C Hood
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York; Columbia University, New York, New York
| | | | | | - Felipe A Medeiros
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California-San Diego, San Diego, California
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California-San Diego, San Diego, California
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California-San Diego, San Diego, California
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
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27
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Prager AJ, Hood DC, Liebmann JM, De Moraes CG, Al-Aswad LA, Yu Q, Cioffi GA, Blumberg DM. Association of Glaucoma-Related, Optical Coherence Tomography-Measured Macular Damage With Vision-Related Quality of Life. JAMA Ophthalmol 2017; 135:783-788. [PMID: 28594977 DOI: 10.1001/jamaophthalmol.2017.1659] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Little is known about the association between structural macular damage and self-reported visual function of people with glaucoma. Objective To determine the association between vision-related quality of life among patients with primary open-angle glaucoma with structural macular retinal ganglion cell plus inner plexiform layer (RGC+IPL) loss identified by spectral-domain optical coherence tomography (SD-OCT) machine-generated deviation maps and thickness measurements. Design, Setting, and Participants This cross-sectional prospective study was conducted from March 1, 2014, to March 30, 2015, at the Department of Ophthalmology at Columbia University Medical Center. The participants were 107 patients who were enrolled in the study and represented the entire range of glaucomatous damage. All 214 eyes of the 107 participants underwent 10-2 visual field tests and SD-OCT scans, and all participants completed the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). They also received ophthalmologic examination, including medical history review, best-corrected visual acuity, slitlamp biomicroscopy, intraocular pressure measurement, gonioscopy, dilated ophthalmoscopy, and standard automated perimetry. Macular RGC+IPL loss was determined by diffuse or focal patterns on SD-OCT-generated deviation maps (probability map that compared patients with aged-matched normative database) and thickness measurements. Main Outcomes and Measures Regression analyses to assess the association of NEI VFQ-25 scores (score range: 41.9-99.5; higher scores indicate better functioning) with patterns of RGC+IPL loss and with RGC+IPL thickness measurements. Results Of the 107 patients, 48 (45%) were men and the mean (SD) age was 65 (11) years. The self-reported race/ethnicity of participants consisted of 45 (46%) black, 47 (48%) white, and 6 (6%) "other" individuals. In the univariable analyses, patients with diffuse macular RGC+IPL loss had mean composite Rasch-calibrated NEI VFQ-25 scores that were 6.15 points lower than the scores of patients with focal damage (β = -6.15; 95% CI, -11.7 to -0.59; P = .03). The effect remained significant even after controlling for mean RGC+IPL thickness (β = -7.64; 95% CI, -14.2 to -1.03; P = .02). Conclusions and Relevance Characteristic patterns of glaucoma-related macular RGC+IPL loss appeared to be more important predictors of vision-related quality of life than thickness measures, with diffuse RGC+IPL loss as an indicator for diminished vision-related quality of life.
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Affiliation(s)
- Alisa J Prager
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Donald C Hood
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York2Department of Psychology, Columbia University, New York, New York
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - C Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Lama A Al-Aswad
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Qi Yu
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - George A Cioffi
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Dana M Blumberg
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
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De Moraes CG, Murphy JT, Kaplan CM, Reimann JJ, Skaat A, Blumberg DM, Al-Aswad L, Cioffi GA, Girkin CA, Medeiros FA, Weinreb RN, Zangwill L, Liebmann JM. β-Zone Parapapillary Atrophy and Rates of Glaucomatous Visual Field Progression: African Descent and Glaucoma Evaluation Study. JAMA Ophthalmol 2017; 135:617-623. [PMID: 28494060 DOI: 10.1001/jamaophthalmol.2017.1082] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance β-zone parapapillary atrophy (βPPA) has been reported as a risk factor for glaucoma onset and progression. Previous studies have shown that the prevalence of βPPA differs between individuals of African descent (AD) and European descent (ED). Objective To test whether the association between the presence and progression of βPPA vs visual field progression of glaucoma differs between these 2 ancestry groups. Design, Setting, and Participants In a prospective, multicenter, longitudinal cohort study, 634 individuals (1090 eyes) enrolled in the African Descent and Evaluation Study (ADAGES) with a diagnosis of glaucomatous optic neuropathy (GON) or ocular hypertension (OHT) and at least 2 disc stereophotographs were included. Two graders masked to clinical and ancestry data reviewed and graded the baseline and last disc stereophotographs for the presence of βPPA at baseline and βPPA progression (development or enlargement). Mixed-effects linear models were tested with visual field mean deviation as a dependent variable and time (alone and with interaction terms) as independent variables. ADAGES enrollment began in January 2003 and ended in July 2006; follow-up ended in 2016. Exposures Disc stereophotographs. Main Outcomes and Measures Progression of βPPA in AD and ED individuals. Results In 634 patients, a total of 814 eyes of AD (395 eyes) and ED (419) patients with GON and 276 eyes of AD (106) and ED (170) patients with OHT who were enrolled in ADAGES were analyzed. There were 336 (53.0%) women in the study; mean (SD) age was 61.9 (12.7) years. In the OHT group, the association between βPPA at baseline and visual field progression was not significantly different between AD and ED eyes (β = 0.071; 95% CI, -0.016 to 0.158; P = .11), nor was the association between βPPA progression and visual field progression (β = 0.020; 95% CI, -0.465 to 0.506; P = .93). In the GON group, ED eyes with baseline βPPA progressed faster than did AD eyes with baseline βPPA (β = -0.124; 95% CI, -0.241 to -0.007; P = .04), although the association between βPPA progression and visual field progression did not differ significantly between race groups (β = -0.101; 95% CI, -0.323 to 0.119; P = .37). Conclusions and Relevance Race had a significant effect on the association between baseline βPPA and rates of visual field progression in eyes with GON. Progression of βPPA was not associated with faster visual field progression in either racial group.
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Affiliation(s)
- C Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - James T Murphy
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - Chad M Kaplan
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - Jeremy J Reimann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - Alon Skaat
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana M Blumberg
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - Lama Al-Aswad
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - George A Cioffi
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - Christopher A Girkin
- Department of Ophthalmology, School of Medicine, University of Alabama, Birmingham
| | - Felipe A Medeiros
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego
| | - Linda Zangwill
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
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Blumberg DM, Prager AJ, Liebmann JM, Cioffi GA, De Moraes CG. Cost-Related Medication Nonadherence and Cost-Saving Behaviors Among Patients With Glaucoma Before and After the Implementation of Medicare Part D. JAMA Ophthalmol 2015; 133:985-96. [PMID: 26042393 DOI: 10.1001/jamaophthalmol.2015.1671] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Understanding factors that lead to nonadherence to glaucoma treatment is important to diminish glaucoma-related disability. OBJECTIVES To determine whether the implementation of the Medicare Part D prescription drug benefit affected rates of cost-related nonadherence and cost-reduction strategies in Medicare beneficiaries with and without glaucoma and to evaluate associated risk factors for such nonadherence. DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional study using 2004 to 2009 Medicare Current Beneficiary Survey data linked with Medicare claims. Coding to extract data started in January 2014 and analyses were performed between September and November of 2014. Participants were all Medicare beneficiaries, including those with a glaucoma-related diagnosis in the year prior to the collection of the survey data, those with a nonglaucomatous ophthalmic diagnosis in the year prior to the collection of the survey data, and those without a recent eye care professional claim. INTERVENTION Effect of the implementation of the Medicare Part D drug benefit. MAIN OUTCOMES AND MEASURES The change in cost-related nonadherence and the change in cost-reduction strategies. RESULTS Between 2004 and 2009, the number of Medicare beneficiaries with glaucoma who reported taking smaller doses and skipping doses owing to cost dropped from 9.4% and 8.2% to 2.7% (P < .001) and 2.8%, respectively (P = .001). However, reports of failure to obtain prescriptions owing to cost did not improve in the same period (3.4% in 2004 and 2.1% in 2009; P = .12). After Part D, patients with glaucoma had a decrease in several cost-reduction strategies, namely price shopping (26.2%-15.2%; P < .001), purchasing outside the United States (6.9%-1.3%; P < .001), and spending less money to save for medications (8.0% to 3.5%; P < .001). Using a multivariate analysis, the main independent risk factors common to all cost-related nonadherence measures were female sex, younger age, lower income (<$30 000), self-reported visual disability, and a smaller Lawton index. CONCLUSIONS AND RELEVANCE After the implementation of Part D, there was a decrease in the rate that beneficiaries with glaucoma reported engaging in cost-saving measures. Although there was a decline in the rate of several cost-related nonadherence behaviors, patients reporting failure to fill prescriptions owing to cost remained stable. This suggests that efforts to improve cost-related nonadherence should focus both on financial hardship and medical therapy prioritization, particularly in certain high-risk sociodemographic groups.
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Affiliation(s)
- Dana M Blumberg
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Alisa J Prager
- Columbia University Medical Center, College of Physicians and Surgeons, New York, New York
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - George A Cioffi
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - C Gustavo De Moraes
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
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Kaplan RI, De Moraes CG, Cioffi GA, Al-Aswad LA, Blumberg DM. Comparative Cost-effectiveness of the Baerveldt Implant, Trabeculectomy With Mitomycin, and Medical Treatment. JAMA Ophthalmol 2015; 133:560-7. [PMID: 25741886 DOI: 10.1001/jamaophthalmol.2015.44] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The Tube vs Trabeculectomy Trial (TVT) found that the 350-mm2 Baerveldt implant (tube) and trabeculectomy with mitomycin may be similarly effective in lowering intraocular pressure in primary open-angle glaucoma. However, to date, there are no published long-term clinical data on the cost-effectiveness of trabeculectomy with mitomycin vs tube insertion. OBJECTIVE To assess the cost-effectiveness of these procedures compared with maximal medical treatment. DESIGN, SETTING, AND PARTICIPANTS We used the Markov cohort model with a 5-year time horizon to study a hypothetical cohort of 100 000 patients who required glaucoma surgery. MAIN OUTCOMES AND MEASURES Quality-adjusted life-years (QALYs) gained, costs from the societal perspective, and the incremental cost-effectiveness ratio of medical treatment, trabeculectomy, and tube insertion. Costs were identified from Medicare Current Procedural Terminology and Ambulatory Payment Classification reimbursement codes and Red Book medication costs. The QALYs were based on visual field and visual acuity outcomes. The hypothetical societal limit to resources was included using a willingness-to-pay threshold of $50 000 per QALY. Costs and utilities were discounted at 3% per year. Uncertainty was assessed using deterministic sensitivity analyses. RESULTS The mean costs for medical treatment, trabeculectomy, and tube insertion were $6172, $7872 and $10 075, respectively; these amounts resulted in a cost difference of $1700 (95% CI, $1644-$1770) for medical treatment vs trabeculectomy, $3904 (95% CI, $3858-$3953) for medical treatment vs tube insertion, and $2203 (95% CI, $2121-$2261) for trabeculectomy vs tube insertion. The mean 5-year probability of blindness was 4% for both surgical procedures and 15% for medical treatment. The utility gained after medical treatment, trabeculectomy, and tube insertion was 3.10, 3.30, and 3.38 QALYs, respectively. The incremental cost-effectiveness ratio was $8289 per QALY for trabeculectomy vs medical treatment, $13 896 per QALY for tube insertion vs medical treatment, and $29 055 per QALY for tube insertion vs trabeculectomy. The cost-effectiveness of each surgical procedure was most sensitive to early and late surgical failure rates and was minimally affected by adverse events, rates of visual field progression, or medication costs. CONCLUSIONS AND RELEVANCE Assuming a willingness to pay of $50 000 per QALY, trabeculectomy and tube insertion are cost-effective compared with medical treatment alone. Trabeculectomy, however, is cost-effective at a substantially lower cost per QALY compared with tube insertion. More research is necessary to reliably account for patient preferences between the 2 operations.
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Affiliation(s)
- Richard I Kaplan
- Department of Ophthalmology, Edward Harkness Eye Institute, Columbia University, New York, New York
| | - C Gustavo De Moraes
- Department of Ophthalmology, Edward Harkness Eye Institute, Columbia University, New York, New York
| | - George A Cioffi
- Department of Ophthalmology, Edward Harkness Eye Institute, Columbia University, New York, New York
| | - Lama A Al-Aswad
- Department of Ophthalmology, Edward Harkness Eye Institute, Columbia University, New York, New York
| | - Dana M Blumberg
- Department of Ophthalmology, Edward Harkness Eye Institute, Columbia University, New York, New York
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Charlson ME, De Moraes CG, Liebmann JM, Wells MT, Link A, Harmon G, Peterson JC, Ritch R. Author reply: To PMID 24869467. Ophthalmology 2015; 122:e26-7. [PMID: 25797093 DOI: 10.1016/j.ophtha.2014.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 08/27/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
| | | | - Jeffrey M Liebmann
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary at Mount Sinai School of Medicine, New York; Department of Ophthalmology, New York University Medical Center, New York
| | - Martin T Wells
- Department of Statistical Science, Cornell University, Ithaca, New York
| | | | - Gregory Harmon
- Department of Ophthalmology, Weill Cornell Medical College, New York
| | | | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary at Mount Sinai School of Medicine, New York
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Babic M, De Moraes CG, Hatanaka M, Ju G, Susanna R. Reproducibility of the water drinking test in treated glaucomatous patients. Clin Exp Ophthalmol 2014; 43:228-33. [PMID: 25214176 DOI: 10.1111/ceo.12434] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 09/06/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND To evaluate the reproducibility of intraocular pressure peaks and fluctuation elicited during the water drinking test in treated glaucomatous patients with a long follow-up interval. DESIGN Retrospective cohort study in a tertiary care practice. PARTICIPANTS Thirty-four treated primary open-angle glaucoma patients. METHODS All patients underwent the water drinking test performed in two consecutive visits without any change in the therapeutic regimen. The mean interval between tests was 4.85 (range: 3-6) months. Reproducibility of peak and fluctuation during the water drinking test was assessed using intraclass correlation coefficients. Bland-Altman analysis was used to assess the agreement of intraocular pressure peaks and fluctuation measured between two consecutive tests. MAIN OUTCOME MEASURES Intraclass correlation and agreement of intraocular pressure peaks and fluctuation between visits. RESULTS There were no significant differences in baseline intraocular pressure values (mean ± standard deviation, 11.73 ± 2.36 and 11.61 ± 2.71 mmHg; P = 0.72) and peaks (14.55 ± 3.41 and 15.02 ± 3.66 mmHg, respectively; P = 0.163) detected during the water drinking test between the first and second visits. There was also no significant difference between the average intraocular pressure fluctuation values (2.82 ± 1.99 and 3.41 ± 2.54 mmHg, respectively; P = 0.135). Intraocular pressure peaks and fluctuation presented intraclass correlation coefficients of 0.85 (P < 0.001) and 0.50 (P < 0.001), respectively. CONCLUSIONS Our results demonstrate excellent reproducibility of intraocular pressure peaks during the water drinking test. Intraocular pressure fluctuation did not reveal good reproducibility, though. These results emphasize the applicability of this test to assess treatment efficacy in daily practice and interventional studies.
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Affiliation(s)
- Mirko Babic
- Ophthalmology Clinic, University of São Paulo, São Paulo, Brazil
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