Alvine Kamdeu Fansi

Racial variability of glaucoma risk factors between African Caribbeans and Caucasians in a Canadian urban screening population.

BACKGROUND The significance of race in the development and progression of glaucoma remains controversial, although in most cases the evidence shows greater prevalence and progression of the disease in African American populations. The purpose of this study was to determine the impact of the African Caribbean race on the variability of risk factors for glaucoma in an urban Canadian screening population. STUDY DESIGN Population-based, cross-sectional study. PARTICIPANTS Participants with high risk for development of open-angle glaucoma. METHODS Participants underwent confocal scanning laser ophthalmoscopy (Heidelberg Retina Tomograph),frequency-doubling technology (FDT) perimetry, and complete ophthalmic examination during a high-risk glaucoma screening clinic. Statistical analysis was performed comparing the data gathered from these tests in the different racial groups. Students t tests as well as Pearsons c2 tests were done. RESULTS Racial breakdown included 64 African Caribbeans (22%) and 224 Caucasians (78%). Racial groups had similar female/male ratios, but Caucasians were significantly older (66 [SD 12] years) than African Caribbeans (56 [SD12] years) ( p = 0.001). African Caribbeans had significantly higher intraocular pressure (IOP) ( p < 0.001); thinner central corneal thickness (CCT) ( p < 0.001); greater cup/disc ratio ( p = 0.016), disc area ( p < 0.001), cup area ( p = 0.002), and cup/disc area ratio ( p = 0.009); and smaller rim/disc area ratio ( p = 0.009). The latter optic disc parameter differences were not statistically different when corrected for disc area differences. CONCLUSIONS In this study, African Caribbeans in a Canadian urban setting were associated with increased risk factors for open-angle glaucoma development, including higher IOP and thinner CCT. The larger cup/disc and cup/disc area ratios of the African Caribbean group were directly correlated to disc area differences between the 2 groups.

Savings from the use of a probiotic formula in the prophylaxis of antibiotic-associated diarrhea

Abstract Objective: Antibiotic-associated diarrhea (AAD) and particularly Clostridium difficile-associated diarrhea (CDAD) are the most common causes of healthcare associated infectious diarrhea. A double-blind, dose response, placebo-controlled trial of the probiotic formula (Bio-K+ Lactobacillus acidophilus CL1285 and Lactobacillus casei LBC80R formula) for prophylaxis of AAD and CDAD was published in 2010. The Bio-K+ Lactobacillus acidophilus CL1285 and Lactobacillus casei LBC80R formula is a registered trademark of Bio-K Plus International Inc. (Laval, Québec, Canada). Results indicated that the incidence of AAD and CDAD were lower for patients assigned to the probiotic formula compared with the placebo option. The present study aims to estimate the savings in direct medical costs that might result from the use of two different doses of the probiotic formula vs placebo. Methods: A cost-consequence analysis was conducted to compare the two doses of the probiotic formula compared to placebo. The analysis was based upon published data and adjusted to the North American context. Results: Economic analyses showed that the use of the probiotic formula would result in estimated mean per patients savings of US

Estimation of ocular rigidity in glaucoma using ocular pulse amplitude and pulsatile choroidal blood flow.

1968 for the single dose and US

Screening for glaucoma with Moorfields regression analysis and glaucoma probability score in confocal scanning laser ophthalmoscopy.

2661 for the double dose compared with the placebo option if used an average of 13 days by all patients at risk of developing AAD and CDAD. Limitations: Several key parameters considered within the economic model were not captured within the Gao et al. study. Numerous sensitivity analyses were conducted to address this issue. Conclusion: The use of the probiotic formula in prophylaxis of AAD and CDAD would lead to estimated savings in direct medical costs that would substantially offset its acquisition cost. Treating 1000 hospitalized patients on antibiotics with the double dose of the product compared to current practice would save a single payer system the sum of

Combining rim area to disc area asymmetry ratio and Moorfields regression analysis of confocal scanning laser ophthalmoscopy for glaucoma screening.

2,661,218.

Validity of Screening for Glaucomatous Optic Nerve Damage Using Confocal Scanning Laser Ophthalmoscopy (Heidelberg Retina Tomograph II) in High-Risk Populations: A Pilot Study

PURPOSE Theoretical models and animal studies have suggested that scleral rigidity plays an important role in the pathogenesis of glaucoma. The aim of this study was to present a noninvasive technique for estimating ocular rigidity (E) in vivo, and to compare the estimated rigidity between patients with open-angle glaucoma (OAG); ocular hypertension (OHT); suspect glaucomatous disc (GS); and normal subjects (N). We hypothesized that OHT patients would have higher rigidity. METHODS All patients underwent measurements of ocular pulse amplitude (OPA) using dynamic contour tonometry, pulsatile choroidal blood flow (ChBFP) using laser Doppler flowmetry; axial length (AL); and assessment of automated visual field mean deviation (MD). The ratio between OPA and ChBFP was calculated according to the Friedenwalds equation of ocular rigidity. The calculated ratio is denoted as (ER). The average ER values of the four diagnostic groups were compared using nonparametric tests. The relationship between ER and other ocular and systemic factors was examined using correlation and regression analysis. RESULTS A total of 257 subjects were included in the study (56 N, 108 OAG, 48 GS, and 45 OHT). ER correlated negatively with AL and positively with MD, signifying that a lower rigidity was associated with a longer eye and a worse (more negative) MD. ER was also found to be highest in OHT (0.235 ± 0.16) and lowest in OAG (0.188 ± 0.14; P = 0.01). CONCLUSIONS Estimated coefficient of ocular rigidity by OPA and ChBFP suggested that glaucoma patients had the lowest rigidity and OHT the highest. It supports the idea that a more compliant ocular shell may predispose the optic nerve head to intraocular pressure (IOP)-related damage.

Screening for primary open-angle glaucoma in the developed world: are we there yet?

OBJECTIVE To compare the validity of Moorfields regression analysis (MRA) and glaucoma probability score (GPS) of the confocal scanning laser ophthalmoscopy (Heidelberg retina tomograph 3; HRT3) in detecting glaucomatous optic nerve damage in a screening population. DESIGN Population-based, cross-sectional study. PARTICIPANTS Subjects at high risk for development of open-angle glaucoma (OAG). METHODS All subjects underwent confocal scanning ophthalmoscopy (Heidelberg retina tomograph; HRTII) testing, visual fields testing with frequency-doubling technology perimetry (FDT), and a standard ophthalmologic examination. All HRTII images were reprocessed with HRT3. Based on an ophthalmologic examination and FDT results, eyes were classified into 4 categories: normal, possible glaucoma, probable glaucoma, and definitive glaucoma. Main outcome measures included sensitivity and specificity of HRTII/MRA, HRT3/MRA, HRT3/GPS, and combination HRT3/MRA/GPS. RESULTS The left eyes of 221 of 291 subjects were included; 4 (1.8%) eyes were classified as definitively having glaucoma. Depending on the reference standard diagnosis as well as on the borderline test-positive definition of the HRTII-3, sensitivity and specificity varied between 36.4% and 100%. For HRTII/MRA, 88.2% to 96.5%, 54.5% to 100%, and 74.5% to 93.6%; for HRT3/MRA, 61.9% to 100% and 64.3% to 85.2%; for HRT3/GPS, 85.7% to 100%; and for combination HRT3/MRA/GPS, 73.4% to 78.2%. CONCLUSIONS In this pilot study, the MRA of the HRT3 appears to be more sensitive but less specific than the MRA in the HRTII version. The GPS, although somewhat less specific than MRA (and some discs are nonclassifiable by this technique), had greater sensitivity and as a screening method may have the additional advantage of being contour-line independent.

Screening for glaucoma in high-risk populations using optical coherence tomography.

OBJECTIVE To determine the utility of combining rim area to disc area asymmetry ratio (RADAAR) and Moorfields regression analysis (MRA) to detect primary open-angle glaucoma (POAG) using confocal scanning laser ophthalmoscopy (CSLO) (Heidelberg retina tomograph 3 (HRT3)) in high-risk populations. DESIGN Cross-sectional study. PARTICIPANTS Subjects with high risk for developing POAG. METHODS Subjects underwent HRT, frequency doubling technology perimetry (FDT), and complete ophthalmic examination. Based on an ophthalmologic examination and FDT results of the worse eye, subjects were classified into 4 categories: normal, possible glaucoma, probable glaucoma, and definite glaucoma. Main outcome measures included sensitivities (Se), specificities (Sp), positive and negative predictive values (PPV, NPV), and positive and negative likelihood ratios (PLR, NLR) of the MRA, RADAAR, and combined MRA- RADAAR tests. RESULTS Of 375 subjects, 11 were classified as having definite glaucoma. Depending on the reference standard, range results for Se, Sp, PPV, NPV, PLR, and NLR were, respectively, 57.7% to 100%; 55.1% to 85.4%; 6.3% to 39%; 92.6% to 100%; 1.97 to 4.9; 0 to 0.49 for MRA; 11.5% to 27.3%; 98.1% to 98.8%; 30% to 60%; 87.4% to 97.8%; 9.29 to 14.1; and 0.74 to 0.89 for RADAAR; and 57.7% to 90.9%; 81.3% to 85.1%; 12.8% to 38.5%; 92.6% to 99.7%; 3.87 to 4.85; 0.11 to 0.50 for combination MRA-RADAAR. DISCUSSION When using HRT in populations at high risk for glaucoma, RADAAR had a higher specificity than MRA in identifying glaucoma. When patients were classified as borderline on MRA, combining RADAAR values decreased the number of false-positives as well, and may be recommended when high specificity is required.