Dana M. Blumberg

A Single Wide-Field OCT Protocol Can Provide Compelling Information for the Diagnosis of Early Glaucoma.

Purpose To evaluate a report for glaucoma diagnosis based on a single optical coherence tomography (OCT) protocol. Methods A wide-field (9 × 12 mm) swept-source (SS) OCT scan, encompassing the macula and disc, was obtained on 130 eyes (patients) with or suspected open-angle glaucoma, a mean deviation greater than or equal to −6 dB on a 24-2 visual field (VF), and spherical refractive error between ± 6 diopters (D). The single-page report contained a circumpapillary retinal nerve fiber layer (cpRNFL) thickness plot; retinal ganglion cell layer and retinal nerve fiber layer (RNFL) thickness and probability plots of the macula and optic nerve; and an enface slab image of the optic nerve. A report specialist judged each eye as healthy (H); probably healthy (PH); forced-choice healthy (FC-H); optic neuropathy (ON); probably ON (PON); forced-choice optic neuropathy (FC-ON). Two glaucoma specialists made similar judgments about the presence of glaucomatous damage. The glaucoma specialists had 24-2 and 10-2 VFs, fundus photos, patient chart information, and the single-page report including the report specialists interpretation. Results The reference standard consisted of 57 eyes judged as glaucomatous (ON or PON) and 45 eyes judged as healthy (H or PH) by both glaucoma specialists. The report specialist identified 56 of the glaucomatous eyes as optic neuropathy (i.e., ON, PON, or FC-ON), and 44 of the healthy eyes as healthy (i.e., H, PH, or FC-H), an accuracy of 98.0%. Conclusions A single-page report based upon a single, wide-field OCT scan has the information needed to diagnose early glaucoma with excellent sensitivity/specificity. Translational Relevance It is possible that screening for glaucoma can be effective with only a single OCT protocol.

Association Between Undetected 10-2 Visual Field Damage and Vision-Related Quality of Life in Patients With Glaucoma

Importance Recent evidence supports the presence of macular damage (within 8° of the central field) to retinal ganglion cells and associated central visual field (VF) defects in glaucoma, even in early stages. Despite this, to our knowledge, the association of 10-2 VF damage with vision-related quality of life (QOL) has not been well studied. Objective To determine the association between QOL and visual function as measured by 24-2 and 10-2 VFs in patients with primary open-angle glaucoma and to test the hypothesis that patients with vision-related QOL disproportionate to their 24-2 VF status may exhibit 10-2 damage overlooked by the 24-2 test. Design, Setting, and Participants In this cross-sectional analysis of observational cohort study data taken from a tertiary care specialty practice, 113 patients with glaucoma with the entire range of 24-2 VF damage completed the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Data were collected from May 2014 to January 2015 and were analyzed from March 2016 to May 2016. Interventions Standardized binocular 24-2 and 10-2 VF sensitivities were calculated for each patient. Main Outcomes and Measures Association of binocular 24-2 and 10-2 VF sensitivity with Rasch-calibrated NEI VFQ-25 scores. Detection of outliers was based on Cook distance of the regression of binocular 24-2 and NEI VFQ-25 score. Outlier association with QOL was then assessed using a linear regression model, with binocular 10-2 VF sensitivity as the independent variable. Results Of the 113 patients, the mean (SD) age was 70.1 (10.9) years, and 51 (45.1%) were male and 71 (62.8%) were white. The composite NEI VFQ-25 score was associated with both binocular 24-2 (&bgr; = 1.95; 95% CI, 0.47-3.43; P = .01) and 10-2 (&bgr; = 2.57; 95% CI, 1.12-4.01; P = .001) sensitivities, but the 10-2 VF univariable model showed an almost 2-fold better fit to the data (R2 = 9.2% vs 4.9%). However, the binocular 10-2 sensitivities of 24-2 outliers had the strongest association with the composite NEI VFQ-25 scores (&bgr; = 2.78; 95% CI, 0.84-4.72; P = .006.) and the best fit to the data (R2 = 18.2%.) Conclusions and Relevance The 10-2 VF model showed a stronger association with NEI VFQ-25 score than the 24-2 VF model. Patients with disproportionately low quality of vision relative to patients with 24-2 VF damage may have damage on the central field missed by the 24-2 grid. Future prospective testing, including additional dimensions of quality of life, is indicated.

Comparative Cost-effectiveness of the Baerveldt Implant, Trabeculectomy With Mitomycin, and Medical Treatment.

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

Cost-Related Medication Nonadherence and Cost-Saving Behaviors Among Patients With Glaucoma Before and After the Implementation of Medicare Part D

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

Emerging risk factors for glaucoma onset and progression

6172,

Association of Glaucoma-Related, Optical Coherence Tomography–Measured Macular Damage With Vision-Related Quality of Life

7872 and

Discrimination of Glaucoma Patients From Healthy Individuals Using Combined Parameters From Spectral-domain Optical Coherence Tomography in an African American Population.

10 075, respectively; these amounts resulted in a cost difference of

Self-reported Function, Health Resource Use, and Total Health Care Costs Among Medicare Beneficiaries With Glaucoma

1700 (95% CI,

Hybrid Deep Learning on Single Wide-field Optical Coherence Tomography Scans Accurately Classifies Glaucoma Suspects

1644-

Retinal nerve fiber layer analysis of cupping in children born prematurely.

1770) for medical treatment vs trabeculectomy,