Dara Lankaranian

Importance of Visual Acuity and Contrast Sensitivity in Patients With Glaucoma

OBJECTIVE To determine which aspects of vision most influence the ability of patients with glaucoma to function. METHODS A total of 192 patients with a full range of glaucomatous visual loss were selected from the Glaucoma Service of Wills Eye Institute. Patients were evaluated clinically with standard visual assessments: visual acuity, contrast sensitivity, visual field, stereopsis, the Disc Damage Likelihood Scale, and intraocular pressure. Patients were evaluated objectively using a comprehensive performance-based measure of visual function, the Assessment of Disability Related to Vision (ADREV), and subjectively with the 25-item National Eye Institute Visual Function Questionnaire. Statistical analyses, including Spearman correlation coefficients and regression analysis, were performed on the data. RESULTS Performance on the ADREV was most strongly associated with binocular visual acuity (r = -0.79; P < .001) and binocular contrast sensitivity (r = 0.80; P < .001). Monocular and binocular visual field test results correlated well with the ability to perform the ADREV tasks, but there was a significantly weaker association (P < .05) compared with visual acuity and contrast sensitivity. CONCLUSION The aspects of visual function that best predict the ability of a patient with glaucoma to perform activities of daily living are binocular visual acuity and contrast sensitivity.

Comparison of single thickness and double thickness processed pericardium patch graft in glaucoma drainage device surgery: a single surgeon comparison of outcome.

PurposeTo compare the incidence of conjuctival erosions with single thickness versus double thickness allograft processed pericardium used in mitomycin-C (MMC) augmented glaucoma drainage device (GDD) sugery. Patients and MethodsIn a retrospective comparative case series, medical records of 84 consecutive glaucoma patients who underwent GDD surgery between July 1996 to December 2004 were reviewed. All surgeries were done by one glaucoma surgeon (M.R.M.). MMC was adminstered in all cases over the plate area and either single thickness processed pericardium patch graft (STPP) or double thickness processed pericardium patch graft (DTPP) was used to cover the external silicone tube of the glaucoma device at the limbus. The principal outcome measure was the incidence of conjunctival erosions associated with GDD surgery. ResultsEighty-four patients (90 eyes) who met the eligibility criteria were enrolled in the study. Thirty-one consecutive eyes received a STPP, and 59 consecutive eyes received a DTPP. Five eyes (16.0%) in the STPP group developed conjunctival erosion. None of the eyes in DTPP group developed conjunctival erosion. The Mann-Whitney U test difference in the rate of conjunctival erosion was statistically significant between 2 groups (P=0.002). For the STPP group, the average time to conjunctival erosion was 9 months (range, 4 to 14 mo). All erosions were surgically corrected using DTPP and followed up for a mean of 8.6 months after repair with no additional conjunctival erosions. ConclusionsDTPP placed over the silicone tube significantly reduced the incidence of conjunctival erosion after MMC augmented GDD surgery.

Relationships in Glaucoma Patients Between Standard Vision Tests, Quality of Life, and Ability to Perform Daily Activities

Purpose: To determine the relationships among three methods of assessing visual loss caused by glaucoma: (1) standard clinical tests of vision, (2) self-reported quality of life, and (3) the ability to perform activities of daily living. Methods: One hundred and ninety two glaucoma patients with a full range of glaucomatous visual loss were selected from the Glaucoma Service of Wills Eye Institute. Subjects were evaluated clinically by visual acuity, contrast sensitivity, visual field, stereopsis, the Disc Damage Likelihood Scale, and intraocular pressure. Subjects were evaluated subjectively by the 25-item National Eye Institute’s Visual Functioning Questionnaire (NEI-VFQ-25) and objectively by a performance-based measure of visual function, the Assessment of Disability Related to Vision (ADREV). Statistical analysis, including Spearman coefficients, was performed on the data from the clinical measures, NEI-VFQ-25, and ADREV. Results: The clinical tests had higher correlations with ADREV than with the NEI-VFQ-25. There was a moderate, but not strong, connection between how patients rated their own visual ability with how they performed when objectively tested. Conclusions: ADREV provides valid estimates of how visual loss due to glaucoma affects the ability to perform activities of daily living. Performance-based testing and quality of life evaluations are both independently important measures of health, which are related, but by no means the same.

The effect of personality on measures of quality of life related to vision in Glaucoma patients

Aim: To determine the effect of personality on vision-specific health-related quality of life (HRQoL). Methods: Based on power calculations, 148 individuals diagnosed as having glaucoma or ocular hypertension, without ocular comorbidity, were selected using criteria that included age over 30, no recent or upcoming surgery, the absence of a diagnosis of clinical depression or any other psychiatric illness. Qualifying participants completed the 25-Item National Eye Institute’s Visual Function Questionnaire (VFQ), the Neuroticism, Extraversion and Openness Personality Inventory Revised (NEO PI-R) and the 15-Item Geriatric Depression Scale (GDS-15), and provided information regarding their demographic characteristics and past medical history. Each patient also underwent an ocular examination. Data analysis was conducted to determine the relationship between NEO PI-R personality profiles and VFQ scoring, while controlling for the effects of a range of demographic, psychiatric, past medical and clinical ophthalmic variables. Results: Multivariate analysis indicated that after controlling for a range of covariates, three out of five NEO PI-R personality domains shared statistically significant associations with a variety of VFQ total and subscale score measurements. Conclusion: Normal variations in personality characteristics influence how patients report their vision-specific HRQoL.

Intermediate-term results of the Ex-PRESS miniature glaucoma implant under a scleral flap in previously operated eyes

Background:  To report the safety and efficacy of Ex‐PRESSTM miniature glaucoma implant under a scleral flap in patients with previous ocular surgeries.

The amount of intraocular pressure rise during pharmacological pupillary dilatation is an indicator of the likelihood of future progression of glaucoma.

Aim: To determine if there is a relationship between the amount of increase in IOP following dilatation with a cycloplegic agent and the future course of glaucoma. Method: A retrospective chart review of 100 eyes from 55 subjects with open-angle glaucoma who had had IOP measured before and after pharmacological pupillary dilatation was performed to establish the rate of progression of glaucoma, based on serial evaluation of the visual fields using the glaucoma staging system 2 (GSS 2), and optic discs using the disc damage likelihood scale (DDLS). Progressive visual field loss was defined as an increase of two or more stages with the GSS 2 and progressive deterioration of the disc was defined as an increase of two or more stages with the DDLS. Mean follow-up time was 7.2 years. Results: A total of 26 eyes showed glaucomatous progression. The likelihood of progression of glaucoma was related to the amount of IOP increase after pharmacological pupillary dilatation. For every 1 mmHg increase in IOP, the odds of progression increased 24% (p = 0.008). The likelihood of progression of glaucoma, however, was not related to the baseline IOP, which was 20.63 mmHg (SD = 4.59 mmHg) in those showing deterioration of disc or field and 19.72 mmHg (SD = 5.32 mmHg) in those not worsening according to our definition. Conclusion: In patients with open-angle glaucoma, the amount of increase in IOP caused by pharmacological pupillary dilatation is related to the likelihood of future progression of glaucoma.

Assessing age-related macular degeneration with the ADREV performance-based measure.

Purpose: To validate a new third-generation performance-based measure titled the “assessment of disability related to vision” (ADREV) in a study population of individuals with age-related macular degeneration. Methods: Patients with either exudative or nonexudative age-related macular degeneration, but without ocular comorbidity, completed the ADREV, the 25-item National Eye Institute’s visual functioning questionnaire, and a range of clinical assessments. Correlations were calculated between the data provided by the ADREV, visual functioning questionnaire, and clinical ophthalmic measures. Regression and bootstrap analysis were preformed to determine the relative relationship between specific clinical measures and ADREV performance, while controlling for a range of potentially confounding factors. Results: One hundred twelve patients completed the study and correlative analysis showed that ADREV total and subscale scores were more related to nearly all measures of clinical ophthalmic status in comparison with the data provided by the visual functioning questionnaire. Significant correlative relationships between ADREV and visual functioning questionnaire scores showed moderate to high correlation. Central visual acuity and contrast sensitivity shared the strongest association with performance of activities. Conclusions: The ADREV is a valid instrument for the assessment of visual disability in patients with age-related macular degeneration. Furthermore, the data provided by this performance measure had stronger relationships with clinical indicators of visual impairment in comparison with self-report.

Should an iridectomy be routinely performed as a part of trabeculectomy? two surgeons' clinical experience

PurposeTo investigate the effects of performing peripheral iridectomy on the outcome of trabeculectomy.MethodsRetrospective chart review of the medical records of 75 patients (75 eyes) who underwent trabeculectomy surgery, with or without peripheral iridectomy, who had been followed for more than 1 year. Data were collected preoperatively, 1 day postoperatively, on days 30–90 postoperatively, and 1–3 years postoperatively. The collected data included visual acuity, intraocular pressure, bleb development, postoperative inflammation, and complications. Thirty-six eyes (48%) had cataract extraction at the time of trabeculectomy. A peripheral iridectomy was performed in 43 cases (57%). Students t-test was used for the statistical analyses.ResultsPatients having peripheral iridectomy had more inflammation on days 30–90 than those who did not have peripheral iridectomy performed (in patients having cataract extraction with trabeculectomy (P=0.018) and those not having cataract extraction (P=0.038)). There was no statistically significant difference in intraocular pressure in eyes with or without iridectomy. Postoperative complications were rare in both groups but greater in number in the eyes with peripheral iridectomy.ConclusionsTrabeculectomy performed without peripheral iridectomy appears to be as effective in lowering intraocular pressure as when performed with peripheral iridectomy, but it is a safer procedure, with a lower incidence of postoperative inflammation. It may be an advantage to avoid performing peripheral iridectomy during trabeculectomy in eyes that are not predisposed to postoperative shallowing of the anterior chamber or pupillary block.