Jose Maria Martínez de la Casa

Development of a Specific Questionnaire Measuring Patient Satisfaction with Glaucoma Treatment: Glausat

Objective: Patient satisfaction with glaucoma therapy is one of the aspects that affects adequate adherence to treatment; therefore, it would be interesting to measure the satisfaction properly. We present the development process and psychometric properties of a new instrument for measuring patient satisfaction with glaucoma treatment. Material and methods: After collection and discussion of contents, a 38-item questionnaire was proposed and arranged into seven theoretical domains. The questionnaire was applied to a sample of 194 patients and its length was reduced using an exploratory factor analysis. Psychometric properties were assessed under classic theory. Results: The final questionnaire is formed by 22 items grouped into seven dimensions: expectations and beliefs about treatment, ease of use, efficacy, undesired effects, impact on health-related quality of life, medical care, and general satisfaction with treatment. Some dimensions correlated slightly. The reliability of the dimensions ranged from 0.77 to 0.93. Confirmatory factor analysis revealed an additional support of the proposed structure (χ2 (188) = 217, P = 0.073). Glausat scores were proven to correlate with patients’ self rating on medication tolerability, and with clinicians’ assessment of tolerability, effectiveness and compliance. Conclusions: The Glausat questionnaire has proven to be reliable and structurally valid. This instrument may be used to assess patients’ satisfaction with glaucoma treatment.

Medulloepithelioma of the ciliary body: Ultrasonographic biomicroscopic findings

Intraocular medulloepithelioma is an uncommon embryogenic neoplasm of neuroepithelial origin that usually develops from the nonpigmented epithelium of the ciliary body, retina, and optic nerve. 1 Clinically, medulloepithelioma usually appears as a tumor of the ciliary body; only rarely does it arise in the optic nerve and retina. It frequently occurs on the ciliary body of a young child as a fleshy gray or pink mass, which, on examination using slit lamp biomicroscopy, often reveals cysts. These cysts impart an irregular shape to the tumor surface. 1 , 2 The tumor tends to be locally aggressive and can invade adjacent intraocular structures, but it rarely metastasizes. 1 , 3 The utility of conventional echography in the diagnosis of medulloepithelioma has been established, 4 but, to our knowledge, no reports have been published describing the ultrasonographic biomicroscopic features of medulloepithelioma. Ultrasonographic biomicroscopy (UBM) is an ideal method to analyze the anterior segment 5 ; it allows an accurate assessment of iris and ciliary body tumors, including size, tumor margins, and internal characteristics. 6 - 8 Moreover, UBM can help with the differential diagnosis of ocular tumors. In this report, we describe the UBM characteristics of medulloepithelioma.

Comparing Corneal Variables in Healthy Subjects and Patients with Primary Open-Angle Glaucoma

PURPOSE This study was designed to identify possible differences between healthy subjects and patients with primary open-angle glaucoma (POAG) in keratometry, central corneal thickness, overall corneal thickness, mean thickness of a circular zone centered at the corneal apex of 1-mm radius (zone I), and mean thickness of several concentric rings also centered at the apex of 1-mm width (zones II to VI, respectively). METHODS These variables were recorded in 126 healthy subjects and 130 patients with POAG. Corneal thicknesses and the power of the flattest and steepest axes were compared between the two populations using a t-test and the position of the flattest axis using a Mann-Whitney U test. A binary logistic regression procedure was used to determine the diagnostic capacity of the corneal variables using the area under the receiver operator characteristic curve (AUC) to select the best regression equation. RESULTS Significant differences between subjects and patients were detected in mean corneal thickness and in mean thicknesses of zones I to VI. The logistic regression model included as predictors the mean corneal thickness and the mean thicknesses of zones IV and VI; for this model, the AUC was 0.711, sensitivity was 67.7%, and specificity was 65.5%. CONCLUSIONS Healthy subjects and glaucoma patients differ significantly in terms of mean overall corneal thickness and thicknesses of the corneal zones I to VI defined here. The variables mean corneal thickness and mean thicknesses of zones IV and VI are able to discriminate between subjects with or without glaucoma.

Ocular Redness Measured with the Keratograph 5M in Patients Using Anti-Glaucoma Eye Drops

ABSTRACT Purpose: To examine correlations between ocular redness measured with the new topographer Keratograph 5M and the use of topical anti-glaucoma medication. Methods: A total of 211 eyes of 211 patients with open-angle glaucoma or ocular hypertension on topical medication and 51 eyes of 51 healthy volunteers were recruited over 10 months. Outcome variables were keratograph redness scores (RS): overall, bulbar temporal (BT), bulbar nasal (BN), limbar temporal (LT), and limbar nasal (LN). In each subject, we also recorded the intraocular pressure-lowering eye drops used, daily doses and daily and cumulative preservative concentrations, fluorescein corneal staining score (OXFORD), lower tear meniscus height (Fourier-domain OCT), non-invasive tear film breakup time (Keratograph 5M), and ocular surface disease questionnaire index (OSDI). Results: Higher RS were recorded in the medication than control group (P < 0.01 all scores). Within the medication group, older patients returned greater RS (P < 0.05 all scores). Prostaglandin was a strong predictor of higher scores, except LN RS. A higher OSDI was associated with a higher LN RS (β = 0.007; P < 0.05), while the use of β-blockers was linked to a lower LN RS (β = −0.225; P < 0.05). The use of ≥3 daily eye drops with preservative gave rise to a higher BN RS and ≥3 daily eye drops to a higher LN RS (β = 0.366, P < 0.01; β = 0.296, P < 0.05, respectively). Conclusion: Keratograph 5M can objectively detect the hyperaemia induced by glaucoma medication. The factors contributing to ocular redness were advanced age, more daily eye drops (nasal sectors), a higher OSDI, and prostaglandin as the medication used.

Variations in retinal nerve fiber layer measurements on optical coherence tomography after implantation of trifocal intraocular lens

Purpose: To establish the changes produced after implantation of a trifocal intraocular lens (IOL) on retinal nerve fiber layer measurements performed with Fourier-domain optical coherence tomography (OCT). Methods: This prospective study included 100 eyes of 50 patients with bilateral cataract in surgical range, no other associated ocular involvement, refractive errors between +5 and −5 spherical diopters, and less than 1.5 D of corneal astigmatism. The eyes were operated by phacoemulsification with implantation of 2 different trifocal IOLs (FineVision and AT LISA tri 839MP) in randomized equal groups. Cirrus OCT and Spectralis OCT were performed before surgery and 3 months later. Both analyzed the thickness of the nerve fiber layer and thickness divided by quadrants (6 in case of Spectralis and 4 in case of Cirrus HD). Results: The mean age of patients was 67.5 ± 5.8 years. The global nerve fiber layer thickness measured with Spectralis OCT was 96.77 μm before surgery and 99.55 μm after. With Cirrus OCT, the global thickness was 85.29 μm before surgery and 89.77 μm after. Statistically significant differences in global thickness measurements between preimplantation and postimplantation of the IOL were found with both OCT in the 2 groups. Statistically significant differences were also found in temporal and superior quadrants. Conclusions: The implantation of a diffractive trifocal IOL alters the results of the optic nerve fiber layer on Fourier-domain OCT in these patients, which should be taken into account in the posterior study of these patients.

Correlating Corneal Biomechanics and Ocular Biometric Properties with Lamina Cribrosa Measurements in Healthy Subjects.

ABSTRACT Purpose: To examine interrelations between corneal biomechanics, ocular biometric variables and optic disc size (ODS), lamina cribosa depth (LCD) or thickness (LCT) in a healthy population. Material and Methods: In a cross-sectional case-control study, the following measurements were made in 81 eyes of 81 participants: axial length, anterior chamber depth, lens thickness, and central corneal thickness using the optical biometer Lenstar LS900; and corneal hysteresis (CH), corneal resistance factor (CRF), Goldman-correlated intraocular pressure (IOPg), and corneal-compensated IOP (IOPcc) using the Ocular Response Analyzer. Serial horizontal enhanced depth imaging optical coherence tomography (EDI OCT) B-scans of the optic nerve head were obtained in each participant. Mean ODS, mean LCD, and mean LCT were measured in 11 equally spaced horizontal B-scans, excluding the LC insertion area under Bruch’s membrane and scleral rim. Results: LCD was measured in 74 of 81 eyes (91.36%); LCT in 60/81 (75.3%); ODS in 81/81 (100%). CRF was poorly, but significantly, correlated with LCT (Pearson’s R = 0.264; P = 0.045). IOPcc, IOPg, CH, and ocular biometrics variables were poorly (non-significantly) correlated with LCD, LCT, and ODS. Conclusions: CRF was poorly but directly correlated with LCT. No association was detected between CH or ocular biometric variables and ODS, LCD, or LCT.

Ultrasound Biomicroscopy in Glaucoma

Ultrasound biomicroscopy (UBM) is a high-resolution ultrasound technique, which allows noninvasive in vivo imaging of the anterior ocular segment. It shows excellent images of the anterior chamber angle, and the ciliary body. In glaucoma, UBM can be used to image the changes of the ocular structures after glaucoma surgery, such us filtering blebs and suprachoroidal drainage. It also provides with relevant information in cases of angle closure glaucoma, secondary glaucoma, and pigmentary glaucoma.

Minimally Invasive Glaucoma Surgery

Minimally invasive glaucoma surgery techniques have been developed with the aim of safely controlling intraocular pressure. We now review the available evidence for current devices, and discuss their indications and complications.

Adaptación cultural y validación al español del cuestionario de síntomas de glaucoma (Glaucoma Symptom Scale, GSS)

BACKGROUND AND OBJECTIVE To describe the process of the cultural and psychometric adaptation (validation) into Spanish of the Glaucoma Symptom Scale (GSS) in order to measure the impact of glaucoma symptoms, and inform about the psychometric properties. MATERIAL AND METHOD The study was supervised by a 6-member expert panel. After forward and backward translations in duplicate, a Spanish version was obtained which was administered to three samples: a 16-patient sample to check comprehenssion and face validity, a 100-patient sample to check structural validity (factor analysis and reliability) and, finally, a 387-patient sample for assessing construct and discrimination validity. RESULTS The questionnaire yielded 2 dimensions, which are not exactly the same as the ones in the original study. Reliability was high (alpha=0.82), and correlation between even-odd items was high too (r=0.92). The scale discriminated between lower and upper quartile groups (p<0.001). The average on non visual symptoms was higher than on visual ones (p=0.001), showing more inconvenience of the former. There were differences between compliant and non-compliant patients (p=0.004), but a lack of agreement between self-reported measures was also found. We found differences between patients with one or 2 drops treatments (p=0.0014). CONCLUSIONS The results showed acceptable psychometric properties and they make available to health professionals a new instrument to assess glaucoma symptoms, taking into account the patient perspective.