Lama Al-Aswad

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;u2009=u20091.95; 95% CI, 0.47-3.43; Pu2009=u2009.01) and 10-2 (&bgr;u2009=u20092.57; 95% CI, 1.12-4.01; Pu2009=u2009.001) sensitivities, but the 10-2 VF univariable model showed an almost 2-fold better fit to the data (R2u2009=u20099.2% 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;u2009=u20092.78; 95% CI, 0.84-4.72; Pu2009=u2009.006.) and the best fit to the data (R2u2009=u200918.2%.) 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.

Corneal graft survival and intraocular pressure control in coexisting penetrating keratoplasty and pars plana Ahmed Glaucoma Valves.

Purpose To evaluate corneal graft survival and intraocular pressure (IOP) control after penetrating keratoplasty (PK) and pars plana Ahmed Glaucoma Valve (AGV) implantation among patients with coexisting glaucoma and corneal disease. Methods Retrospective chart review at an institution of 25 eyes (24 patients) that received PK and pars plana AGV. Results The mean postoperative follow-up was 23 months (range, 2–106 months). Survival of the grafts was 89% (16 of 18 eyes) at 1 year and 63% (5 of 8) at 2 years. IOP control was 78% (15 of 19) at 1 year and 44% (4 of 9) at 2 years. By Kaplan–Meier analysis, the 50% probability of sustained graft clarity occurred at 28 months and that of sustained IOP control at 24 months. By last follow-up, best-corrected visual acuity had improved by at least 1 line in 52% (13 of 25) of eyes compared with preoperative values. Preoperative factors, including peripheral anterior synechiae, were not found to be associated with graft survival, IOP control, or visual acuity at 1 year. Conclusion Pars plana AGV can successfully control IOP in PK patients in the short and intermediate terms, but graft clarity and IOP control diminish over time. Graft decompensation, when it did occur, likely reflects the associated ocular morbidity and clinical complexity of this circumscribed cohort of eyes.

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

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 (&bgr;u2009=u2009−6.15; 95% CI, −11.7 to −0.59; Pu2009=u2009.03). The effect remained significant even after controlling for mean RGC+IPL thickness (&bgr;u2009=u2009−7.64; 95% CI, −14.2 to −1.03; Pu2009=u2009.02). 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.

β-Zone Parapapillary Atrophy and Rates of Glaucomatous Visual Field Progression: African Descent and Glaucoma Evaluation Study

Importance &bgr;-zone parapapillary atrophy (&bgr;PPA) has been reported as a risk factor for glaucoma onset and progression. Previous studies have shown that the prevalence of &bgr;PPA differs between individuals of African descent (AD) and European descent (ED). Objective To test whether the association between the presence and progression of &bgr;PPA 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 &bgr;PPA at baseline and &bgr;PPA 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 &bgr;PPA 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 &bgr;PPA at baseline and visual field progression was not significantly different between AD and ED eyes (&bgr;u2009=u20090.071; 95% CI, −0.016 to 0.158; Pu2009=u2009.11), nor was the association between &bgr;PPA progression and visual field progression (&bgr;u2009=u20090.020; 95% CI, −0.465 to 0.506; Pu2009=u2009.93). In the GON group, ED eyes with baseline &bgr;PPA progressed faster than did AD eyes with baseline &bgr;PPA (&bgr;u2009=u2009−0.124; 95% CI, −0.241 to −0.007; Pu2009=u2009.04), although the association between &bgr;PPA progression and visual field progression did not differ significantly between race groups (&bgr;u2009=u2009−0.101; 95% CI, −0.323 to 0.119; Pu2009=u2009.37). Conclusions and Relevance Race had a significant effect on the association between baseline &bgr;PPA and rates of visual field progression in eyes with GON. Progression of &bgr;PPA was not associated with faster visual field progression in either racial group.

Screening for glaucoma in populations at high risk: The eye screening New York project

Abstract Purpose: To explore the yield and feasibility of glaucoma screening and the prevalence of glaucoma in high risk populations in New York City. Methods: A Community based glaucoma screening study was conducted in a high-risk population in NYC from 2007–2014 using fixed sites and mobile van. Participant underwent visual acuity testing, Tonopen intraocular pressure (IOP), frequency doubling technology (FDT), and optic nerve cup/disk ratio (C/D) by an ophthalmologist or optometrist. Glaucoma suspects (GS) were defined by IOP ≥ 21 mm Hg, abnormal FDT, and cup/disc ≥ 0.5. Results: 8,547 where screened between 2007–2014. 54% were Hispanics and 16% were African Americans. Of the 8,547 screened 2,118 (24.94%) where referred for glaucoma evaluation, 1,243(14.63%) where referred for an ophthalmic evaluation and 5,133(60.43%) where recommended for routine eye exam. 31.96% of our screened population were uninsured and 56.85% never saw an eye doctor in their life. Having IOP ≥ 21 had 36.27fold increase in RRR of being a GS [95% 29.45–44.44, p < 0.001]. Having C/D ratio of ≥ 0.5 had 23.6fold increase in RRR of being a GS [95% 20.65–27, p < 0.001]. Having an abnormal FDT had 2fold increase in RRR of being a GS [95% 1.79–2.19, p < 0.001]. Follow up was available in 610 subjects. Glaucoma was confirmed in 52% of the individuals who followed up. Conclusions: Our data suggests the prevalence of positive screening is substantial in high risk populations. It establishes the feasibility of mobile screening as a method of facilitating access to care. Furthermore, it highlights the importance of an active blindness prevention program in the context of population management.

The Current State of Artificial Intelligence in Ophthalmology

Artificial intelligence (AI) is a branch of computer science that deals with the development of algorithms that seek to simulate human intelligence. We provide an overview of the basic principles in AI that are essential to the understanding of AI and its application in health care. We also present a descriptive analysis of the current state of AI in various fields of medicine, especially ophthalmology. Finally, we review the potential limitations and challenges that come along with the development and implementation of this new technology that will likely play a major role in clinical medicine in the near future.