Michael Fanariotis

Vision-specific quality of life in Greek glaucoma patients.

PurposeThe aim of the study was to assess the vision-specific quality-of-life (VS-QoL) of Greek glaucoma patients, and the impact of potential influencing factors. MethodsThis was a 2-center, cross-sectional study. One hundred twenty-one patients were recruited from the outpatient glaucoma service and 100 successfully responded to the self-administered, Greek version of the National Eye Institute Visual Function Questionnaire 25. The results were quantified in terms of scores (0-100) and correlations with possible modifiers were investigated. The effects of sex, income, education, and comorbidities on VS-QoL scores were examined by analysis of variance. ResultsOur sample consisted of 49 men and 51 women with a mean age of 64.1 years, ranging from 18 to 89 years. The QoL score (mean±SD) was 81.7±14.7, the mean general health subscale score was 57.3±21.0 and the mean general vision subscale score was 72.7±16.3. Men generally presented higher VS-QoL scores (P=0.042). Age had a negative impact on the “General health” (ρ=−0.325, P=0.001) and “General vision” (ρ=−0.265, P=0.008) subscales. Higher educational background contributed to higher scores in General health, “General vision,” and “Central vision” while urban residence correlated with “Distant activities” and “Social functioning”. Cup-to-disc ratio, visual acuity and visual field indices like the Advanced Glaucoma Intervention Study, the Hodapp-Anderson-Parrish, and the Collaborative Initial Glaucoma Treatment Study scores, and pattern standard deviation and mean deviation all correlated with National Eye Institute Visual Function Questionnaire scores (r values ranging from −0.240 to 0.757). ConclusionsIn this first study in a Greek native population, both the structural measure of cup-to-disc ratio and a multitude of functional scores correlated with VS-QoL scores in glaucoma patients.

Anterior chamber volume measurements with Visante optical coherence tomography and Pentacam: repeatability and level of agreement

Background:  The purpose of this study is to examine the repeatability of Pentacam‐derived anterior chamber volume measurements, and assess the level of agreement of anterior chamber volume measurements obtained with the Visante and the Pentacam imaging devices.

Bimatoprost and Bimatoprost/Timolol Fixed Combination in Patients with Open-Angle Glaucoma and Ocular Hypertension

PURPOSE To investigate the intraocular pressure (IOP) lowering effect of bimatoprost (BIM) 0.03% and the potential additional effect of the BIM 0.03%/timolol 0.5% fixed combination (BTFC) in eyes with ocular hypertension, primary open-angle glaucoma, or exfoliation glaucoma. METHODS Following an appropriate washout period that varied with previous medication, participants with ocular hypertension, primary open-angle glaucoma, or exfoliation glaucoma were treated with evening-dosed BIM for 5 weeks. They were then given evening-dosed BTFC for another 5 weeks. One randomly selected eye was evaluated. Goldmann applanation tonometry was performed by the same investigator at 8 a.m., 12 noon, 4 p.m., and 8 p.m. at baseline and at the end of each treatment period. RESULTS Thirty-three participants completed the study. Three patients discontinued because of local adverse effects during the BIM treatment period. The mean diurnal IOP (mean ± SD) at baseline, on BIM, and on BTFC were 24.8 ± 5.4, 17.3 ± 3.5, and 14.9 ± 3.1 mmHg, respectively (repeated measures analysis of variance, P < 0.001 for all pairwise comparisons). The individual time-point IOP values showed similar significant reductions. The percentage of IOP reduction from baseline was 30.2% for BIM and 39.9% for the BTFC. The mean ± SD diurnal fluctuation at baseline was 6.8 ± 3.2 mmHg, which decreased to 4.0 ± 3.1 and 2.9 ± 1.4 mmHg on BIM and BTFC, respectively (P < 0.05 for both treatments versus baseline). CONCLUSIONS Both BIM 0.03% and the BTFC were effective in lowering IOP in eyes with ocular hypertension and open-angle glaucoma. However, the fixed combination provided an additional statistically significant reduction in IOP compared with BIM 0.03%.

Retinal nerve fiber layer thickness in patients with exfoliation, exfoliative glaucoma, and primary open angle glaucoma.

Purpose T ev lu te the retin I nerve fi er I yer (RNFL) pr file f he Ithy ntr Is, pers ns with exf - li ti n syndr me (XFS), nd p tients with exf li ti n gl u m (XFG) nd prim ry pen ngle gl u - m (POAG). Methods One eye fr m e h f 269 p rti ip nts w s n lyzed. Fifty eyes were n rm I, 45 eyes h d XFS, 89 eyes h d POAG, nd 89 h d XFG. Gl u m p tients were divided rding t the severity f the dise se int mild nd dv n ed gr ups. All p rti ip nts underwent im ging with the GDx-VCC devi e. Me surements f the p r meters TSNIT ver ge, TSNIT SD, nd nerve fi er indi t r (NFI) were perf rmed. P I rimetri RNFL thi kness v lues were mp red y me ns f B nferr ni- rre - ted t-tests. Results Reg rding ntr I nd gl u m gr ups, st tisti lly signifi nt differen es were identified in II GDx p r meters. RNFL thi kness v lues f the ntr I gr up differed signifi ntly fr m the v lues f the XFS gr up. There w s n st tisti lly signifi nt differen e etween RNFL thi kness v lues f r the mild POAG nd mild XFG gr ups rf rthe dv n ed POAG nd dv n ed XFG gr ups. Conclusions P I rimetry-determined RNFL in eyes with XFS is thinner th n th t f he Ithy eyes. N differen es in RNFL thi kness were f und when eyes with POAG nd XFG f simil r seventy were mp red.

Greek Physicians’ Perceptions on Generic Drugs in the Era of Austerity

Purpose. To assess the beliefs and preferences of Greek physicians, regarding generic drugs, in the years of financial crisis. Setting. Multicentered, nationwide survey. Material and Methods. A custom questionnaire based on former similar studies was developed and administered to Greek physicians. The variable “perception on generics” was constructed after an exploratory study and the instrument was validated by conventional and Rasch analysis methods. 22 items formed 5 subscales that constructed the variable in question. Results. 908 physicians successfully participated in the study (response rate: 80%). Mean total scores to the instrument were 60.63 ± 12.12 for men and significantly less (58.24 ± 11.73) for women (p = 0.04). Greek physicians were not persuaded on the potential economic gain (45.79 ± 10.53); moreover they identified that Greek authorities cannot address the increased pharmacovigilance mandates. Physicians working in Athens and those working in surgical units demonstrated significantly worse scores than their colleagues from the rest of Greece and those working in Internal Medicine wards (p = 0.03).  Conclusion. Our results suggest an overall poor acceptance of the national initiative on generic drugs by Greek physicians. This trial is registered with Clinicaltrials.gov identifier: NCT01855802.

Reproducibility of OCT/SLO measurements in healthy eyes.

Purpose. To determine the reproducibility of optical coherence tomography/scanning laser ophthalmoscope (OCT/SLO) measurements within and between observers and within and between sessions in healthy eyes. Methods. Forty eyes of 40 healthy volunteers recruited from the outpatient service of the Department of Ophthalmology at the University Hospital of Alexandroupolis, Greece, were included. Retinal thickness scans were performed 3 times by two experienced operators within each of 3 sessions, which took place within a month, using the spectral OCT/SLO. The OCT/SLO provides retinal nerve fiber layer (RNFL) thickness and volume measurements and a 3D tomography analysis of optic nerve head. Statistical analysis was conducted using Bland-Altman plots, coefficient of variation (CoV), and intra-class correlation coefficient (ICC). Results. AS shown by the CoV values, RNFL parameters were generally found to have high reproducibility (CoV ranging from 4.3% to 10.9% for both operators), whereas optic disc parameters had scores reaching up to 22.5%. On the other hand, as shown by the ICC values, intraobserver and interobserver reproducibility for the OCT/SLO was high for optic disc parameters but low for RNFL thickness and volume measurements. Interobserver reproducibility was found to be highest for the maximum cup depth parameter and lowest for the superior volume. Bland-Altman plots indicate that bias is minimal for practically all parameters and scatterplot homoscedasticity is high. Conclusions. According to our data, SLO/OCT generally has a good reproducibility profile, as differences between the two operators were small. However, additional studies on the reproducibility of measurements with the OCT/SLO are needed.

The relationship between Rarebit perimetry and OCT‐derived retinal nerve fibre layer thickness in glaucoma

Purpose:  To examine the association between measures of neuroretinal matrix integrity as determined with Rarebit perimetry and optical coherence tomography (OCT)‐derived retinal nerve fibre layer thickness.

A proposed methodology for the assessment of glaucoma awareness in Greece: introduction of the EIT-8G scale.

Purpose To develop a reliable and practical questionnaire for glaucoma awareness and evaluate the impact of potential determinants. Methods Patients with primary open-angle, pigmentary, and exfoliation glaucoma, as well as healthy controls, were recruited. The instrument included questions about demographic characteristics, as well as 8 questions assessing the participants familiarity with glaucoma. Rasch analysis was used for the validation of the questionnaire. The effect of demographics as potential determinants of awareness was examined with a multivariate logistic regression analysis. Bonferroni-corrected statistical significance was tested with the Mann-Whitney U test or one-way analysis of variance. Association between demographics and questionnaire scores was examined with Spearman correlation. Results As indicated by power analysis, responses from 175 patients (mean age 65.5 years) and 314 controls (mean age 43.3 years) were analyzed. Rasch analysis indicated no multidimensionality and good item-person targeting. Mean ± SD awareness scores for the glaucoma and control groups were 4.43±2.10 and 4.20±2.11, respectively (p=0.207). Sex and residence were not predictors of disease awareness, whereas educational level was only a determinant in the control group (p<0.001). Income was a predictor only for patients (r=0.357, p<0.001), whereas family history was predictive for both groups (p<0.001). Logistic regression analysis revealed that only family history was associated with increased awareness (χ2=4.61, p=0.03, odds ratio 1.98). Conclusions This study introduces a practical and valid instrument for the assessment of glaucoma awareness.