Undraa Altangerel

Assessment of Function Related to Vision (AFREV)

Objectives: To evaluate the relationship of a performance-based measure of visual functioning to clinical and subjective measures in glaucoma patients. Design: Cross-sectional survey of glaucoma patients. Participants: Forty-three patients with primary open-angle glaucoma. Methods: Patients were evaluated using a novel performance-based measure, the Assessment of Function Related to Vision (AFREV), standard clinical tests of visual function, and the National Eye Institutes Visual Functioning Questionnaire (NEI-VFQ-25), a self-reported quality of life measure. Correlations of the AFREV scores with visual field scores, monocular and binocular visual acuity, contrast sensitivity scores, and NEI-VFQ scores were calculated. Rasch analysis was used to estimate the visual ability required by each task of AFREV for a particular response (item measures) and to estimate the visual ability of each patient (person measures). Main Outcome Measures: AFREV and NEI-VFQ total scores. Results: The AFREV total scores were highly correlated with contrast sensitivity (r = 0.772), binocular visual acuity (r = −0.768), better-eye visual acuity (r = −0.737), worse-eye visual acuity (r = −0.675), and Estermann visual field efficiency scores (r = 0.606) as well as with NEI-VFQ scores (r = 0.70). The resulting index, constructed from 5 items of the AFREV, is unidimensional, thereby satisfying the primary assumption of the Rasch model. The Rasch person-item map demonstrates that the “putting stick into holes” and “reading small print” tests require the most visual ability. Conclusions: The AFREV performance-based measure, a new test of a spectrum of activities, correlates well with some standard measures of visual function and certain aspects of self-report assessments. AFREV appears to be a valid measure of performance ability that may provide information not obtainable from standard measures of visual function or subjective surveys.

Visual function, disability, and psychological impact of glaucoma.

Purpose of review This report briefly reviews recent instruments designed to test the visual function and quality of life of patients with glaucoma. Recent findings Several investigators have examined the functional status and vision-related quality of life among patients with glaucoma. These studies have shown that patients with glaucoma experience diminished visual function and poorer quality of life. Summary Because glaucoma and its treatment, either medical or surgical, can affect global quality of life as well as vision-related functioning, the assessment of both general and visual system health status is relevant.

Reliability of the disk damage likelihood scale

PURPOSE To report the reliability of the glaucoma disk damage likelihood scale (DDLS) in comparison to the Armaly cup/disk ratio by determining the interobserver and intraobserver agreement for optic disk stereo photographs and the interobserver agreement for in vivo patient measurements of the optic disk. DESIGN Observational case series. METHODS Optic disk photographs: 48 stereo pairs of optic nerve photographs were selected from patients with a spectrum of glaucomatous visual field loss. Two masked observers graded the optic disk photographs three times according to the DDLS and Armaly cup/disk ratio. Interobserver and intraobserver agreements were calculated using the test-retest method. Patient measurements: three observers performed in vivo patient measurements on 34 eyes of glaucoma clinic patients and made a single determination of the DDLS stage and Armaly cup/disk ratio, based on the indirect biomicroscopic examination. Level of interobserver agreement was tabulated. RESULTS Optic disk photographs: interobserver and intraobserver agreement for the vertical DDLS measurement was greater than for two determinations (clinical impression and measured) of the vertical Armaly cup/disk ratio (interobserver: 85% vs 68% and 74%, respectively; intraobserver grader 1: 97% vs 89% and 80%, grader 2: 99% vs 95% and 89%, respectively). In vivo patient measurements: the interobserver agreement for the DDLS and Armaly cup/disk ratio was similar (70.1% vs 67.6%, respectively). CONCLUSIONS For the stereo optic disk photographs, the inter- and intra-observer agreement for the DDLS is greater than the Armaly cup/disk ratio. For the in vivo patient measurements, the level of agreement for the DDLS and the Armaly cup/disk ratio is similar.

Performance-based measures of visual function.

Review of the substantial literature reveals that the importance of performance-based measures of visual function is becoming increasingly recognized. Alone, or in combination with other assessment modalities, they have been shown to provide a reliable and valid means of evaluating visual ability. Further, they have been demonstrated to predict outcomes better than self-report or clinical measures alone.

Intracameral 2.3% Sodium Hyaluronate to Treat Postoperative Hypotony in Patients With Glaucoma

BACKGROUND AND OBJECTIVE To evaluate the intracameral use of Healon5 (2.3% sodium hyaluronate) (Advanced Medical Optics, Santa Ana, CA) in patients with hypotony. PATIENTS AND METHODS Fifteen consecutive patients with glaucoma who had hypotony for at least 7 days were prospectively recruited. Indications for the intracameral injection of Healon5 were an intraocular pressure (IOP) of less than 6 mm Hg with negative results on Seidel test. RESULTS The mean IOP readings at baseline, 1 to 2 weeks post-injection, and 4 to 6 weeks post-injection were 3.8 +/- 1.58, 6.58 +/- 2.62, and 6.50 +/- 2.24 mm Hg, respectively. The increase in IOP at both follow-up points was significant (P < .01). The visual acuity improvement was small but significant at the 4 to 6 week point (P = .05). In the early-onset cases, IOP increased significantly from baseline at both follow-up points (P< .05), but visual acuity did not. No significant change from baseline IOP or visual acuity occurred among the late-onset cases. The existing hypotony-related conditions consistently improved by the 4 to 6 week point. CONCLUSIONS Intracameral injection of Healon5 raised IOP more in early-onset hypotony cases than in late-onset cases. Although the improvements in IOP and visual acuity were statistically significant, the overall clinical picture did not change because the endpoint IOP was still hypotonus. Twenty percent of the patients had IOP spikes that required medical treatment.

Evaluating a new disc staging scale for glaucomatous damage: the ability to detect change over time.

Purpose To assess the ability of Disc Damage Likelihood Scale (DDLS) in detecting glaucomatous changes in the optic nerve on sequential optic disc stereo-photographs as compared with three other different cup/disc grading systems (C/D). Methods Eighty-three pairs of stereo-photographs with a minimum of 5-year follow-up were examined by one group of three observers masked to chronological order by using their clinical expertise. Their conclusions were considered gold standard. Another group of three glaucoma experts examined the same masked pairs to evaluate glaucomatous changes using four different optic nerve grading systems: DDLS, vertical, horizontal, and maximal cup/disc. Ratings of these four methods in the second group were then compared with the gold standard. Results Baseline and follow-up photographs of 83 eyes were included. Mean follow-up was 6 years. The sensitivities for detecting glaucomatous nerve changes were 71.4%, 63.9%, 66.7%, and 47.2% for DDLS, vertical, horizontal, and maximal cup/disc, respectively. The specificity for finding nerve change was 70.9%, 51.1%, 40.4%, and 48.9%, respectively. The proportion of photographs identified as showing glaucomatous changes differed significantly between the DDLS and vertical C/D (VCD) (χ2=7.900, p=0.005), between the DDLS and horizontal C/D (HCD) (χ2=13.89, p=0.000), and between DDLS and maximum C/D (MCD) (χ2=4.192, p=0.041). The largest area (74.4%) under the receiver operator characteristic curve was obtained by using the DDLS. Conclusions DDLS had higher sensitivity and specificity for detecting glaucomatous changes versus the other three C/Ds when considering sequential stereo-photographs.