The noninvasive methodology used in this study constitutes a new tool for serial and simultaneous evaluation of arterial hemodynamics and left ventricular energetics in systemic hypertension. In this study, we demonstrate the differential effects of chronic antihypertensive therapies on systemic arterial circulation and indexes of MVO2 in African-American subjects. Consideration of drug-induced differential responses of arterial load and indexes of MVO2 with each drug may provide a more physiological approach to the treatment of systemic hypertension in indivi

Purpose To evaluate the association between binocular visual field defects in drivers with glaucoma and risk of motor vehicle collision (MVC) involvement. Methods A retrospective cohort study was conducted on 438 drivers with glaucoma aged ≥ 55 years old using data from 1994 through 2000. Demographic, clinical, and driving characteristics were obtained from chart abstractions and patient survey. Binocular field measures were generated by combining data from the monocular (central 24° radius) fields whereby the binocular field measure was defined as the more sensitive point at each monocular field location. Measures included threshold (TH), total deviation (TD), and pattern deviation (PD); severe impairment in these measures was defined as falling into the worst quartile. MVC data was obtained from police records. Rate ratios (RR) and 95% confidence intervals (CI) were calculated. Results Drivers with severely impaired PD measures were twice as likely to have an at-fault MVC compared to those not severely impaired (RR 2.13, 95% CI 1.21-3.75); those with severely impaired TH (RR 1.49, 95% CI 0.81-2.74) and TD (RR 1.50, 95% CI 0.82-2.74) also had an increased rate of at-fault MVCs, although these were not significant. When the binocular central visual field was stratified into 9 regions, drivers with impaired TH, TD, or PD had similarly elevated MVC rates in all regions compared to those not severely impaired, though not all reached statistical significance. Conclusions Based on clinical measures of visual field routinely used in the management of glaucoma, drivers with glaucoma with severe PD field defects in the binocular field have a higher rate of at-fault MVC compared to those with less impaired or unimpaired binocular visual fields.

As the ophthalmology accreditation system undergoes major changes, training programs must evaluate residents in the 6 core competencies, including appropriately communicating bad news. Although the literature is replete with recommendations for breaking bad news across various non-ophthalmology specialties, no formal training programs exist for ophthalmology. There are many valuable lessons to be learned from our non-ophthalmology colleagues regarding this important skill. We examine the historic basis for breaking bad news, explores current recommendations among other specialties, and then evaluate a pilot study to teach breaking bad news to ophthalmology residents. The results of this study are limited by a small number of residents at a single academic center. Future studies from multiple training programs should be conducted to further evaluate the need and efficacy of formal communication skills training in this area, as well as the generalizability of our pilot training program. If validated, this work could serve as a template for future ophthalmology resident training and evaluation in this core competency.

In this prospective study, naive prostaglandin use in primary open-angle glaucoma was associated with scleral biomechanical alteration and intraocular pressure (IOP) measuring errors.Purpose: The purpose of this study is to determine the effects of naïve use of prostaglandin analogues (PGA) on IOP and anterior chamber volume (ACV), as well as investigate how PGAs might affect corneal and scleral stiffness and their impact on ocular rigidity. Materials and Methods:This study was a prospective study of 21 recently diagnosed open-angle glaucoma patients (33 eyes) initiating medical therapy with a topical prostaglandin eye drop. Corneal morphologic and biomechanical parameters as well as IOP were measured at 3 visits over a 4-month period with the following equipment: Pentacam, Corvis ST, Ocular Response Analyzer, Goldmann applanation tonometry (GAT) and Pascal dynamic contour tonometry. Results:The study demonstrated a significant decrease in mean IOP with initiation of PGA in all 4 tonometers (P < 0.0001). The greatest change in IOP occurred in the first 4 weeks of treatment (P < 0.0001). The mean ACV showed a significant decrease at visit 2 (P < 0.02) and visit 3 (P < 0.04) compared with baseline visit 1. However, there was a paradoxical increase in ACV in 37% of eyes at visit 2, despite a significant mean reduction in IOP by GAT and dynamic contour tonometry. The IOP/ACV ratio at visit 1 significantly predicted the reduction in respective measures of IOP, as well as scleral stiffness measured by stiffness parameter-highest concavity. Conclusion:In clinical practice, GAT may not be the most appropriate tonometer for measuring IOP in PGA treated eyes due the measurement errors from ocular biomechanical alteration. The IOP/ACV ratio could potentially serve as a new diagnostic parameter to determine the likelihood of PGA treatment success.

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