A Critical Reevaluation of Current Glaucoma Management

Garway-Heath, David F.

doi:10.1016/j.ophtha.2007.08.032

Cited by 19 publications

(14 citation statements)

References 88 publications

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“…The early manifest glaucoma group consisted of patients diagnosed with glaucoma in both eyes, who had been administered antiglaucomatous medications achieving target IOP. The latter had been set according to previously proposed published studies 9. All early manifest glaucoma group patients had applanation tonometry readings above 21 mmHg in both eyes before the administration of antiglaucomatous medications but below 21 mmHg under treatment, CDR above 0.5 in both eyes whereas in automated perimetry, the pattern standard deviation was outside 95% limits of the normal reference in both eyes.…”

Section: Methodsmentioning

confidence: 99%

Macular retinal and nerve fiber layer thickness in early glaucoma: Clinical correlations

Arvanitaki

Tsilimbaris

Pallikaris

et al. 2012

Middle East Afr J Ophthalmol

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Purpose:Previous studies have evaluated macular retinal thickness (RT) and nerve fiber layer thickness (RNFLT) changes in early glaucoma using elaborate optical coherence tomography (OCT) scanning protocols.Materials and Methods:This study examines RT and RNFLT using standard scanning protocols in early glaucoma. In this prospective, nonrandomized case series, 95 eyes of 95 patients were evaluated, including 29 nonglaucomatous subjects (control group), 34 glaucoma suspects, and 32 early manifest glaucoma patients. RT and RNFLT were measured using scanning fast macular thickness map and Fast RNFLT (3.4) protocols on a 1.70 mm radius around the macular center (respectively) in all four quadrants. The fast RNFLT (3.4) protocol was transposed on the macula from the peri-papillary area. Data were statistically analyzed for differences between groups, and for correlations between parameters. P<0.5 was statistically significant.Results:Both early manifest glaucoma patients and glaucoma suspects had significantly lower RT than controls in all quadrants. RNFLT differences in all quadrants were not statistically significant (P>0.05). RT was significantly inversely correlated with axial length in early manifest glaucoma patients and glaucoma suspects but not in controls.Conclusions:The finding that RT was significantly lower in early manifest glaucoma patients and glaucoma suspects indicates that the transposition of the OCT fast RNFL thickness (3.4) protocol from the peri-papillary area to the peri-macular area can be used for early glaucoma diagnosis. Intraretinal changes in early glaucoma, likely precede nerve fiber changes.

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Section: Methodsmentioning

confidence: 99%

Macular retinal and nerve fiber layer thickness in early glaucoma: Clinical correlations

Arvanitaki

Tsilimbaris

Pallikaris

et al. 2012

Middle East Afr J Ophthalmol

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“…We found that, with the use of all the statistical analyses, there was a greater time-saving which is very important in the clinical practice [17]. In the event-based statistical approach [18], the criterion for progression is defined at the start of the study, and progression is confirmed when changes in VF have dipped below the preset threshold. Information at baseline and that from the most recent test is used to decide whether an eye has progressed or not.…”

Section: Discussionmentioning

confidence: 99%

“…Information at baseline and that from the most recent test is used to decide whether an eye has progressed or not. Trend-based statistical methods [18] can be adopted to improve progression rate measurement. These may be applied to the MD or VF sectors or at individual test locations over time by linear regression analysis.…”

Section: Discussionmentioning

confidence: 99%

Classification and Statistical Trend Analysis in Detecting Glaucomatous Visual Field Progression

Valente

D’Alessandro

Iester

2019

Journal of Ophthalmology

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Aim. To evaluate the agreement between different methods in detection of glaucomatous visual field progression using two classification-based methods and four statistical approaches based on trend analysis. Methods. This is a retrospective and longitudinal study. Twenty Caucasian patients (mean age 73.8 ± 13.43 years) with open-angle glaucoma were recruited in the study. Each visual field was assessed by Humphrey Field Analyzer, program SITA standard 30-2 or 24-2 (Carl Zeiss Meditec, Inc., Dublin, CA). Full threshold strategy was also accepted for baseline tests. Progression was analyzed by using Hodapp–Parrish–Anderson classification and the Advanced Glaucoma Intervention Study visual field defect score. For the statistical analysis, linear regression (r2) was calculated for mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI), and when it was significant, each series of visual field was considered progressive. We also used Progressor to look for a significant progression of each visual field series. The agreement between methods, based on statistical analysis and classification, was evaluated using a weighted kappa statistic. Results. Thirty-eight visual field series were analyzed. The mean follow-up time was 6.2 ± 1.53 years (mean ± standard deviation). At baseline, the mean MD was −7.34 ± 7.18 dB; at the end of the follow-up, the mean MD was −9.25 ± 8.65 dB; this difference was statistically significant (p<0.001). The agreement to detect progression was fair between all methods based on statistical analysis and classification except for PSD r2. A substantial agreement (κ = 0.698 ± 0.126) was found between MD r2 and VFI r2. With the use of all the statistical analysis, there was a better time-saving. Conclusions. The best agreement to detect progression was found between MD r2 and VFI r2. VFI r2 showed the best agreement with all the other methods. GPA2 can help ophthalmologists to detect glaucoma progression and to help in treatment decisions. PSD r2 was the worse method to detect progression.

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“…9 We believe that current glaucoma guidelines underestimate the importance of modifying recumbent sleeping positions as this topic is not mentioned in the risk factors, searches, or treatment sections of the most recent PPP for POAG 9 or in an extensive 2006 think tank review of glaucoma. 61 All PD patients should avoid the prone sleeping position. Until recently, it has been difficult to adjust the incline of only the head in commercially available beds.…”

Section: Discussionmentioning

confidence: 99%

Effects of different sleeping positions on intraocular pressure in secondary open-angle glaucoma and glaucoma suspect patients

Sedgewick

et al. 2018

OPTH

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PurposeThe aim of this study was to investigate the effects of different recumbent sleeping positions of the head and body on intraocular pressure (IOP) in secondary open-angle glaucoma and glaucoma suspect patients, specifically pigmentary dispersion (PD) as measured using the ICare rebound tonometer.Patients and methodsA total of 44 eyes of 24 patients with PD were selected in this study. The IOP of 44 eyes was measured in the initial seated position, in the 4 recumbent positions, and again in the sitting position between each of the recumbent positions.ResultsThe IOP of the right eyes and left eyes was higher in each of the 4 recumbent positions compared to its initial sitting position (all P<0.001). Dependent (D) vs nondependent (ND) comparisons failed to show a significant difference. All lateral vs prone comparisons showed a higher average IOP in the prone position than in the lateral position regardless of D vs ND status. The range of recumbent IOP changes was −4 to +17 mmHg or −17% to +142%. A total of 64% had at least a ≥33% IOP increase with 43% having a ≥50% increase.ConclusionLateral and prone sleeping positions usually do result in significant elevations of IOP in PD patients. Dependency status did not make a difference. A significantly larger IOP increase was seen in the prone position than in the lateral position. The presence of 3 clinical variables (disk hemorrhage [DH], notches, and BV changes) might increase the chances of developing a large recumbent increase in IOP. These patients and possibly all PD syndrome (PDS) or PD glaucoma (PDG) patients should consider sleeping in a bed that allows a head elevation of 30°.

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A Critical Reevaluation of Current Glaucoma Management

Cited by 19 publications

References 88 publications

Macular retinal and nerve fiber layer thickness in early glaucoma: Clinical correlations

Macular retinal and nerve fiber layer thickness in early glaucoma: Clinical correlations

Classification and Statistical Trend Analysis in Detecting Glaucomatous Visual Field Progression

Effects of different sleeping positions on intraocular pressure in secondary open-angle glaucoma and glaucoma suspect patients

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