Impact of Intraocular Pressure Control on Rates of Retinal Nerve Fiber Layer Loss in a Large Clinical Population

Jammal, Alessandro A.; Mariottoni, Eduardo B.; Estrela, Tais; Shigueoka, Leonardo; Berchuck, Samuel I.; Medeiros, Felipe A.

doi:10.1016/j.ophtha.2020.06.027

Cited by 36 publications

(20 citation statements)

References 40 publications

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“…Major clinical studies in glaucoma have demonstrated that more aggressive IOP control, with treatment targets <20 mmHg, decreases the risk of visual field loss progression 2,5,25,26 . Additionally, eyes with stricter IOP control over follow-up visits had a smaller chance of exhibiting fast deterioration 27 . Accordingly, it is a notable finding of this study that substantial proportions of patients receiving netarsudil as monotherapy or concomitant therapy, overall and across the different therapy subgroups, had IOP under thresholds of 14 to 18 mmHg.…”

Section: Discussionmentioning

confidence: 96%

A multicenter, open-label study of netarsudil for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension in a real-world setting

Zaman

Gieser

Schwartz

et al. 2021

Current Medical Research and Opinion

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Objective: Assess the real-world efficacy of netarsudil, either as monotherapy or concomitant therapy, in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT) requiring modification of intraocular pressure (IOP)-lowering treatment. Methods: Multicenter, prospective, interventional, open-label, Phase 4 study, clinical trial registration number: NCT03808688. Netarsudil ophthalmic solution 0.02% was prescribed at the recommended once-daily dosage, with treatment regimens determined by the investigators. Netarsudil could be used alone or in combination with other IOP-lowering medications, consistent with standard clinical practice. Primary efficacy endpoint: percentage reduction from baseline IOP at week 12. Results: Among 261 enrolled patients, 242 received !1 netarsudil dose and had !1 follow-up IOP measurement (efficacy population). Mean IOP in patients who were treatment-naïve at baseline and using netarsudil as monotherapy (n ¼ 24) decreased by 16.9%. Netarsudil monotherapy was comparable in efficacy to prior therapy across subgroups, and those who replaced prostaglandin analog (n ¼ 57) monotherapy demonstrated reduction of 2.5% from prostaglandin analog-treated baseline values. Among patients who used netarsudil as concomitant therapy (n ¼ 151), reductions in mean IOP (± standard deviation) to week 12 were seen across subgroups who added netarsudil to a single agent (4.3 ± 2.88 mmHg; 20.5%) or !2 classes of concomitant therapy (4.5 ± 4.08 mmHg; 20.9%) and who used netarsudil to replace !1 other drug classes (0.4 ± 2.47 mmHg; 1.7%). Of 260 netarsudil-treated patients, 41 (15.8%) discontinued, including 29 (11.2%) due to adverse events. Conclusions: In the real-world treatment of patients with OAG or OHT, netarsudil consistently maintained IOP control when it replaced previous IOP-lowering therapies and provided additional IOP-lowering efficacy when added to other treatments.

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Section: Discussionmentioning

confidence: 96%

A multicenter, open-label study of netarsudil for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension in a real-world setting

Zaman

Gieser

Schwartz

et al. 2021

Current Medical Research and Opinion

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“…Healthy individuals as well as patients having or suspected of having glaucoma were included in the study. Diagnosis of glaucoma or suspect was based on International Classification of Diseases (ICD) codes 29 . We excluded patients who underwent procedures such as panretinal photocoagulation or suffered from other diseases like retinal detachment, optic neuritis, proliferative diabetic retinopathy, etc.…”

Section: Methodsmentioning

confidence: 99%

RetiNerveNet: using recursive deep learning to estimate pointwise 24-2 visual field data based on retinal structure

Datta

Mariottoni

Dov

et al. 2021

Sci Rep

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Glaucoma is the leading cause of irreversible blindness in the world, affecting over 70 million people. The cumbersome Standard Automated Perimetry (SAP) test is most frequently used to detect visual loss due to glaucoma. Due to the SAP test’s innate difficulty and its high test-retest variability, we propose the RetiNerveNet, a deep convolutional recursive neural network for obtaining estimates of the SAP visual field. RetiNerveNet uses information from the more objective Spectral-Domain Optical Coherence Tomography (SDOCT). RetiNerveNet attempts to trace-back the arcuate convergence of the retinal nerve fibers, starting from the Retinal Nerve Fiber Layer (RNFL) thickness around the optic disc, to estimate individual age-corrected 24-2 SAP values. Recursive passes through the proposed network sequentially yield estimates of the visual locations progressively farther from the optic disc. While all the methods used for our experiments exhibit lower performance for the advanced disease group (possibly due to the “floor effect” for the SDOCT test), the proposed network is observed to be more accurate than all the baselines for estimating the individual visual field values. We further augment the proposed network to additionally predict the SAP Mean Deviation values and also facilitate the assignment of higher weightage to the underrepresented groups in the data. We then study the resulting performance trade-offs of the RetiNerveNet on the early, moderate and severe disease groups.

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“…ICD and CPT codes used for inclusion and exclusion in the study have been described in detail previously. 11 Finally, subjects were required to have at least two valid SD-OCT scans (see below) and two IOP measures with GAT on different days over a minimum follow-up period of 6 months.…”

Section: Methodsmentioning

confidence: 99%

“…1 Although reducing intraocular pressure (IOP) helps to decrease the risk of the onset and progression of glaucomatous disease, [2][3][4][5][6] many eyes with relatively low IOP continue to progress while others with high IOP levels never develop damage. [7][8][9][10][11] Aging plays an important role in glaucoma, as the prevalence of glaucoma increases exponentially with age. 12,13 However, the pathophysiology underlying increasing age as a risk factor for glaucoma is not well understood.…”

mentioning

confidence: 99%

The Effect of Age on Increasing Susceptibility to Retinal Nerve Fiber Layer Loss in Glaucoma

Jammal

Berchuck

Costa

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To determine whether aging modifies the effect of intraocular pressure (IOP) on progressive glaucomatous retinal nerve fiber layer (RNFL) thinning over time. METHODS. This was a retrospective cohort study involving patients with glaucoma or suspected of having glaucoma who were followed over time from the Duke Glaucoma Registry. Rates of RNFL loss from spectral-domain optical coherence tomography (SD-OCT) were used to assess disease progression. Generalized estimating equations with robust sandwich variance estimators were used to investigate the effects of the interaction of age at baseline and mean IOP on rates of RNFL loss over time. Models were adjusted for gender, race, diagnosis, central corneal thickness, follow-up time, and baseline disease severity. RESULTS. The study included 85,475 IOP measurements and 60,026 SD-OCT tests of 14,739 eyes of 7814 patients. Eyes had a mean follow-up time of 3.5 ± 1.9 years. The average rate of change in RNFL thickness was-0.70 μm/year (95% confidence interval,-0.72 to-0.67). There was a significant interaction between age and mean IOP and the rate of RNFL loss (P = 0.001), with older eyes having significantly faster rates of RNFL loss than younger ones for the same level of IOP. The effect of IOP on rates of change was greater in the inferior and superior regions of the optic disc. CONCLUSIONS. Age is a significant modifier of the relationship between IOP and glaucomatous loss in RNFL thickness over time. Older patients may be more susceptible to glaucomatous progression than younger patients at the same level of IOP.

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Impact of Intraocular Pressure Control on Rates of Retinal Nerve Fiber Layer Loss in a Large Clinical Population

Cited by 36 publications

References 40 publications

A multicenter, open-label study of netarsudil for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension in a real-world setting

A multicenter, open-label study of netarsudil for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension in a real-world setting

RetiNerveNet: using recursive deep learning to estimate pointwise 24-2 visual field data based on retinal structure

The Effect of Age on Increasing Susceptibility to Retinal Nerve Fiber Layer Loss in Glaucoma

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