Impact of Vision Loss on Costs and Outcomes in Medicare Beneficiaries With Glaucoma

Bramley, Thomas

doi:10.1001/archopht.126.6.849

Cited by 92 publications

(63 citation statements)

References 55 publications

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“…By strengthening emotional brain reactivity in these areas, ambient blue light in the responses of the thalamus (including in the pulvinar) and in the brainstem related to auditory cognitive tasks might promote accurate and contrasting responses to emotional signals, which could ultimately enhance efficient mood regulation processes. In fact, recent reports showed that prolonged darkness or lack of light in rodents induces a depression-like state associated with structural brain changes (46), whereas complete blindness increases depression risk (47). Likewise, long-term changes in ambient light daily profile, such as light therapy, seem to restore normal mood regulation (1,2), and the spectral composition of light changes across the seasons (48).…”

Section: Discussionmentioning

confidence: 99%

Spectral quality of light modulates emotional brain responses in humans

Vandewalle

Schwartz

Grandjean

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

205

160

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Light therapy can be an effective treatment for mood disorders, suggesting that light is able to affect mood state in the long term. As a first step to understand this effect, we hypothesized that light might also acutely influence emotion and tested whether short exposures to light modulate emotional brain responses. During functional magnetic resonance imaging, 17 healthy volunteers listened to emotional and neutral vocal stimuli while being exposed to alternating 40-s periods of blue or green ambient light. Blue (relative to green) light increased responses to emotional stimuli in the voice area of the temporal cortex and in the hippocampus. During emotional processing, the functional connectivity between the voice area, the amygdala, and the hypothalamus was selectively enhanced in the context of blue illumination, which shows that responses to emotional stimulation in the hypothalamus and amygdala are influenced by both the decoding of vocal information in the voice area and the spectral quality of ambient light. These results demonstrate the acute influence of light and its spectral quality on emotional brain processing and identify a unique network merging affective and ambient light information.ight therapy is the treatment of choice for seasonal affective disorder (SAD) and is a promising treatment for other major affective disorders (1, 2), suggesting that light can modulate mood in the long term. To better understand this effect and because neural networks involved in emotional behavior have been implicated in mood disorders (3), we first assessed whether light can acutely influence normal brain emotional processing. Indeed, ambient light is known to regulate processes other than vision, such as hormone secretion, body temperature, and sleep, but also alertness and cognition (4-8). These nonclassical [also called "non-image-forming" or "nonvisual" response, but see recent findings (9)] responses to light are mediated through a nonclassical photoreception system, which is maximally sensitive to blue light (≈480 nm), as opposed to the classical photopic luminance visual pathways, maximally sensitive to green light (≈550 nm), and recruits the recently discovered intrinsically photosensitive retinal ganglion cells (ipRGC) expressing the photopigment melanopsin, in addition to rods and cones (7,(10)(11)(12)(13).The impact of ambient light is detected in the longer term through the regulation of circadian rhythms (4, 7), and the benefit of light therapy on mood has been proposed to be mediated through a long-term circadian effect (14). However, nonclassical responses to ambient light also result in acute physiological changes. For example, ambient light significantly modulates ongoing cognitive brain function, including attention, working memory, updating, and sensory processing, within a few tens of seconds (6,(15)(16)(17)(18). The amygdala, a core component of the emotional brain (3, 19) that receives sparse direct projections from ipRGC (20), is one of the brain areas acutely affected by changes in ambie...

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Section: Discussionmentioning

confidence: 99%

Spectral quality of light modulates emotional brain responses in humans

Vandewalle

Schwartz

Grandjean

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

205

160

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“…As the cost of treating glaucoma increases by 46% after the occurrence of vision loss, 69 delaying disease-related vision loss in POAG is not solely critical to maintain patients' quality of life but also to reduce associated health-economic burdens. Screening for early-stage POAG using saccadic eye movements can potentially complement ongoing endeavors for a timely detection of this debilitating disease.…”

Section: 98mentioning

confidence: 99%

Disrupted Eye Movements in Preperimetric Primary Open-Angle Glaucoma

Najjar

Sharma

Drouet

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. Primary open-angle glaucoma (POAG) can be associated with abnormal ocular motor behavior, possibly as a compensatory strategy following visual field loss. The aim of this study was to explore the characteristics of saccadic eye movements in patients with early-stage POAG without any detectable glaucomatous visual field loss (i.e., preperimetric POAG).METHODS. Binocular eye movements were explored in 16 patients with bilateral preperimetric POAG and 16 age-matched healthy controls in a cross-sectional, observational study. Visually guided horizontal prosaccades (58, 108, 158, and 208 amplitude) and antisaccades (128 amplitude) were measured using infrared oculography. The latency, average and peak velocities, amplitude and gain of prosaccades as well as the percentage of errors in the antisaccades task were compared between groups.RESULTS. POAG patients exhibited a reduced average velocity of saccades compared to controls across all amplitudes of peripheral visual target presentation (P ¼ 0.03). Saccades performed by POAG patients were hypometric, and with reduced amplitude (P ¼ 0.007) and gain (P ¼ 0.01) compared to controls. On average, POAG patients displayed more antisaccade errors (40.6%), as compared to controls (23.4%; P ¼ 0.04).CONCLUSIONS. Here, we show that patients with POAG without detectable glaucomatous visual field loss exhibit altered saccadic eye movements. These abnormalities may indicate disordered cortical and subcortical saccadic regulation, either on the basis of subthreshold visual impairment, or as a result of wider disease-associated neurodegeneration. Additional studies, controlling for glaucoma medications, are required to delineate the neural basis of eye movement abnormalities associated with POAG.

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“…Annual eye care-related costs for glaucoma patients with no vision loss were $8157 (2007 US dollars); this increased to $14,237 for moderate to severe vision loss before reaching $18,670 for patients blinded by the disease. 5 A major risk factor for glaucoma is age; however, the only modifiable risk factor -and the sole target for clinical intervention -is elevated intraocular pressure (IOP). 6 First line treatment for glaucoma is the use of topical eye drops containing IOP-lowering drugs.…”

Section: Introductionmentioning

confidence: 99%

Nanosponge-Mediated Drug Delivery Lowers Intraocular Pressure

Lambert

Carlson

Ende

et al. 2015

Trans. Vis. Sci. Tech.

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Purpose: We examined the efficacy of an extended-release drug delivery system, nanosponge (NS) encapsulated compounds, administered intravitreally to lower intraocular pressure (IOP) in mice.Methods: Bilateral ocular hypertension was induced in mice by injecting microbeads into the anterior chamber. Hypertensive mice received NS loaded with ocular hypotensive drugs via intravitreal injection and IOP was monitored. Retinal deposition and retinal ganglion cell (RGC) uptake of Neuro-DiO were examined following intravitreal injection of Neuro-DiO-NS using confocal microscopy.Results: Brimonidine-loaded NS lowered IOP 12% to 30% for up to 6 days (P , 0.02), whereas travoprost-NS lowered IOP 19% to 29% for up to 4 days (P , 0.02) compared to saline injection. Three bimatoprost NS were tested: a 400-nm NS and two 700-nm NS with amorphous (A-NS) or amorphous/crystalline (AC-NS) crosslinkers. A single injection of 400 nm NS lowered IOP 24% to 33% for up to 17 days compared to saline, while A-NS and AC-NS lowered IOP 22% to 32% and 18% to 26%, respectively, for up to 32 days (P , 0.046). Over time retinal deposition of Neuro-DiO increased from 19% to 71%; Neuro-DiO released from NS was internalized by RGCs.Conclusions: A single injection of NS can effectively deliver ocular hypotensive drugs in a linear and continuous manner for up to 32 days. Also, NS may be effective at targeting RGCs, the neurons that degenerate in glaucoma.Translational Relevance: Patient compliance is a major issue in glaucoma. The use of NS to deliver a controlled, sustained release of therapeutics could drastically reduce the number of patients that progress to vision loss in this disease.

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Impact of Vision Loss on Costs and Outcomes in Medicare Beneficiaries With Glaucoma

Cited by 92 publications

References 55 publications

Spectral quality of light modulates emotional brain responses in humans

Spectral quality of light modulates emotional brain responses in humans

Disrupted Eye Movements in Preperimetric Primary Open-Angle Glaucoma

Nanosponge-Mediated Drug Delivery Lowers Intraocular Pressure

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