Journal of Current Glaucoma Practice

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2023 | July-September | Volume 17 | Issue 3

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EDITORIAL

Nidhi Chauhan

Optimizing Glaucoma Care: A Holistic Approach

[Year:2023] [Month:July-September] [Volume:17] [Number:3] [Pages:2] [Pages No:111 - 112]

   DOI: 10.5005/jp-journals-10078-1416  |  Open Access |  How to cite  | 

450

ORIGINAL RESEARCH

Ngozika E Ezinne, Michael A Kwarteng, Kingsley K Ekemiri, Victoria I Iroanachi, Selassie Tagoh, Grace Ogbonna, Khathutshelo P Mashige

Clinical Profile of Primary Open-angle Glaucoma Patients at an Eye Center in Nigeria

[Year:2023] [Month:July-September] [Volume:17] [Number:3] [Pages:5] [Pages No:113 - 117]

Keywords: Abuja, Central cornea thickness, Intraocular pressure, Nigeria, Primary open-angle glaucoma, Retinal nerve fiber layer thickness

   DOI: 10.5005/jp-journals-10078-1413  |  Open Access |  How to cite  | 

Abstract

Aim: Globally, one of the leading causes of preventable blindness is primary open-angle glaucoma (POAG). The study assessed the clinical presentations of POAG patients attending an eye center in Abuja, Nigeria. Materials and methods: Records of 188 eyes, collected from 94 patients diagnosed with POAG for a period of 1 year at the eye center, were reviewed. Clinical records, including age, gender, visual acuity (VA), central cornea thickness (CCT), intraocular pressure (IOP), cup-to-disk ratios, and retinal nerve fiber layer (RNFL) thickness of the participants, were extracted and analyzed. Results: The majority of the participants were males (56.4%) and adults (57.4%), most of whom had normal VA (>70% in each eye). Our analysis revealed normal average estimates of RNFL thickness, IOP, and CCT among the participants. Females had thicker RNFL compared to males (p = 0.02). Although CCT decreased with age (r = −0.28, p = 0.005), there was no such link between IOP and CCT (r = 0.09, p = 0.38). Conclusion: Central cornea thickness (CCT), RNFL thickness, and IOP in isolation should not be used as early indicators for POAG; rather, a combination of these and other indices is recommended. Early detection through active screening and treatment in the community for at-risk groups is highly advised.

452

ORIGINAL RESEARCH

Muge Toprak, Nursen Yuksel, Gurler Akpinar, Murat Kasap, Dilara Pirhan, Busra Yilmaz Tugan

Comparative Proteomic Analysis of the Aqueous Humor from Patients with Pseudoexfoliation Syndrome

[Year:2023] [Month:July-September] [Volume:17] [Number:3] [Pages:8] [Pages No:118 - 125]

Keywords: Apolipoprotein A4, Liver X receptor, Pseudoexfoliation, Retinoid X receptor, Transthyretin

   DOI: 10.5005/jp-journals-10078-1411  |  Open Access |  How to cite  | 

Abstract

Purpose: The goal of this study was to pinpoint potential molecular pathways that may have contributed to the onset of pseudoexfoliation syndrome (PEX), a systemic illness associated with aging that has no known cause and is brought on by the deposition of fibrillary white flaky debris in ocular tissues. Materials and methods: Protein pools representing each group were created using two-dimensional gel electrophoresis (2DE) in conjunction with a matrix-assisted laser desorption ionization-time of flight/time of flight (MALDI-TOF/TOF) mass spectrometer. Aqueous humor (AH) from patients with PEX and cataracts was also collected for a comprehensive study of the data; ingenuity pathway analysis (IPA) was used for the discovered proteins. Results: In comparison to controls, 2DE showed that 10 sites in PEX patients had differently altered gene expression. Two of these proteins, transthyretin (TTR) and apolipoprotein A4 (ApoA4) were significantly overexpressed in PEX patients, but the remaining proteins were only mildly altered. The liver X receptor (LXR) and the retinoid X receptors (RXR) may play a crucial role in the pathophysiology of PEX according to IPA employing these 10 proteins. Conclusion: The altered proteins, particularly ApoA4 and TTR, may be important in revealing the molecular process behind PEX, as anticipated by IPA.

385

ORIGINAL RESEARCH

Elizabeth C Ciociola, Kush Patel, Tyler Blahnik, Arko Ghosh, Meredith R Klifto, David Fleischman

A Retrospective Cohort Study on the Difficulties of Diagnosing and Managing Glaucoma in Patients with Coexistent Neurodegenerative Disease

[Year:2023] [Month:July-September] [Volume:17] [Number:3] [Pages:8] [Pages No:126 - 133]

Keywords: Cerebrovascular accident, Cohort study, Dementia, Glaucoma, Multiple sclerosis, Parkinson's disease

   DOI: 10.5005/jp-journals-10078-1415  |  Open Access |  How to cite  | 

Abstract

Aim: To investigate the limitations of diagnosing glaucoma in patients with coexistent neurodegenerative disease (NDD) by collecting information on demographics, examination findings, optical coherence tomography (OCT), and visual field (VF) tests. Materials and methods: Retrospective cohort study of patients with primary open-angle glaucoma and coexistent dementia, multiple sclerosis (MS), Parkinson's disease (PD), or cerebrovascular accident (CVA) from 2014 to 2020. We included patients with a minimum of 3 years of follow-up. Demographics, ophthalmic exam, OCT, and VF findings were reported and compared across NDD groups using the Chi-squared and analysis of variance tests. Results: We included 199 patients with glaucoma and coexistent NDD, including dementia (51.3%), CVA (11.2%), PD (18.1%), and MS (19.6%). Cupping, neuroretinal rim thinning, pallor, and peripapillary atrophy of the optic nerve were most frequently observed. There was a high number of missing values from OCT to VF tests, and zero patients had a complete OCT or VF test. Additionally, 67.8 and 77.4% of patients received <1 OCT and VF/year, respectively. Retinal nerve fiber layer (RNFL) thinning was observed most frequently in the superior (33.2% OD and 30.7% OS) and inferior (25.6% OD and 30.2% OS) quadrants, with the most significant thinning seen in CVA patients compared to other NDDs (p < 0.05). Glaucoma hemifield tests (GHTs) were abnormal in 23.1% OD and 22.6% OS, and the average mean deviation was −7.43 [standard deviation (SD) 8.23] OD and −8.79 (SD 7.99) OS. Conclusion: The OCT and VF tests are frequently unavailable and may be confounded in patients with coexistent glaucoma and NDDs, complicating glaucoma diagnosis and management. Clinical significance: Diagnosing and managing glaucoma in patients with coexistent NDD is difficult, given the lack of available and reliable OCT and VF testing data. Providers may be forced to rely on intraocular pressure (IOP) and other imperfect measures.

428

ORIGINAL RESEARCH

Joseph Da, Matthew Gillings, Shivani Kamat, Niraj Nathan

Outcomes of Trainee-performed MIGS at Parkland Memorial Hospital: A Retrospective Cohort Study

[Year:2023] [Month:July-September] [Volume:17] [Number:3] [Pages:7] [Pages No:134 - 140]

Keywords: Cataract surgery, Minimally invasive glaucoma surgery, Retrospective cohort study, Trainee outcomes

   DOI: 10.5005/jp-journals-10078-1414  |  Open Access |  How to cite  | 

Abstract

Aims and background: As the use of minimally invasive or microinvasive glaucoma surgery (MIGS) continues to expand, it is important to look at its outcomes in the hands of trainees. This study aims to examine the efficacy and safety of Kahook Dual Blade (KDB) goniotomy and endocyclophotocoagulation (ECP) with cataract extraction (CE) done by residents and fellows. Methods: All cases of KDB or ECP performed with CE between 2012 and 2020 at Parkland were reviewed, excluding cases with multiple MIGS procedures or other procedures. Results: A total of 153 eyes of 136 patients who underwent KDB and 125 eyes of 124 patients who underwent ECP were included. Mean intraocular pressure (IOP) decreased from 17.2 ± 5.2 at baseline to 15.4 ± 5.5 mm Hg at postoperative (post-op) month (POM) 12 in the KDB group (p = 0.02) and from 18.6 ± 6.3 at baseline to 15.1 ± 4.9 mm Hg at POM12 in the ECP group (p < 0.001), with wide variation in IOP change among subjects for both. The mean change in IOP across all time points was statistically significant for both groups. Medication counts were reduced from baseline at POMs 1, 3, and 6, but not 12, in both the KDB and ECP groups (p = 0.43 and p = 0.35, respectively). The rate of serious complications was very low; the most common complication was cystoid macular edema (CME) (six cases) and active inflammation beyond POM1 (15 cases) for KDB and ECP, respectively. Conclusion: Combined CE/MIGS procedures performed by trainees were safe but less efficacious in lowering IOP and medications compared to literature reporting outcomes of attending surgeons, apart from ECP/MIGS with regards to IOP lowering, which was found to be similarly efficacious. Clinical significance: Cataract extraction (CE) combined with KDB or ECP in the hands of trainees decreased mean IOP from baseline and was safe. IOP and medication reduction of MIGS/CE in the hands of trainees were overall lesser than reported values by attending surgeons.

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Original Article

Rutvi Chahal, Ankush Jindal, Rohan Bir Singh

Lifestyle Measures for Glaucoma Patients: An Objective Social Media Content Analysis

[Year:2023] [Month:July-September] [Volume:17] [Number:3] [Pages:8] [Pages No:141 - 148]

Keywords: Glaucoma, Lifestyle changes, Patient education, Social media

   DOI: 10.5005/jp-journals-10078-1412  |  Open Access |  How to cite  | 

Abstract

Aim: In this study, we analyze the content quality and characteristics of the most viewed search results on various internet platforms related to lifestyle measures for patients with glaucoma. Materials and methods: In this internet-based cross-sectional study, we used search keywords “glaucoma,” “lifestyle,” “glaucoma,” and “exercise” on the most popular internet platforms—Google, Facebook, YouTube, and Reddit. The top 30 Google searches about each of the keyword combinations were identified. We also assessed the first 30 videos on YouTube and Facebook Watch, the first 30 Reddit posts and the first 30 Google images about each of the keyword combinations. The quality of content from the platforms was evaluated by three independent reviewers using the well-established Sandvik score, Health on Net (HON) code, and risk score for different uploaders. The quality of content regarding lifestyle measures in glaucoma uploaded by healthcare professionals (HCPs) was further evaluated. Results: The established criteria resulted in 48 websites from the Google search engine, 22 videos from YouTube, 37 posts from Reddit, and 28 videos from Facebook Watch, which were included in the final analysis. The mean Sandvik scores were 11.14 ± 1.8 (Google webpages), 10.4 ± 2.19 (YouTube videos), 10.54 ± 2.21 (Facebook Watch), and 4.24 ± 1.18 (Reddit). The mean risk scores were 0.22 ± 0.68 (YouTube videos), 0.18 ± 0.47 (Facebook Watch), and 0.11 ± 0.31 (Reddit). The mean HON code scores were 5.45 ± 1.62 (YouTube), 6.55 ± 1.44 (Google webpages), 5.29 ± 1.04 (Facebook Watch), and 8.27 ± 3.05 (Reddit). The content uploaded by HCPs was primarily from ophthalmologists and had significantly (p < 0.05) higher content quality scores. The majority of the content recommended aerobic exercise as a lifestyle measure in patients with glaucoma as an adjuvant to medical and surgical management. Conclusion: The majority of the content regarding lifestyle measures in glaucoma was uploaded by HCPs and had medically accurate and well-referenced information, especially on Google and YouTube. Clinical significance: Primary care physicians and ophthalmologists can reliably use social media content to guide recently diagnosed patients about the requisite lifestyle measures.

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Original Article

James J Sng, Bryan C H Ang, Wai Cheng Soo Hoo, Angela P H Lim, Hwei Yee Teo, Leonard W L Yip

The Effectiveness of a Nurse-led Glaucoma Education on Patient Knowledge and Compliance Motivation Levels: A 1-year Prospective Case Series

[Year:2023] [Month:July-September] [Volume:17] [Number:3] [Pages:8] [Pages No:149 - 156]

Keywords: Compliance motivation, Glaucoma, Knowledge, Patient education

   DOI: 10.5005/jp-journals-10078-1418  |  Open Access |  How to cite  | 

Abstract

Purpose: To evaluate the impact of a nurse-led glaucoma education program on patient knowledge and compliance levels in an Asian population. Materials and Methods: A 1-year prospective case series involving 69 adult glaucoma patients. Each patient attended a standardized nurse-led glaucoma education session. A questionnaire was administered by a single nurse-clinician and analyzed at three time points (preeducation for baseline, immediately posteducation, and at the 1-year follow-up) to evaluate for associations with patient knowledge and compliance motivation levels. Results: A total of 64 patients were included in the final analysis. Patients with higher educational qualifications or who were employed had better baseline knowledge of glaucoma. Younger patients had higher baseline compliance motivation levels. Immediately posteducation, both median patient knowledge score and compliance motivation levels had a statistically significant increase. Patients on more glaucoma eye drops had greater immediate improvement in confidence in eye drop application. Patients with more positive Humphrey visual field mean deviation values had a greater immediate improvement in confidence in their understanding of glaucoma. A total of 34 patients were readministered the questionnaire at the 1-year time point. Median score for patient knowledge was highest at this point. Employed patients demonstrated better patient knowledge at baseline and at 1-year time point compared to unemployed patients. Unemployed patients experienced a significant improvement in scores from baseline to immediately posteducation, but improvement from immediately posteducation to the 1-year time point was insignificant was insignificant. Conclusion: Our study has examined the effectiveness of a nurse-led glaucoma education program in an Asian population, demonstrating improvement in both patient knowledge and compliance motivation levels up to 1 year after intervention.

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RETROSPECTIVE COHORT STUDY

Elizabeth C Ciociola, Alicia Anderson, Huijun Jiang, Ian Funk, Feng-Chang Lin, Jean-Claude Mwanza, Meredith R Klifto, David Fleischman

Decision Factors for Glaucoma Suspects and Ocular Hypertensive Treatment at an Academic Center

[Year:2023] [Month:July-September] [Volume:17] [Number:3] [Pages:9] [Pages No:157 - 165]

Keywords: Cohort study, Ganglion cell–inner plexiform layer, Glaucoma suspect, Retinal nerve fiber layer, Treatment, Visual field

   DOI: 10.5005/jp-journals-10078-1417  |  Open Access |  How to cite  | 

Abstract

Aims and background: Practice guidelines assert that high-risk glaucoma suspects should be treated. Yet, there is ambiguity regarding what constitutes a high enough risk for treatment. The purpose of this study was to determine which factors contribute to the decision to treat glaucoma suspects and ocular hypertensive patients in an academic ophthalmology practice. Materials and methods: Retrospective cohort study of glaucoma suspects or ocular hypertensives at an academic ophthalmology practice from 2014 to 2020. Demographics, comorbidities, intraocular pressure (IOP), optical coherence tomography (OCT) findings, and visual field measurements were compared between treated and untreated patients. A multivariable logistic regression model assessed predictors of glaucoma suspected treatment. Results: Of the 388 patients included, 311 (80%) were untreated, and 77 (20%) were treated. There was no statistical difference in age, race/ethnicity, family history of glaucoma, central corneal thickness (CCT), or any visual field parameters between the two groups. Treated glaucoma suspects had higher IOP, thinner retinal nerve fiber layers (RNFL), more RNFL asymmetry, thinner ganglion cell–inner plexiform layers (GCIPL), and a higher prevalence of optic disc drusen, disc hemorrhage, ocular trauma, and proliferative diabetic retinopathy (PDR) (p < 0.05 for all). In the multivariable model, elevated IOP {odds ratio [OR] 1.16 [95% confidence interval (CI) 1.04–1.30], p = 0.008}, yellow temporal [5.76 (1.80–18.40), p = 0.003] and superior [3.18 (1.01–10.0), p = 0.05] RNFL quadrants, and a history of optic disc drusen [8.77 (1.96–39.34), p = 0.005] were significant predictors of glaucoma suspect treatment. Conclusion: Higher IOP, RNFL thinning, and optic disc drusen were the strongest factors in the decision to treat a glaucoma suspect or ocular hypertensive patient. RNFL asymmetry, GCIPL thinning, and ocular comorbidities may also factor into treatment decisions. Clinical significance: Understanding the clinical characteristics that prompt glaucoma suspect treatment helps further define glaucoma suspect disease status and inform when treatment should be initiated.

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