Search Results for: Glaucoma

Background
The growing global burden of diabetes suggests a currently unrealised growth in prevalence of eye disease. This prospective observational study addresses gaps in evidence of blood sugar control as a risk factor for the diagnosis of glaucoma, diabetic eye disease, macular degeneration and cataract using waves 2–9 (2004–2019) of the English Longitudinal Study of Ageing.

Methods
Logistic regression modelling is used to predict the probability of self-reported diagnosis of four eye conditions separately over a 14-year period in a community-dwelling sample in England. Analysis of approximately 29 000 person observations over eight study waves from around 5600 participants for each eye disease is conducted with an average of 5.7 waves per participant. Participants’ baseline blood sugar control is categorised as non-diabetic (diabetes not previously diagnosed and glycated haemoglobin (HbA1c)

Objectives
To investigate the incidence and determinants of glaucoma in an elderly Chinese population, and clinical, mental health and economic impacts.

Design
This nationally representative, longitudinal study assessed self-reported 6-year (from 2011 to 2018) incident glaucoma diagnosis by a physician and measured biological, clinical and socioeconomical participant characteristics at baseline and endline.

Setting
In the first stage, 150 county-level units from across China were randomly selected with a probability-proportional-to-size sampling technique from a frame containing all county-level units nationwide. The sample was stratified by region and within region by urban district or rural county and per capita gross domestic product. The final sample of 150 counties included 30 out of 31 provinces and autonomous regions in China.

Participants
Consenting, community-dwelling Chinese persons aged 50 years and older.

Primary and secondary outcome measures
Incident glaucoma incidence (primary), factors associated with incident glaucoma (secondary), impact of glaucoma (secondary).

Results
Among 9973 individuals, 3.4% reported a glaucoma diagnosis between 2011 and 2018; Central China had the highest incidence (3.95%) and Eastern China the lowest (2.64%) between 2011 and 2018. Those diagnosed with glaucoma during 2011 and 2018 were of older age (beta coefficient: 0.050, 95% CI: 0.001, 0.001, p

Objectives
Glaucoma is a major cause of irreversible blindness in India; however, if detected early, its progression can be either prevented or stabilised through appropriate medical or surgical treatment. We aim to evaluate the cost–utility of various models for population-based glaucoma screening at primary health centres in India. We also assess the potential impact of the implementation of a population-based screening programme on overall costs of care for glaucoma.

Design
Cost–utility analysis using a mathematical model comprising a decision tree and Markov model was conducted to simulate relevant costs and health outcomes over a lifetime horizon.

Setting
Screening services were assumed to be delivered at primary health centres in India.

Participants
A hypothetical cohort of different target population groups in terms of age groups and risk of glaucoma (age group 40–75 years, 50–75 years, 40–75 years age group at high risk of glaucoma, 50–75 years age group at high risk of glaucoma) were included in comparative screening strategies.

Interventions
The exclusive intervention scenarios were 12 screening strategies based on different target population groups (age group 40–75 years, 50–75 years, 40–75 years age group at high risk of glaucoma, 50–75 years age group at high risk of glaucoma), screening methods (face-to-face screening and artificial intelligence-supported face-to-face screening) and screening frequencies for 40–75 years aged population (annual vs once every 5 years screening), in comparison to usual care scenario. The usual care scenario (current practice) implied opportunistic diagnosis by the ophthalmologists at higher levels of care.

Primary and secondary outcomes
The primary outcome was the incremental cost–utility ratio for each of the screening strategies in comparison to usual care. The secondary outcomes were per person lifetime costs, lifetime out-of-pocket expenditures, life years and quality-adjusted life-years (QALYs) in all screening scenarios and usual care.

Findings
Depending on the type of screening strategy, the gain in QALY per person ranged from 0.006 to 0.046 relative to usual care. However, the screening strategies, whether adjusted for specific age groups, patient risk profiles, screening methods or frequency, were not found to be cost-effective. Nonetheless, annual face-to-face screening strategies for individuals aged 40–75 years could become cost-effective in a scenario of strengthened public financing and provisioning, such that at least 67% of those seeking care for confirmatory diagnosis and treatment use government-funded facilities, in conjunction with 60% availability of medications at government hospitals.

Conclusions
Enhancing continuity of care following screening through either strengthening of public provisioning or strategic purchasing of care could make glaucoma screening interventions not only cost-effective, but also potentially cost-saving.

Background
Primary glaucoma patients faced many difficulties that affected their treatment during the COVID-19 pandemic. Glaucoma treatment often starts with prescription eye-drops. However, delays in ophthalmic therapy often occur due to poor awareness of the dangers of glaucoma, which subsequently leads to irreversible visual field defects and eventual blindness.

Objective
This study aimed to explore the social, personal and medical factors that contributed to barriers in the treatment of primary glaucoma during the COVID-19 pandemic, with the overarching goal of providing insights to develop measures that can identify the barriers of the treatment process and prevent consequent adverse outcomes.

Methods
We adopted a phenomenological approach and used purposive sampling to recruit 122 patients into our study. Face-to-face, semistructured, one-on-one interviews were conducted in a private office. The data were analysed using Colaizzi’s seven-step method. In cases where classification was difficult, consensus was reached among the three researchers who formed the core assessment team.

Results
A total of 122 glaucoma patients experienced delayed pharmaceutical treatment during the outbreak. Delays were longer among females and patients over 75 years old, highlighting that treatment delays were a significant issue for glaucoma patients during the COVID-19 pandemic, particularly for older females. Coding of the transcripts yielded three themes (eight subthemes): (1) the impact of social support on glaucoma pharmaceutical treatment: (a) the inability to seek pharmaceutical treatment alone and (b) online reservation and payment requirements; (2) the impact of personal reasons on glaucoma pharmaceutical treatment: (c) fear of being infected with COVID-19, (d) being infected with COVID-19 or coming into contact with COVID-19 patients, (e) being busy with work or life; (3) the impact of medical resources on glaucoma pharmaceutical treatment: (f) abnormal diagnosis and treatment processes, (g) insufficient medical manpower and (h) insufficient communication from medical staff.

Conclusions
To prevent medication delays and potential irreversible damage to the visual field in primary glaucoma patients during health crises, it is essential to further explore personalised strategies for coping with the impact of pandemics. Special attention should be given to glaucoma patients facing significant life burdens, such as the elderly and females, and efforts should be made to increase their awareness of the risks of glaucoma. Future studies could explore the feasibility of providing more support to glaucoma patients, such as online payment and appointment scheduling options, to reduce delays and alleviate patient anxiety.

Dal 9 al 15 marzo la Settimana mondiale della malattia

Introduction
The primary therapeutic approach to glaucoma involves the long-term use of intraocular pressure (IOP)-lowering eyedrops. However, the prevalent use of benzalkonium chloride (BAK) as a preservative in glaucoma eyedrops has been associated with ocular side effects, prompting a demand for alternatively preserved (AP) or preservative-free (PF) eyedrops. Studies comparing various preservatives have shown conflicting evidence concerning the safety of BAK-preserved (BP) eyedrops, some studies indicating no notable concerns and others reporting adverse effects. The current protocol concerns a network meta-analysis enabling systematic investigation of the IOP-lowering efficacy and safety profiles of BP, AP and PF eyedrops in patients with glaucoma for whom randomised controlled trials (RCTs) are available.

Methods and analysis
This study will evaluate the IOP-lowering effects of glaucoma eyedrops, comparing formulations with and without preservatives in patients with glaucoma. A systematic search for RCTs, regardless of language or publication date, will be conducted across three electronic databases (Cochrane search engine, Embase and MEDLINE) from 1 March 2024. Two reviewers will conduct a sequential screening of titles and abstracts, followed by full-text papers, to extract useful data. The two reviewers will also assess the internal validity of studies using the relevant and domain-based risk of bias assessment tool. Overall evidence quality will be assessed using the Confidence in Network Meta-Analysis approach and presented in summarised form with network diagrams. Forest plots will be generated for enhanced visualisation of the included glaucoma eyedrops’ effects, and pairwise effect sizes will be calculated based on available evidence in the network.

Ethics and dissemination
No ethics review or approval is required for this work, as it will synthesise evidence obtained from published studies. A paper presenting the findings will be submitted to a peer-reviewed journal for publication.

PROSPERO registration number
CRD42024498328

Introduction
Glaucoma is one of the most common causes of blindness and affects more than 70 million people worldwide. The disease is characterised by the loss of retinal ganglion cells associated with a progressive optic neuropathy, resulting in an impairment of visual functions, for example, visual field loss. Nowadays, the only modifiable risk factor is the increase in intraocular pressure, and its treatment is to lower this pressure by medication, laser treatment or surgery to avoid disease progression. New methods for preventing and reversing vision loss are thus urgently needed. Several small and two multicentre studies have presented evidence that repetitive transorbital alternating current stimulation (rtACS) can lead to long-lasting visual field improvement. This could open a new and inexpensive therapeutic option for optic atrophy. However, the level of evidence for this method is still fairly rather poor, and further trials are needed. Therefore, this clinical trial aims to prove the effectiveness of rtACS compared with sham stimulation in patients with primary open-angle glaucoma (POAG).

Methods and analysis
VIRON (Vision Restoration in Optic Neuropathy) is a national, multicentre, prospective, randomised, placebo-controlled, double-blind trial with three arms. The primary objective is to assess the effectiveness of rtACS in patients with POAG compared with sham stimulation. The primary outcome is the change in mean defect (MD) in the visual field immediately after 10 sessions of rtACS (days 9, 16 and 23) compared with the values of initial perimetry (days –21 to –14 and 0) after applying electrical stimulation with a classical montage, compared with sham and electrical stimulation using individualised montage. Secondary outcome measures comprise a long-term effect with changes in MD at 24 weeks after stimulation, and data from the National Eye Institute Visual Function-25 and quality of life (Short Form 36) questionnaires. The target population are patients with glaucomatous optic atrophy and significant glaucomatous visual field defects (MD of 5–22 dB) due to POAG.
After randomisation, patients received either classical rtACS (group 1), individual rtACS (group 2) or sham stimulation (group 3) in daily 25 min stimulation sessions in two series of five consecutive days separated by a weekend interval. In group 1, active stimulation will be via the routinely applied montage using two electrodes affixed on the right and left side of the head, next to the eyes, with straightforward fixation. In group 2, the current flow will be individually modelled (MRI-based) to target areas of partial visual field defects by optimising electrode positions in conjunction with an optimised visual fixation direction. Group 3 with sham stimulation will serve as control.
The calculated sample size required to achieve a statistical power of 80% for a relevant effect size and allow for dropouts was 300 (100 per group). The trial has already begun with the first patient in July 2023. The planned recruitment period is 24 months with an estimated end of the study in November 2025 (last patient out). An adjusted extension of the study period is planned.

Ethics and dissemination
VIRON was approved by the Central Ethics Committee of the University Medical Center Göttingen (19 October 2022) and those of the individual participating centres (Bonn: 446/23-EP, Hamburg: 2023-200889-BO-bet, Cologne: 23-1487 and Mainz: 2023-17399-§23b). The study protocol complies with the Declaration of Helsinki, the national medicine device regulation (MDR) laws and the international standards of good clinical practice (GCP).
The study protocol (V.5, 24 November 2023) was designed following the Standard Protocol Items: Recommendations for Interventional Trials guidelines and is registered on https://drks.de/search/de/trial/DRKS00029129.
As study initiatior the University Medical Center Göttingen (UMG) is responsible for data ownership and data management of the VIRON study. The study data will be published within 6 months of the study being completed. After the publication of the primary results, all data are anonymised and published in an open-access journal to ensure access to the data for third parties.

Trial registration number
https://drks.de/search/de/trial/DRKS00029129.

Purpose
To investigate the characteristics and publication status of minimally invasive glaucoma surgery (MIGS) clinical trials registered on ClinicalTrials.gov.

Design
A cross-sectional study.

Methods
All 1212 interventional glaucoma trials registered on ClinicalTrials.gov with start dates between 1 October 2007 and 30 April 2024 were included. All trials were categorised into ‘MIGS trials’ and ‘other interventional glaucoma trials’. Based on the anatomical site of action and the research content, MIGS trials were classified into different groups, and intergroup comparisons were conducted. The characteristics and publication status of MIGS trials were comprehensively analysed.

Results
Compared with all other interventional glaucoma trials, MIGS trials had a higher proportion of single-arm trials (p

Objective
Adaptive coping mechanisms (ACMs) are effective ways to cope with stress and anxiety in patients with chronic illnesses, such as glaucoma. This study aimed to assess the proportion of ACM and associated factors among adult glaucoma patients enrolled at the tertiary eye care and training centre in Northwest Ethiopia.

Design
An institution-based cross-sectional study.

Setting
This study was conducted at a tertiary eye care and training centre in Northwest Ethiopia from 15 May 2022 to 30 June 2022.

Participants
The study included a sample of 398 adult glaucoma patients selected using a systematic random sampling technique.

Primary and secondary outcome measures
The participants were diagnosed with glaucoma by ophthalmologists. Optometrists conducted interviews, reviewed medical records and administered a pretested, structured questionnaire based on the Brief Coping Orientation to Problems Experienced inventory. Binary logistic regression was performed to identify associated factors, with significance considered at a p

Objective
This study aimed to assess the prevalence of cataract and associated factors among adults aged 40 years and above in Durame town, Southern Ethiopia.

Design
A community-based cross-sectional study was conducted using a systematic random sampling method.

Setting
The study was conducted in Durame town, Southern Ethiopia.

Participants
The study included 734 adults aged ≥40 years who lived in Durame town for more than 6 months.

Main outcome measures
Data were collected using face-to-face interviews completed by an interviewer and ophthalmic examinations.

Results
A total of 734 study participants aged 40 years and above were involved. The prevalence of cataract was 29.16% (95% CI: 25.89% to 32.59%). Factors associated with the prevalence of cataract were older age of 70–95 years (adjusted odds ratio (AOR)=8.60, 95% CI: 3.09 to 23.90), being diabetic (AOR=2.27, 95% CI: 1.37 to 3.74), exposure to sunlight (AOR=2.83, 95% CI: 1.45 to 5.53), trauma to eye (AOR=2.39, 95% CI: 1.19 to 4.81), hypertension (AOR=1.86, 95% CI:1.16 to 2.99) and glaucoma (AOR=5.36,95% CI: 3.13 to 9.18).

Conclusion
The prevalence of cataract was lower than previous national survey results. Old age, known history of trauma to eye, hypertension, diabetes, exposure to sunlight and glaucoma had statistically significant association with cataract.

Objectives
To identify suitable patients for glaucoma home monitoring and explore clinicians’ perceptions of the possible benefits and risks of home monitoring within the National Health Service.

Design
An online survey composed of open-ended and closed-ended questions.

Setting
Secondary care.

Participants
Glaucoma specialists registered with the UK and Eire Glaucoma Society.

Outcome measures
Agreement with clinical scenarios.

Results
The estimated response rate was 68% (n=49). Of 49 participants, 92% (n=45) were consultant ophthalmologists and 71% (n=35) had over 10-year experience. There was a poor agreement regarding an ideal glaucoma patient for home monitoring, with only one scenario achieving over 60% agreement. Most participants believed that home monitoring would be most suitable for low-risk scenarios, rather than high-risk, due to fear of missing progression. In relation to acceptability, key facilitators included the potential to increase healthcare capacity and promote patient safety. However, low clinician trust in equipment reliability and fear of patient harm were reported as concerns.

Conclusions
There was no clear consensus on which patients would benefit most from glaucoma home monitoring. While many clinicians believe home monitoring may enhance healthcare, there were also many concerns about the technologies themselves. Further work to address clinician concerns is warranted.

Research Registry registration number
6213.

More than 1 million people in the US and more than 40 million people worldwide are bilaterally blind (ie, visual acuity

Circulation, Volume 150, Issue Suppl_1, Page A4135239-A4135239, November 12, 2024. A 67-year-old male with a history of hypertension presented to the emergency department with abnormal cardiac monitor results. Prior to this, he was diagnosed with primary open-angle glaucoma by ophthalmology and underwent left-sided aqueous tube shunt placement, which was complicated by hypotony requiring revision and holding of all topical glaucoma medications. Concurrently, he was noted to have an irregular heart rhythm during a routine physical. In office ECG showed normal sinus rhythm, but subsequent 14-day continuous ECG monitor showed sinus bradycardia with nadir heart rate of 21 beats-per-minute and 114 ventricular pauses (longest 4.8 seconds) primarily due to second-degree atrioventricular (AV) block, Mobitz type 1, but also periods of high-grade AV block. He was sent to the emergency department for expedited pacemaker evaluation. On further review, heart block and ventricular pauses occurred exclusively over a 12-hour period that temporally coincided with a hospitalization for acute ocular hypertension following shunt revision. His intraocular pressure peaked at 56 mmHg (normal range 10-21 mmHg), then normalized to 21 mmHg after acetazolamide and anterior chamber paracentesis. Bradycardia resolved following ophthalmic intervention. Bradyarrhythmias were attributed to excess vagal tone from acute ocular hypertension via an atypical but recognized cause of the oculocardiac reflex, and pacemaker placement was avoided.The oculocardiac reflex is a reflex bradycardia involving the trigeminal and vagus nerves. Cardiac effects are consistent with other vagally-mediated bradyarrhythmias, including sinus bradycardia, AV block, and even asystole. This reflex occurs commonly during traction on extraocular muscles during strabismus surgery, but can be seen in other orbital and ocular stimuli. To our knowledge, this is the first documented case of ocular hypertension leading to atrioventricular block through this mechanism. This case illustrates the importance of (1) clinical context of abnormal events during extended cardiac monitoring, (2) understanding the oculocardiac reflex as a cause of bradyarrhythmias, and (3) ruling out reversible medical causes of dysrhythmias prior to permanent device implantation.

His eyes wash over families of fruit, crushed cardboard, sticky hands. The trick is to be molecular: a watermelon sick with jaundice is no good, mushy inside. Carries disease internal to itself. Like how cells hold instructions for their own death or how birds always know the way home. His eyes washed with chemical droplets and still unseeing. Like light flushed down the sink. Shade of white so brutal it could kill you. Choose the roundest, brightest fruit, says Appa. Glaucoma, from glausso, from glow, the consequences of blurred closeness, of seeing beyond yourself. Any wound but this. Fruit with the darkest stripes. It is a kind of science. Like the weather forecast and like poetry. His eyes wash over his daughter’s face. The bravery of searching for sweetness where there is only dust.

Objective
To investigate the views, hopes and concerns of patients living with glaucoma and age-related macular degeneration (AMD) regarding vision home-monitoring.

Design
Qualitative study using focus groups and questionnaires. Participants were given three disease-relevant home-monitoring tests to try. The tests consisted of three visual field tests for the glaucoma groups (Melbourne Rapid Fields, Eyecatcher, Visual Fields Fast) and three acuity and/or contrast-sensitivity tests for AMD groups (Alleye, PopCSF, SpotChecks). Focus group data were thematically analysed.

Setting
University meeting rooms in London, UK.

Participants
Eight people with glaucoma (five women, median age 74) and seven people with AMD (four women, median age 77) volunteered through two UK-based charities. Participants were excluded if they did not self-report a diagnosis of glaucoma or AMD or if they lived further than a 1-hour travel distance from the university (to ensure minimal travel burden on participants).

Results
Six themes emerged from focus groups, the two most frequently referenced being: ‘concerns about home-monitoring’ and ‘patient and practitioner access to results’. Overall, participants believed home-monitoring could provide patients with a greater sense of control, but also expressed concerns, including: the possibility of home-monitoring replacing face-to-face appointments; the burden placed on clinicians by the need to process additional data; struggles to keep up with requisite technologies; and potential anxiety from seeing worrying results. Most devices were scored highly for usability, though several practical improvements were suggested.

Conclusion
Patients with mild-to-moderate glaucoma/AMD expect vision home-monitoring to be beneficial, but have significant concerns about its potential implementation.

Objectives
To assess whether patients from minority ethnic groups have different perceptions about the quality-of-life outcomes that matter most to them.

Design
Cross-sectional observational study.

Setting
High volume eye centres serving the most ethnically diverse region in the UK, recruiting from July 2021 to February 2022.

Participants
511 patients with primary open-angle glaucoma and the predisease state of ocular hypertension.

Main outcome measures
The main outcome was participants’ self-reported priorities for health outcomes.

Results
Participants fell into one of four clusters with differing priorities for health outcomes, namely: (1) vision, (2) drop freedom, (3) intraocular pressure and (4) one-time treatment. Ethnicity was the strongest determinant of cluster membership after adjusting for potential confounders. Compared with white patients prioritising vision alone, the OR for black/black British patients was 7.31 (95% CI 3.43 to 15.57, p