Virtual clinics for glaucoma care - Patients' and clinicians' experiences and perceptions: a qualitative evaluation.

Background: The role of glaucoma virtual clinics has developed to help meet demand for capacity within busy glaucoma services. There is limited research of patient and clinician experiences and perceptions of these clinics and the aim of this study is to provide further information to help improve patient experience and guide service delivery.

Methods: A mixed methods research design was employed comprising of a patient satisfaction survey, and patient and clinician interviews.

Defining stable glaucoma: a Delphi consensus survey of UK optometrists with a specialist interest in Glaucoma.

Background: Increasing demand on hospital services has led to the development of alternative community-based services, often run by optometrists for monitoring 'stable' and low-risk glaucoma patients.

Methods: An online Delphi exercise was undertaken to derive a consensus definition of 'stable glaucoma' amongst optometrists with a special interest in glaucoma. Participants were asked to score their agreement for various clinical parameters.

Care pathways for glaucoma detection and monitoring in the UK.

Glaucoma presents considerable challenges in providing clinically and cost-effective care pathways. While UK population screening is not seen as justifiable, arrangements for case finding have historically been considered relatively ineffective. Detection challenges include an undetected disease burden, whether from populations failing to access services or difficulties in delivering effective case-finding strategies, and a high false positive rate from referrals via traditional case finding pathways.

Acceptability and use of glaucoma virtual clinics in the UK: a national survey of clinical leads.

Objective: The purpose of this paper is to describe the findings of a national survey that aimed to estimate the proportion of Hospital Eye Service (HES) units using glaucoma virtual clinics, to determine how these services differ and to gauge clinicians' views and opinions on the safety and acceptability of this model of care compared with usual care.

Methods And Analysis: This 12-question survey was disseminated nationally to 92 clinical lead consultant ophthalmologists using SurveyMonkey.

Results: The response rate was 45.

Adalimumab in refractory cystoid macular edema associated with birdshot chorioretinopathy.

Purpose: To report the clinical outcomes of adalimumab therapy in cases of birdshot chorioretinitis (BCR) with cystoid macular edema (CME) refractory to conventional immunotherapy.

Methods: This is a retrospective case series of three BCR patients treated with adalimumab for refractory CME. The main outcome measure was central subfield thickness (CST) on optical coherence tomography.

A Population-based survey of the prevalence and types of glaucoma in Nigeria: results from the Nigeria National Blindness and Visual Impairment Survey.

Background: Glaucoma is the leading cause of irreversible blindness worldwide. There tends to be a lower reporting of glaucoma in Africa compared to other blinding conditions in global burden data. Research findings of glaucoma in Nigeria will significantly increase our understanding of glaucoma in Nigeria, in people of the West African diaspora and similar population groups.

Nigeria normative data for defining glaucoma in prevalence surveys.

Purpose: To determine normative values for defining glaucoma in cross-sectional surveys in Nigerian adults.

Methods: Multistage stratified cluster random sampling with probability-proportional-to-size procedures to select a nationally representative sample of 15,027 persons aged ≥ 40 years in 305 clusters across Nigeria. Systematic sampling of 1 in 7 participants gave 1759 who were examined in detail to construct a normative database.

Latanoprost for open-angle glaucoma (UKGTS): a randomised, multicentre, placebo-controlled trial.

Background: Treatments for open-angle glaucoma aim to prevent vision loss through lowering of intraocular pressure, but to our knowledge no placebo-controlled trials have assessed visual function preservation, and the observation periods of previous (unmasked) trials have typically been at least 5 years. We assessed vision preservation in patients given latanoprost compared with those given placebo.

Methods: In this randomised, triple-masked, placebo-controlled trial, we enrolled patients with newly diagnosed open-angle glaucoma at ten UK centres (tertiary referral centres, teaching hospitals, and district general hospitals).

Cancer-associated retinopathy presenting as retinal vasculitis with a negative ERG suggestive of on-bipolar cell pathway dysfunction.

A 62-year-old female patient presented to our clinic complaining of a 2 month history of shimmering photopsias and floaters. An ocular examination, fluorescein angiography, and electrophysiological testing were obtained that suggested either an inflammatory retinal vasculitis or a paraneoplastic syndrome. Melanoma-associated retinopathy was highly suspected despite the absence of previous history for cutaneous melanoma since an electronegative scotopic ERG was recorded on standard flash electroretinography.

Analysis of the diurnal intraocular pressure profile pre and post trabeculectomy using 24-hour monitoring of intraocular pressure.

Purpose: To compare the diurnal intraocular pressure (IOP) profile pre and post trabeculectomy with a control group of medically controlled patients. We compared the change in mean, peak, and diurnal IOP fluctuation.

Methods: This was an observational study of patients at the Bristol Eye Hospital, United Kingdom.

Technical Note: grading the vertical cup:disc ratio and the effect of scaling.

Purpose: To evaluate the effect of scaling on sensitivity to change for grading the vertical cup:disc ratio (CDR).

Methods: Vertical CDR was assessed by six observers (three ophthalmologists and three optometrists) on 43 stereo disc photographs. Repeated observations were made for both 0.

Normal age-related sensitivity loss for a variety of visual functions throughout the visual field.

Purpose: The purpose of this study is to compare the rate of age-related decline, the magnitude of practice effects, and test-retest variability among normal subjects using six different tests of visual function.

Methods: One hundred normal subjects aged between 20 and 85 were enrolled in the study. Six visual field test procedures were used consisting of standard automated perimetry (SAP), short wavelength automated perimetry (SWAP), temporal modulation perimetry (TMP), frequency-doubling technology perimetry (FDT), detection acuity perimetry (DAP),and resolution acuity perimetry (RAP).

Characteristics of the normative database for the Humphrey matrix perimeter.

Purpose: The Humphrey Matrix (Carl Zeiss Meditec, Dublin CA; Welch-Allyn, Skaneateles, NY) is a high-spatial-resolution perimeter that uses frequency-doubling stimuli. It incorporates an efficient test strategy that assumes that age, eccentricity, and test procedure type have only small effects on sensitivity. The results used to create the normative database for the perimeter were examined, to see whether these assumptions were met and to examine the form of the normative data.

Psychophysical investigation of ganglion cell loss in early glaucoma.

Purpose: To evaluate ganglion cell loss in early glaucoma using a variety of psychophysical tests and to identify optimal perimetric technique(s) for detection of early glaucomatous visual function loss.

Methods: Five perimetric tests, short wavelength automated perimetry (SWAP), temporal modulation perimetry (TMP), frequency doubling technology perimetry (FDT), detection acuity perimetry (DAP), and resolution acuity perimetry (RAP) were compared in their ability to discriminate between normal individuals and patients with early glaucoma or glaucoma suspects. Comparisons were also made by their ability to produce repeatable defects.

Polymorphisms in OPA1 are associated with normal tension glaucoma.

Purpose: [corrected] To confirm whether specific polymorphisms in intron 8 (IVS8) of the OPA1 gene are found more commonly in patients with normal tension glaucoma (NTG) compared to normal controls.

Methods: This is a cohort study of 61 patients with NTG, 49 known healthy controls and 119 individuals from the general population. The DNA sequence was determined at the +4 and +32 positions of IVS8 of the OPA1 gene.

24-hour monitoring of intraocular pressure in glaucoma management: a retrospective review.

Purpose: Diurnal variation in intraocular pressure (IOP) is well recognized, yet important decisions in glaucoma management are frequently made after 1 or 2 IOP measurements. Twenty-four-hour monitoring of IOP may identify IOP variation and spikes. This study determined the value of 24-hour IOP monitoring in routine clinical practice.

Within-test variability of frequency-doubling perimetry using a 24-2 test pattern.

Purpose: To evaluate patient-response (within-test) variability for targets of the smaller frequency-doubling technology perimetry test that employs a 24-2 stimulus-presentation pattern.

Methods: Patient-response variability was examined using the method of constant stimuli for standard (10 degrees ) and small (4 degrees ) customized frequency-doubling technology perimetry stimuli presented on a CRT screen. Small stimuli were designed for use in a 24-2 test pattern.

Identification of progressive glaucomatous visual field loss.

In normal individuals, visual field measures are not perfectly repeatable and individual test locations exhibit both short- and long-term sensitivity variations. This physiologic variability is greatly increased in glaucoma and confounds detection of real progressive loss in visual function. Distinguishing progressive glaucomatous visual field loss from test variability therefore represents a complex task.

The effect of ocular dominance on visual field testing.

Purpose: During standard automated perimetry (SAP), some patients experience visual disturbances in the tested eye while the other eye is covered with an opaque occluder. It is possible that a binocular interaction producing an inhibitory response in the nonoccluded eye, such as rivalry or Ganzfeld blankout, may be the causative factor, particularly when the dominant eye is occluded. The objective of this experiment was to determine whether subjective visual disturbances occurring during conventional perimetric test conditions were related to ocular dominance and to investigate the effect of these disturbances on measurements made during threshold visual field analysis.

Spatial and temporal processing of threshold data for detection of progressive glaucomatous visual field loss.

Objective: To evaluate the effect of spatial and temporal filtering of threshold visual field data on the ability of pointwise linear regression (PLR) to detect progressive glaucomatous visual field loss.

Methods: Longitudinal visual field data (Full-Threshold Program 30-2 test point pattern) were simulated using a computer model of glaucomatous visual field progression. This approach permitted construction of a "gold standard" because matching visual field data without variability could be generated and analyzed.

Sensitivity differences between real-patient and computer-stimulated visual fields.

Purpose: The authors sought to verify computer simulation of visual fields by comparing thresholds of real and corresponding simulated visual fields.

Methods: Four patients with stable glaucomatous visual fields and three patients with progressing glaucomatous visual fields were chosen for the study. Visual fields had been recorded at 6-month intervals for 5 to 7.