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Glaucoma is one of the most common optic neuropathies, featuring progressive retinal ganglion cell damage and visual field loss (Tham et al., 2014; Xu et al., 2020). Currently, the only effective treatment for this condition is the reduction of intraocular pressure (IOP) (Palmberg, 2001; Heijl et al., 2002). Canaloplasty is a proven bleb-independent surgery with good efficacy and safety profiles in primary open-angle glaucoma (POAG) (Gołaszewska et al., 2021). However, early transient postoperative IOP elevation has been reported in up to 30% of cases (Riva et al., 2019), similar to that commonly observed in other internal drainage glaucoma surgeries such as implantation using iStent (0%-21.0%), CyPass (10.8%), and Hydrus (4.8%-6.5%) (Lavia et al., 2017). This complication may be a predictor of poor reserve in the outflow system and is potentially associated with surgical failure. Nonetheless, the exact pathophysiology of glaucoma remains unknown, and studies clarifying the risk factors for postoperative IOP elevation have been scarce.
Subject(s)
Humans , Intraocular Pressure , Glaucoma, Open-Angle/surgery , Incidence , Treatment Outcome , Risk FactorsABSTRACT
Glaucoma is the leading cause of irreversible blindness worldwide.Screening for glaucoma is a critical intervention to identify individuals at an earlier stage of the disease.However,there is controversy about the necessity of glaucoma screening.Screening is a critical intervention for primary prevention of disease.The screening which suited to the level of our economic development has important benefits for our country,society,families and individuals.Glaucoma has fulfils the criteria of WHO for population screening:(1) Glaucoma is a major public health problem in the world.(2) Glaucoma can be detected in its earlier stage.(3) There are suitable and acceptable examinations for glaucoma screening.(4) Early detection and subsequent treatment could delay or retard glaucoma disease progression.(5) With appropriate strategy design,glaucoma screening can creat good economic benefit.The screening strategies depend on the level of social economy development,the health policies of developed areas tend to prevent disease in its early stages.In poor areas,the limited medical resources are used to treat patients in the advanced stages.In the relatively developed area with complete health care facilities and incomplete referral mechanisms,screening for glaucoma is a critical intervention to identify individuals at an earlier stage of the disease.Glaucoma Screening project in Wenzhou suggested that screening should be implement in relatively developed regions of high density of population to improve efficiency;screening should aim for multiple eye diseases to lower the cost per unit benefit.
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Background Blindness and low vision represent significant public health issues in China.Late diagnosis is the major reason for the irreversible vision impairment.A feasible,cost-effective screening and referral program is very important for the eye health care,prevention and treatment of blindness in China.Objective This study was to evaluate the feasibility and effectiveness of a health examination center-based opportunistic eye disease screening program.Methods This was a cross-sectional study.Subjects undergoing a routine physical examination at the health examination center of the Fourth People's Hospital of Shenyang were invited to attend this program.Presenting visual acuity,intraocular pressure,and nonmydriatic fundus photography were obtained.Optic diso photographs were evaluated independently by two ophthalmologists.Blindness and moderate to severe vision impairment were defined based on the criteria of World Health Organization Visual Impairment Classification in 2009.Glaucoma,diabetic retinopathy (DR) and other suspected eye diseases were diagnosed according to the fundus photography and intraocular pressure.This study was approved by Ethic Committe of the Fourth People's Hospital of Shenyang,the informed consent of each subject was obtained.Results Totally,15 303 subjects were enrolled and 15 197 of them finished the exanimations,giving a response rate of 99.3％.The overall percentage of blindness and moderate to severe visual impairment was 0.08％ (12/15 197) and 2.34％ (355/15 197).Two hundred and twenty-eight (1.50％) subjects were defined as glaucoma suspects and 80 individuals (0.53％) were diagnosed as epimacular membrane.Other suspected eye diseases included DR (0.41％),branchial retinal vessel occlusion (0.24％),macular degeneration (0.09 ％),and macular hole (0.06％).More than 95 ％ of the eye disease suspects have never been previously diagnosed or treated.A total of 358 subjects (2.36％) were defined as ocular hypertension suspects.Conclusions This health examination center-based opportunistic eye disease screening shows a good efficiency and feasibility.It may become an optional program in the national eye health care project,as well as the work of prevention and treatment of blindness.
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Myopia is an important public health issue.Great attention has been paid to myopia in children and teenager since its incidence is progressing rapidly worldwide, especially in Asia.Although there are substantial reports on both myopia progression and its risk factors in children and teenager, challenges are encountered when attempting to compare results among individual studies due to different population, definition of myopia, cycloplegic eye drops, refraction methods, and so on.This review aimed to summarize the reports on myopia progression and its risk factors such as age, gender, refractive state, near work, outdoor activities, parental myopia, or parental bearing age in children and teenager (＜18 years) since 1990.
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<p><b>BACKGROUND</b>Assessment of the optic disc and retinal nerve fiber layer (RNFL) is essential for the diagnosis and monitoring of glaucoma. Knowledge of normal optic disc topography provides a benchmark for evaluating glaucomatous pathologic changes, especially in its early stages. The purpose of this study was to evaluate the characteristics and correlation factors of the optic disc parameters using the Heidelberg Retina Tomograph II (HRT II) in a large sample of normal eyes of adult Chinese subjects.</p><p><b>METHODS</b>Disc data were obtained from 6 830 subjects aged >30 years from the Handan Eye Study. All participants underwent comprehensive eye examinations and physical examinations. The associations of gender, age, body mass index, blood pressure, waist-to-hip ratio; refractive error, intraocular pressure, axial length, and disc area were assessed using simple and multiple regression analysis. The correlation between HRT II parameters was evaluated.</p><p><b>RESULTS</b>Of the 7 557 eligible subjects, 6 830 took part in the study (90.4% response rate) and 2 633 normal eyes with good-quality HRT II images were selected. The mean disc area was 2.28 mm(2) (standard deviation (SD) 0.43) and mean neural rim area was 1.80 mm(2) (SD 0.29). In multiple regression analysis, optic disc area significantly correlated with age, gender, and axial length (P < 0.001). All optic disc parameters showed a significant correlation with disc area (0.054 <r <0.736, P < 0.01). The association between mean RNFL thickness and rim area is statistically significant but not strong (regression linear equation: rim area = 1.42 × mean RNFL thickness + 1.32 mm(2), P < 0.001; R(2) = 0.070). The global RNFL cross-sectional area was significantly associated with global rim area (regression linear equation: rim area = 1.14 × RNFL cross-sectional area + 0.44 mm(2), P < 0.001; R(2) = 0.271).</p><p><b>CONCLUSIONS</b>The optic disc area in rural Chinese population is larger than reported in white and Japanese populations, similar to that of Indian population and urban Chinese population. Most optic disc measurements were moderately or weakly affected by disc area. In addition to the RNFL, there may be other factors affecting the rim area. The relationship between optic disc and axial length may suggest a link between larger disc area, thinning of the lamina cribrosa, and increased glaucoma susceptibility in myopic eyes.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Glaucoma , Epidemiology , Myopia , Epidemiology , Optic DiskABSTRACT
Objective To compare the changes in optic disc parameters after intraocular pressure (lOP) reduction between primary angle-closure glaucoma (PACG) and primary open angle glaucoma (POAG) eyes, and to determine if there is a difference of lamina eribrosa compliance between POAG and PACG. Design Prospective comparative study. Participants 36 PACG (49 eyes) and 35 POAG (49 eyes). Methods Patients underwent Heidelberg Retina Tomography (HRT Ⅱ) and Humphrey visual field test before IOP reduction. HRT and Humphrey visual field test were repeated one month after the IOP was reduced by laser, anti-glaucomatous medications or surgery treatment. Factors that affected the change in IOP were assessed including age, pretreatment IOP, IOP reduction, initial cup: disc ratio and diagnosis (POAG/PACG). Main outcome measures Changes of HRT parameters including cup area, mean cup depth, cup volume, and rim area after IOP reduction. Results The cup area, mean cup depth and cup volume decreased, and rim area in-creased significantly when the IOP was reduced (P<0.05), but there were no significant differences in the changes between PACG and POAG patients (P>0.05). Changes of these four HRT parameters were related to the amount of IOP reduction and the baseline ratio of cup to disc(P>0.05), but not related to age and pre-treatment IOP (P<0.05). Conclusions The cup became smaller and the rim area in-creased after IOP lowering with treatment in both POAG and PACG, and the magnitude of the change was similar in both groups. The lamina cribrosa compliance may not be different between POAG and PACG. (Ophthalmol CHN, 2009, 18: 264-269)