Prevalence of depressive and anxiety disorders in patients with glaucoma: a cross-sectional study / Prevalência de depressão e ansiedade em pacientes com glaucoma

ABSTRACT Purpose: Our goal was to analyze the prevalence of depression and anxiety among patients with glaucoma and to identify risk factors related to these disorders. Methods: A cross-sectional study was carried out between August 2016 and August 2017 at the Hospital das Clínicas of Universidade Estadual de Campinas and at the Hospital Oftalmológico de Brasília to evaluate the prevalence of depressive and anxiety disorders among patients diagnosed with glaucoma. All patients underwent a complete ophthalmologic examination with standard automated perimetry to confirm the diagnosis of glaucoma. All participants were asked to complete the Hospital Anxiety and Depression Scale questionnaire. Results: One hundred and twenty-nine patients were included in the study. Seventy-four were men (57.36%) and 55 (42.64%) were women. The mean age of the patients was 70.14 ± 15.8 years. Ninety participants were white (69.77%) and 38 (29.46%) were black. The study demonstrated a prevalence of depression and/or anxiety at 10.08%. Logistic regression revealed that women were at higher risk for anxiety and/or depression (OR: 5.25, p=0.015) and patients with a larger number of comorbidities also were at higher risk for anxiety and/or depressive disorders (OR: 2.82, p=0.038). Conclusion: A significant proportion of patients with glaucoma present with depression and/or anxiety. Females and patients with comorbidities are at greater risk for these disorders.

RESUMO Objetivo: Avaliar a prevalência de transtornos de depressão e ansiedade em pacientes com glaucoma e identificar fatores de riscos associados. Métodos: Estudo transversal em pacientes com glaucoma, avaliados durante Agosto de 2016 e Agosto de 2017 no Hospital das Clínicas da Universidade de Campinas e no Hospital Oftalmológico de Brasília. Todos pacientes foram submetidos à exame oftalmológico completo para confirmar o diagnóstico de glaucoma. Todos pacientes preencheram o questionário "Hospital Anxiety and Depression Scale". Resultados: Foram incluídos 129 pacientes no estudo, sendo 74 homens (57.36%) e 55 (42.64%) mulheres, 90 pacientes eram brancos (69.77%) e 38 (29.46%) eram negros. A idade média foi de 70.14 ± 15.8 anos. O estudo demonstrou uma prevalência de 10.08% de transtornos depressivo e/ou ansiedade. A regressão logística demonstrou que mulheres apresentam maior risco de desenvolver transtornos depressivos e/ou ansiedade (Risco relativo: 5.25, p=0.015), assim como pacientes com maior número de comorbidades clínicas (Risco relativo: 2.82, p=0.038). Conclusão: Uma proporção significativa dos pacientes com glaucoma podem apresentar transtornos de depressão e/ou ansiedade. Pacientes com glaucoma do sexo feminino e que apresentem maiores comorbidades clínicas apresentam maior risco de apresentar esses transtornos.

Associação entre diabetes mellitus e doenças oculares em pessoas com deficiência visual / Association between diabetes mellitus and eye diseases in people with visual impairment / Asociación entre diabetes mellitus y enfermedades oculares en personas con discapacidad visual

Objetivo: verificar associação entre diabetes mellitus e doenças oculares em pessoas com deficiência visual. Método: estudo transversal com 51 pessoas com diabetes e deficiência visual, em um centro de reabilitação visual do interior paulista, que participaram de entrevista estruturada, em 2018. Utilizou-se os testes: Kolmogorov Smirnov, Regressão de Poisson, Regressão de Logística Binária, e Correlação de Spearman. Resultados: a maioria das pessoas era cega e relatou que a retinopatia diabética, o glaucoma e a catarata foram causa da deficiência visual; com tempo de diagnóstico do diabetes acima de 109 meses. A catarata apresentou um nível de correlação baixa (r=0,280 e p=0,047), e a retinopatia diabética um nível de correlação moderada (r=0,565 e p=0,000), considerando o tempo de diagnóstico do diabetes. Conclusão: associação estatisticamente significante entre o tipo de diabetes e a retinopatia, e correlação estatisticamente significante entre o tempo de diagnóstico do diabetes, a catarata e a retinopatia diabética.

Objective: to verify the association between diabetes mellitus and eye diseases in people with visual impairment. Method: this cross-sectional study involved 51 people with diabetes and visual impairment at a Visual Rehabilitation Center in São Paulo, who participated in a structured interview in 2018. The tests used were: Kolmogorov Smirnov, Poisson Regression, Binary Logistic Regression, and Spearman Correlation. Results: most participants were blind, reported that diabetic retinopathy, glaucoma and cataracts were the causes of their visual impairment, and had been diagnosed with diabetes over 109 months earlier. Cataract returned a low level of correlation with time with diagnosis of diabetes (r = 0.280 and p = 0.047), and diabetic retinopathy, moderate correlation (r = 0.565 and p = 0.000). Conclusion: a statistically significant association was found between type of diabetes and retinopathy, and statistically significant correlations between the time diagnosed with diabetes, cataracts and diabetic retinopathy.

Objetivo: verificar la asociación entre diabetes mellitus y enfermedades oculares en personas con discapacidad visual. Método: este estudio transversal involucró a 51 personas con diabetes y discapacidad visual en un Centro de Rehabilitación Visual en São Paulo, quienes participaron en una entrevista estructurada en 2018.Las pruebas utilizadas fueron: Kolmogorov Smirnov, Regresión de Poisson, Regresión Logística Binaria y Spearman Correlación. Resultados: la mayoría de los participantes eran ciegos, informaron que la retinopatía diabética, el glaucoma y las cataratas eran las causas de su discapacidad visual y habían sido diagnosticados con diabetes más de 109 meses antes. La catarata devolvió un bajo nivel de correlación con el tiempo con el diagnóstico de diabetes (r = 0,280 yp = 0,047) y la retinopatía diabética, correlación moderada (r = 0,565 yp = 0,000). Conclusión: se encontró asociación estadísticamente significativa entre tipo de diabetes y retinopatía, y correlaciones estadísticamente significativas entre el tiempo de diagnóstico de diabetes, cataratas y retinopatía diabética.

Enfermedades sistémicas y glaucoma / Systemic diseases and glaucoma

El glaucoma, considerado el ladrón silencioso de la visión, es la segunda causa de ceguera irreversible en el mundo. A pesar de los avances científicos y tecnológicos no se ha encontrado una cura definitiva para esta enfermedad. Lo más evidente ha sido el control adecuado de los valores de presión intraocular para evitar la progresión del daño del nervio óptico y sus consecuencias en el campo visual, así como la ceguera irreversible. En muchas ocasiones logramos tener la presión intraocular en valores óptimos y aun así la enfermedad avanza, por lo que nos preguntamos qué falló y por qué sucede. No podemos olvidar que el nervio óptico no es lo único que se altera en esta patología; existe evidencia de que se extiende de las células ganglionares de la retina al cuerpo geniculado lateral y a la corteza visual en los hemisferios cerebrales. Ante fenómenos de espasmo, isquemia o bajo flujo, se desencadenan reacciones bioquímicas, estrés oxidativo y otras situaciones que contribuyen al desarrollo de esta neuropatía. Con el objetivo de evaluar con mayor profundidad a los pacientes glaucomatosos, se realizó una revisión sobre la influencia de las más frecuentes enfermedades sistémicas en la neuropatía óptica glaucomatosa(AU)

Glaucoma, also known as the "silent thief of sight", is the second leading cause of irreversible blindness worldwide. Despite the scientific and technological advances achieved in the field, a definitive cure has not been found for this disease. The most evident achievement so far has been the adequate control of intraocular pressure values to prevent the progress of optic nerve damage and its effects on the visual field, as well as irreversible blindness. On many occasions it has been possible to maintain intraocular pressure at optimal values, and even then the disease continues to advance, making us wonder what went wrong and why this happens. It should not be forgotten that the optic nerve is not the only organ affected by this condition. There is evidence that damage extends from retinal ganglion cells to the lateral geniculate body and the visual cortex in cerebral hemispheres. Spasm, ischemia or low flow phenomena trigger biochemical reactions, oxidative stress and other processes contributing to the development of this neuropathy. With the purpose of evaluating glaucoma patients in greater depth, a review was conducted about the influence of a number of very common systemic diseases on glaucomatous optic neuropathy(AU)

Facotrabeculectomía por dos vías como tratamiento combinado de pacientes con glaucoma y catarata / Two-site phacotrabeculectomy as combined therapy for patients with glaucoma and cataract

RESUMEN Objetivo: Determinar los resultados de la facotrabeculectomía por dos vías como tratamiento combinado de pacientes cubanos con glaucoma y catarata. Métodos: Se realizó un estudio observacional descriptivo longitudinal prospectivo en pacientes adultos cubanos tratados con facotrabeculectomía en el Servicio de Glaucoma del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" entre junio del año 2016 y abril de 2017. El universo estuvo constituido por todos los pacientes operados con facotrabeculectomía por dos vías. La muestra la integraron pacientes operados por un mismo cirujano, quienes estuvieron de acuerdo con participar en la investigación. Se excluyeron aquellos con cirugía intraocular previa. Salieron del estudio los que no pudieron mantener el seguimiento en la institución. Se estudiaron las variables edad, sexo, color de la piel, agudeza visual mejor corregida, presión intraocular, número de medicamentos hipotensores oculares y complicaciones presentadas. El seguimiento fue por dos años con consultas al día siguiente, a los siete y a los treinta días; a los tres y a los seis meses; al año y a los dos años. Resultados: Se observaron 31 pacientes. La edad promedio fue de 70 años, con predominio del sexo femenino y el color de la piel no blanco; la agudeza visual mejor corregida preoperatoria media 0,58 y la posoperatoria 0,73. La presión intraocular media preoperatoria 22,04 mmHg y a los dos años 16,37 mmHg. La media de los medicamentos hipotensores preoperatorios fue 3,0 y 0,3 a los dos años. Las complicaciones más frecuentes resultaron la ruptura transquirúrgica de la cápsula posterior y la opacidad posquirúrgica de la cápsula posterior. Conclusiones: Con la facotrabeculectomía por dos vías disminuye la presión intraocular; mejora la agudeza visual mejor corregida y se reduce el número de fármacos hipotensores oculares al menos durante dos años. Las complicaciones asociadas a la técnica son mínimas(AU)

ABSTRACT Objective: Determine the results of two-site phacotrabeculectomy as combined therapy for Cuban patients with glaucoma and cataract. Methods: An observational prospective longitudinal descriptive study was conducted of Cuban patients undergoing phacotrabeculectomy at the Glaucoma Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from June 2016 to April 2017. The study universe was all the patients undergoing two-site phacotrabeculectomy. The sample was patients operated on by the same surgeon who consented to participate in the research. Patients with a history of intraocular surgery were excluded, as well as those who could not be followed up at the institution. The variables considered were age, sex, skin color, best corrected visual acuity, intraocular pressure, number of ocular hypotensive drugs, and complications developed. Follow-up extended for two years with visits on the next day, at seven and thirty days, at three and six months, and at one and two years. Results: Thirty-one patients were observed. Mean age was 70 years, with a predominance of the female sex and non-white skin color. Best corrected visual acuity was 0.58 preoperative and 0.73 postoperative. Mean preoperative intraocular pressure was 22.04 mmHg, whereas at two years it was 16.37 mmHg. Hypotensive drugs averaged 3.0 preoperative and 0.3 at two years. The most common complications were intraoperative posterior capsule rupture and postsurgical posterior capsule opacity. Conclusions: Two-site phacotrabeculectomy reduces intraocular pressure, improves best corrected visual acuity and lowers the number of ocular hypotensive drugs for at least two years. The complications associated to the technique are minimum(AU)

Pharmacoepidemiology of the antiglaucoma drugs in Brazil from 2012 to 2018 / Farmacoepidemiologia das drogas antiglaucomatosas no Brasil de 2012 a 2018

Abstract Purpose: To outline the epidemiological profile of clinical treatments for glaucoma provided by the Brazilian Unified Health System (SUS, acronym in Portuguese) between January 2012 and December 2018. Methods: A quantitative and descriptive study was conducted using available data based on the outpatient information system from SUS (SIA/SUS, acronym in Portuguese). The variables were monocular treatment with first, second, and third-line drugs; monocular treatment with combinations of two drugs and three drugs from different lines; binocular treatment with first, second, and third-line drugs; and binocular treatment with combinations of two drugs and three drugs from different lines. Results: During the analysis period, the prevalence of clinical therapies for glaucoma increased from 2012 to 2017 and decreased from 2017 to 2018. Of the clinically treated patients, 96% were carriers of binocular glaucoma. Among the regions of Brazil, the Northeast had the highest prevalence of binocular glaucoma (about 60% of the number of cases), and the most common therapy was combinations of two drugs from different lines. The Southeast region had the highest concentration of monocular glaucoma (53% of cases), and the predominant therapy was combinations of three drugs from different lines. The Midwest region had the lowest prevalence of monocular-treatments for glaucoma (less than 6%). Conclusion: In Brazil, the highest number of treatments offered by the public health system was in the Northeast and Southeast regions. There is a high national prevalence and potential for the morbidity of this disease. Therefore, it is necessary to strengthen programs aimed at early diagnosis and appropriate treatment to reduce adverse outcomes.

Resumo Objetivo: Traçar o perfil epidemiológico do tratamento clínico para o glaucoma no Brasil fornecido pelo Sistema Único de Saúde (SUS), no período de janeiro de 2012 a dezembro de 2018. Métodos: Estudo quantitativo e descritivo, utilizando a base de dados disponível no Sistema de Informações Ambulatoriais do SUS (SIA/SUS). As variáveis utilizadas foram: tratamento monocular com drogas de primeira, de segunda e de terceira linha; tratamento monocular com combinações de duas drogas e de três drogas de diferentes linhas; tratamento binocular com drogas de primeira, de segunda e de terceira linha; e tratamento binocular com combinações de duas drogas e de três drogas de diferentes linhas. Resultados: Durante o período analisado, a prevalência de terapias clínicas para o glaucoma aumentou entre 2012 e 2017 e diminuiu entre 2017 e 2018. Dos pacientes tratados clinicamente, 96% eram portadores de glaucoma binocular. Entre as regiões do Brasil, o Nordeste teve a maior prevalência de glaucoma binocular (cerca de 60% do número de casos), e a terapia mais comum foi a combinação de duas drogas de diferentes linhas. A região Sudeste teve a maior concentração de glaucoma monocular (53% dos casos), e a terapia predominante foi a combinação de três drogas de diferentes linhas. A região Centro-Oeste apresentou a menor prevalência de tratamentos monoculares para o glaucoma (menos de 6%). Conclusão: No Brasil, o maior número de tratamentos oferecidos pelo sistema público de saúde foi nas regiões Nordeste e Sudeste. Existe uma alta prevalência nacional e um alto potencial para morbidade desta doença. Portanto, é necessário fortalecer programas voltados para o diagnóstico precoce e para o tratamento adequado a fim de reduzir os resultados adversos.

Perfil clínico e epidemiológico dos pacientes com glaucoma atendidos em um ambulatório no interior da Amazônia / Clinical and epidemiological profile of patients with glaucoma attended at a clinic in the interior of the Amazon

Resumo Objetivo: Avaliar a prevalência e o perfil clinico-epidemiológico dos pacientes acometidos pelo glaucoma em Santarém-PA, no período de janeiro de 2016 a dezembro de 2017. Métodos: Estudo descritivo, retrospectivo e quantitativo em que foram analisados os prontuários de 718 pacientes, de ambos os gêneros, atendidos pelo SUS no ambulatório de uma clínica oftalmológica em Santarém - PA. Foi utilizada uma ficha adaptada pelos pesquisadores a partir de um modelo pré-existente no local de coleta e, depois de colhidos, os dados foram sistematizados. Resultados: O estudo encontrou uma prevalência de 6% (n=43), distribuída em 6,8% (n=21) em 2016 e 5,4% (n=22) em 2017. Quanto ao gênero, a maior parte correspondeu ao sexo feminino (53,5%, n=23) e 46,5% (n=20) ao sexo masculino. O Glaucoma Primário de Ângulo Aberto demonstrou maior prevalência, acometendo 2,5% (n=18) dos pacientes. A faixa etária demonstrou predominância do público acima dos 40 anos, 96% (n=24) dos 25 com a idade disponibilizada. Também foi observado que 42% manifestavam hipertensão arterial isoladamente, 2% diabetes mellitus isoladamente, 5% combinação entre as duas e 51% não possuíam nenhuma comorbidade. Conclusão: A prevalência encontrada para os casos de glaucoma foi superior àquelas observadas em estudos nacionais e internacionais. O Glaucoma Primário de Ângulo Aberto teve maior prevalência, principalmente em indivíduos acima dos 40 anos. A relação entre doenças crônicas e a manifestação do glaucoma ou elevação da PIO apontou uma sútil indicação da HAS como fator de risco por conta de sua maior prevalência, semelhante aos estudos sobre o tema.

Abstract Objective: To evaluate the prevalence and clinical-epidemiological profile of patients with glaucoma in Santarém-PA, from January 2016 to December 2017. Methods: Study descriptive, retrospective, quantitative and cross-sectional that was analyzed the medical records of 718 patients, both genders, attended by SUS in an ophthalmologic clinic from Santarém-PA. Was used an adapted record from a pre-existing model in the clinic and, after being searched, the data was systematized. Results: The study was found a prevalence of 6% (n=43), distributed in 6.8%(n=21) in 2016 and 5.4%(n=22) in 2017. Regarding gender, the majority corresponded to women (53.5% n=23) and 46.5%(n=20) were men. Primary open angle glaucoma demonstrated a higher prevalence, affecting 2.5% (n=18) of the patients. The age group demonstrated the predominance of the public over 40 years, 96% (n=24) of the 25 with the age was informed. Regarding chronic diseases, 42% had only arterial hypertension, 2% only diabetes mellitus, 5% had bot comorbidities, and 51% had no one. Conclusion: The prevalence found for glaucoma cases was higher than values of other studies about the subject in Brazil and abroad. Primary open angle glaucoma was the more prevalent in the public studied, especially in individuals over 40 years. The relation between chronic diseases and the manifestation of glaucoma or IOP elevation, reached a subtle indication to hypertension as a risk factor due to its higher prevalence, similar to the studies on the subject.

La uveítis y el glaucoma, un reto para el oftalmólogo / Uveitis and glaucoma, a challenge for ophthalmologists

La incidencia y la prevalencia de las uveítis varía alrededor del mundo, así como los agentes causales y el grupo de edad más afectado. De forma general, pueden asociarse a gran número de complicaciones oculares que originan marcada disminución de la visión, a veces de modo irreversible, e incluso pueden llevar a la ceguera de uno o de ambos ojos. Existe una asociación frecuente entre uveítis y glaucoma. La incidencia de glaucoma secundario a uveítis oscila sobre el 10 por ciento, con fluctuaciones relacionadas con su origen y la edad de presentación. Una parte de las uveítis cursa con hipertensión ocular más o menos marcada durante o después del proceso inflamatorio, lo que constituye un reto para el oftalmólogo, quien debe tratar simultáneamente dos entidades con terapéuticas prácticamente antagónicas. El tratamiento de la inflamación ocular está bien establecido; la hipertensión ocular debe ser tratada sobre la base de las características y el origen de cada entidad. Realizamos una revisión del tema por su importancia, así como de los elementos a tener en cuenta para un mejor resultado del tratamiento en estos pacientes. Se utilizó la plataforma Infomed, específicamente la Biblioteca Virtual de Salud(AU)

The incidence and prevalence of uveitis vary around the world, and so do its causative agents and most affected age group. In general terms, these may be associated to a large number of ocular complications which cause marked, at times irreversible vision reduction, and may even lead to vision loss in one or both eyes. An association is often found between uveitis and glaucoma. The incidence of glaucoma secondary to uveitis ranges around 10 percent, with fluctuations related to its origin and presentation age. A form of uveitis develops with more or less marked ocular hypertension during or after the inflammation process. This is a challenge for ophthalmologists, who should treat two conditions simultaneously with practically opposite therapies. The treatment for ocular inflammation is well established, whereas ocular hypertension should be treated according to the characteristics and origin of each condition. Due to its importance, we conducted a review of the topic, as well as of the elements to be borne in mind to obtain better treatment results. Use was made of the platform Infomed, specifically the Virtual Health Library(AU)

Glaucoma e qualidade de vida / Glaucoma and quality of life

Objetivos: 1) Investigar as propriedades psicométricas da versão portuguesa do "National Eye Institute Visual Functioning Questionnaire" (NEI VFQ-25) num grupo de pacientes com diferentes doenças oculares (catarata, glaucoma e degeneração macular relacionada à idade - DMRI). 2) Analisar de maneira longitudinal qual região do campo visual avaliada através da perimetria computadorizada apresenta maior impacto na qualidade de vida (QV) em pacientes com glaucoma. 3) Apresentar uma nova metodologia utilizando dados de perimetria computadorizada e do NEI VFQ-25 para investigar fatores preditivos associados ao desenvolvimento de deficiência visual em pacientes com glaucoma. Métodos: 1) O primeiro estudo, realizado na Universidade Estadual de Campinas é uma avaliação transversal de pacientes com glaucoma, catarata e DMRI para validação psicométrica do NEI VFQ-25 através da análise de Rasch. 2) O segundo e terceiro estudos foram desenvolvidos na Universidade da Califórnia em San Diego, com pacientes de uma coorte na qual o NEI VFQ-25 era preenchido anualmente e exame de perimetria computadorizada realizado a cada 6 meses. No segundo estudo, a associação entre as taxas de mudança dos índices de QV do NEI VFQ-25 e a progressão do dano glaucomatoso em diferentes regiões do campo visual (central inferior, central superior, periférica superior e periférica inferior) foram analisada através de um modelo longitudinal de regressão linear multivariada misto. 3) No terceiro estudo, um modelo de análise de transição latente foi utilizado para classificar os pacientes (com deficiência visual ou não) de acordo com resultados do NEI VFQ-25 no exame inicial e estimar a probabilidade dos pacientes desenvolverem deficiência visual ao longo do seguimento, baseados na perimetria computadorizada. Resultados: 1) De acordo com a análise de Rasch, ao observamos os valores de ajuste, quatro ítens apresentaram valores de ajuste fora do padrão. Além disso, na análise de componente principal, o NEI VFQ-25 não se mostrou unidimensional, sendo que oito itens foram identificados como pertencentes de um componente secundário (sócioemocional). Estes itens pertencem ao domínio de: saúde geral, saúde mental, limitações e dependência. Após a exclusão destes itens, foi possível isolar os - itens do NEI VFQ-25 relacionados apenas com a QV associada à função visual. 2) O segundo estudo mostrou uma correlação significativa entre mudanças nos índices de QV do NEI VFQ-25 com a progressão do glaucoma em diferentes regiões do campo visual, principalmente na região central inferior. Para cada 1 decibel (dB)/ano de queda na sensibilidade binocular retiniana na região central inferior, ocorreu uma queda de 2,6 unidades/ano no índice de QV do NEI VFQ-25. As maiores quedas nos índices de QV também ocorreram em pacientes com doença mais avançada no exame inicial. 3) No terceiro estudo, pacientes classificados como não-deficientes visuais apresentaram probabilidade de 14,2% de desenvolverem a deficiência durante o seguimento. As taxas de progressão do dano glaucomatoso na perimetria computadorizada foram 4 vezes mais rápidas nos pacientes que desenvolveram deficiência visual em comparação com aqueles que não desenvolveram. Além disso, a análise multivariada permitiu mostrar que, apesar dos pacientes com glaucoma avançado no exame inicial apresentarem um risco maior de desenvolver deficiência visual durante o seguimento, a velocidade de progressão da doença se mostrou um fator de risco ainda mais importante para o surgimento da deficiência visual. Conclusões: 1) A versão portuguesa do NEI VFQ-25 não é unidimensional, ou seja, o presente estudo evidenciou itens que podem estar relacionados a um componente sócio-emocional. 2) Uma piora na sensibilidade retiniana no exame de perimetria na região central inferior apresenta a maior correlação com queda nos índices de QV em pacientes com glaucoma. 3) Uma nova metodologia baseada nos resultados do NEI VFQ-25 e da perimetria computadorizada para classificar e estimar o risco de pacientes com glaucoma desenvolverem deficiência visual foi apresentada(AU)

Objectives: To investigate the psychometric properties of the Brazilian Portuguese version of the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) in a group of patients with different eye diseases. 2) To evaluate the association between rates of visual field loss in different regions and longitudinal changes in quality of life (QoL) in glaucoma patients. 3) To present a new methodology that uses data from the NEI VFQ-25 and automated perimetry to investigate predictive factors associated with development of vision-related disability in glaucoma. Methods: 1) The first project was a cross-sectional study performed at University of Campinas to evaluate the psychometric properties of the Portuguese version of the NEI VFQ-25 using Rasch analysis in patients with glaucoma, cataract and age related macular disease. 2) The second and third projects were performed at University of California in San Diego and had a prospective, observational cohort design in which all subjects had the NEI VFQ-25 performed annually and standard automated perimetry at 6-month intervals. In the second study, the association between change in NEI VFQ-25 Rasch-calibrated scores and change in different regions (central inferior, central superior, peripheral inferior, and peripheral superior) of the visual field was investigated with a joint multivariable longitudinal linear mixed model. 3) In the third study, a latent transition analysis model was used to categorize patients with visual disability or not at baseline according to NEI VFQ-25 results and to estimate the probability of developing vision-related disability during follow-up, according to standard automated perimetry results. Results: 1) In the first study, according to Rasch analysis, four items were found to misfit and according to the principal component analysis, the NEI VFQ-25 was not unidimensional, with eight items belonging to a second component (socioemotional). These items belonged to the following subscales: general health, mental health, role limitations and dependency. After excluding those items, we were able to isolate items from the NEI VFQ-25 that were related only to a visual functioning component. 2) The second study showed significant correlations between change in the NEI VFQ-25 Rasch scores during follow- - up and change in different regions of the visual field, especially the central inferior area. Each 1 decibel (dB)/year change in binocular mean sensitivity of the central inferior area was associated with a decline of 2.6 units/year in the NEI VFQ-25 scores. Greater declines in NEI VFQ-25 scores were also seen in patients who had worse visual field sensitivity at baseline. 3) In the third study, patients classified as nondisabled at baseline had a 14.2% probability of developing disability during follow-up. Rates of visual field loss as estimated by integrated binocular MS were almost 4 times faster for those in whom disability developed versus those in whom it did not. Multivariable analysis showed that fast progressors were at higher risk of developing visual disability than those with worse baseline disease. Conclusions: 1) The Portuguese version of the NEI VFQ-25 is not an unidimensional instrument. We were able to find items that belonged to a different trait, possibly related to a socio-emotional component. 2) Progressive decline in retinal sensitivity in the central inferior area of the visual field had the strongest association with longitudinal decline in QoL of patients with glaucoma. 3) We presented a new methodology for classification and analysis of change in patient-reported QoL outcomes, allowing construction of models for predicting vision-related disability in glaucoma.(AU)

Uso da tonometria de ar em pesquisas populacionais - comparação com o tonômetro de Goldmann em indivíduos com suspeita de hipertensão ocular / Air-Puff Tonometry in population research - a comparison with Goldmann tonometer in individuals with suspected ocular hypertension

RESUMO Objetivo: Avaliar a utilidade do tonômetro de ar (TA) em estudos populacionais em indivíduos suspeitos de hipertensão ocular, comparando os valores com os fornecidos pelo tonômetro de aplanação de Goldmann (TG). Métodos: Estudo transversal, de amostra probabilística, composta por 11.452 indivíduos e"20 anos, compondo-se uma subamostra dos que apresentaram valores de pressão intraocular (PIO) obtidos com o TA e"20mmHg, nos quais a PIO foi repetida com o TG. Os resultados dos dois tonmetros foram comparados considerando sexo, cor da pele referida, lateralidade, relação escavação/disco (Â0,6; entre e"0,6 e <0,8; e"0,8) e diagnóstico. Foram consideradas três situações: não-portadores de glaucoma (NG), suspeitos (SG) e portadores de glaucoma (CG). Para comparação entre as medidas foi utilizado o teste t de Student para amostras pareadas e o teste de correlação de Pearson para avaliar a associação entre PIO, idade e tonometria. Resultados: Foram detectados 198 indivíduos (339 olhos) com PIOe"20mmHg com o TA, que tiveram a medida repetida com o TG. Foram considerados 233 olhos como NG, 47 olhos como SG e 19 olhos como CG. Em olhos com escavação e"0,8, a medida com TA e TG foram semelhantes. Nos NG e SG, o TA superestimou os valores. Houve associação entre aumento da PIO e aumento da idade com os dois tonmetros. Conclusão: Valores de PIO são superiores com TA comparados ao TG, principalmente quando a PIO é normal. Há concordância entre os métodos quando a PIO é alta e a escavação do nervo óptico é aumentada, o que valida a aplicação do TA em campanhas populacionais.

ABSTRACT Purpose: to evaluate the use of air tonometer (TA) in population studies in individuals suspected of ocular hypertension, comparing values with those provided by the Goldmann Tonometer (GT). Methods: a cross-sectional study was done using a probabilistic sample consisting of 11,452 individuals e"20 years old.A subsample composed by the individuals with IOP values obtained with TA e"20 mmHg was selected, in which IOP was repeated with the GT. The results of both tonometers were compared considering gender, referred color of skin, laterality, cup-to-disc ratio (Â0.6; e"0.6 and <0.8; e"0.8) and diagnosis, considering three situations: without glaucoma (NG), suspected glaucoma (SG) and patients with glaucoma (CG). The Student t test was used for paired samples and the Pearson correlation test to evaluate the association between IOP, age and tonometry. Results: we identified 198 individuals (339 eyes) with IOP e"20mmHg with the TA, who had the measures repeated with the GT. Two hundred and thirty-three eyes were considered as NG, 47 eyes as SG and 19 eyes as CG. In eyes with cup-to-disc ratio e"0.8, the TA and GT measurements were similar. In NG and SG, the TA overestimated values. There was an association between increased IOP and increasing age with both tonometers. Conclusion: IOP values are higher with TA compared to GT, especially when IOP is normal.There is agreement between the methods when IOP is high and the optic nerve excavation is increased, which validates the application of TA in population campaigns.

Perfil epidemiológico dos pacientes com glaucoma congênito atendidos no Hospital Regional de São José / Epidemiological profile of patients with congenital glaucoma treated in the Hospital Regional de São José

Objetivo Delinear um perfil epidemiológico de pacientes com glaucoma congênito atendidos no serviço de Oftalmologia do Hospital Regional de São José, bem como a evolução destes pacientes com os tratamentos empregados. Métodos Foi realizado um estudo longitudinal, retrospectivo, descritivo que avaliou 32 pacientes com glaucoma congênito atendidos em ambulatório, desde a primeira consulta quando ingressaram no serviço e consultaram pelo menos duas vezes no período de 1º de março de 2009 até 1º de fevereiro de 2011. Resultados Houve predominância do sexo feminino (59,37%). Com relação à lateralidade, ambos os olhos foram acometidos em 91% dos casos. A maioria dos pacientes (78,12%) apresentava glaucoma congênito primário. Oitenta e cinco cirurgias foram realizadas para o glaucoma congênito, destes 63,52% foram submetidos à trabeculotomia. A pressão intraocular aferida na primeira e na última consulta diminuiu em 85,93% dos 64 olhos, já em relação à pressão intraocular média houve uma diminuição de 82,81% em relação ao valor na primeira consulta. Ao realizar a comparação do diâmetro corneano horizontal da primeira consulta em relação à última, bem como da primeira consulta em relação à média das aferições de todas as consultas, em 25,42% ocorreu aumento. Conclusão Nos pacientes com glaucoma congênito, houve predomínio do acometimento bilateral e do sexo feminino. A maioria dos pacientes apresentou diminuição da pressão intraocular na última consulta em relação à primeira e em poucos pacientes houve um aumento do diâmetro corneano horizontal...

Objective To outline an epidemiological profile of patients with congenital glaucoma treated in the ophthalmology service, as well as the evolution of these patients with the treatment adopted. Methods A longitudinal, retrospective, descriptive study was undertaken in order to evaluate 32 patients with congenital glaucoma treated in the clinic, from the first consultation in which they entered the service and who attended the clinic at least two times in the period from march 1st, 2009 to february 1st, 2011. Results There was a predominance of female patients (59.37%). In relation to the lateralization, both eyes were affected in 91% of the cases. Most patients (78.12%) presented primary congenital glaucoma. Eighty-five surgeries were performed for congenital glaucoma, 63.52% of them were submitted to trabeculotomy. The intraocular pressure measured in the first and in the last consultation diminished in 85.93% of the 64 eyes, and in relation to the mean intraocular pressure there was a decrease of 82.81% in relation to the value of the first consultation. When making the comparison of the horizontal corneal diameter of the first consultation in relation to the last one, as well as of the first consultation in relation to the average of the measurements of all consultations, in 25.42% there was an increase. Conclusion In the patients with congenital glaucoma, there was a predominance of bilateral involvement and of female patients. Most patients presented a decrease of intraocular pressure in the last consultation in relation to the first one, and in a few patients there was an increase of horizontal corneal diameter...

Prevalencia del glaucoma y su contribución a la discapacidad visual en Colombia / Glaucoma prevalence and its contribution to visual impairment in Colombia

Objetivo: determinar la prevalencia de glaucoma en Colombia por grupos de edad y sexo al año 2005, además de su contribución a la discapacidad visual. Métodos y Materiales: se tomaron como casos prevalentes de glaucoma los notificados por el estudio de Carga de Enfermedad Colombia CENDEX 2008 (datos año 2005) y como base poblacional los datos demográficos y de discapacidad del Departamento Administrativo Nacional de Estadística (DANE) para el mismo período. Se estimó la frecuencia del evento por grupos de edad y sexo (prevalencia estandarizada), así como la prevalencia sobre el total de casos de discapacidad visual; los resultados se presentaron en tablas de distribución de frecuencia. Resultados: La prevalencia general de glaucoma en Colombia para el año 2005, fue de 1,1% siendo más común en mujeres (razón de feminidad 2,1:1), contribuyendo al 2,7% del total de discapacidad visual al mismo período. Conclusiones: Se halló la prevalencia de glaucoma en Colombia para el año 2005, por grupos de edad y sexo así como su contribución a la discapacidad visual para el mismo período. Es importante contar con registros actualizados para determinar la prevalencia de esta patología, para así conocer la frecuencia de ésta en la actualidad y su aporte a la discapacidad visual en Colombia. Los resultados de este estudio servirán de partida a quienes diseñen modelos de prevención para el glaucoma como causa prevenible de discapacidad visual.

Objectives: to determine the prevalence of glaucoma in Colombia for 2005 by age and sex groups and its contribution to visual impairment. Methods and materials: prevalent cases were defined as those cases reported with glaucoma by the study Burden of the Diseases in Colombia CENDEX 2008 (2005 data). The population for Colombia for this investigation was defined by the demographics and disability data reported by DANE for 2005. The frequency of the event was estimated by age and sex groups (standardized prevalence), and the prevalence of total cases of visual impairment was also estimated; the results are presented in frequency distribution tables. Results: the overall prevalence of glaucoma in Colombia for 2005 was 1.1%, being more common in women (femininity ratio 2,1:1), contributing to 2.7% of all visual impairment the same period. Conclusions: the prevalence of glaucoma was found in Colombia for 2005, by age and sex groups and its contribution to visual impairment for the same period. It is important to have available updated data in order to determine the prevalence of this pathology, the current frequency and contribution to visual impairment in Colombia. The results of this study will be useful as a starting point to those who design prevention models for glaucoma as a preventable cause of visual impairment.

Encuesta de ceguera y deficiencia visual evitable en Panamá / Survey on avoidable blindness and visual impairment in Panama

OBJETIVO: Determinar la prevalencia de ceguera y deficiencia visual en adultos de 50 años o más de Panamá, identificar sus principales causas y caracterizar la oferta de servicios de salud ocular. MÉTODOS: Estudio poblacional transversal mediante la metodología estándar de evaluación rápida de ceguera evitable. Se seleccionaron 50 personas de 50 años o más de cada uno de 84 conglomerados escogidos mediante muestreo aleatorio representativo de todo el país. Se evaluó la agudeza visual (AV) mediante una cartilla de Snellen y el estado del cristalino y del polo posterior por oftalmoscopía directa. Se calculó la cobertura de cirugía de catarata y se evaluó su calidad, así como las causas de tener AV < 20/60 y las barreras para acceder al tratamiento quirúrgico. RESULTADOS: Se examinaron 4 125 personas (98,2% de la muestra calculada). La prevalencia de ceguera ajustada por la edad y el sexo fue de 3,0% (intervalo de confianza de 95%: 2,3-3,6). La principal causa de ceguera fue la catarata (66,4%), seguida del glaucoma (10,2%). La catarata (69,2%) fue la principal causa de deficiencia visual (DV) severa y los errores de refracción no corregidos fueron la principal causa de DV moderada (60,7%). La cobertura quirúrgica de catarata en personas fue de 76,3%. De todos los ojos operados de catarata, 58,0% logró una AV < 20/60 con la corrección disponible. CONCLUSIONES: La prevalencia de ceguera en Panamá se ubica en un nivel medio con respecto a la encontrada en otros países de la Región. Es posible disminuir este problema, ya que 76,2% de los casos de ceguera y 85,0% de los casos de DV severa corresponden a causas evitables.

OBJECTIVE: Determine prevalence of blindness and visual impairment in adults aged > 50 years in Panama, identify their main causes, and characterize eye health services. METHODS: Cross-sectional population study using standard Rapid Assessment of Avoidable Blindness methodology. Fifty people aged > 50 years were selected from each of 84 clusters chosen through representative random sampling of the entire country. Visual acuity was assessed using a Snellen chart; lens and posterior pole status were assessed by direct ophthalmoscopy. Cataract surgery coverage was calculated and its quality assessed, along with causes of visual acuity < 20/60 and barriers to access to surgical treatment. RESULTS: A total of 4 125 people were examined (98.2% of the calculated sample). Age- and sex-adjusted prevalence of blindness was 3.0% (95% CI: 2.3-3.6). The main cause of blindness was cataract (66.4%), followed by glaucoma (10.2%). Cataract (69.2%) was the main cause of severe visual impairment and uncorrected refractive errors were the main cause of moderate visual impairment (60.7%). Surgical cataract coverage in individuals was 76.3%. Of all eyes operated for cataract, 58.0% achieved visual acuity < 20/60 with available correction. CONCLUSIONS: Prevalence of blindness in Panama is in line with average prevalence found in other countries of the Region. This problem can be reduced, since 76.2% of cases of blindness and 85.0% of cases of severe visual impairment result from avoidable causes.

Análise dos fatores de risco e epidemiologia em campanha de prevenção da cegueira pelo glaucoma em João Pessoa, Paraíba / Analysis of risk factors and epidemiology of blindness prevention campaign by glaucoma in João Pessoa, Paraíba

OBJETIVO: Este trabalho tem por objetivo avaliar a incidência dos fatores de risco em uma amostra da população, avaliada durante uma campanha de prevenção da cegueira pelo glaucoma, bem como analisar os dados epidemiológicos sobre a ocorrência de casos suspeitos de glaucoma na cidade de João Pessoa, Paraíba. MÉTODOS: Após prévia divulgação, pessoas com idade ≥ 40 anos, compareceram voluntariamente ao Hospital Universitário Lauro Wanderley, João Pessoa, Paraíba. Realizou-se anamnese, medida da pressão intraocular (PIO) com tonômetro de aplanação de Goldmann e biomicroscopia de fundo. Considerados suspeitos aqueles com PIO ≥ 21 mmHg ou disco óptico com relação escavação sobre disco (E/D) ≥ 0,5 x 0,5. Os suspeitos foram subdivididos por idade, sexo e tipo de alteração e divididos em: Grupo I de 40 e 49 anos; Grupo II de 50 e 59 anos; Grupo III ≥ 60 anos; P+ se apenas PIO Analysis of risk factors and epidemiology of blindness prevention campaign by glaucoma in João Pessoa, Paraíba 21 mmHg; E/D+ se apenas E/D ≥ 0,5x0,5; e P/E/D+ quando ambos alterados. RESULTADO: No total de 244 pacientes, 29,50% foram considerados suspeitos (48,61% homens (H) e 51,38% mulheres(M), sendo 41,66% pertencentes ao Grupo I; 23,61% ao Grupo II e 34,72% ao Grupo III. Com relação ao tipo de alteração: 70,83% eram E/D+; 15,27% eram P+ e 13,88% P/E/D+. Foi ainda realizada uma análise detalhada entre homens e mulheres. CONCLUSÃO: Apesar da irreversibilidade das alterações conseqüentes ao glaucoma, o diagnóstico precoce e o tratamento adequado, associado à conscientização da população, são capazes de prevenir cegueira, comprovando a importância da realização periódica dessas campanhas.

OBJECTIVE: This study aims evaluating the incidence of risk factors in a population sample, assessed during campaign of prevention of blindness by glaucoma, and analyzing epidemiological data incidence of glaucoma in the city of João Pessoa (PB). METHODS: After prior disclosure, individuals aged≥ 40 years, attended voluntarily at Lauro Wanderley University Hospital, Joao Pessoa (PB) for examination, anamnesis, intraocular pressure (IOP) measured by applanation tonometer of Goldmann, and direct fundoscopy. Those who were considered suspect showed IOP ≥ 21 mmHg or/and a cup to disc ratio (CDR) ≥ 0,5. The cases suspects were separated by age, sex and abnormal signs. We referred to Group I individuals from 40 to 49 years old, Group II from 50 to 59 years old, Group III ≥ 60 years, "P+" for IOP ≥ 21 mmHg, "E/ D+" for CDR ≥ 0.5 and "P/E/D+" for individuals with all the showing signs. RESULTS: Within a total of 244 patients, 29.50% were considered suspects (48.61% male, 51.38% female, and 41.66% of group I, 23.61% of Group II and 34.72% of Group III). Regarding the type of sign: 70.83% were E/D+, 15.27% were P+ and 13.88% were P/ E/D+. There was also carried out a detailed analysis of men and women. CONCLUSION: Despite the irreversibility of the modifications caused by glaucoma, early diagnosis and proper treatment associated with raising awareness of population are preventive actions to inhibit blindness, confirming the relevance of conducting periodic preventive campaigns.

Caracterización epidemiológica del glaucoma en la población del Servicio de Oftalmología del Hospital Nacional Arzobispo Loayza: Enero û diciembre 2012 / Epidemiological characterization of glaucoma Service population Ophthalmology Archbishop Loayza National Hospital: January to december 2012

Objetivo: Describir las características clínicas y epidemiológicas de los pacientes sometidos a estudio de glaucoma en la unidad de glaucoma del servicio de oftalmología del Hospital Nacional Arzobispo Loayza durante el periodo Enero a Diciembre 2012. Material y método:: Estudio descriptivo, retrospectivo y observacional donde se revisaron 190 historias de pacientes atendidos en la unidad de glaucoma del servicio de oftalmología del Hospital Nacional Arzobispo Loayza con sospecha de glaucoma durante el periodo Enero – Diciembre 2012. Los datos recolectados fueron vaciados a una base de datos del programa Microsoft Excel y luego trasladados al programa estadístico SPSS v.21.0.para su análisis. Resultados: De los 190 pacientes, 130 tuvieron diagnóstico de glaucoma, los datos demográficos fueron los siguientes: 88 mujeres (66,7%) y 42 varones (32,3%), la edad promedio de los pacientes con glaucoma fue61,38 años.La mayor parte de los casos fue clasificado como glaucoma primario de ángulo abierto (GPAA) que correspondeal 50% de los subtipos encontrados (n=65), seguido de los pacientes con sospecha de glaucoma (n=25, 19,23%), glaucoma primario de ángulo cerrado (GPAC), (n=20, 15,4%), hipertensión ocular (HTO), (n=17, 13,1%), glaucoma tensión normal (GTN), (n= 2, 1,5%), y glaucoma neovascular (GNV), (n=1, 0,8%). Conclusiones: La variedad más frecuente de glaucoma fue GPAA, el promedio de edad para este subtipo es de 64 años.Se encontró que el número de casos de GPAA y GPAC se incrementó al doble en pacientes mayores de 60 años de edad.

Purpose: To describe clinical and epidemiological characteristics of glaucoma patients evaluated by medical faculty of Glaucoma Unit at ArzobispoLoayza Hospital`s Ophthalmology Department since January through December 2012. Material and methods: Descriptive, retrospective and observational study of 190 medical charts of patients evaluated at Glaucoma Unit of ArzobispoLoayza Hospital since January through December 2012. The collected data were converted to Microsoft Excel program and transferred to SPSS v 21.0 for statistical analysis. Results: Of 190 patients, 130 patients were diagnosed of glaucoma: 88 women (66.7 %) and 42 males (32.3 %) with mean age of 60.18 years. Most of the cases were classified as primary open angle glaucoma (POAG corresponding to 50 % of the subtypes found (n=65), followed by glaucoma suspects (n=25, 19.23%), primary angleclosure glaucoma (PACG), (n=20, 15.4%), ocular hypertension (OHT), (n=17, 13.1%), normal tension glaucoma (NTG), (n=2, 1.5%), and neovascular glaucoma (NVG), (n=1, 0.8%). Conclusions: The most common form of glaucoma was POAG and the mean age was 64 years. It was found that the number of cases of POAG and PACG increased twofold in patients over 60 years old.

Prevalence of congenital eye anomalies in a paediatric clinic in Ghana

There is little information about the epidemiology of congenital eye anomalies in Ghana. We retrospectively reviewed the clinical records of 485 admissions to the paediatric eye centre of the Korle-Bu Teaching Hospital, Ghana [2004-2009] and 263 were diagnosed with at least one anomaly. Visual acuity was quantitatively assessed in 209 patients and 130 had some visual impairment; 49 with bilateral and 64 with unilateral blindness. The most frequent congenital anomaly overall was cataract [n = 44]. In infants, cataract was the most frequent finding [28/121]. Toddlers most frequently presented with retinoblastoma [10/65]. Glaucoma was the most frequent anomaly in preschool [9/39] and school [10/38] children. We conclude that avoidable causes of childhood blindness caused most congenital eye anomalies. Intensification of community-based health promotion and preventive eye care, early detection and provision of adequate resources for effective therapy could reverse these trends

Espesor corneal y variables epidemiológicas y fisiológicas en población de riesgo de glaucoma / Corneal thickness and the epidemiological and physiological variables seen in the glaucoma risk population

Objetivo: caracterizar el espesor corneal central en pacientes con factores de riesgo de glaucoma crónico simple.Métodos: se realizó un estudio epidemiológico, observacional, descriptivo y longitudinal prospectivo, en el Servicio de Glaucoma del Hospital Dr Salvador Allende durante el año 2010. El universo estuvo constituido por 1 238 pacientes que acudieron a la consulta de oftalmología por síntomas astenópicos. La muestra, aplicados los criterios de inclusión y exclusión, quedó conformada por 656 pacientes con factores de riesgo de la enfermedad, de estos se desecharon 19 por una diferencia entre los ojos de 10 µm o más de espesor corneal. Las variables analizadas fueron: espesor corneal, edad, sexo, color de la piel y presión intraocular...

Objective: to characterize the central corneal thickness seen in patients with simple chronic glaucoma risk factors.Methods: a prospective longitudinal, descriptive, observational, and epidemiological study was conducted in the Glaucoma Service of Dr Salvador Allende hospital during 2010. The universe of study was made up of 1 238 patients that went to the ophthalmological service due to asthenopic symptoms. Taking the inclusion and exclusion criteria into account, the final sample was composed by 656 patients with glaucoma risk factors, 19 of whom were excluded because of 10 µm and over difference in the corneal thickness between the eyes. The analyzed variables were corneal thickness, age, sex, race and intraocular pressure...

Glaucoma in developing countries.

Objective: To describe the background and strategy required for the prevention of blindness from glaucoma in developing countries. Materials and Methods: Extrapolation of existing data and experience in eye care delivery and teaching models in an unequally developed country (India) are used to make recommendations. Results: Parameters like population attributable risk percentage indicate that glaucoma is a public health problem but lack of simple diagnostic techniques and therapeutic interventions are barriers to any effective plan. Case detection rather than population-based screening is the recommended strategy for detection. Population awareness of the disease is low and most patients attending eye clinics do not receive a routine comprehensive eye examination that is required to detect glaucoma (and other potentially blinding eye diseases). Such a routine is not taught or practiced by the majority of training institutions either. Angle closure can be detected clinically and relatively simple interventions (including well performed cataract surgery) can prevent blindness from this condition. The strategy for open angle glaucoma should focus on those with established functional loss. Outcomes of this proposed strategy are not yet available. Conclusions: Glaucoma cannot be managed in isolation. The objective should be to detect and manage all potential causes of blindness and prevention of blindness from glaucoma should be integrated into existing programs. The original pyramidal model of eye care delivery incorporates this principle and provides an initial starting point. The routine of comprehensive eye examination in every clinic and its teaching (and use) in residency programs is mandatory for the detection and management of potentially preventable blinding pathology from any cause, including glaucoma. Programs for detection of glaucoma should not be initiated unless adequate facilities for diagnosis and surgical intervention are in place and their monitoring requires reporting of functional outcomes rather than number of operations performed.