Intravitreal bevacizumab improves trabeculectomy survival at 12 months: the bevacizumab in trabeculectomy study-a randomised clinical trial.

AIMS: To evaluate the effect of an intraoperative dose of intravitreal bevacizumab (Avastin) on surgical success following trabeculectomy with mitomycin-C (MMC) over 12 months. METHODS: A single centre, parallel, double-blinded randomised, placebo-controlled trial recruiting patients requiring trabeculectomy for progressing glaucoma. Patients were randomised to intravitreal bevacizumab or placebo. MAIN OUTCOME MEASURE: The primary outcome of treatment success was defined by 'complete success' when intraocular pressure (IOP) remained less than a predefined target IOP without the requirement of topical medication, or 'qualified success' where topical medication was required to meet the predefined target IOP threshold. Secondary outcomes included the need for subsequent IOP-lowering interventions, and structural parameters associated with bleb function. RESULTS: From 131 patients randomised to bevacizumab (n=65) or placebo (n=66), 128 patients completed 12 months of follow-up (98%). At 12 months, success rates were higher in the bevacizumab group (complete success: 94% vs 83%; p=0.015; qualified success: 98% vs 90%; p=0.033). Within the placebo group, the requirement for topical therapy was higher at 6 months (p=0.045) and 12 months (p=0.045), and the requirement for bleb needling was higher at 1 month (p=0.035). Blebs within the bevacizumab group were larger at 1 month (p<0.001) and demonstrated less vessel inflammation (p<0.0001). CONCLUSION: Bevacizumab given as a single intravitreal dose during trabeculectomy with MMC resulted in improved surgical success as 12 months. Furthermore, bevacizumab was associated with a significant reduction in the need for additional medication or further surgery to achieve target IOP. Bevacizumab was also associated with larger blebs that were less inflamed and required fewer subsequent interventions. TRIAL REGISTRATION NUMBER: ACTRN12614000375651.

Heritability of central corneal thickness in nuclear families.

PURPOSE: Many ocular parameters show strong heritable tendencies. The significance of central corneal thickness (CCT) in the context of glaucoma has been the subject of much debate recently, but its heritability has not been extensively explored. This study was designed to investigate the parent-child heritability of CCT among groups who have CCT considered to be at the extreme ends of the normal range. METHODS: Index cases were recruited through a tertiary referral center if their CCT was greater than 578 microm (thick) or less than 510 microm (thin), representing +/-1 SD from a previously published meta-analysis mean of 544 microm (34 microm SD). Subsequently, CCT was measured in all available family members of the index cases. Family units were then analyzed to establish the degree of heritability of CCT from parent to child. RESULTS: Thirty-three index cases were included in the analysis (10 >1 SD and 23 <1 SD from the meta-analysis CCT mean). The mean CCT of the children of index cases with a CCT more than 1 SD from the mean (n = 15) and less than 1 SD from the mean (n = 40) was 568 microm (32 microm SD) and 521 microm (22 microm SD), respectively (t = 6.14; P < 0.0001). The parent-child heritability estimate for CCT was h(2) = 0.68 (95% CI, 0.64-0.73). CONCLUSIONS: These results indicate that CCT shows strong parent-child heritability, with offspring likely to demonstrate CCT similar to the parental index case.

Effect of a blue-light-blocking intraocular lens on the quality of sleep.

PURPOSE: To evaluate whether implantation of a blue-light-blocking intraocular lens (IOL) affects sleep quality. SETTING: Repatriation General Hospital, Adelaide, Australia. METHODS: This study comprised patients who had bilateral cataract surgery during the preceding 12 months with implantation of a conventional SI40NB IOL or an AcrySof Natural SN60WF blue-light-blocking IOL. Patients were contacted by telephone at least 6 months after second-eye surgery, and the Pittsburgh Sleep Quality Index (PSQI) questionnaire was administered. Results were compared between groups. RESULTS: Of the 49 patients, 31 received conventional IOLs and 18, blue-light-blocking IOLs. The mean age of the patients was 80 years +/- 8.1 (SD). The median PSQI score was 6 (interquartile range 3 to 8). There were no statistically significant differences in PSQI scores between the 2 IOL groups (P = .65). This remained true after adjustment for sex, age, medication, and time since surgery. CONCLUSION: The blue-light-blocking IOL had no effect on the sleep quality of patients, indicating that these IOLs might serve as an alternative to conventional IOLs without a detrimental effect on circadian rhythm.

Central corneal thickness of indigenous Australians within Central Australia.

PURPOSE: To document the central corneal thickness (CCT) among a group of Indigenous Australians compared with a group of Australian Caucasian individuals. DESIGN: Clinic-based case-control study. METHODS: A total of 91 Indigenous Australians from remote clinics in Central Australia and 84 Caucasian subjects from a teaching hospital in South Australia were recruited. Each subject underwent ultrasound pachymetry, and results were compared between groups. RESULTS: Mean +/- SD CCT for Indigenous Australians for right and left eyes, respectively, was 511 +/- 34 microm and 513 +/- 35 microm; and 541 +/- 31 microm and 543 +/- 33 microm in Caucasian subjects (t = 6.96; P < .0001 for right eyes and t = 6.56; P < .0001 for left eyes). CONCLUSIONS: Indigenous Australians exhibit CCT that is significantly lower than that of Caucasian subjects. Given that Indigenous Australians are considered to be at very low risk of developing glaucoma, low CCT values alone may not be sufficient to increase the risk of developing glaucoma in a particular race.

Optic nerve head parameters of an indigenous population living within Central Australia.

PURPOSE: Clinical examination of the optic disc is an essential element in the assessment of its health. Previous work has described normal optic disc appearance among different races. No such description of optic discs exists for indigenous Australians, who are at low risk of developing glaucoma. This study was designed to evaluate optic disc parameters of indigenous Australians. METHODS: A sample of 208 indigenous Australians were recruited as they presented to remote clinics in Central Australia. Each subject underwent optic disc photography using a Topcon TRC-NW100 digital fundus camera. Optic discs were measured and analysed with Topcon ImageNet 2000 software. RESULTS: Among other parameters, mean vertical disc diameter and disc area were 2.13 +/- 0.21 mm (mean +/- SD) and 3.13 +/- 0.57 mm2, respectively, for right eyes and 2.14 +/- 0.21 mm and 3.16 +/- 0.58 mm2 for left eyes. When compared with published studies, these parameters were significantly larger than Caucasians, but similar to African individuals. CONCLUSION: Our results suggest that indigenous Australians have optic discs that are larger than those of Caucasians, but similar to those of Africans who are considered to at a greater risk of glaucoma. Factors other than optic disc area are likely to underlie the higher prevalence of primary open angle glaucoma among African individuals.

Detection of early visual field loss in glaucoma using frequency-doubling perimetry and short-wavelength automated perimetry.

OBJECTIVE: To investigate whether frequency-doubling perimetry (FDP) predicts future visual field loss with achromatic automated perimetry (AAP), just as it may be predicted with short-wavelength automated perimetry (SWAP). METHODS: We recruited 62 patients selectively from an urban glaucoma practice. At the commencement of the study, each patient had ocular hypertension with normal visual fields on AAP. Baseline SWAP and FDP were performed to determine whether underlying earlier visual field loss was present. Patients were then followed up prospectively for 3 years with annual AAP, SWAP, and FDP. Main Outcome Measure The development of visual field loss on AAP. RESULTS: Nine subjects had abnormal SWAP findings and 10 had abnormal FDP findings. At the conclusion of the study, field loss on AAP developed in 5, all of whom had preexisting abnormal SWAP and FDP results. No AAP visual field loss developed in patients with a normal SWAP or FDP. The rate of development of visual field loss on AAP was therefore significantly greater for those with abnormal SWAP (chi21 = 40.83; P<.001) and abnormal FDP findings (chi21 = 32.76; P<.001) than for those with normal SWAP and FDP findings. CONCLUSION: In the same way that SWAP may predict AAP visual field loss, FDP may also detect field loss earlier than AAP.

Comparison of clinical optic disc assessment with tests of early visual field loss.

PURPOSE: Clinical optic disc assessment may identify glaucomatous optic neuropathy prior to a patient developing visual field abnormalities on achromatic automated peri-metry (AAP). Tests targeting axons that are selectively damaged or whose redundancy is low, such as short wavelength automated perimetry (SWAP) and frequency doubling perimetry (FDP), may detect visual field loss before it is seen on AAP. This study investigated whether patients in whom characteristic glaucomatous optic disc damage was present without AAP abnormalities had visual field abnormalities with SWAP and FDP. METHODS: A sample of patients (n = 50) with ocular hypertension (normal AAP) were selected, who had SWAP, FDP and stereofundus photography performed. The photographs were then analysed by two glaucoma subspecialists who were masked to the assessments of the other and to the patients' SWAP and FDP results. A categorization of the optic discs was made as either normal or abnormal and this was compared with their SWAP and FDP findings. RESULTS: On comparing SWAP and FDP with clinical optic disc assessment as the 'gold standard', the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 33%, 92%, 57% and 81%, respectively, for SWAP and 25%, 89%, 49% and 79%, respectively, for FDP. CONCLUSION: In glaucoma suspects, the study suggests that SWAP and FDP identify subjects with early glaucomatous optic neuropathy missed by AAP.

Factors affecting awareness and knowledge of glaucoma among patients presenting to an urban emergency department.

BACKGROUND: Until advanced, glaucoma is asymptomatic. For early diagnosis to occur, patients may need to be aware of it and seek assessment regularly. People who have risk factors for glaucoma may have a greater awareness of the disease. METHODS: Patients presenting to an urban hospital emergency department were surveyed with a brief questionnaire to assess their knowledge of glaucoma. Data was collected about their gender, age, family history of glaucoma and presence of systemic hypertension, diabetes, Raynaud's phenomenon, migraines and myopia. RESULTS: Women (Odds ratio 2.3; 95% CI 1.4-3.7; P < 0.01), people who were 40 years or older (Odds ratio 2.2; 95% CI 1.1-4.4; P < 0.05) and those who were aware of a family history of glaucoma (Odds ratio 15.7; CI 5.5-45.3; P < 0.01) knew significantly more about the disease than others. People with other risk factors did not demonstrate significantly greater knowledge despite 89% of all participants having had a previous eye examination. CONCLUSION: This information may be useful to predict which patients may know about glaucoma when they present for an eye examination and who should be targeted in public health campaigns.