The African Descent and Glaucoma Evaluation Study (ADAGES): design and baseline data.

OBJECTIVE: To identify factors accounting for differences in glaucoma onset and rate of progression between individuals of African descent and European descent. DESIGN: A prospective, multicenter observational cohort study of 1221 participants of African descent and European descent with no glaucoma (normal), suspected glaucoma, and glaucoma. Six hundred eighty-six patient participants in the African Descent and Glaucoma Evaluation Study will be followed up longitudinally. Four hundred thirty-six participants of European descent from the Diagnostic Innovations in Glaucoma Study (DIGS) were also included. Baseline demographics, visual function (standard automated perimetry, short-wavelength automated perimetry, frequency doubling technology perimetry), optic nerve structure (retina tomography, optical coherence tomography), clinical status, and risk factors were measured. RESULTS: Individuals of African descent had (1) thinner corneas (P < .001) across all diagnostic groups, (2) a higher percentage of reported diabetes mellitus (P < .001) and high blood pressure (P < .001) and a lower percentage of reported heart disease (P = .001), and (3) worse pattern standard deviation for standard automated perimetry fields overall (P = .001) and within normal limits (P = .01) than individuals of European descent. No differences were present for mean intraocular pressure (P = .79). CONCLUSIONS: Significant baseline differences were found in a number of clinical findings between persons of African descent compared with European descent. Longitudinal data from the African Descent and Glaucoma Evaluation Study will be important for determining which baseline features are important and predictive for accurate diagnosis and follow-up in this high-risk group. Trial Registration clinicaltrials.gov Identifier: NCT00221923.

Comparison of diagnostic accuracy of Heidelberg Retina Tomograph II and Heidelberg Retina Tomograph 3 to discriminate glaucomatous and nonglaucomatous eyes.

PURPOSE: To compare the diagnostic accuracy of the Moorfields regression analysis (MRA), parameters, and glaucoma probability score (GPS) from Heidelberg Retinal Tomograph (HRT) 3 (Heidelberg Engineering, Heidelberg, Germany) with MRA and parameters from HRT II in discriminating glaucomatous and healthy eyes in subjects of African and European ancestry. DESIGN: Case-control institutional setting. METHODS: Seventy-eight glaucoma patients (44 of African ancestry, 34 of European ancestry) and 89 age-matched controls (46 of African ancestry, 33 European ancestry), defined by visual fields and self-reported race were included. Imaging was obtained with HRT II, and data were exported to a computer with the HRT 3 software using the same contour line. Area under the receiver operating characteristic (ROC) curves (AUCs), sensitivity, and specificity were evaluated for the entire group, the African ancestry group, and the European ancestry group separately. Mean disk area was compared between correctly and incorrectly diagnosed eyes by each technique. RESULTS: Disk, cup, and rim areas from HRT 3 were lower than HRT II (P < .0001). AUC (sensitivity at 95% specificity) was 0.85 (54%) for vertical cup-to-disk ratio (VCDR) HRT 3, 0.84 (45%) for VCDR HRT II, and 0.81 (44%) for GPS at the temporal sector. MRA HRT 3 showed greater sensitivity but lower specificity than HRT II for the entire group, the African ancestry group, and the European ancestry group. GPS classification had the lowest specificity. Glaucomatous eyes incorrectly classified by GPS had smaller mean disk area (P = .0002); control eyes incorrectly classified had greater mean disk area (P = .015). CONCLUSIONS: VCDR from HRT 3 showed higher sensitivity than HRT II and GPS for the entire group and for those of African ancestry and of European ancestry separately. Sensitivity of MRA improved in HRT 3 with some trade-off in specificity compared with MRA of HRT II. GPS yielded erroneous classification associated to optic disk size.

Agreement in assessing cup-to-disc ratio measurement among stereoscopic optic nerve head photographs, HRT II, and Stratus OCT.

PURPOSE: To compare the level of agreement between subjective and objective methods in estimating horizontal and vertical cup-to-disc ratios (HCDR and VCDR, respectively) to determine if objective techniques may be used as surrogates for subjective cup-to-disc (CDR) estimation. METHODS: Fifty-one glaucoma patients and 49 control subjects underwent full ophthalmic examination, stereoscopic optic nerve head photographs (ONHPs), confocal scanning laser ophthalmoscopy (Heidelberg Retina Tomography II [HRT II]), and optical coherence tomography (Stratus OCT). The intraclass correlation coefficient (ICC) and Bland Altman plots were used to assess the agreement across the three methods. Repeated measures analysis of variance (ANOVA), Tukey adjustment, and pairwise P values were used to compare the HCDR and VCDR estimates between three clinicians who reviewed photos, Stratus OCT, and HRT II. RESULTS: For the clinicians, the agreement in subjectively assessed HCDR and VCDR was substantial (ICC=0.84 and 0.85, respectively), and for all three methods, overall agreement was good (ICC=0.75 and 0.77 for the HCDR and VCDR, respectively). Stratus OCT provided the largest overall mean+/-SD HCDR (0.68+/-0.14) and VCDR (0.62+/-0.13). The smallest overall mean+/-SD HCDR was provided by ONHP (0.32+/-0.16), and the smallest overall mean+/-SD VCDR was provided by HRT II (0.26+/-0.20). Repeated measures ANOVA test demonstrated significant differences across the three methods for glaucomatous (P=0.0017 and 0.0016, HCDR and VCDR, respectively) and normal (P=0.0001 for both HCDR and VCDR) eyes. Tukey adjustment demonstrated specific statistical differences between pairs of methods. CONCLUSIONS: Although the overall agreement between various methods was good, the mean estimates were statistically different. Additional studies are needed to evaluate the sources of variability, their level of significance, and longitudinal agreement between various methods of the CDR estimation.

Is reading disability likely to interfere with glaucoma screening of adults using frequency-doubling technology perimetry?

PURPOSE: The present study is a preliminary investigation of whether frequency doubling technology perimetry (FDT) performance deficits exist in adults with reading disability (RD) and could thereby interfere with screening assessments for glaucoma. DESIGN: Cross-sectional. METHOD: The study population was composed of 46 college students. Twenty-four of the participants were identified as having a RD, and 22 served as controls. All participants underwent assessments of reading, IQ, FDT, Humphrey Visual Fields (HVF), and an ophthalmologic examination. RESULTS: No differences between the RD and control groups were found in age, education, IQ, far visual acuity, HVF, or FDT performance, regardless of how FDT was evaluated (P's >.05). CONCLUSIONS: Preliminary results indicate that FDT performance deficits, which have previously been demonstrated in children with RD, are either small in magnitude or do not exist in adults. Thus, it is unlikely that RD will interfere with assessment for glaucoma using FDT perimetry.

Ocular trauma-related glaucoma.

Glaucoma following ocular injury is a multifactorial condition. Management of posttraumatic ocular hypertension is especially critical in that many of the complications that may develop are preventable. Management is aimed at preventing further damage to the injured eye.

Retinopatía en pacientes diabéticos tratados por diferentes especialistas. Reporte preliminar / Retinopathy in diabetics seen by different specialists

Se realizó un estudio retrospectivo para determinar si existen diferentes proporciones de pacientes con retinopatía en grupos manejados por diferentes especialistas médicos.Material y método: Las valoraciones oftalmológicas iniciales de pacientes diabéticos se dividieron de acuerdo al médico que los refirió: grupo 1: endocrinólogos; grupo 2: médicos internistas; y grupo 3: médicos generales. Se comparó la proporción de ojos con: a) retinopatía diabética, b) retinopatía proliferativa y c) pérdida visual severa. Se valoró también la oportunidad de la detección de acuerdo con las recomendaciones internacionales. Las diferencias entre cada grupo se analizaron mediante x2.Resultados: Se valoraron 756 ojos de 387 pacientes. Se asignaron 264 ojos al grupo 1, 152 al grupo 2 y 340 al grupo 3. La proporción general de ojos con retinopatía, con retinopatía proliferativa y con pérdida visual severa fue de 48 por ciento, 16 por ciento y 14 por ciento respectivamente. La presencia de retinopatía diabética, retinopatía proliferativa y pérdida visual severa fue significativamente menor para el grupo 1 al compararlo con los grupos 2 y 3 (p < 0.05), pero las diferencias entre los grupos 2 y 3 no fueron significativas (p > 0.05). La detección no fue oportuna para ninguno de los grupos.Discusión: Debe reforzarse la práctica de la detección de retinopatía por el médico que maneja al paciente diabético y la referencia oportuna para calificación, especialmente durante la formación de pregrado.