A comparison of optic disc area measured by confocal scanning laser tomography versus Bruch's membrane opening area measured using optical coherence tomography.

BACKGROUND: Precise optic disc size measurements based on anatomically exact disc margins are fundamental for a correct assessment of glaucoma suspects. Computerized imaging techniques, such as confocal-scanning-laser-tomography (CSLT), which applies operator defined boundaries and optical-coherence-tomography (OCT), which incorporates an alternative detectable landmark (Bruch's-membrane-opening (BMO)), have simplified the planimetry of the optic disc and BMO-area, respectively. This study's objectives are to compare both modalities for area and to define a threshold for macro-BMO using BMO-OCT. METHODS: Retrospectively, patients that simultaneously received CSLT and BMO-OCT scans were included. Their images were correlated and agreement was determined using Bland-Altman-analysis. The diagnostic power of a macro-BMO threshold using OCT was derived after creating a receiver-operating-characteristics-curve using the well-established analogous CSLT threshold (2.43 mm2). RESULTS: Our study included 373 eyes with a median optic disc area by CSLT/ BMO-area by OCT of 2.56 mm2 and 2.19 mm2 respectively. The Bland-Altman-analysis revealed a systematic deviation with a diverging tendency with increasing area, which enabled the creation of the following mathematical relation: disc-area (CSLT)*0.73 + 0.3 = BMO-area (OCT). BMO-area of 2.19 mm2 showed the best diagnostic power for identifying macro-BMOs using OCT (sensitivity: 75%, specificity: 86%). CONCLUSIONS: Area measurements (CSLT optic disc area vs. BMO-area by OCT) showed a systematic deviation with a divergent tendency with increasing size. Our mathematical equation offers an estimated comparison of these anatomically diverse entities. Considering BMO-OCT´ anatomical accuracy, the 2.19 mm2 threshold may improve discernment between glaucoma suspects and norm variants.

Ophthalmic Care in Nursing Homes for the Blind: A Growing Challenge. / Augenärztliche Betreuung in Blindenheimen: eine wachsende Herausforderung.

BACKGROUND: The demographic change in Germany will lead to an increase in irreversible age-related eye diseases. This will increase the need for specialised care facilities for visually impaired people. Due to reduced mobility, residents in such facilities often do not receive adequate ophthalmological care. New concepts must therefore be considered for this group of patients. One approach is to set up an ophthalmological examination unit within the facility combined with regular visits by an ophthalmologist. We now present the experience with such a model in a home for the blind. PATIENTS AND METHODS: The project was initiated in 2009. Since then there have been visits by medical staff of the Eye Center at Medical Center, University of Freiburg, every two weeks. All patient records (2010 - 2017) were reviewed systematically. The following data were extracted in a structured and anonymous way: Age at first presentation, gender, ophthalmological diagnoses and if a therapy was initiated. This data set was finally analysed descriptively. RESULTS: Out of 130 residents aged between 48 and 100 years, half were between 78 and 90 years old. The youngest resident was 48, the oldest 100 years old. The median visual acuity was 0.2. Sixty percent of the residents had at least mild visual impairment according to the WHO (visual acuity < 0.5; category 1 - 6). In one of 6 - 7 residents, visual acuity could not be determined using Snellen charts. The most frequent ophthalmological diagnoses included cataract (44%), age-related macular degeneration (36%) and glaucoma (29%). In 67 residents (52%), the ophthalmological examination lead to treatment, such as application of local therapy or planning an operation. CONCLUSION: In every second resident, the ophthalmologist's visit lead to treatment during the observation period. This underlines the difficulty of providing ophthalmological care even in specialised institutions for the blind and visually impaired, which is possibly due to the residents' mobility problems. The concept presented here has established a low-threshold, sustainable and high-quality ophthalmological service on site. These positive experiences indicate that corresponding measures may also be useful for other locations. However, in order to implement such a project on a larger scale, suitable financing and accounting modalities for the construction measures, the nursing staff and the ophthalmological procedure still need to be developed.

Long-term follow-up of intraocular pressure and pressure-lowering medication in patients after ab-interno trabeculectomy with the Trabectome.

BACKGROUND: The minimally invasive ab-interno trabeculectomy (AIT) via electro-ablation with the Trabectome has been on the European market since 2009. Many studies have proven the safety and efficacy of the procedure. Up until now, studies investigating the long-term effect of AIT have been sparse. In this study, we present long-term results of AIT in patients with primary and secondary open-angle glaucoma. METHODS: In a retrospective monocentric study, the data of all the patients having undergone the procedure in 2010 at our institution were recorded. Data was collected during routine examinations at our institution. In total, 81 eyes of 74 patients (46 patients with primary open-angle glaucoma (POAG), 28 patients with pseudoexfoliative glaucoma (PEXG)) were included. At every examination, the intraocular pressure (IOP) was measured using Goldmann applanation tonometry and the number of IOP-lowering medication was registered. Statistical analysis was done using the Kaplan-Meier analysis or Dunnett's t test, respectively. RESULTS: For both groups (POAG and PEXG), we found a significant lowering of the IOP (28% for POAG and 26% for PEXG) and a significant reduction of the number of IOP-lowering medication (32% for POAG and 29% for PEXG) after a median follow-up period of 3.5 years. CONCLUSION: In patients with open-angle glaucoma and especially pseudoexfoliative glaucoma, ab-interno trabeculectomy is an effective surgical procedure to significantly lower the intraocular pressure on a long-term basis.

[Is the Patient Record Sufficient for Prescribing Low-Vision Magnification Aids or Is a Consultation in a Low-Vision Clinic Required?] / Ist die Verordnung von vergrößernden Sehhilfen anhand der Krankenakte möglich oder bedarf es einer Beratung in einer Sehbehindertenambulanz?

BACKGROUND: Many visually impaired and blind patients regain reading ability by using magnification aids. They are tested and prescribed in a time-intensive consultation at our low-vision clinic. Thus, the question arises if it is possible to automate the selection and prescription of low-vision aids only on the basis of the patients' records. METHODS: The following parameters were extracted from the database of medical records from the low-vision clinic between 2001 and 2006: diagnosis, visual acuity, magnification need, prescribed low-vision aid and prescription request. The prescriptions (optic magnifiers, electronic magnifiers and closed-circuit television) were predicted by statistical models and compared with the real prescription. RESULTS: The database research provided the records of 1203 patients. Sixty-four percent were female and the median age was 80 years. The prescriptions consisted of 29% closed-circuit televisions, 11% electronic magnifiers, 34% optic magnifiers and 26% other aids or no aids. Overall, the statistically predicted prescription matched the real prescription of the magnification aids in only 73% of the cases. The magnification need was the most significant statistical factor. CONCLUSION: The reliability of an automated prescription of low-vision magnification aids on the basis of the patient record was not sufficient to implement this in the standard clinical process. Thus, an individual and personal consultation with detailed testing of magnification aids is important. In addition to the prescription of low-vision magnification aids, a psycho-social consultation is also provided in a low-vision clinic.