Burden of Glaucoma in the United Kingdom: A Multicenter Analysis of United Kingdom Glaucoma Services

OBJECTIVE: ,To determine the spectrum of glaucoma-associated health care resource utilization among outpatients attending National Health Service (NHS) hospital glaucoma clinics and the costs of managing glaucoma in this setting. DESIGN: Retrospective observational cohort study using electronic medical record data. SUBJECTS: Patients aged ≥ 18 years attending 5 NHS glaucoma clinics in the United Kingdom (2013‒2018) with ≥ 12 months of continuous electronic medical record data. METHODS: Deidentified Medisoft Ophthalmology electronic medical record data (January 2013‒December 2018) from 43 742 eligible patients were categorized by year of clinic visit. Extracted information included patient demographics, glaucoma diagnoses, topical glaucoma medication prescription start/stop dates, types/numbers of glaucoma clinic visits, glaucoma investigations (visual acuity, intraocular pressure, visual field, and OCT), and glaucoma procedures received over 12 months after the first (“index”) visit of the specified year. Direct glaucoma-related health care costs (clinic visits, investigations, procedures, and ongoing glaucoma medication initiated in the clinic) were estimated from event volumes and unit costs (UK national tariffs) and expressed from the direct-payer perspective. MAIN OUTCOME MEASURES: Glaucoma diagnoses and topical glaucoma medication use at the index clinic visit; numbers of glaucoma clinic visits, investigations and procedures; and glaucoma-related health care costs over 12 months postindex. RESULTS: For the 2016 cohort (n = 21 719), the estimated average total cost of NHS-provided glaucoma care over 12 months was £405 per patient (medical staff services £209, glaucoma investigations £126, glaucoma medication £40, glaucoma procedures £26). Among this cohort, 40.8% had ocular hypertension/suspected glaucoma, 70% had 0-to-mild visual field impairment, and 14% had undergone a glaucoma procedure. Over 12 months, patients received (mean) 2.0 glaucoma clinic visits and 1.5 visual field tests, and 7% underwent glaucoma procedure(s). Results were similar for the other years examined. CONCLUSIONS: Cost estimates for managing patients with glaucoma in the UK are required for effective service planning. Appreciable proportions of patients managed in NHS glaucoma clinics may be considered at low risk of blindness (glaucoma suspects and those with ocular hypertension with mild visual field loss) and may be more appropriately managed with alternative, more affordable models of care

Development and validation of a computerized expert system for evaluation of automated visual fields from the Ischemic Optic Neuropathy Decompression Trial

BACKGROUND: The objective of this report is to describe the methods used to develop and validate a computerized system to analyze Humphrey visual fields obtained from patients with non-arteritic anterior ischemic optic neuropathy (NAION) and enrolled in the Ischemic Optic Neuropathy Decompression Trial (IONDT). The IONDT was a multicenter study that included randomized and non-randomized patients with newly diagnosed NAION in the study eye. At baseline, randomized eyes had visual acuity of 20/64 or worse and non-randomized eyes had visual acuity of better than 20/64 or were associated with patients refusing randomization. Visual fields were measured before treatment using the Humphrey Field Analyzer with the 24-2 program, foveal threshold, and size III stimulus. METHODS: We used visual fields from 189 non-IONDT eyes with NAION to develop the computerized classification system. Six neuro-ophthalmologists ("expert panel") described definitions for visual field patterns defects using 19 visual fields representing a range of pattern defect types. The expert panel then used 120 visual fields, classified using these definitions, to refine the rules, generating revised definitions for 13 visual field pattern defects and 3 levels of severity. These definitions were incorporated into a rule-based computerized classification system run on Excel(® )software. The computerized classification system was used to categorize visual field defects for an additional 95 NAION visual fields, and the expert panel was asked to independently classify the new fields and subsequently whether they agreed with the computer classification. To account for test variability over time, we derived an adjustment factor from the pooled short term fluctuation. We examined change in defects with and without adjustment in visual fields of study participants who demonstrated a visual acuity decrease within 30 days of NAION onset (progressive NAION). RESULTS: Despite an agreed upon set of rules, there was not good agreement among the expert panel when their independent visual classifications were compared. A majority did concur with the computer classification for 91 of 95 visual fields. Remaining classification discrepancies could not be resolved without modifying existing definitions. Without using the adjustment factor, visual fields of 63.6% (14/22) patients with progressive NAION and no central defect, and all (7/7) patients with a paracentral defect, worsened within 30 days of NAION onset. After applying the adjustment factor, the visual fields of the same patients with no initial central defect and 5/7 of the patients with a paracentral defect were seen to worsen. CONCLUSION: The IONDT developed a rule-based computerized system that consistently defines pattern and severity of visual fields of NAION patients for use in a research setting

Latanoprost treatment for open angle glaucoma. The United Kingdom Glaucoma Treatment Study: a multicentre, randomised, placebo-controlled clinical trial

BACKGROUND: Treatment of open-angle glaucoma (OAG) aims to prevent vision loss by lowering intraocular pressure (IOP), yet there has been no previous placebo-controlled medical treatment trial assessing vision function preservation. Observation periods in previous (unmasked) trials assessing visual function have typically been at least 5 years. The aim of this study was to assess vision preservation by latanoprost treatment compared to placebo. METHODS In this randomised, triple-masked, placebo-controlled trial, patients with newly-diagnosed OAG were enrolled at 10 UK centres (tertiary referral centres, teaching hospitals, and district general hospitals) between Feb 2007 and Mar 2010. Eligible patients were randomly allocated (1:1) to receive either latanoprost 0·005% or placebo eye drops, provided in identical bottles, once daily to both eyes. Randomization was in permuted blocks stratified by participating centre. The primary hypothesis was that latanoprost treatment reduces incident visual field (VF) deterioration, compared with placebo, by 50% over 2 years. The primary outcome was VF deterioration: 3 locations in the Pattern Deviation Glaucoma Change Probability maps worse than baseline in 2 consecutive VFs, present in 2 consecutive VF pairs. The primary analysis was VF survival in the intention-to-treat population. The trial was terminated in July 2011 on the recommendation of the independent data monitoring committee following an interim analysis. Trial registration number: ISRCTN96423140. FINDINGS: 516 patients were randomised and data on all subjects with post-allocation data (461) were analysed. 18 serious adverse events were reported, none attributable to the study drug. Baseline mean (SD) IOP was 19·6 (4·6) mmHg and 20·1 (4·8) mmHg, and IOP reduction at 24 months 3·8 (4·0) mmHg and 0·9 (3·8) mmHg, in the latanoprost and placebo groups, respectively. Incident VF deterioration (95% CI) by 24 months was 15·0% (10·8, 20·0) in the latanoprost group and 24·8% (19·5, 30·7) in the placebo group (P=0·007). VF survival was significantly longer in the latanoprost group: at 24 months, adjusted hazard ratio (HR) 0·44 (0·28, 0·69) (P=0·0003). The difference between treatment groups was evident after only 12 months, HR 0·47 (0·23, 0·95) (P=0·035). INTERPRETATION: This is the first placebo-controlled trial to demonstrate VF preservation with an IOP-lowering agent in OAG. The study design enabled a relatively short observation period. FUNDING: Pfizer Inc.; UK National Institute for Health Research Biomedical Research Centre

Real-World Outcomes of Selective Laser Trabeculoplasty in the United Kingdom

Purpose: Selective laser trabeculoplasty (SLT) is a common treatment option for managing glaucoma and ocular hypertension. We assessed the real-world effectiveness of SLT and baseline factors associated with treatment success in the United Kingdom. Design: Retrospective observational study of de-identified electronic medical records (Medisoft Glaucoma module [Medisoft Ltd, Leeds, UK]) from 5 UK ophthalmology teaching centers. Participants: Adult patients undergoing their first recorded SLT. For bilateral SLT (same day), analyses included 1 randomly selected eye. Methods: Patient demographics, procedure details, and clinical outcomes data were extracted. Factors associated with treatment success were assessed using multivariable Cox regression. Main Outcome Measures: Change from baseline in intraocular pressure (IOP) and glaucoma medication use at 12 to 18 and 24 to 36 months post-SLT. A Kaplan–Meier survival analysis was also conducted. Failure of SLT was defined as any further glaucoma procedure post-SLT or any of the following at 2 consecutive visits: IOP >21 mmHg, IOP reduction <20% from baseline, or increase in glaucoma medications from baseline. Results: A total of 831 SLT-treated eyes (mean baseline IOP 22.0 mmHg) of 831 patients were analyzed. At 12 to 18 and 24 to 36 months post-SLT, respectively, significant reductions in IOP (−4.2 [95% confidence interval {CI}, −4.7 to −3.7] and −3.4 [95% CI, −4.1 to −2.7] mmHg; both P 21 mmHg vs. ≤21 mmHg, 95% CI, 0.57–0.80; P < 0.001). Selective laser trabeculoplasty success was not significantly associated with age (P = 0.78), baseline visual field mean deviation (P = 1.00), or concurrent use of IOP-lowering medication (P = 0.52). Conclusions: Most patients initially responded to SLT, but the majority failed within 1 year. Efficacy of SLT was better in patients with higher baseline IOP but did not differ by glaucoma severity or concurrent use of IOP-lowering medication. These findings may help inform which patients are suitable for SLT therapy

Iris ischaemic changes and visual outcome after acute primary angle closure

10.1111/j.1442-9071.2005.01064.xClinical and Experimental Ophthalmology335473-47

A Special Material or a New State of Matter: A Review and Reconsideration of the Aerogel

The ultrahighly nanoporous aerogel is recognized as a state of matter rather than as a functional material, because of its qualitative differences in bulk properties, transitional density and enthalpy between liquid and gas, and diverse chemical compositions. In this review, the characteristics, classification, history and preparation of the aerogel were introduced. More attention was paid to the sol-gel method for preparing different kinds of aerogels, given its important role on bridging the synthetic parameters with the properties. At last, preparation of a novel single-component aerogel, design of a composite aerogel and industrial application of the aerogel were regarded as the research tendency of the aerogel state in the near future