Lower corneal hysteresis in glaucoma patients with acquired pit of the optic nerve (APON)

Objective: Acquired pit-like changes of the optic nerve head (APON) are characteristic of glaucomatous damage and may be a sign of a localized susceptibility of the optic nerve. Thus, it is possible that biomechanical properties of the ocular tissues may play a pressure-independent role in the pathogenesis of glaucoma. Corneal hysteresis (CH) appears to provide information of the biomechanical properties of the ocular hull tissues. The purpose of this study was to compare CH of patients with primary open angle glaucoma (POAG) with and without APON. Methods: A prospective case control study was done. POAG patients with and without APON were measured using the Ocular Response Analyzer by masked investigators. Patients in both groups were matched for sex, age, corneal thickness, and type of glaucoma according to maximal IOP (NTG or POAG). Statistical analysis was done using ANOVA. Results: Corneal hysteresis of 16 glaucomatous eyes with APON and 32 controls (glaucoma without APON) was measured. The mean (±SD) CH in the APON group was 8.89 (±1.53) and 10.2 (±1.05) in the control group. The difference is statistically significant (p = 0.005). Conclusions: Corneal hysteresis in POAG patients with APON was significantly lower than in patients that did not have such structural changes of the optic disc. These findings may reflect pressure-independent mechanisms involved in the pathogenesis of such glaucomatous optic nerve change

The Accuracy of Accredited Glaucoma Optometrists in the Diagnosis and Treatment Recommendation for Glaucoma

Background/aims: To compare the diagnostic performance of accredited glaucoma optometrists (AGO) for both the diagnosis of, and decision to treat glaucoma with that of routine hospital eye care against a reference standard of expert opinion, i.e. consultant ophthalmologist with a special interest in glaucoma. Methods: A directly comparative, masked, performance study was performed in Grampian, Scotland. 165 people were invited to participate and, of those, 100 (61%) were examined. People suspected of having glaucoma underwent a full ophthalmic assessment both in a newly established, community optometry led, glaucoma management scheme and in a consultant led hospital eye service within a month. Results: The agreement between the AGO and the consultant ophthalmologist in the diagnosis of glaucoma was substantial (89%, kappa = 0.703, SE=0.083). The agreement regarding the need for treatment was also substantial (88%, kappa = 0.716, SE =0.076). The agreement between the trainee ophthalmologists and the consultant ophthalmologist in the diagnosis of glaucoma and treatment recommendation were moderate (83%, kappa = 0.541, SE = 0.098, SE = 0.98; and 81%, kappa = 0.553, SE = 0.90, respectively). The diagnostic accuracy of the optometrists in detecting glaucoma in this population was high for specificity (0.93 [95% CI 0.85 to 0.97]) but lower for sensitivity at 0.76 (95% CI 0.57 to 0.89). The performance was similar when accuracy was assessed for treatment recommendation (sensitivity, 0.73[95% CI 0.57 to 0.85]; specificity 0.96[95% CI 0.88 to 0.99]). The differences in sensitivity and specificity between AGO and junior ophthalmologist was not statistically significant.Conclusions: Community optometrists trained in glaucoma provided satisfactory decisions regarding diagnosis and initiation of treatment for glaucoma. With such additional training in glaucoma optometrists are at least as accurate as junior ophthalmologists but some cases of glaucoma missed.Chief Scientist Office of the Scottish Executive Health Departmen

Topical antihistamines and mast cell stabilisers for treating seasonal and perennial allergic conjunctivitis

Peer reviewedPublisher PD

Outcome Measures in Glaucoma : a systematic review of Cochrane Reviews and Protocols

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Recurrent vitreous occlusion of glaucoma drainage device tube in a patient with glaucoma in aphakia: a case report

Patients with spontaneous lens dislocation and glaucoma can be challenging to manage. We present a forty-six year old Caucasian lady who was referred with bilateral high intraocular pressure, and was subsequently diagnosed with glaucoma in association with lens dislocation and Marfan syndrome. Baerveldt glaucoma drainage device tubes were inserted in both eyes due to poor response to medical therapy. However, this was complicated by recurrent vitreous occlusion of both glaucoma drainage tubes requiring further multiple surgical interventions. There have not been any further recurrences of vitreous incarceration or posterior segment complications since, but the patient remains under close follow-up

Developing the Intervention and Outcome Components of a Proposed Randomised Controlled trial (RCT) of a National Screening Programme for Open Angle Glaucoma (OAG) : Medical Research Council funded trial platform study (G0701759): Study protocol

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Different lasers and techniques for proliferative diabetic retinopathy

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of different techniques and types of laser photocoagulation treatment for PDR. We will compare different wavelengths; power and pulse duration; pattern, number and location of burns versus standard argon laser single spot treatment as defined by ETDRS

Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma:An economic evaluation based on data from the EAGLE trial

This study was funded by the UK Medical Research Council (ref G0701604), and managed by the National Institute for Health Research (NIHR-EME 09-800-26) on behalf of the MRC-NIHR partnership, Efficiency and Mechanism Evaluation Programme. The Health Services Research Unit and the Health Economics Research Unit are both funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. The funders had no role in the study design; collection, analysis, and interpretation of data; the writing of the report; or in the decision to submit the article for publication. The views expressed in this article are those of the authors and do not necessarily reflect the views of the MRC, National Institute for Health Research, the Department of Health, or the Scottish Government.Peer reviewedPublisher PD