Standard achromatic perimetry, short wavelength automated perimetry, and frequency doubling technology for detection of glaucoma damage

Objective: Reevaluation of the relationship between short wavelength automated perimetry (SWAP), standard achromatic perimetry (SAP), and frequency doubling technology (FDT) in glaucoma and ocular hypertensive patients and in glaucoma suspects. Design: Prospective comparative observational study. Participants: Four age-matched groups were evaluated (42 patients with early to moderate glaucoma, 34 ocular hypertensives, 22 glaucoma suspects, and 25 normal controls) using SAP, SWAP, and FDT. Intervention: All participants underwent full clinical ophthalmologic evaluation followed by SWAP, SAP, and FDT perimetry within a period of not more than 3 months. Mean defect (MID), pattern standard deviation (PSD), visual field (VF) indices, and the percentage of depressed visual field points with P value <5% and <1% in the pattern deviation plot were evaluated. Main Outcome Measures: For each of the four study groups, the MID, PSD, and the percentage of abnormal points significantly depressed <5% and <1% were compared for the three VF testing modalities. Results: In the glaucoma group, the mean percentage of the total number of abnormal points in SWAP was significantly less than abnormal points in SAP and FDT, both for 5% (P values were 0.0001 and 0.0001, respectively) and 1% (P values were 0.0001 and 0.0001, respectively). The same applied to the ocular hypertensives group. However, in the suspects group, no significant difference was detected. In normal controls, the abnormal points in SWAP were significantly lower than those in SAP for 5% (P value was 0.01) and 1% (P value was 0.05). FDT detected significantly larger defects (percentage of points <5%) than SAP in ocular hypertensives and suspects (P values were 0.01 and 0.004, respectively). Conclusions: SWAP in its existing condition is markedly less efficient than either SAP or FDT in detecting VF defects, especially in glaucoma patients and ocular hypertensives (defects detected with SWAP are less than both SAP and FDT). Defects detected with FDT are equivalent to SAP and sometimes larger, especially in ocular hypertensives and glaucoma suspects; this makes it a useful tool for picking up early glaucomatous defects in populations at risk. Ophthalmology 2002;109:444-454 (C) 2002 by the American Academy of Ophthalmolog

Retinal nerve fiber layer analysis: Relationship between optical coherence tomography and red-free photography

PURPOSE: Comparison of retinal nerve fiber layer (RNFL) thickness measurements using optical coherence tomography (OCT) to the clinical standard red-free photography (evaluated semiquantitatively), in relation to functional visual field damage in primary open-angle glaucoma (POAG) patients, ocular hypertensives, and POAG suspects. METHODS: Concurrent, cross-sectional study. In four age matched groups (42 patients with early to moderate POAG, 34 ocular hypertensives, 22 POAG suspects, and 25 normal controls), RNFL was assessed with OCT, standardized red-free photographic scoring method and standard achromatic perimetry. RESULTS: OCT RNFL thickness decreases with in creased RNFL damage (detected with red,free photography). The global average OCT RNFL thickness correlated significantly with the photographic total RNFL score (r = .650, P = .0001). Both OCT and photographic scoring system were able to find significantly thinner RNFL in the glaucoma group as compared with normals (P = .0001 for both), ocular hypertensives (P = .0001 for both), and suspects (P = .0001 for both). However, neither OCT nor photography could significantly differentiate between ocular hypertensives, suspects, and normals. Both OCT and photography were significantly correlated with VF loss. For the percentage of VF points depressed <5%, the correlation was highest for OCT (r = -0.615 for OCT and r = -0.476 for photography). OCT had a higher diagnostic accuracy than photography (86% and 77%, respectively). CONCLUSION: For RNFL thickness measurements, the presence of high correlations between OCT, photographic scores, and functional visual field loss suggest the validity of OCT measurements. The higher diagnostic accuracy of OCT RNFL measurements suggests its potential advantage for detection of early cases of glaucoma. (Am J Ophthalmol 2002;133:187-195. (C) 2002 by Elsevier Science Inc. All rights reserved.

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)