Two-Year Clinical Results After Selective Laser Trabeculoplasty for Normal Tension Glaucoma

Open Access JournalThis article aims to investigate the clinical results at 2 years after selective laser trabeculoplasty (SLT) for normal tension glaucoma (NTG). This prospective cohort study recruited NTG patients taking antiglaucoma medication. Subjects were excluded if they had previous glaucoma surgery/laser or corneal pathologies. All subjects underwent a 1-month washout. A single session of SLT was performed to 360° of the trabecular meshwork. Medication was resumed at 1 month to achieve a targeted 30% intraocular pressure (IOP) reduction from the post-washout/pre-SLT IOP. IOP was measured every 3 months and medication use was recorded at 3, 6, 12, and 24 months. Subjects with a secondary SLT or cataract extraction were excluded from IOP and medication analyses. At 24 months, 34 of the initial 45 right eyes were eligible for analyses. There were significant IOP reductions at all time intervals (except at 1 week) following SLT when compared to the prestudy (without medication) or pre-SLT (post-washout) IOP (P 20% from pre-SLT, without medication) was achieved in 11.1% (5/45). Reductions in IOP and medication use were evident at 2 years following SLT for the treatment of NTG whereas 11% remained medication free. Trial Registrations: The Clinical Trials Register of the University of Hong Kong HKCTR1847. The European Clinical Trials Database 2014-003305-15 (August 11, 2014).published_or_final_versio

Prospective study on retinal nerve fibre layer changes after an acute episode of phacomorphic angle closure

To investigate the retinal nerve fibre layer (RNFL) changes after an acute attack of phacomorphic angle closure. This prospective study involved ten cases of phacomorphic angle closure that underwent cataract extraction and intraocular lens insertion after intraocular pressure lowering. Apart from visual acuity and intraocular pressure (IOP), RNFL thickness and vertical cup disc ratio (VCDR) were measured by optical coherence tomography (OCT) at 3-9 months post attack. Humphrey visual field assessment was performed at 9 months post attack. All cases had mean phacomorphic duration of  0.2. Patients with <5 days duration of phacomorphic angle closure are likely to have reasonable postoperative vision. An acute episode of phacomorphic angle closure can trigger an accelerated RNFL thinning despite normal IOP and open angles, most noticeable in the superior and inferior quadrants, occurring between 3 and 9 months post attack. Glaucomatous optic neuropathy in the attack eye was evident by OCT but not by visual field assessment at the same time interval. © 2012 The Author(s).published_or_final_versio

Central Macular Thickness in Children with Myopia, Emmetropia, and Hyperopia: An Optical Coherence Tomography Study

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The Association Between Clinical Parameters And Glaucoma-specific Quality Of Life In Chinese Primary Open-angle Glaucoma Patients

Objective: To investigate the association between clinical measurements and glaucoma-specific quality of life in Chinese glaucoma patients. Design: Cross-sectional study. Setting: An academic hospital in Hong Kong. Patients: A Chinese translation of the Glaucoma Quality of Life–15 questionnaire was completed by 51 consecutive patients with bilateral primary open-angle glaucoma. The binocular means of several clinical measurements were correlated with Glaucoma Quality of Life–15 findings using Pearson’s correlation coefficient and linear regression. The measurements were the visual field index and pattern standard deviation from the Humphrey Field Analyzer, Snellen best-corrected visual acuity, presenting intra-ocular pressure, current intra-ocular pressure, average retinal nerve fibre layer thickness via optical coherence tomography, and the number of topical anti-glaucoma medications being used. Results: In these patients, there was a significant correlation and linear relationship between a poorer Glaucoma Quality of Life–15 score and a lower visual field index (r=0.3, r2=0.1, P=0.01) and visual acuity (r=0.3, r2=0.1, P=0.03). A thinner retinal nerve fibre layer also correlated with a poorer Glaucoma Quality of Life–15 score, but did not attain statistical significance (r=0.3, P=0.07). There were no statistically significant correlations for the other clinical parameters with the Glaucoma Quality of Life–15 scores (all P values being >0.7). The three most problematic activities affecting quality of life were “adjusting to bright lights”, “going from a light to a dark room or vice versa”, and “seeing at night”. Conclusion: For Chinese primary open-angle glaucoma patients, binocular visual field index and visual acuity correlated linearly with glaucoma- specific quality of life, and activities involving dark adaptation were the most problematic.published_or_final_versio

Retinal Nerve Fiber Layer Thickness in Myopic, Emmetropic, and Hyperopic Children

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The effects of a 6-month Tai Chi Qigong training program on temporomandibular, cervical and shoulder joint mobility and sleep problems in nasopharyngeal cancer survivors

Introduction. Nasopharyngeal cancer (NPC) survivors often sustain head–neck–shoulder impairments from conventional treatments, which could disturb sleep. This novel study aimed to examine the efficacy of Tai Chi (TC) Qigong in optimizing temporomandibular joint (TMJ), cervical, and shoulder joint mobility and reducing sleep problems in NPC survivors. Methods. Fifty-two NPC survivors participated in the study. The experimental group (n = 25) received 6 months of TC Qigong training (1.5 h/session; 4 sessions/wk including self-practice) while the control group (n = 27) received no training. Cervical side flexion and rotation, shoulder flexion and horizontal flexion range of motion (ROM), mouth opening capacity (interincisor distance), and sleep problems (Medical Outcomes Study Sleep Scale) were assessed at baseline, mid-intervention (3 months), immediately after TC Qigong training, and at 6-month follow-up. Results. Intention-to-treat analysis revealed improvement in cervical side flexion ROM only (P .008) after the TC Qigong training. Deterioration was observed in shoulder flexion ROM and mouth opening capacity in the no-training controls over time (P < .008). Sleep problems also decreased in the TC Qigong group (P < .008), and this effect was most profound during the follow-up period. In addition, improvement in cervical side flexion ROM was associated with a reduction in sleep problems in the experimental group after TC Qigong training (P < .05). Conclusions. The 6-month TC Qigong intervention improved neck mobility, maintained TMJ and shoulder joint mobility, and reduced sleep problems for NPC survivors. TC Qigong could be an effective nonpharmacological intervention for managing progressive trismus, chronic neck and shoulder hypomobility, and reducing sleep problems among NPC survivors.postprin

Incidence and Risk Factors for Retinopathy of Prematurity in Multiple Gestations: a Chinese population study

To determine the incidence and risk factors of retinopathy of prematurity (ROP) among new-born Chinese infants of multiple gestations. A retrospective review of medical records was performed for all neonates of multiple gestations screened for ROP between January 2007 and December 2012 in 2 neonatal intensive care units in Hong Kong. Screening was offered to very low birth weight (VLBW; ≤1500g) and/or preterm (gestation ≤32 weeks) neonates using the Royal College of Ophthalmologists ROP guideline and the International Classification of ROP by 3 pediatric ophthalmologists. Maternal and neonatal covariates were analyzed using univariate and multivariate regression analyses for both ROP and Type 1 ROP. A total of 153 Chinese infants of multiple gestations were included in the study. The mean gestational age (GA) was 30.8±2.4 weeks and the mean birth weight (BW) was 1284.8±267.4g. The incidence of ROP and Type 1 ROP was 11.8% and 3.9%, respectively. On univariate analysis, younger GA, lighter birth weight, postnatal hypotension, inotropes use, bronchopulmonary disease, and intraventricular hemorrhage were common independent risk factors for the development of ROP and Type 1 ROP (all P≤0.04). On multivariate analysis, younger GA, surfactant use, invasive mechanical ventilation, higher mean oxygen concentration, thrombocytopenia, intraventricular hemorrahage, total parental nutrition, and hypoglycemia were significant risk factors for ROP. For Type 1 ROP, there were no significant dependent risk factors. In preterm Chinese infants born from multiple gestations, prematurity, lighter weight, postnatal hypotension, inotropes use, bronchopulmonary dysplasia, and an intraventricular hemorrhage were common independent risk factors for the development of ROP and Type 1 ROP.published_or_final_versio

Musculoskeletal strength, balance performance and self-efficacy in elderly Ving Tsun Chinese martial art practitioners: Implications for fall prevention

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The use of optical coherence tomography in the assessment of diabetic retinopathy and maculopathy

This review was performed to assess the use of optical coherence tomography in diabetic retinopathy and maculopathy and its application in the diagnosis and management of these conditions. A comprehensive literature search on MEDLINE was performed for studies published until 2013 with key words 'diabetes mellitus', 'optical coherence tomography', 'diabetic retinopathy', 'diabetic maculopathy', 'intersessional repeatability', 'diurnal variation' , 'fundus autofluorescence' and 'treatment'. Search results were limited to studies published in English and in human subjects only. The Early Treatment Diabetic Retinopathy Study established the current standard of care for diabetic retinopathy and maculopathy with the diagnosis based on slit-lamp biomicroscopy, indirect ophthalmoscopy, and fluorescein angiography. There has been a recent shift to the use of optical coherence tomography in the qualitative and quantitative assessment of such diseases. Furthermore, the advancement of optical coherence tomography from time-domain to spectraldomain technology allows us to visualize pathological changes of diabetic maculopathy in details in different retinal layers. Such observed changes have been used to establish new classifications of diabetic maculopathy. The high sensitivity and quantitative nature of optical coherence tomography make it a highly popular modality used extensively to monitor disease progression and efficacy of new treatment modalities. Optical coherence tomography plays a crucial role in the modern clinical management of diabetic retinopathy and maculopathy. Its use has revolutionized the understanding and management of these eye diseases.published_or_final_versio

The Correlation of Retinal Nerve Fiber Layer Thickness With Blood Pressure in a Chinese Hypertensive Population

To investigate the association between retinal nerve fiber layer (RNFL) thickness and blood pressure (BP) in subjects with systemic hypertension. Subjects with systemic hypertension on anti-hypertensive medications were screened by fundus photography and referred for glaucoma work-up if there was enlarged vertical cup-to-disc (VCDR) ratio ≥0.6, VCDR asymmetry ≥0.2, or optic disc hemorrhage. Workup included a complete ophthalmological examination, Humphrey visual field test, and RNFL thickness measurement by optical coherence tomography. The intraocular pressure (IOP) and RNFL thicknesses (global and quadrant) were averaged from both eyes and the means were correlated with: the systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) using Pearson correlation. Among 4000 screened hypertensive subjects, 133 were referred for glaucoma workup and 110 completed the workup. Of the 4000 screened subjects, 1.3% had glaucoma (0.9% had normal tension glaucoma [NTG], 0.2% had primary open angle glaucoma, and 0.2% had primary angle closure glaucoma), whereas 0.3% were NTG suspects. The SBP was negatively correlated with the mean superior RNFL thickness (P=0.01). The DBP was negatively correlated with the mean global (P=0.03), superior (P=0.02), and nasal (P=0.003) RNFL thickness. The MAP was negatively correlated with the mean global (P=0.01), superior (P=0.002), and nasal (P=0.004) RNFL thickness while positively correlated with the mean IOP (P=0.02). In medically treated hypertensive subjects, glaucoma was present in 1.3%, with NTG being most prevalent. MAP control may help with IOP lowering and RNFL preservation, although future prospective studies will be needed. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.published_or_final_versio