Comparison of different analytic algorithms for interpretation of the Swedish interactive threshold algorithm strategy

OBJECTIVE: To compare 4 analytic algorithms for interpretation of the Swedish Interactive Threshold Algorithm. INTRODUCTION: Analytic algorithms were initially developed for interpretation of standard automated perimetry (using a full threshold strategy). The Swedish interactive threshold algorithm is a novel strategy that was developed to shorten test duration. METHODS: One hundred forty-three printouts of normal and glaucomatous patients were analyzed using Caprioli's (strict, moderate and liberal) criteria and Anderson's modified criteria for perimetric defect. Areas under the receiver operator characteristics (ROC) curves, sensitivity, and specificity for each criteria were calculated. RESULTS: Caprioli's strict and Anderson's modified criteria presented similar sensitivity (94.5% and 92.3%, respectively) and specificity (63.5% and 61.5%, respectively). Caprioli's liberal criteria were more sensitive (98.9%) and less specific (42.5%) than the other three criteria. CONCLUSION: Both Caprioli's and Anderson's modified criteria can be used for interpretation of the Swedish interactive threshold algorithm

Flutuação da pressão intraocular em olhos saudáveis e olhos glaucomatosos: análise comparativa entre a curva tensional diária simplificada nas posições sentada, supina e o teste de sobrecarga hídrica

Purpose: To compare intraocular pressure (IOP) using the simplified daily tensional curve (SDTC) between supine and sitting positions in terms of peak levels and amount of fluctuation in both, glaucomatous and healthy subjects. The secondary endpoint was the comparison of these measures with those derived from the water drinking test (WDT). Methods: Thirty patients with primary open-angle glaucoma (POAG) that were undergoing medical therapy and 30 healthy subjects were enrolled in this study. Each patient underwent a diurnal curve between 8 am and 4 pm. After lying down for 5 minutes, the IOP was measured with the Perkins tonometer. Patients were instructed to sit in the upright position for 5 minutes and the tonometry was repeated. At 4:15 pm, the WDT test was performed. Fluctuation was defined as the difference between the highest and the lowest IOP readings (range). The Student's t test was used to assess differences and a P value <0.05 was considered to be statistically significant. Results: The diurnal curve in the supine position demonstrated higher IOP average values (on average 3-4 mmHg higher) compared to the sitting position (p<0.0001) for both groups. IOP peaks were higher in the supine position; however, the IOP range was essentially the same between the three methods. Treated glaucomatous patients had higher IOP levels in all measurements, but the fluctuation for all tests performed appeared to be similar to that of healthy patients. Conclusion: The data suggested that WDT can be used to estimate the diurnal IOP peak and fluctuation observed in the SDTC of the supine position for treated glaucomatous patients. Further studies can compare the possible correlation between the WDT results and those obtained from nocturnal supine measurements.Objetivo: Comparar a flutuação da pressão intraocular (PIO) nas posições sentada e supina, através da curva tensional diária simplificada (CTDS), durante o horário de consultório em pacientes saudáveis e com glaucoma primário de ângulo aberto (GPAA). O objetivo secundário foi comparar estas medidas com a flutuação da PIO verificada através do teste de sobrecarga hídrica (TSH) desses dois grupos. Métodos: A amostra foi constituída por 60 indivíduos, divididos em dois grupos, 30 saudáveis e 30 glaucomatosos. Nenhum dos pacientes saudáveis usava medicação anti-glaucomatosa. Entre os portadores de glaucoma, todos estavam medicados. Foi realizada a CTDS (medidas realizadas entre 8:00 h e às 16:00 h) na posição sentada e supina utilizando o mesmo tonômetro de Perkins. Imediatamente após a última medida (às 16:15 h), foi realizado o TSH. Flutuação foi definida como a diferença entre a maior e a menor medida de PIO. O teste t-Student foi usado para analisar as diferenças e o valor de p<0,05 foi considerado estatisticamente significante. Resultados: Os picos de PIO foram sempre maiores na CTDS quando medidos na posição supina (em média 4 mmHg maior) em pacientes saudáveis e pacientes glaucomatosos em tratamento, comparado a posição sentada (p<0.0001). Pacientes glaucomatosos em tratamento apresentaram PIO mais alta em todas as medidas, porém a flutuação em todos os testes realizados foi semelhante comparada aos pacientes saudáveis. A flutuação da PIO não apresentou diferença estatística entre os 3 métodos. Conclusão: Dados sugerem que o TSH pode ser usado para estimar o pico e a flutuação diurna da PIO na posição supina na CTDS em pacientes glaucomatosos em tratamento. Estudos futuros poderão avaliar uma possível correlação entre os resultados do TSH e as medidas noturnas em posição supina.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of Ophthalmology and Visual SciencesSanta Casa de Misericórdia de São Paulo Department of Ophthalmology Glaucoma SectorUNIFESP, EPM, Department of Ophthalmology and Visual SciencesSciEL

Comparison of different analytic algorithms for interpretation of the Swedish interactive threshold algorithm strategy

OBJECTIVE: To compare 4 analytic algorithms for interpretation of the Swedish Interactive Threshold Algorithm. INTRODUCTION: Analytic algorithms were initially developed for interpretation of standard automated perimetry (using a full threshold strategy). The Swedish interactive threshold algorithm is a novel strategy that was developed to shorten test duration. METHODS: One hundred forty-three printouts of normal and glaucomatous patients were analyzed using Caprioli’s (strict, moderate and liberal) criteria and Anderson’s modified criteria for perimetric defect. Areas under the receiver operator characteristics (ROC) curves, sensitivity, and specificity for each criteria were calculated. RESULTS: Caprioli’s strict and Anderson’s modified criteria presented similar sensitivity (94.5% and 92.3%, respectively) and specificity (63.5% and 61.5%, respectively). Caprioli’s liberal criteria were more sensitive (98.9%) and less specific (42.5%) than the other three criteria. CONCLUSION: Both Caprioli’s and Anderson’s modified criteria can be used for interpretation of the Swedish interactive threshold algorithm

Translaminar Pressure Difference and Ocular Perfusion Pressure in Glaucomatous Eyes with Different Optic Disc Sizes

Purpose: Intracranial pressure (ICP) and ocular perfusion pressure (OPP) are both involved with the pathogenesis of glaucoma. The orbital ICP determines a retrolaminar counter pressure that is antagonistic to the intraocular pressure (IOP). The purpose of this study is to evaluate whether the translaminar pressure difference (TLPD) and the OPP varies in glaucoma patients with different optic disc sizes. Methods: In this university hospital-based, observational, cross-sectional clinical study, all patients underwent an ophthalmic evaluation. Blood pressure, height, weight, and the results of retinal nerve fiber layer examination with optical coherence tomography examination were recorded. TLPD and OPP were calculated for each patient using proxy algorithms to attain indirect surrogate parameter values. Patients’ eyes were stratified into three quantiles according to optic disc sizes and the differences compared. Data from both eyes were used after using the appropriate correction for inter-eye dependency. Results: The sample consisted of 140 eyes of 73 patients with primary open-angle glaucoma and suspects. Patients with large disc size presented with higher TLPD as compared to those with average and small-sized discs (2.4 ± 4.5, 2.8 ± 3.8, and 3.7 ± 4.7 mmHg for first, second, and third tertile, respectively (P &lt; 0.000). OPP did not vary according to the optic disc size. Conclusion: Glaucoma patients with larger optic discs have higher TLPD. The pathological significance of this finding warrants further investigation

Improved Automated Perimetry Performance in Elderly Subjects after Listening To Mozart

PURPOSE: To evaluate the performance of automated perimetry of elderly subjects naïve to AP after listening to a Mozart sonata. INTRODUCTION: Automated perimetry (AP) is a psychophysical test used to assess visual fields in patients with neurological disorders and glaucoma. In a previous study, Fiorelli et al. showed that young subjects who listened to a Mozart sonata prior to undergoing AP performed better in terms of reliability than those who did not listen to the sonata. METHODS: Fifty-two AP-naïve, normal subjects underwent Automated perimetry (SITA 24-2). The study group (25 subjects) underwent AP after listening to Mozart's Sonata for Two Pianos in D Major, and the control group (27 subjects) underwent Automated perimetry without prior exposure to the music. RESULTS: The study group had significantly lower false negative rates and a lower visual field reliability score than the controls (P=0.04 and P=0.04, respectively). The test time was shorter for the study group (P=0.03). DISCUSSION: This study shows that elderly subjects, when exposed to the Mozart sonata immediately before AP testing, have lower false negative rates and lower visual field reliability scores when compared with an age- and gender-matched control group. Our results differ from those of Fiorelli et al. who found lower false positive rates and less fixation loss in addition to lower false negative rates. CONCLUSION: Listening to a Mozart sonata seems to improve automated perimetry reliability in elderly subjects

Longterm comparison between extracapsular cataract extraction combined with trabeculectomy and combined phacofiltration surgery

Purpose: To compare the safety and efficacy of extracapsular cataract extraction (ECCE) combined with trabeculectomy and combined phacoemulsification/trabeculectomy. Methods: The records of 46 patients (53 eyes) who underwent combined glaucoma and cataract surgery at the Santa Casa de São Paulo between January 1996 and November 1999 were reviewed. Results: After a mean follow-up of 18 months, visual acuity improved and intraocular pressure decreased in both groups after surgery (P<0.05). In the phacofiltration group 55.5% of eyes achieved intraocular pressure < 22 mmHg without medication as compared to 46.1% in the extracapsular cataract extraction/trabeculectomy group (P=0.3). Conclusion: Both techniques proved to be safe and efficacious in the treatment of glaucoma and cataract. However, the phacofiltration surgery seems to promote lower intraocular pressure without additional medication in a larger number of eyes.Objetivo: Comparar os resultados a longo prazo entre a cirurgia extracapsular da catarata combinada à trabeculectomia (FEC/TREC) e a facotrabeculectomia (FACO/TREC). Métodos: Os prontuários de 46 pacientes (53 olhos) submetidos à cirurgia combinada na Santa Casa de São Paulo entre janeiro de 1996 e novembro de 1999 foram revisados; dados relativos à pressão ocular (PO), acuidade visual (AV) e número de medicações foram analisados. Resultados: Em ambos os grupos, após seguimento médio de 18 meses, a acuidade visual melhorou e a pressão ocular diminuiu em relação aos valores pré-operatórios (P<0,05); 55,5% no grupo da facotrabeculectomia e 46,1% no grupo da catarata combinada à trabeculectomia obtiveram a pressão ocular final menor que 22 mmHg sem medicação (P=0,3). Conclusão: Ambas as técnicas são eficazes no tratamento simultâneo do glaucoma e da catarata. Entretanto, a facotrabeculectomia parece promover pressão ocular menor sem a necessidade do uso de medicações hipotensoras oculares em maior número de pacientes.Irmandade da Santa Casa de Misericórdia de São Paulo Faculdade de Ciências MédicasIrmandade da Santa Casa de Misericórdia de São Paulo Serviço de GlaucomaUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

The role of frequency doubling perimetry in the diagnosis of glaucoma: screening in employees of a public hospital in an urban area of São Paulo

PURPOSE: To study the prevalence of glaucoma in employees of a public hospital in São Paulo and to analyze the role of frequency doubling perimetry along with non-contact tonometry and direct ophthalmoscopy, in the screening for glaucoma. METHODS: 612 employees of the Central Hospital of the Santa Casa de São Paulo were evaluated from October 15 to 20, 2000; 438 were women and 174 men, with mean age of 45.05±7.7 years (range, 35 to 81 years); 437 were white, 104 mulatto, 43 black and 28 Asian. All examinations were done by 10 eye specialists with experience in glaucoma. All employees had both eyes examined, by means of frequency doubling perimetry (FDT), ophthalmoscopy (FO), and non-contact tonometry (TNC). RESULTS: 159 (25.98%) subjects presented with at least one abnormal testing; 5 (3.14%) had high IOP (TNC+); 13 (8.17%) presented suspicious disk (FO+); 110 (69.18%) presented abnormal FDT (FDP+); 8 (5.03%) TNC+ and FO+; 10 (6.28%) had TNC+ and FDT+; 9 (5.66%) presented FO+ and FDT+; 4 (2.51%) had TNC+, FO+ and FDT+; 12 (1.96%) individuals were diagnosed with glaucoma, four of whom (0.65%), with normal pressure glaucoma. CONCLUSIONS: Frequency doubling perimetry was found to be an important step in the screening for glaucoma in the study. Of the 12 individuals that had the diagnosis of glaucoma, 5 (41.6%) would not have been diagnosed if they had not undergone frequency doubling perimetry.OBJETIVO: Estudar a prevalência de glaucoma, em funcionários da Santa Casa de Misericórdia de São Paulo e analisar a validade da inclusão da perimetria de freqüência dupla junto à tonometria de não-contato e à oftalmoscopia direta, na triagem para glaucoma. MÉTODOS: Foram examinados 612 funcionários voluntários, 438 mulheres e 174 homens, com idade média de 45,05±7,7 anos. Eram 437 da raça branca, 104 mulatos, 43 da raça negra e 28 da raça amarela. Todos os funcionários tiveram ambos os olhos examinados por especialistas em glaucoma, que realizaram os seguintes exames: perimetria de freqüência dupla (FDT), oftalmoscopia direta (FO), tonometria de não-contato (TNC). RESULTADOS: Dos 612 indivíduos triados, 159 (25,98%) apresentaram alguma anormalidade em pelo menos um dos exames: 5 (3,14%) apresentaram pressão intra-ocular elevada (TNC+); 13 (8,17%) apresentaram oftalmoscopia suspeita (FO+); 110 (69,18%) apresentaram perimetria de freqüência dupla alterado (FDT+); 8 (5,03%) TNC+ e FO+; 10 (6,28%) TNC+ e FDT+; 9 (5,66%) FO+ e FDT+; 4 (2,51%) TNC+, FO+ e FDT+. Foram detectados 12 (1,96%) indivíduos com glaucoma, quatro dos quais (0,65%) com glaucoma de pressão normal. CONCLUSÕES: A perimetria de freqüência dupla mostrou-se útil para o rastreamento de glaucoma dentro da amostragem estudada. Do total de 12 indivíduos que tiveram o diagnóstico de glaucoma, 5 (41,6%) não teriam sido detectados se não tivessem sido submetidos a perimetria de freqüência dupla.Santa Casa de São Paulo Departamento de OftalmologiaSanta Casa de Misericórdia de São Paulo Departamento de Oftalmologia Setor de GlaucomaUniversidade Federal de São Paulo (UNIFESP) Departamento de OftalmologiaSanta Casa de São Paulo Faculdade de Ciências Médicas Departamento de OftalmologiaUNIFESP, Depto. de OftalmologiaSciEL

Comparative study of the stability of bimatoprost 0.03% and latanoprost 0.005%: A patient-use study

<p>Abstract</p> <p>Background</p> <p>The stability of ophthalmic preparations in multidose containers is influenced by the preservative as well as the stability of the active ingredient. Unstable drugs may require refrigeration to preserve their active ingredient level and they are more likely to degrade over time, therefore becoming more susceptible to degradation based on patient mishandling. The purpose of this study was to determine the degree of molecular degradation that occurs in bimatoprost and latanoprost in a patient-use setting.</p> <p>Methods</p> <p>This was an open-label, laboratory evaluation of the relative stability of bimatoprost and latanoprost. Patients presently using bimatoprost (n = 31) or latanoprost (n = 34) were identified at 2 clinical sites in Brazil. Patients were instructed to use and store their drops as usual and return all used medication bottles between day 28 and day 34 after opening.</p> <p>Results</p> <p>Bimatoprost demonstrated no degradation, but latanoprost degraded at various levels. The mean age of bimatoprost was 43.0 ± 3.4 days and the mean age of latanoprost was 43.9 ± 2.8 days (P = .072). The mean percentage of labeled concentration was 103.7% in the bimatoprost bottles and 88.1% in the latanoprost bottles (P < 001).</p> <p>Conclusion</p> <p>This study showed that bimatoprost maintained ≥100% concentration throughout the study period while latanoprost did not.</p