Health-related quality of life in patients with primary open-angle glaucoma. An italian multicentre observational study

PurposeAs a progressive condition, glaucoma may impair health-related quality of life (HRQoL), due to vision loss and other factors. This study evaluated HRQoL in a cohort of patients treated for primary open-angle glaucoma (POAG) and assessed its association with clinical features. MethodsThis was an Italian, multicentre, cross-sectional, observational study with the subgroup of newly diagnosed patients with POAG prospectively followed up for one year. Patients with previous or new diagnosis (or strong clinical suspicion) of POAG aged >18years were considered eligible. Information was collected on demographic characteristics, medical history, clinical presentation and POAG treatments. HRQoL was measured using the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and Glaucoma Symptom Scale (GSS). Subscale and total scores were obtained and a Pearson correlation coefficient between instruments' scores calculated. ResultsA total of 3227 patients were enrolled from 2012 to 2013 and 3169 were analysed. Mean age was 66.9years. A total of 93.8% had a previous diagnosis (median duration: 8.0years). Median values for mean deviation and pattern standard deviation were 3.9 and 3.6 dB, respectively. Mean scores on most subscales of the NEI-VFQ-25 exceeded 75.0 and mean GSS subscale scores ranged between 70.8 and 79.7 (with a total mean score of 74.8). HRQoL scores on both scales were significantly inversely associated with POAG severity. ConclusionIn this large sample of Italians treated for POAG, disease severity was limited and HRQoL scores were high. QoL decreased with advancing disease severity. These findings confirm the role of vision loss in impairing QoL in POAG, underlying the importance of timely detection and appropriate treatment

Vision-related quality of life and symptom perception change over time in newly-diagnosed primary open angle glaucoma patients.

To evaluate the change over time of vision-related quality of life (QoL) and glaucoma symptoms in a population of newly-diagnosed primary open angle glaucoma (POAG) patients. Multicenter, prospective study. Consecutive newly-diagnosed POAG patients were enrolled and followed-up for one year. Follow-up visits were scheduled at 6 and 12 months from baseline. At each visit, vision-related QoL and glaucoma-related symptoms were assessed by the means of the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and the Glaucoma Symptom Scale (GSS), respectively. Trends over time for NEI-VFQ-25 and GSS scores were evaluated with longitudinal linear mixed models. One-hundred seventy-eight patients were included in the analysis. At baseline, early to moderate glaucoma stages were associated with higher scores for most GSS and NEI-VFQ-25 items, while lower best-corrected visual acuity was associated with lower scores for 4 of the 12 NEI-VFQ-25 items. During the follow-up, all the GSS scores, the NEI-VFQ-25 total score, and 7 of the 12 NEI-VFQ-25 scores significantly improved (p < 0.05). In multivariate model, higher increases of most GSS and NEI-VFQ-25 scores were modeled in patients with low scores at baseline. Vision-related QoL and glaucoma-related symptom perception significantly improved during the one-year follow-up in this population of newly diagnosed POAG patients

Visual field loss and vision-related quality of life in the Italian Primary Open Angle Glaucoma Study

The aim of this study was to examine the relationship between visual field (VF) loss, vision-related quality of life (QoL) and glaucoma-related symptoms in a large cohort of primary open angle glaucoma (POAG) patients. POAG patients with or without VF defects or "glaucoma suspect" patients were considered eligible. QoL was assessed using the validated versions of the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and glaucoma-related symptoms were assessed using the Glaucoma Symptom Scale (GSS). Patients were classified as having VF damage in one eye (VFD-1), both eyes (VFD-2), or neither eye (VFD-0). 3227 patients were enrolled and 2940 were eligible for the analysis. 13.4% of patients were classified in the VFD-0, 23.7% in the VFD-1, and 62.9% in the VFD-2 group. GSS visual symptoms domain (Func-4) and GSS non-visual symptoms domain (Symp-6) scores were similar for the VFD-0 and VFD-1 groups (p = 0.133 and p = 0.834 for Func-4 and Symp-6, respectively). VFD-0 group had higher scores than VFD-2 both in Func-4 (p < 0.001) and Symp-6 domains (p = 0.035). Regarding the NEI-VFQ-25, our data demonstrated that bilateral VF defects are associated with vision-related QoL deterioration, irrespective of visual acuity

The silent sinus syndrome: diagnosis and surgical treatment

The silent sinus syndrome consists of painless facial asymmetry characterized by unilateral enophthalmos. Reabsorbed bone with displacement of the orbital floor is a constant finding. It is secondary to chronic maxillary sinus atelectasis. The onset of symptoms is usually slightly progressive but can be brisk due to sudden collapse of the orbital thin bony floor. The diagnosis is suggested by clinical findings including endonasal endoscopic examination and confirmed on the basis of computed tomography and magnetic resonance imaging. The restitution treatment of the silent sinus syndrome involves functional endoscopic sinus surgery and plastic reconstruction of the floor of the orbit via transconjunctival approach; an additional vestibular incision may be necessary to treat the malar region. Four cases of this rare and therefore relatively unknown disease are fully discussed

The silent sinus syndrome: diagnosis and surgical treatment

The silent sinus syndrome consists of painless facial asymmetry characterized by unilateral enophthalmos. Reabsorbed bone with displacement of the orbital floor is a constant finding. It is secondary to chronic maxillary sinus atelectasis. The onset of symptoms is usually slightly progressive but can be brisk due to sudden collapse of the orbital thin bony floor. The diagnosis is suggested by clinical findings including endonasal endoscopic examination and confirmed on the basis of computed tomography and magnetic resonance imaging. The restitution treatment of the silent sinus syndrome involves functional endoscopic sinus surgery and plastic reconstruction of the floor of the orbit via transconjunctival approach; an additional vestibular incision may be necessary to treat the malar region. Four cases of this rare and therefore relatively unknown disease arefully discussed

PERIMETRIA NON CONVENZIONALE SITA-SWAP NELLA DIAGNOSI PRECOCE DI GLAUCOMA

FINALITA’ DELLO STUDIO: verificare le caratteristiche dell’algoritmo SITA (Swedish Interactive Threshold Algorithm) per SWAP (Short-Wavelength Automated Perimetry) nella diagnosi della neuropatia glaucomatosa. MATERIALI E METODI: tra i pazienti afferenti all’ambulatorio glaucomi della Clinica Oculistica dell’Università di Pavia si sono selezionati soggetti in base ai dati clinici ed al risultato di esami morfometrici (GDx-VCC). Lo studio è tuttora in corso e finora i pazienti si sono suddivisi in “sospetti glaucomi” ed in “glaucomi” sulla base del parametro NFI (Nerve Fiber Indicator). I pazienti sono stati poi sottoposti ad esame perimetrico automatizzato SITA con test acromatico (SAP o Standard Automated Perimetry) e con test blu su giallo (SWAP). La durata e gli indici perimetrici MD e PSD dell’esame SAP e SWAP sono stati confrontati. RISULTATI: SITA-SWAP risulta significativamente più breve di SITA-SAP. SITA-SWAP determina un indice MD; dipendente anche dalla trasparenza dei mezzi, significativamente più alterato in entrambi i gruppi rispetto a SITA-SAP: L’indice PSD, correlato alla presenza di difetti perimetrici localizzati, risulta alterato solamente nei “sospetti”, mentre nei glaucomatosi non risulta statisticamente diverso da SITA-SAP. CONCLUSIONI: SITA-SWAP appare un esame perimetrico breve, probabilmente in grado di mettere in evidenza segni funzionali precoci di neuropatia glaucomatosa. SWAP sembra comunque influenzato dall’assorbimento della luce blu da parte dei mezzi diottrici

Il nuovo algoritmo SITA-SWAP nella diagnosi di glaucoma.

Finalità dello studio Lo studio si propone di verificare le caratteristiche del nuovo algoritmo SITA applicato alla perimetria automatizzata a corta lunghezza d’onda (SWAP), nella diagnosi di neuropatia ottica glaucomatosa. Pazienti e metodi Si stanno selezionando pazienti afferenti all’ambulatorio glaucoma della Clinica Oculistica dell’Università di Pavia, Fondazione I.R.C.C.S. Policlinico San Matteo, con sospetto glaucoma sulla base di una completa valutazione oculistica comprendente anche: tonometria, pachimetria ad ultrasuoni, tomografia laser della papilla ottica (HRT-II), polarimetria laser dello strato delle fibre nervose (GDx-VCC) e perimetria automatizzata con programma 24-2 e strategia SITA-Standard (SAP). Il sospetto di neuropatia viene posto sulla base dei risultati degli esami morfometrici e perimetrici bianco-su-bianco. I difetti perimetrici eventualmente rilevati con SAP devono essere comunque compatibili con una diagnosi di glaucoma iniziale secondo la classificazione di Hodapp. Tutti i pazienti così selezionati si sottopongono anche ad esame perimetrico SWAP 24-2 con algoritmo SITA. I risultati dei diversi test perimetrici SAP e SWAP sono confrontati. Risultati L’algoritmo SITA-SWAP è disponibile da poche settimane. I primi risultati sembrano evidenziare in alcuni pazienti difetti perimetrici più ampi e più profondi che con SAP. Conclusioni SWAP è da tempo ritenuta una metodologia di esame perimetrico in grado di mettere in evidenza precocemente segni di difetti funzionali di tipo glaucomatoso. Tuttavia il test blu-su-giallo con strategia soglia piena aveva numerose criticità (lunga durata, facile affaticamento del paziente, influenza dei mezzi diottrici, ampie fluttuazioni di soglia) che ne limitavano l’utilità clinica. La recente applicazione dell’algoritmo SITA alla perimetria SWAP potrebbe migliorarne le prestazioni e così costituire un valido mezzo per una precoce diagnosi di danno funzionale glaucomatoso

Perimetria non convenzionale sita-swap nella diagnosi precoce di glaucoma

FINALITA’ DELLO STUDIO: verificare le caratteristiche dell’algoritmo SITA (Swedish Interactive Threshold Algorithm) per SWAP (Short-Wavelength Automated Perimetry) nella diagnosi della neuropatia glaucomatosa. MATERIALI E METODI: tra i pazienti afferenti all’ambulatorio glaucomi della Clinica Oculistica dell’Università di Pavia si sono selezionati soggetti in base ai dati clinici ed al risultato di esami morfometrici (GDx-VCC). Lo studio è tuttora in corso e finora i pazienti si sono suddivisi in “sospetti glaucomi” ed in “glaucomi” sulla base del parametro NFI (Nerve Fiber Indicator). I pazienti sono stati poi sottoposti ad esame perimetrico automatizzato SITA con test acromatico (SAP o Standard Automated Perimetry) e con test blu su giallo (SWAP). La durata e gli indici perimetrici MD e PSD dell’esame SAP e SWAP sono stati confrontati. RISULTATI: SITA-SWAP risulta significativamente più breve di SITA-SAP. SITA-SWAP determina un indice MD; dipendente anche dalla trasparenza dei mezzi, significativamente più alterato in entrambi i gruppi rispetto a SITA-SAP: L’indice PSD, correlato alla presenza di difetti perimetrici localizzati, risulta alterato solamente nei “sospetti”, mentre nei glaucomatosi non risulta statisticamente diverso da SITA-SAP. CONCLUSIONI: SITA-SWAP appare un esame perimetrico breve, probabilmente in grado di mettere in evidenza segni funzionali precoci di neuropatia glaucomatosa. SWAP sembra comunque influenzato dall’assorbimento della luce blu da parte dei mezzi diottrici

Evaluation of the optic nerve in early glaucoma diagnosis: standard automated perimetry, short-wavelength automated perimetry, frequency doubling technology, pattern electroretinogram and visual evoked potential in glaucoma suspects

Purpose To compare the ability of different functional tests in detecting early glaucomatous damage Methods 68 randomly selected patients screened by the glaucoma unit of the University Eye Clinic of Pavia were considered glaucoma suspects on the basis of the IOP and the morphometric analysis of the optic nerve with GDx-VCC and HRT-III. They were submitted to SAP and divided into two age-matched groups according to Glaucoma Staging System II: group A (45 subjects, mean age 62±8 y) with GSSII 0 (MD≤-2dB, PSD<2.7dB) and group B (23 subjects , mean age 64±6 y) with GSSII ≤ 2 (MD≤-10dB, PSD≤9dB). The two groups were then submitted to a complete evaluation of the optic nerve function based on SWAP, FDT, PERG, VEP. Number of points significantly depressed <5% and <1% in the pattern deviation plot,MD,PSD, and test duration for all perimetric tests, amplitude and latency of P50 and N95 for PERG and P100 for VEP were compared using the Wilcoxon signed rank test Results All parameters of SAP and SWAP pointed out a good correlation to glaucomatous damage.Only PSD and the number of points <1% were correlated to GSSII in FDT. PERG and VEP outcomes were not correlated to glaucatous damage. Conclusion SITA-SWAP can point out glaucomatous functional damage at least as well as SAP while FDT seems to be less efficient. In perimetric testing the global index PSD seems to be effective in pointing out glaucomatous damage. PERG and VEP are less sensitive but this could be due to the criteria based on VF outcomes to divide examined subjects