Interobserver and Intertest Agreement in Telemedicine Glaucoma Screening with Optic Disk Photos and Optical Coherence Tomography

t: Purpose: To evaluate interobserver and intertest agreement between optical coherence tomography (OCT) and retinography in the detection of glaucoma through a telemedicine program. Methods: A stratified sample of 4113 individuals was randomly selected, and those who accepted underwent examination including visual acuity, intraocular pressure (IOP), non-mydriatic retinography, and imaging using a portable OCT device. Participants' data and images were uploaded and assessed by 16 ophthalmologists on a deferred basis. Two independent evaluations were performed for all participants. Agreement between methods was assessed using the kappa coefficient and the prevalence-adjusted bias-adjusted kappa (PABAK). We analyzed potential factors possibly influencing the level of agreement. Results: The final sample comprised 1006 participants. Of all suspected glaucoma cases (n = 201), 20.4% were identified in retinographs only, 11.9% in OCT images only, 46.3% in both, and 21.4% were diagnosed based on other data. Overall interobserver agreement outcomes were moderate to good with a kappa coefficient of 0.37 and a PABAK index of 0.58. Higher values were obtained by experienced evaluators (kappa = 0.61; PABAK = 0.82). Kappa and PABAK values between OCT and photographs were 0.52 and 0.82 for the first evaluation. Conclusion: In a telemedicine screening setting, interobserver agreement on diagnosis was moderate but improved with greater evaluator expertise

The Effect of Oral Citicoline and Docosahexaenoic Acid on the Visual Field of Patients with Glaucoma: A Randomized Trial

The role of nutraceuticals in the treatment of glaucoma remains controversial. The aim of this study was to evaluate the effect of citicoline, vitamin C, and docosahexaenoic acid (DHA) in patients with glaucoma. Methods: This was a prospective, randomized study. Patients with glaucoma were randomized to one of four groups and treated for 3 months with vitamin C, DHA, citicoline, or a combination of DHA and citicoline. We conducted a complete ophthalmic examination and visual fields each month and calculated the slopes of field indices. Changes in visual field indices (VFIs) and their slopes were assessed in each group and compared. Results: Seventy-three persons were included in the study. Mean defect (MD) significantly improved (p = 0.001) from −9.52 ± 4.36 to −7.85 ± 4.36 dB during the study period in persons taking DHA + citicoline. Similarly, the mean VFI significantly improved (p = 0.001) in this group. The only treatment group showing a statistically significant improvement (p = 0.006) in the MD (from −0.1041 ± 0.2471 to 0.1383 ± 0.2544 dB/month) and VFI slope was the group treated with DHA+citicoline. Conclusions: The combination of oral treatment with DHA + citicoline significantly improved VF indices and their slopes in patients with glaucoma after 3 months of treatment

Agreement among spectral-domain optical coherence tomography, standard automated perimetry, and stereophotography in the detection of glaucoma progression.

PURPOSE: The purpose of this study was to evaluate the agreement among spectral-domain optical coherence tomography, standard automated perimetry (SAP), and optic disc stereo photography in the detection of glaucomatous progression. METHODS: This was an observational cohort study enrolling 246 eyes (148 patients) followed for an average of 31.8 ± 9 months. Images were obtained every 6 to 12 months with optical coherence tomography (OCT), visual field test, and optic disc stereo photography. Progression was determined with OCT using guided progression analysis (GPA) software, in perimetry with Humphrey field analyzer GPA, and by masked assessment of stereo photograph series. Agreement among methods was reported using the κ coefficient, prevalence-adjusted bias-adjusted κ (PABAK), Gwet's first-order agreement coefficient (AC1), overall percentage agreement (OPA), percentage of positive agreement (Ppos), and percentage of negative agreement (Pneg). RESULTS: Progression by stereo photos, SAP, and OCT was found in 17 eyes (6.9%), 37 eyes (15%), and 63 eyes (25.6%), respectively. Most cases with detectable changes were only identified by one examination method, resulting in low Ppos (<33%). On the contrary, 147 eyes (59.7%) were identified as nonprogressing cases by all three methods, showing high OPA (72.8-89.8) and high Pneg (83.8-94.5). PABAK and AC1 between methods reached 0.67 to 0.88. Measurements of agreement showed a trend toward better agreement between photos and visual field (VF) than between photos and OCT. Spectral-domain OCT parameters reflected a tendency toward better agreement with stereo photos than with VF. CONCLUSIONS: Methods obtained acceptable agreement outcomes in terms of PABAK, AC1, and OPA. However, most cases with detectable changes were identified only by one examination method, resulting in low Ppos

Cost and detection rate of glaucoma screening with imaging devices in a primary care center

PURPOSE: To analyze the cost and detection rate of a screening program for detecting glaucoma with imaging devices. MATERIALS AND METHODS: In this cross-sectional study, a glaucoma screening program was applied in a population-based sample randomly selected from a population of 23,527. Screening targeted the population at risk of glaucoma. Examinations included optic disk tomography (Heidelberg retina tomograph [HRT]), nerve fiber analysis, and tonometry. Subjects who met at least 2 of 3 endpoints (HRT outside normal limits, nerve fiber index ≥30, or tonometry ≥21 mmHg) were referred for glaucoma consultation. The currently established ("conventional") detection method was evaluated by recording data from primary care and ophthalmic consultations in the same population. The direct costs of screening and conventional detection were calculated by adding the unit costs generated during the diagnostic process. The detection rate of new glaucoma cases was assessed. RESULTS: The screening program evaluated 414 subjects; 32 cases were referred for glaucoma consultation, 7 had glaucoma, and 10 had probable glaucoma. The current detection method assessed 677 glaucoma suspects in the population, of whom 29 were diagnosed with glaucoma or probable glaucoma. Glaucoma screening and the conventional detection method had detection rates of 4.1% and 3.1%, respectively, and the cost per case detected was 1,410 and 1,435€, respectively. The cost of screening 1 million inhabitants would be 5.1 million euros and would allow the detection of 4,715 new cases. CONCLUSION: The proposed screening method directed at population at risk allows a detection rate of 4.1% and a cost of 1,410 per case detected

Clinical results of diffractive, refractive, hybrid multifocal, and monofocal intraocular lenses

PURPOSE: To present the outcomes of hybrid multifocal and monofocal intraocular lenses (IOLs) and to compare with refractive and diffractive multifocal IOLs (MFIOLs). METHODS: Three hundred twenty eyes (160 patients) underwent cataract surgery with randomized IOLs bilateral implantation. Changes in uncorrected and distance-corrected logMAR distance, intermediate and near (UNVA and DCNVA) visual acuity (VA), contrast sensitivity (CS), presence of dysphotopsia, spectacle independence, and patient satisfaction were analyzed. RESULTS: Postoperative VA in the hybrid (OptiVis) group was improved in all distances (p < 0.001). OptiVis acted superiorly to monofocal IOLs in UNVA and DCNVA (p < 0.001 for both) and to refractive ones in DCNVA (p < 0.005). Distance, mesopic, without glare CS in OptiVis was lower than in the monofocal group and similar to other MFIOLs. No differences in dysphotopsia pre- and postoperatively and spectacle independence in near for OptiVis and refractive MFIOLs were detected. OptiVis patients were more satisfied than those with monofocal IOLs (p=0.015). CONCLUSIONS: After cataract surgery, patients with OptiVis improved VA in all distances. Near and intermediate VA was better than monofocal, and DCNVA was better than the refractive group. CS was lower in OptiVis than in the monofocal group, but there was no difference between MFIOLs. Patient satisfaction was higher in OptiVis than in the monofocal group. This trial is registered with NCT03512626

Cost and detection rate of glaucoma screening with imaging devices in a primary care center

To analyze the cost and detection rate of a screening program for detecting glaucoma with imaging devices. In this cross-sectional study, a glaucoma screening program was applied in a population-based sample randomly selected from a population of 23,527. Screening targeted the population at risk of glaucoma. Examinations included optic disk tomography (Heidelberg retina tomograph [HRT]), nerve fiber analysis, and tonometry. Subjects who met at least 2 of 3 endpoints (HRT outside normal limits, nerve fiber index ≥30, or tonometry ≥21 mmHg) were referred for glaucoma consultation. The currently established ("conventional") detection method was evaluated by recording data from primary care and ophthalmic consultations in the same population. The direct costs of screening and conventional detection were calculated by adding the unit costs generated during the diagnostic process. The detection rate of new glaucoma cases was assessed. The screening program evaluated 414 subjects; 32 cases were referred for glaucoma consultation, 7 had glaucoma, and 10 had probable glaucoma. The current detection method assessed 677 glaucoma suspects in the population, of whom 29 were diagnosed with glaucoma or probable glaucoma. Glaucoma screening and the conventional detection method had detection rates of 4.1% and 3.1%, respectively, and the cost per case detected was 1,410 and 1,435€, respectively. The cost of screening 1 million inhabitants would be 5.1 million euros and would allow the detection of 4,715 new cases. The proposed screening method directed at population at risk allows a detection rate of 4.1% and a cost of 1,410 per case detected

Evaluation of the retinal nerve fiber layer Tthickness, the mean deviation, and the visual field index in progressive glaucoma.

PURPOSE: To determine and compare the retinal nerve fiber layer (RNFL) thickness, the mean deviation, and the visual field index (VFI) in glaucoma cases with progression detected by spectral domain optical coherence tomography, standard automated perimetry (SAP), and optic disc stereophotographs. METHODS: The authors studied 246 eyes of 148 patients prospectively (97 glaucoma cases, 132 suspects, and 17 healthy eyes). SAP fields, optical coherence tomography (OCT) images, and optic disc stereophotographs were obtained every 6 to 12 months. Progression was determined in SAP and in OCT with a Glaucoma Progression Analysis software, and also by masked assessment of the stereophotograph series. The Kruskal-Wallis test was applied to evaluate differences between methods in RNFL thickness, visual field (VF) mean deviation, and VFI. The relationship between the baseline classification and the detection of glaucomatous progression by the different tests was assessed by the χ statistic. RESULTS: Ninety-nine eyes (40.2%) presented glaucomatous progression detected by at least 1 examination method. Progressing eyes detected only by OCT had a higher mean RNFL thickness and mean VFI than progressing eyes detected only by VF or stereophotographs (P<0.003). Most progressive cases detected by OCT (68%) were initially classified at baseline as suspects, whereas most eyes with VF progression (61%) were initially classified as glaucoma. The initial classification was significantly related to the presence of progression by different tests [χ (2)=9.643 for VF event analysis and 7.290 for OCT event analysis (P<0.005)]./nCONCLUSIONS: Different tests are more likely to detect the progression in different clinical circumstances or stages of glaucoma; these should be taken into consideration when performing the difficult task of progression detection