Factors Associated with 5-Year Glaucomatous Progression in Glaucoma Suspect Eyes

Background: The US Preventive Services Task Force found that treatment of early asymptomatic primary open-angle glaucoma reduces visual field defects. However, it remains unclear which factors are associated with glaucomatous progression and which patients are at higher risk. The purpose of this study was to assess demographic factors, medical comorbidities, Humphrey visual field (VF) results, and Cirrus optical coherence tomography variables that could be predictive for 5-year glaucoma progression. Methods: A retrospective longitudinal study was conducted with the following inclusion criteria: glaucoma suspect eyes (defined as an asymmetric cup to disc ratio or an intraocular pressure \u3e21mmHg), best-corrected visual acuity 20/100 or better, spherical equivalent better than −8 diopters and astigmatism less than 3 diopters. Two consecutive abnormal VF tests during a 5-year follow-up was considered glaucomatous progression. Results: A total of 365 eyes (288 patients) were included in the study, of which 55 (15%) converted to glaucoma after 5 years. Logistic regression analysis showed that baseline mean deviation (MD), pattern standard deviation (PSD), VF index, and retinal nerve fiber layer (RNFL) colors were statistically significant in predicting 5-year glaucomatous progression. Though there were differences in glaucoma progression rates when analyzing sex, age, hypertension, diabetes mellitus, family history of glaucoma, and baseline intraocular pressure, these factors were not statistically significant. Conclusions: The study found that VF test results (MD and PSD) and RNFL colors can strongly predict which patients are at an increased risk of glaucoma progression. Clinicians can consider these factors when initiating, or continuing, prophylactic treatment for patients with glaucoma suspect eyes

Post-operative Day 1 versus Day 0 follow-up for Uncomplicated Cataract Surgeries: A comparison of post-operative outcomes and managements

Purpose: To compare the postoperative outcomes and management of uncomplicated cataract surgery (CEIOL) patients seen on post-operative day zero (POD 0) versus post-operative day one (POD 1). Methods: A retrospective chart review of 533 patients who had CEIOL at the Kresge Eye Institute from December 2017 to September 2019 was performed. Visual acuity (VA) and intraocular pressure (IOP) were collected from the pre-operative visit, and the first and second post-operative day visits. In addition, changes in management were recorded from the first post-operative day visit. Patients were excluded if they had a complex cataract procedure, had combined glaucoma filtering surgery, or did not complete two follow up visits within 14 days of surgery. Results: The pre-operative demographic data between patients seen on POD 0 (n=119) versus POD1 (N=414) were equally distributed. By unpaired t-test, the average VA of patients seen on POD 1 was significantly better than those seen on POD 0 (P0.50). Conclusion: There was no significant difference in management between POD 0 and POD 1 patients having undergone uncomplicated cataract surgeries. Therefore, surgeons can safely consider POD 0 or POD 1 evaluations for uncomplicated cataract surgeries and improve healthcare cost efficiency for CEIOL