Imaging of the Lamina Cribrosa using Swept-Source Optical Coherence Tomography.

The lamina cribrosa (LC) is the presumed site of axonal injury in glaucoma. Its deformation has been suggested to contribute to optic neuropathy by impeding axoplasmic flow within the optic nerve fibers, leading to apoptosis of retinal ganglion cells. To visualize the LC in vivo, optical coherence tomography (OCT) has been applied. Spectral domain (SD)-OCT, used in conjunction with recently introduced enhanced depth imaging (EDI)-OCT, has improved visualization of deeper ocular layers, but in many individuals it is still limited by inadequate resolution, poor image contrast and insufficient depth penetrance. The posterior laminar surface especially is not viewed clearly using these methods. New generation high-penetration (HP)-OCTs, also known as swept-source (SS)-OCT, are capable to evaluate the choroid in vivo to a remarkable level of detail. SS-OCTs use a longer wavelength (1,050 nm instead of 840 nm) compared to the conventional techniques. We review current knowledge of the LC, findings from trials that use SD-OCT and EDI-OCT, and our experience with a prototype SS-OCT to visualize the LC in its entirety. Key Points What is known? •     The LC is the presumed site of axonal injury in glaucoma •     Compared to spectral domain-OCT, enhanced depth imaging-OCT improves imaging of the LC •     Even so, currently used SD-OCT techniques are restricted by poor wavelength penetrance of the deeper ocular layers What our findings add? •    SS-OCT may be a superior imaging modality for deep ocular structures •    Prior studies used SS-OCT to evaluate choroidal thickness in both healthy and 'normal tension glaucoma' eyes •    SS-OCT enables good evaluation of three-dimension (3D) lamina cribrosa morphology. How to cite this article: Nuyen B, Mansouri K, Weinreb RN. Imaging of the Lamina Cribrosa using Swept-Source Optical Coherence Tomography. J Current Glau Prac 2012;6(3): 113-119

Recognition of anxiety disorders by family physicians after rigorous medical record case extraction Results of the Netherlands Study of Depression and Anxiety

Objective: Previous studies reported low and inconsistent rates of recognition of anxiety disorders by family physicians (FPs). Our objectives were to examine (a) which combination of indications within medical records most accurately reflects recognition of anxiety disorders and (b) whether patient and FP characteristics were related to recognition. Method: A cross-sectional comparison was made between FPs' registration and a structured diagnostic interview, the Composite International Diagnostic Interview, according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Seven definitions of recognition were tested using diagnostic codes, medication data, referral data and free text in medical records. Data were derived from the Netherlands Study of Depression and Anxiety. A total of 816 patients were included. Results: Recognition ranged between 9.1% and 85.8%. A broader definition was associated with a higher recognition rate, but led to more false positives. The best definition comprised diagnostic codes for anxiety disorders and symptoms, strong free-text indications, medication and referral to mental health care. Generalized anxiety disorder was best recognized by this definition. Recognition was better among patients with increased severity, comorbid depression and older age. Conclusion: FPs recognized anxiety disorders better than previously reported when all medical record data were taken into account. However, most patients were nonspecifically labeled as having a mental health problem. (C) 2012 Elsevier Inc. All rights reserved

Determinants of (non-)recognition of depression by general practitioners: Results of the Netherlands study of depression and anxiety

Background: Although most depressed patients are treated in primary care, not all are recognized as such. This study explores the determinants of (non-)recognition of depression by general practitioners (GPs), with a focus on specific depression symptoms as possible determinants. Methods: Recognition of depression by GPs was investigated in 484 primary care participants of the Netherlands Study of Depression and Anxiety, with a DSM-IV diagnosis of depression in the past year. Recognition (yes/no) by GPs was based on medical file extractions (GP diagnosis of depressive symptoms/depressive disorder and/or use of antidepressants/referral to mental health care). Potential determinants of (non-)recognition (patient, depression, patient-GP interaction, and GP characteristics) were bivariately tested and variables with a p-value <= 0.2 entered into a multilevel multivariate model. Subgroup analysis was performed on 361 respondents with more reliable GP diagnosis data. Results: 60.5% of patients were recognized by their GP. Patients who did not consult their GP for mental problems, and without comorbid anxiety disorder(s) were less often recognized. In the subgroup, where 68.7% was recognized, in addition to these, decreasing number of symptoms of depression and increased appetite were associated with decreased recognition. No GP characteristics were retained in the final model. Limitations: Some data on recognition were collected retrospectively. Conclusions: In addition to patients without a comorbid anxiety disorder or who did not consult their GP for mental problems, GPs less often recognized patients with fewer depression symptoms or with increased appetite. Recognition may be improved by informing/teaching GPs that also increased appetite can be a symptom of depression. (C) 2012 Elsevier B.V. All rights reserved