Preventing blindness from glaucoma with patient education, the NIDEK GS-1 Gonioscope, lensectomy and microinvasive glaucoma surgery.

OBJECTIVES: The purpose of this report is to demonstrate the patient education ability and benefits in treating glaucoma and preventing blindness with the NIDEK GS-1 Gonioscope and earlier surgical intervention with cataract surgery/lensectomy and microinvasive glaucoma surgery (MIGS). METHODS: This data was collected using a NIDEK GS-1 Gonioscope. Informed consent was obtained from all participants following explanation of possible risks. RESULTS AND DISCUSSION: NIDEK GS-1 automated gonioscopy offers many advantages, including (1) the ability to capture high quality, 360-degree chromatic documentation of the iridocorneal angle and trabecular meshwork, (2) improved patient education on the condition at hand through images; and (3) visualization of the change in the angle and trabecular meshwork before and after surgical intervention in patients with glaucoma. CONCLUSION AND IMPLICATIONS: Gonioscopic imaging is helpful in educating patients on the anatomy of the angle and how its anatomical configuration can contribute to glaucoma. It also gives clinicians a supplementary tool to document features of the ICA; to evaluate anatomical changes before and after surgical treatment of glaucoma and cataracts; and to demonstrate to patients how a specific surgical device or technique is controlling their intraocular pressure (IOP).

A Novel, Low-Cost Glaucoma Calculator to Identify Glaucoma Patients and Stratify Management.

Glaucoma is a leading cause of preventable blindness globally. Nearly, half of the patients who have glaucoma in the United States are unaware of their diagnosis, and this number is far greater in resource poor areas. The risk of progressive and irreversible loss of vision is decreased with an early diagnosis, and better access to treatment is vital to improve the visual outcome for patients. We therefore postulated that a minimally invasive, low-cost calculator used to predict the risk of glaucoma and inform the course of follow-up care will improve patient prognosis. We retrospectively examined data from 104 eyes of patients who underwent a complete ocular examination, visual field, and corneal pachymetry at Advanced Eye Care of New York (54 with glaucoma and 50 controls). Receiver operating curves (ROC) were utilized to determine the correct glaucoma classification rates of the Laroche glaucoma calculator (Range -3 to 18), a novel tool that combines age, intraocular pressure (IOP), and central corneal thickness (CCT) into a composite metric. Additionally, we compared the discriminatory power of this calculator to age, intraocular pressure (IOP), and central corneal thickness (CCT) separately. A score of greater than or equal to 6 on the Laroche glaucoma calculator (sensitivity 90.74%, specificity 64.00%, correct classification 77.88%) optimizes the accuracy of this tool. Compared to IOP (Area Under the Curve (AUC) = 0.72, chi2 = 4.21, p=0.04) and CCT (AUC = 0.53), chi2 24.72 p < 0.001), the Laroche glaucoma calculator (AUC = 0.81) was significantly better at discriminating against glaucoma patients vs. controls. These results demonstrate that the Laroche calculator is a novel, effective tool for identifying glaucoma, and it may provide a low-cost risk stratification tool, particularly in areas with limited resources.

Imaging of vitreous cortex hyalocyte dynamics using non-confocal quadrant-detection adaptive optics scanning light ophthalmoscopy in human subjects.

Vitreous cortex hyalocytes are resident macrophage cells that help maintain the transparency of the media, provide immunosurveillance, and respond to tissue injury and inflammation. In this study, we demonstrate the use of non-confocal quadrant-detection adaptive optics scanning light ophthalmoscopy (AOSLO) to non-invasively visualize the movement and morphological changes of the hyalocyte cell bodies and processes over 1-2 hour periods in the living human eye. The average velocity of the cells 0.52 ± 0.76 µm/min when sampled every 5 minutes and 0.23 ± 0.29 µm/min when sampled every 30 minutes, suggesting that the hyalocytes move in quick bursts. Understanding the behavior of these cells under normal physiological conditions may lead to their use as biomarkers or suitable targets for therapy in eye diseases such as diabetic retinopathy, preretinal fibrosis and glaucoma.

Case report: Cataract extraction/lensectomy, excisional goniotomy and transscleral cyclophotocoagulation: Affordable combination MIGS for plateau iris glaucoma.

We report the successful treatment of angle closure glaucoma and plateau iris with combined early cataract surgery/lensectomy, goniotomy, and transscleral cyclophotocoagulation. The underlying mechanism of angle closure and plateau iris was addressed with cataract extraction and goniosynechiolysis. Goniotomy was used to enhance trabecular meshwork outflow and lower intraocular pressure, and the "slow burn" transscleral cyclophotocoagulation was safely performed to reduce the size of the ciliary processes. The unique combinations of these procedures restored the iridocorneal angle anatomy to normalize IOP and prevent vision loss from glaucoma in patients with plateau iris. This is a cost-effective option with longer term efficacy.

Augmented reality-based dance intervention for individuals with Parkinson's disease: A pilot study.

BACKGROUND: The effects of dance on improving the symptoms of individuals with Parkinson's disease (PD) is well documented. Augmented reality devices, such as Google Glass, may be used to implement dance interventions to improve mobility and balance. OBJECTIVE: To evaluate the feasibility, safety, and acceptability of a mobile dance intervention and obtain preliminary efficacy estimates for assessment of the research protocol. METHODS: Seven participants with PD were asked to use Google Glass preloaded with Moving Through Dance modules for three weeks. Changes in motor functions (balance, mobility) and non-motor functions (mood, quality of life) were evaluated before and after completion of the intervention. RESULTS: Recruitment rate was 50%, retention rate was 100%, and adherence to usage was 95%. The intervention was safe and accepted by participants. Use of Moving Through Glass improved mobility with a cognitive load (F(1, 5) = 10.76; p < 0.05). However, there were no significant changes to the participants' balance scores, quality of life or mood. CONCLUSIONS: The outcomes of this pilot study suggest that Moving Through Glass, as a mobile dance intervention, may be a safe way to increase physical activity through dance in individuals with PD. Its efficacy should be investigated in a properly powered randomized controlled trial.