The Effectiveness of a Nurse-led Glaucoma Education on Patient Knowledge and Compliance Motivation Levels: A 1-year Prospective Case Series.

Purpose: To evaluate the impact of a nurse-led glaucoma education program on patient knowledge and compliance levels in an Asian population. Materials and Methods: A 1-year prospective case series involving 69 adult glaucoma patients. Each patient attended a standardized nurse-led glaucoma education session. A questionnaire was administered by a single nurse-clinician and analyzed at three time points (preeducation for baseline, immediately posteducation, and at the 1-year follow-up) to evaluate for associations with patient knowledge and compliance motivation levels. Results: A total of 64 patients were included in the final analysis. Patients with higher educational qualifications or who were employed had better baseline knowledge of glaucoma. Younger patients had higher baseline compliance motivation levels. Immediately posteducation, both median patient knowledge score and compliance motivation levels had a statistically significant increase. Patients on more glaucoma eye drops had greater immediate improvement in confidence in eye drop application. Patients with more positive Humphrey visual field mean deviation values had a greater immediate improvement in confidence in their understanding of glaucoma. A total of 34 patients were readministered the questionnaire at the 1-year time point. Median score for patient knowledge was highest at this point. Employed patients demonstrated better patient knowledge at baseline and at 1-year time point compared to unemployed patients. Unemployed patients experienced a significant improvement in scores from baseline to immediately posteducation, but improvement from immediately posteducation to the 1-year time point was insignificant was insignificant. Conclusion: Our study has examined the effectiveness of a nurse-led glaucoma education program in an Asian population, demonstrating improvement in both patient knowledge and compliance motivation levels up to 1 year after intervention. How to cite this article: Sng JJ, Ang BCH, Soo Hoo WC, et al. The Effectiveness of a Nurse-led Glaucoma Education on Patient Knowledge and Compliance Motivation Levels: A 1-year Prospective Case Series. J Curr Glaucoma Pract 2023;17(3):149-156.

The performance of iPad-based noise-field perimeter versus Humphrey Field Analyser in detecting glaucomatous visual field loss.

BACKGROUND: To conduct a preliminary evaluation of the feasibility of visual field fast (VFF), a free iPad-based noise-field perimeter, in detecting glaucomatous scotomas versus the clinical-standard Humphrey visual field (HVF) test. VFF confronts subjects with a screen of flickering stimulus, allowing the immediate perception of scotomas. METHODS: This was a cross-sectional observational study of 66 glaucoma patients (66 eyes) and 30 healthy controls (30 eyes). All patients had no other visual field disorders. VFF was compared against HVF in terms of whole field and quadrants for the following: (1) correspondence in scotoma detection. (2) Agreement and correlation of the scotoma size (percentage of abnormal visual field area). (3) Test duration. Other domains tested included: (1) correlation of VFF scotoma area with the severity of visual field loss on HVF (mean deviation, MD; visual field index, VFI). (2) Repeatability of VFF. (3) Patient descriptors of scotomas. RESULTS: Using HVF pattern deviation plot as a reference, VFF detected 52/57 (91.2%) of glaucoma subjects with 1 false-positive (control) (kappa = 0.86). 146/184 (79.3%) of abnormal quadrants (visual field defect present) were localized and 23/157 (14.6%) healthy quadrants were falsely identified as abnormal (kappa = 0.61). VFF underestimated scotoma area as compared to HVF (21.0% versus 44.0%, p < 0.01) but correlated positively (r = 0.268, p = 0.044) with HVF area and negatively with VFI (r = -0.340, p = 0.01) and MD (r = -0.398, p < 0.01). Using HVF total deviation plot as reference, VFF's glaucoma detection rate remained unchanged (kappa = 0.86) with similar quadrant detection (kappa = 0.68). However, a greater underestimation of scotoma area was observed (21.0% versus 85.4%, p < 0.01). VFF's quantitative repeatability was excellent for whole field (intraclass correlation coefficient, ICC: 0.96; p < 0.0001) and quadrants (ICC: 0.82-0.96; all p < 0.001). Qualitatively, 35/37 (94.6%) of subjects reported reduced luminance and flicker in scotomas, with similar morphologies on retests. VFF is faster than HVF SITA-Standard in glaucoma (3.60 ± 1.85 min versus 6.92 ± 1.12 min, p < 0.01) and control (1.12 ± 0.486 min versus 5.16 ± 0.727 min, p < 0.01). CONCLUSION: This early model of VFF accurately detected scotomas with high repeatability. However, its accuracy in localizing and quantifying the scotoma can be improved. Considering its portability and cost-effectiveness, VFF demonstrated potential as a general screening tool for moderate-to-severe glaucoma.

12-Month Outcomes of Combined Phacoemulsification and iStent Inject in Asian Eyes with Normal Tension Glaucoma: A Single-Centre Experience.

PURPOSE: To evaluate efficacy and safety of the iStent inject combined with phacoemulsification in Asian eyes with normal-tension glaucoma (NTG) up to 12 months after surgery. STUDY DESIGN: Retrospective case series. METHODS: Retrospective case series of eyes undergoing surgery from April 2017 to August 2019. Outcome measures included intraocular pressure (IOP), number of topical glaucoma medications and adverse outcomes. Data were retrieved from the post-operative day 1 (POD1), week 1 (POW1), month 1 (POM1), month 3 (POM3), month 6 (POM6) and month 12 (POM12) timepoints. Data were analysed at each timepoint for eyes with available clinical data at that visit. Subgroup analysis was performed for a consistent cohort which included only eyes with data at all six follow-up timepoints. RESULTS: Data from 91 eyes in the collective subject group was analysed. Majority of subjects were male (53, 58.2%) and Chinese (79, 86.8%). Mean age was 73.2 ± 7.2 years. Pre-operatively, mean IOP was 14.3 ± 3.0 mmHg and mean number of medications was 1.5 ± 0.8. Significant IOP reduction was observed at all timepoints except POW1 and POM12. The number of medications was reduced at all timepoints (p < 0.001). By POM12, there was reduction of 1.2 ± 1.0 medications (p < 0.001). Both the collective and consistent cohorts demonstrated a trend towards decreasing surgical efficacy with time, in IOP reduction and decrease in medications. None of the eyes experienced sight-threatening complications. CONCLUSIONS: Asian eyes with NTG undergoing combined phacoemulsification and iStent inject surgery demonstrated significant and sustained reduction in number of glaucoma medications up to 12 months post-operatively.

Accuracy and Reliability of Self-measured Intraocular Pressure in Glaucoma Patients Using the iCare HOME Tonometer.

PRCIS: The iCare HOME tonometer is a useful tool which can be used by patients for fairly accurate and reliable self-measurement of intraocular pressure (IOP). PURPOSE: The aim was to compare the accuracy of IOP measurements of trained glaucoma patients using the iCare HOME tonometer before and after a week of self-monitoring at home and study the repeatability of patient measurements done at home. MATERIALS AND METHODS: A total of 40 glaucoma patients had IOPs measured using the Goldmann applanation tonometer and the iCare HOME. Patients were trained to use the iCare HOME and measured their IOP twice daily over a loan period of 7 days. Bland-Altman analysis was used to assess agreement between Goldmann applanation tonometer and iCare HOME readings. Intraclass correlation coefficient compared inter-rater reliability of iCare HOME measurements, and test-retest variability for the patient's readings over the 7-day period were analyzed. A 5-point Likert scale questionnaire was used to assess the patient's experience with the device. RESULTS: Up to 32 patients (80%) were able to obtain IOP readings within 3 mm Hg of the glaucoma nurse clinician's readings at the preloan visit, and up to 36 patients (90%) at the postloan visit. Good inter-rater reliability was observed between iCare HOME measurements by the glaucoma nurse clinician and patients. At the postloan visit, inter-rater reliability was good for right eye readings and excellent for left eye readings. No distinct trend in test-retest variability was identified over the 7-day period. 65% of patients agreed the device was easy to use and 89% would recommend the device to other glaucoma patients. CONCLUSION: Patients trained to use the iCare HOME device can do so with fair accuracy compared with trainers with accuracy improving within 1 week of usage.

Automatic Glaucoma Detection from Stereo Fundus Images.

This paper proposes a new method for automatic detection of glaucoma from stereo pair of fundus images. The basis for detecting glaucoma is using the optic cup-to-disc area ratio, where the surface area of the optic cup is segmented from the disparity map estimated from the stereo fundus image pair. More specifically, we first estimate the disparity map from the stereo image pair. Then, the optic disc is segmented from one of the stereo image. Based upon the location of the optic disc, we perform an active contour segmentation on the disparity map to segment the optic cup. Thereafter, we can compute the optic cup-to-disc area ratio by dividing the area (i.e. the total number of pixels) of the segmented optic cup region to that of the segmented optic disc region. Our experimental results using the available test dataset shows the efficacy of our proposed approach.

Aqueous humor protein dysregulation in primary angle-closure glaucoma.

PURPOSE: Primary angle-closure glaucoma (PACG) is associated with increased intraocular pressure, optic nerve damage, and progressive vision loss, but the molecular mechanism that underpins retinal ganglion neuropathy in PACG remains poorly understood. To better understand the pathogenesis of human PACG, we performed the first comprehensive proteomic analysis of aqueous humor (AH) samples from PACG patients and matched control donors to study pathogenic alteration in AH composition in disease. METHODS: High-resolution, label-free, liquid chromatography-tandem mass spectrometry-based quantitative proteomic analyses were performed in AH samples collected from PACG patients and a matched control cohort of patients with cataracts. RESULTS: The AH proteome comprised of 1363 distinct proteins, of which more than 50% were differentially expressed in PACG (773 total; 501 up-regulated, 272 down-regulated). AH from PACG patients was enriched in atypical collagens and fibronectins, suggesting that the composition of the trabecular matrix is significantly altered in disease. Pathway and cluster analyses revealed that AH protein modulation in PACG is closely associated with biological processes including platelet degranulation, cellular import/export mechanisms, and control of protease activity. In addition, critical mediators of oxygen homeostasis and neuronal function in AH were significantly dysregulated in disease, strongly implicating oxidative stress responses in PACG-associated nerve damage. CONCLUSIONS: Altered AH proteome in human PACG indicated oxidative stress in the neuronal damage that preceded vision loss. Identifying key mediators of PACG pathology will yield new prognostic biomarkers and novel targets for future therapeutic interventions.

Optical Coherence Tomography Angiography of Optic Disc and Macula Vessel Density in Glaucoma and Healthy Eyes.

AIM: To study the microvascular density of the macular and optic nerve head in healthy and glaucoma subjects using optical coherence tomography angiography. METHODOLOGY: We performed a cross-sectional cohort study on healthy subjects and patients with glaucoma. The AngioVue Enhanced Microvascular Imaging System was used to capture the optic nerve head and macula images during one visit. En face segment images of the macular and optic disc were studied in layers. Microvascular density of the optic nerve head and macula were quantified by the number of pixels measured by a novel in-house developed software. Areas under the receiver operating characteristic curves (AUROC) were used to determine the accuracy of differentiating between glaucoma and healthy subjects. RESULTS: A total of 24 (32 eyes) glaucoma subjects (57.5±9.5-y old) and 29 (58 eyes) age-matched controls (51.17±13.5-y old) were recruited. Optic disc and macula scans were performed showing a greater mean vessel density (VD) in healthy compared with glaucoma subjects. The control group had higher VD than the glaucoma group at the en face segmented layers of the optic disc (optic nerve head: 0.209±0.05 vs. 0.110±0.048, P<0.001; vitreoretinal interface: 0.086±0.045 vs. 0.052±0.034, P=0.001; radial peripapillary capillary: 0.146±0.040 vs. 0.053±0.036, P<0.001; and choroid: 0.228±0.074 vs. 0.165±0.062, P<0.001). Similarly, the VD at the macula was also greater in controls than glaucoma patients (superficial retina capillary plexus: 0.115±0.016 vs. 0.088±0.027, P<0.001; deep retina capillary plexus: 0.233±0.027 vs. 0.136±0.073, P<0.001; outer retinal capillary plexus: 0.190±0.057 vs. 0.136±0.105, P=0.036; and choriocapillaris: 0.225±0.053 vs. 0.153±0.068, P<0.001. The AUROC was highest for optic disc radial peripapillary capillary (0.96), followed by nerve head (0.92) and optic disc choroid (0.76). At the macula, the AUROC was highest for deep retina (0.86), followed by choroid (0.84), superficial retina (0.81), and outer retina (0.72). CONCLUSIONS: Microvascular density of the optic disc and macula in glaucoma patients was reduced compared with healthy controls. VD of both optic disc and macula had a high diagnostic ability in differentiating healthy and glaucoma eyes.

Proteomic Analysis of Aqueous Humor from Primary Open Angle Glaucoma Patients on Drug Treatment Revealed Altered Complement Activation Cascade.

Primary open angle glaucoma (POAG) is a complex disease and a leading cause of irreversible blindness, and its underlying pathophysiology remains poorly understood. Proteomic characterization of the protein composition of aqueous humor (AH) may identify prognostic candidate proteins involved in pathogenesis and progression of the disease. To delineate the possible mechanisms that lead to POAG, this study adopted state-of-art mass spectrometric technique and analyzed AH of POAG and their respective controls. In total, more than 1000 proteins were identified with false discovery rate of less than 1%. Numerous proteins of complement cascade, immunoglobulin, neuronal and amyloidogenic proteins, which were part of processes like acute-phase and inflammatory response, humoral immune and acute inflammatory response, regulation of complement activation and protein processing were identified. Proteins of complement system underwent significant changes, which correlate to pathogenic events characterizing POAG, including altered complement cascade, astrocyte activation, neural degeneration, and apoptosis. Further, protein modification such as deamidation of complement subcomponent was noted, particularly in POAG. Proteomic analysis of AH allows a better understanding of the mechanism involved in the pathogenesis of POAG.

Glaucoma classification from retina optical coherence tomography angiogram.

This paper presents a new method for classification of retina into glaucoma and non-glaucoma cases based on optical coherence tomography angiogram (OCTA). The key idea here is to analyze the retinal microvasculature in the optic disc area of an enface OCTA for glaucoma classification. To facilitate this analysis, we propose a way to extract a so-called "optic disc microvasculature" region and then propose several features that will be extracted from this microvasculature region. A machine classifier is then trained using the designated features and subsequently used to classify the OCTA data. We show that our proposed approach works well on the tested dataset.