Correlation between visual field index and quality of life in glaucoma patients: a new tool to screen quality of life perception?

Purpose: To evaluate the correlation between the visual field index (VFI) and vision-related quality of life (QoL) considering several confounding variables that may have a positive or negative effect. Methods: We conducted a cross-sectional, mono-centric study on glaucoma patients. Quality of life was examined with the NEI-VFQ 25 and the Glaucoma Symptom Scale (GSS). The visual field was examined with the Humphrey Field Analyzer. The variables considered were age, gender, comorbidities, years (at diagnosis and duration of the illness), treatment and related active principles, intraocular pressure, and visual acuity. The analysis was performed on both the better and the worse eye. The linear regression univariate analysis and the multivariate analyses were performed. Results: In total, 193 patients enrolled in the study. The mean age was 70.8 ± 10.4 years. The mean follow-up period since diagnosis 11.4 ± 9.2 years. Approximately 50% of the patients suffered from primary open angle glaucoma (POAG) and 45% were on monotherapy. The mean VFI was 81.3 ± 26. Regarding QoL, the NEI-VFQ total mean was 80.4 ± 17.8 and the GSS total score was 77.2 ± 21. Regarding NEI-VFQ 25, the single linear regression analysis found the following relations: age at time of visit (r = -0.30, p = 0.016), years of illness (r = -0.32, p = 0.020), the minimum and maximal visual acuity (r = 2.04 and r = 3.96, p < 0.001), the IOP min (r = 1.13, p = 0.002) and max (r = -0.52, p = 0.017), and the number of previous surgeries (r = -3.94, p < 0.001). The multivariate analysis found the following relations: gender (r = 5.13, p = 0.019), visual acuity max (r = 3.16, p < 0.001), and previous surgeries (r = -1.80, p = 0.032). Regarding GSS, the single linear regression analysis found relations with visual acuity (r = 2.37, p < 0.001), VFI (r = 0.41, p < 0.001), previous surgeries in the eye considered (r = -7.27, p < 0.001), and number of instillations (r = -3.67, p = 0.031). Data confirmed that a higher VFI has a positive impact on the score of both the NEI-VFQ 25 (r = 0.22, p = < 0.001) and the GSS questionnaire (r = 0.36, p < 0.001). Conclusions: The study demonstrated a correlation between the VFI and QoL of patients and their visual and non-visual ocular symptoms and function both in the worst and in the better eye, even when accounting for several clinical and demographic confounding variables. Our data support that the visual field index is an important metric instrument in the follow up of patients with glaucoma.

Randomised, Single Blind, Controlled, Three-Month Clinical Trial on the Evaluation and Treatment of the Ocular Surface Damage Following Phacoemulsification.

Background: To determine efficacy of two lacrimal substitutes on signs and symptoms of ocular surface disease after phacoemulsification; to determine impact of surgery on patients' vision related quality of life. Monocentric, randomised, physician blinded, three parallel groups clinical trial. Design and Methods: Patients in the operative list for phacoemulsification have been screened for eligibility; they underwent (at time 0, 15, 45 and 90 days): slit lamp examination; tear film break-up time (BUT); corneal staining; tear volume; 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ); Ocular Surface Disease Index (OSDI). Treatments to be compared were: 1. standard of care-SOC (lomefloxacine and tobramicine/dexamethasone fixed combination 4 times a day for 2 weeks), 2. SOC + carboxymethylcellulose sodium 0.5% and glycerin 0.9%, 3. SOC + Sodium Hyaluronate 0.15%. Study treatment started at T15. Groups were compared with parametric or nonparametric tests, and with Pearson's χ2 test. Correlation between continuous variables was assessed by means of Pearson's or Spearman's coefficient. Results: Fifty-three patients were enrolled. At 45 and at 90 days from surgery, the group receiving lacrimal substitutes presented better BUT and Schirmer I test (p = 0.009, <0.001, <0.001 and 0.001, respectively); dry eye presence showed significant difference by group at time 90 (p = 0.019). General vision, near activity and vision-specific dependency subscales improved after surgery (p = <0.001, 0.004 and 0.048, respectively). At 45 and 90 days from surgery, the OSDI score significantly changed (p < 0.001).Conclusions: Cataract surgery causes the onset or the worsening of dry eye. Use of artificial tears can significantly reduce symptoms and signs of dry eye in patients after phacoemulsification.

Multicenter, Prospective, Randomized, Single Blind, Cross-Over Study on the Effect of a Fixed Combination of Citicoline 500 mg Plus Homotaurine 50 mg on Pattern Electroretinogram (PERG) in Patients With Open Angle Glaucoma on Well Controlled Intraocular Pressure.

Purpose: To evaluate the potential beneficial and synergistic effects of oral intake of a fixed combination of citicoline 500 mg plus homotaurine 50 mg (CIT/HOMO) on retinal ganglion cell (RGC) function in subjects with glaucoma using pattern electroretinogram (PERG) and to investigate the effects on visual field and quality of life. Methods: Consecutive patients with primary open-angle glaucoma with controlled IOP (<18 mmHg) receiving beta-blockers and prostaglandin analogs alone or as combination therapy (fixed or un-fixed); with stable disease (progression no more than -1 dB/year at the visual field MD); and an early to moderate visual field defect (MD < -12 dB) were randomized to: arm A. topical therapy + CIT/HOMO for 4 months, 2 months of wash out, 4 months of topical therapy alone; arm B. topical therapy alone for 4 months, topical therapy + CIT/HOMO for 4 months, 2 months of wash out. All patients underwent 4 visits: complete ocular examination, visual field, PERG and quality of life assessment (NEI-VFQ25) were performed at each visit. Results: Fifty-seven patients completed the study: 26 in group A and 31 in group B. At the end of the intake period, PERG's P50 and N95 waves recorded a greater amplitude. The increase was statistically significant in the inferior and superior P50 waves amplitude: 0.47 µV (95%CI, 0.02-0.93; p = 0.04) and 0.65 µV (95% CI, 0.16-1.13; p = 0.009), respectively, and in the inferior N95 wave amplitude 0.63 µV (95% CI, 0.22-1.04; p = 0.002). A significantly shorter peak time of 3.3 µV (95% CI, -6.01- -0.54; p = 0.01) was observed for the superior P50 wave only. Conclusions: Daily oral intake of the fixed combination CIT/HOMO for 4 months improved the function of inner retinal cells recorded by PERG in the inferior and in the superior quadrants, independently from IOP reduction. This interesting association could represent a valid option for practicing neuromodulation in patients with glaucoma to prevent disease progression.

A Pilot, Phase II, Observational, Case-Control, 1-Month Study on Asthenopia in Video Terminal Operators without Dry Eye: Contrast Sensitivity and Quality of Life before and after the Oral Consumption of a Fixed Combination of Zinc, L-Carnitine, Extract of Elderberry, Currant and Extract of Eleutherococcus.

The aims of the study were to investigate the ability and effectiveness of an oral intake of a fixed combination of zinc, L-carnitine, elderberry extract, black currant and Eleutherococcus extract in controlling the symptoms of eyestrain in videoterminal (VDT) users and to record its effects on contrast sensitivity. A single-center, phase II, observational, case-control, 1-month study in VDT workers without dry eye disease was carried out. Demographics and number of actual hours at VDT/day were taken into account. All subjects underwent a complete ophthalmic examination, including assessment of contrast sensitivity, and completed the computer vision symptom scale questionnaire at baseline and one month later. A total of 30 Caucasian subjects adhered to the required inclusion criteria and completed the study; 15 subjects were treated (T) and 15 were controls (C). All clinical data at baseline were similar in both groups (p > 0.05): after one month, all subjects had stable visual acuity, refractive defect and intraocular pressure (IOP); screen exposure time was unchanged. Regarding symptoms, at randomization, the groups had a similar score: 33.1 ± 3.3 in T and 32.8 ± 5.6 in C. One month later, the computer vision symptom scale (CVSS) questionnaire score decreased by -14.1 ± 3, 1 (p = 0.000) and -2.3 ± 1.8 (p = 0.568), respectively. Regarding contrast sensitivity, in group C the values of spatial frequencies remained unchanged, while they improved in almost all the cycles per degree stimuli in the treated group. Oral intake of a fixed combination of zinc, L-carnitine, elderberry extract, black currant and eleutherococcus extract can significantly improve contrast sensitivity and symptoms in VDT workers with no signs of dry eye disease.

Waveform parameters of retrobulbar vessels in glaucoma patients with different demographics and disease severity.

INTRODUCTION: To identify novel velocity waveform parameters of the ophthalmic artery and central retinal artery by computer-aided image processing of Doppler ultrasonography measurements, and to evaluate correlations between the waveform parameters and different demographics and disease severity of open-angle glaucoma patients. METHODS: Thirty-six images of 36 open-angle glaucoma patients were considered. A semiautomated image processing code was used to detect the digitalized ophthalmic artery and central retinal artery velocity waveforms and to extract the waveform parameters. Concordance correlation coefficient, two-sample t-test, and Pearson's correlation coefficient were used to test for similarities, differences, and associations among variables. RESULTS: Female glaucoma patients showed a statistically higher ophthalmic artery normalized distance between ascending and descending limb (p = 0.004), hypertensive glaucoma patients a statistically higher ophthalmic artery peak systolic velocity time (p = 0.025), glaucoma patients with hyperlipidemia a statistically higher ophthalmic artery resistivity index (p = 0.023) and a statistically higher ophthalmic artery peak systolic velocity acceleration (p = 0.025), glaucoma patients with cardiovascular diseases a statistically lower central retinal artery normalized distance between ascending and descending limb of the wave (p = 0.033) and a statistically higher central retinal artery period (p = 0.028), and patients with different body mass index a statistically different central retinal artery normalized distance between ascending and descending limb of the wave (p = 0.016). Groups with different disease severity, classified following the Brusini glaucoma staging system 2, showed statistically different central retinal artery normalized distance between ascending and descending limb of the wave (p < 0.001) and central retinal artery period (p = 0.016). No statistical differences were found in regard to race, diabetes status, glaucoma family history, and smoking. DISCUSSION: Ophthalmic artery and central retinal artery computer-aided analysis of velocity waveforms could identify novel waveform parameters capable of differentiating among different demographics and disease severity of open-angle glaucoma patients.

Early morpho-functional changes in patients treated with hydroxychloroquine: a prospective cohort study.

PURPOSE: We aimed to find earlier morphological and functional alterations in the retinas of patients treated with hydroxychloroquine (HCQ). This was a prospective cohort study. METHODS: We examined 33 patients (mean age, 57.14 [SD, 11.02] years) who were affected by various types of rheumatic diseases. The mean treatment period was 124.7 [SD, 99.4] months, and the mean total drug intake was 5.41 [SD, 3.34] g daily at baseline. The control group consisted of 28 subjects with a mean age of 61.25 [SD, 2.16 years]. The set of tests encompassed best-corrected visual acuity (BCVA), a multifocal electroretinogram (mfERG), spectral-domain optical coherence tomography (SD-OCT), fundus auto fluorescence (FAF), the 10-2 automated visual field (VF) test (10-2 VF), and frequency-doubling technology (FDT). RESULTS: The mfERG P1 wave density amplitudes decreased in all the rings, from 31.10 to 28.02 (p = 0.008) in the first ring, and from 18.29 to 16.55 [p < 0.001], from 12.050 to 10.91 [p = 0.002], from 9.53 to 8.69 [p = 0.003], and from 8.25 to 7.48 [p = 0.001] nanovolts/degree2 in rings 2, 3, 4, and 5, respectively. A significant reduction was found also in the N1 wave in the second ring. The SD-OCT retinal thickness measurement revealed significant thinning in five sectors, including the outer and inner nasal sectors, the outer and inner temporal sectors, and the inner superior sector. The 10-2 VF mean deviation paradoxically improved, while minimal FAF alterations in the retinal pigment epithelium were found in eight eyes. CONCLUSIONS: mfERGs and SD-OCT were altered in our patients before significant retinal changes occurred.

Erratum to: Inter-device reproducibility of retrobulbar blood flow velocity measurements in healthy subjects using color Doppler imaging.

[This corrects the article DOI: 10.1007/s40477-016-0194-5.].

Inter-device reproducibility of retrobulbar blood flow velocity measurements in healthy subjects using color Doppler imaging.

PURPOSE: To evaluate the inter-device reproducibility of retrobulbar blood flow measurements obtained by two commercially available CDI (color Doppler imaging) devices. METHODS: The right eyes of 10 healthy volunteers were investigated. Four examiners, namely two ophthalmologists and two radiologists, performed CDI examination of the ophthalmic artery, central retinal artery and temporal short posterior ciliary arteries using both CDI devices: ESAOTE MYLAB™ and SIEMENS ANTARES STELLAR PLUS™. The peak systolic velocity (PSV), the end-diastolic velocity (EDV) and the resulting resistivity index (RI) were averaged for 3 cardiac cycles. To evaluate the reproducibility between both device measurements, the Lin's concordance correlation coefficient (CCC) was used. CCC can be expressed as the product of Pearson's r (the measure of precision) and C_b (the measure of accuracy). RESULTS: Results show that the inter-device reproducibility for CDI measurements is not acceptable since a poor degree of overall concordance (0.15 0.71) but overall precision low (0.18< Pearson's r <0.47). Ophthalmologists and radiologists obtained similar results. CONCLUSIONS: To evaluate the causal role of blood flow abnormalities in glaucoma, CDI analysis using different devices seems unreliable. CDI inter-device reproducibility seems unrelated to medical speciality of the examiners. However, to improve present results, the use of similar probes and standardized CDI instrument settings as well as a CDI images analysis by a single grader, might possibly improve the inter-device reproducibility when testing the retrobulbar blood flow velocity.

Structure/Function relationship and retinal ganglion cells counts to discriminate glaucomatous damages.

BACKGROUND: Glaucoma is an optic neuropathy characterized by retinal ganglion cells (RGC) loss and retinal nerve fiber layer (RNFL) injury: this results in functional and morphological changes. The first can be observed by Standard Automated Perimetry (SAP), the second by Optic Coherence Tomography (OCT) that measures the RNFL and ganglion cell complex (GCC) thicknesses. Nevertheless, diagnosis of early glaucoma may be difficult. Recently, Medeiros et al. derived an empirical formula combining the measurement of structural and functional tests to provide an estimate of RGC. The aim of the current study is to analyse the correlation between RGC count, estimated by Medeiros' formula, and the structural and functional parameters in patients examined for glaucoma and to evaluate SAP, OCT and RGC counts capability to discriminate the weight of the disease itself. METHODS: Ninety four eyes of 50 consecutive patients clinically referring to glaucoma service of the Universitary Eye Clinic were submitted to a complete ophthalmic evaluation including SAP and Spectral Domain OCT (SD-OCT) of RNFL and macular GCC. Average thickness of RNFL and macular GCC, parameters Global Loss Volume (GLV) and Focal Loss Volume (FLV) over the entire GCC map were taken into account. Estimates of RGC were obtained with the help of a model already published by Medeiros et al. combining light sensitivities from SAP and retinal thickness from OCT. The RGC count was estimated in the entire visual field (central 24°) and in the GCC macular area and then compared with functional and morphological parameters applying Pearson's correlation coefficient. RESULTS: After the classification of the patients by the Glaucoma Staging System 2 of Brusini, we noticed a good correlation among the functional parameters considered, even if the Visual Field Index is unable to identify early glaucoma. An analogous result can be observed for structural data (RNFL and GCC). The correlation detected between functional and structural parameters was moderate. Great differences in RGC counts were found between groups at various stages of glaucoma. GLV showed highest level of correlation (r > -0.8) with RCG counts. CONCLUSIONS: Estimate circumpapillary and macular RGC counts can discriminate various stages of the disease and there is also a good/very good correlation with both functional and structural parameters. GLV could be used instead of RGC counts in clinical practice.

Reproducibility of retrobulbar blood flow velocity measurements in normal subjects using two different CDI devices.

PURPOSE: This study was done to evaluate the intra- and inter-operator reproducibility of colour Doppler imaging (CDI) in assessing blood flow velocity in the ophthalmic (OA), central retinal (CRA) and short posterior ciliary arteries (SPCA) in healthy subjects. MATERIALS AND METHODS: The right eye of two groups of eight healthy volunteers was examined. Two radiologists and two ophthalmologists, divided into pairs, measured peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistivity index (RI) of each vessel using a different CDI device for each group. The concordance between two measurements was evaluated with Lin's concordance correlation coefficient (CCC). RESULTS: Globally, very good degrees of intra-operator concordance were obtained for the PSV (0.859 cm/s), EDV (0.834 cm/s) and RI (0.859) of the OA. There was moderate concordance for PSV (0.574 cm/s) and EDV (0.594 cm/s) and good concordance for RI (0.694) for the CRA. Good degrees of concordance were obtained for the SPCA measurements. However, inter-operator concordance was found globally poor. CONCLUSIONS: These data show that CDI measurements in retrobulbar vessels are operator dependent. To increase the intra-operator and inter-operator concordance, rules should be adopted for timing of the examination and positioning of the probe to minimise the pressure applied on the eye.

Morphologic and functional analysis of the optic nerve in premature and term children with OCT, HRT, and pVEP: a 10-year resurvey.

PURPOSE: Most studies on premature newborns have focused on infants of less than 28 weeks of gestational age (GA) due to their increased risk of developing diseases, such as premature retinopathy. Studies on premature infants born between 28 and 35 weeks GA with normal development are less frequent. The aim of our study was to identify subclinical morphologic or functional defects in these children. METHODS: We evaluated 14 premature newborns at birth (mean gestational age, 33.45 weeks) with a neuro-ophthalmologic examination and patterned visual evoked potentials (pVEP). The same subjects were surveyed when they were young children (mean age, 7.5 ± 0.2 years) using Heidelberg retinal tomography (HRT) and optical coherence tomography (Stratus OCT). The pVEP studies were performed as transient (temporal frequency, 1.96 Hz) and steady-state (7.5-Hz temporal frequency). A complete ophthalmic examination also was performed. The data were compared to those from 15 term newborns who were examined in the same manner (mean age, 9.8 ± 0.3 years). RESULTS: A statistically significant thickening of the macular temporal and inferior nerve fibers was found on OCT in premature newborns. The thickness of the superior and inferior retinal nerve fiber layer (RFNL) also was reduced. A difference also was found in rim area thickness based on HRT. Multiple significant P values were found in the VEP P100 peak time and steady-state amplitudes at the time of birth, but not at the time of morphologic analysis. CONCLUSIONS: Healthy, premature newborns may have morphologic abnormalities of the optic nerve. These abnormalities do not cause visual acuity or functional decreases.

Central corneal thickness and glaucoma treatment: an Italian multicenter cross-sectional study.

PURPOSE: Supposedly, prostaglandin analogs (PGA) could reduce the central corneal thickness (CCT), while topical carbonic anhydrase inhibitors (TCAI) could increase CCT. The aim of the study was to evaluate clinically significant CCT effects in patients treated with PGA or TCAI. METHODS: At least 50 glaucomatous patients were saved on the Italian Glaucoma Register from 16 different glaucoma centers. About 816 glaucomatous patients were found in the register; of these, 316 were recruited in this study because they were treated with PGA or TCAI. The diagnosis of glaucoma was based on visual field examination, optic nerve head analysis, intraocular pressure (IOP) measurements, and gonioscopy. Two age-matched subgroups were created: one treated with PGA and the other with TCAI. CCT, ophthalmoscopic cup/disc ratio (CDR), mean deviation (MD), pattern standard deviation (PSD), and IOP were considered for both eyes of each patient. Student t-test was used to compare the 2 subgroups. RESULTS: The mean age of the PGA group was 66.35±12.17 years, while 65.17±12.52 years was for the TCAI group. No significant difference was found for CCT (543.75±35 µm and 544±35 µm, respectively), CDR (0.55±0.2 and 0.53±0.2, respectively), MD (-4.5±4.9 dB and -5.4±6.4 dB, respectively), PSD (4.6±3.4 and 4.6±4.9, respectively), and IOP (15.9±3.3 mmHg and 15.7±2.9 mmHg, respectively) between the 2 subgroups. A significant (P<0.001) correlation was found between CCT and CDR and between CCT and IOP. CONCLUSION: No significant difference in CCT was found between patients treated with PGA and TCAI, suggesting that these topical medications did not statistically and clinically change the CCT.

The Italian version of the Glaucoma Symptom Scale Questionnaire: translation, validation, and reliability.

PURPOSE: To validate the Italian version of the Glaucoma Symptom Scale (GSS) Questionnaire and its symptoms and function subscales. METHODS: This transversal validation study enrolled nonhospitalized patients with glaucoma, and a reference sample of patients without eye diseases. Eligible participants had to be cognitively able to respond to a health status interview. The Italian self-administered versions of the 25-item National Eye Institute-Visual Function Questionnaire and the GSS Questionnaire were administered to all participants. Reliability and validity of the Italian translation of the GSS Questionnaire were tested using standard statistical methods for questionnaire validation. RESULTS: Ninety-seven patients were enrolled. Cronbach α coefficient ranged from 0.72 to 0.92 across subscales and eyes. Test-retest stability was >85% for each subscale and eye. The control group of participants had better scale scores across all dimensions of vision-targeted health-related quality of life captured by the GSS Questionnaire (P<0.05) and there were good correlations between responses GSS Questionnaire subscales and analogous domains of the 25-item National Eye Institute-Visual Function Questionnaire. CONCLUSIONS: The Italian version of the GSS Questionnaire has good validity, discriminatory power, internal consistence and reliability, showing psychometric properties comparable with those of the English version, and can therefore be used in clinical research as a specific measure of vision-related quality of life in Italian-speaking patients with ocular hypertension or glaucoma.

An evaluation of therapeutic noninferiority of 0.005% latanoprost ophthalmic solution and xalatan in patients with glaucoma or ocular hypertension.

PURPOSE: To assess the therapeutic noninferiority of 0.005% latanoprost ophthalmic solution versus Xalatan in the treatment of patients with primary open-angle glaucoma or ocular hypertension. PATIENTS AND METHODS: This was a double-masked, randomized, multicenter study. A total of 184 patients with a diagnosis of unilateral or bilateral primary open-angle glaucoma or ocular hypertension were randomly assigned to either 0.005% latanoprost ophthalmic solution or Xalatan for 12 weeks. The primary end-point was the change in intraocular pressure (IOP) at 12 weeks in the 2 groups. Noninferiority was reached if the 2-sided 95% confidence intervals (CI) for the difference between adjusted treatment means were entirely within the interval from -1.5 to +1.5 mm Hg. RESULTS: The difference between treatments in the change of IOP from baseline to the end of treatment was 0.12 mm Hg (95% CI: -0.47, 0.71) in the intention-to-treat population and 0 mm Hg (95% CI: -0.58, 0.57) in the per protocol population. There was no statistically significant difference between the 2 groups in terms of drug-related adverse events. The most commonly reported drug-related local adverse events were: ocular hyperemia, eyelashes growth, and eye irritation. CONCLUSIONS: This study demonstrates that 0.005% latanoprost ophthalmic solution is noninferior to Xalatan in lowering IOP and is generally well tolerated.

Cataracts and Dupuytren disease: a case report and review of the literature.

Purpose. Dupuytren disease is an inherited proliferative and progressive connective disease. Ectopic disease may, however, be located distant from the palmar fascia. 
Methods. Case report and review of the literature. 
Results. We describe a case of symmetric bilateral posterior subcapsular cataracts associated with symmetric bilateral Dupuytren disease and symmetric bilateral Ledderhose disease in a 56-year-old Caucasian man. His medical history was negative for glucocorticoids intake, diabetes, and exposure to radiation. Serum transforming growth factor ß (TGF-ß)1 concentration has been evaluated and was found to be almost double compared to the controls. 
Conclusions. We speculate that the TGF-ß plays an important role for ocular and connective tissue disorders.

Monitoring adherence rates in glaucoma patients using the Travatan Dosing Aid. A 6-month study comparing patients on travoprost 0.004% and patients on travoprost 0.004%/timolol 0.5% fixed combination.

OBJECTIVE: To assess adherence in glaucoma patients using the Travatan Dosing Aid (TDA); to record differences in adherence by age, sex, therapy, systemic therapies, years from diagnosis, type of therapy and intraocular pressure (IOP). RESEARCH DESIGN AND METHODS: Sixth-month cohort study; fifty-six Caucasian, primary open-angle glaucoma patients on travoprost (T) or travoprost/timolol fixed combination (TTFC) monotherapy were submitted to four visits: at baseline and months 1, 3 and 6 (M1, M3, M6). Adherence was recorded with TDA and classified as 'high' if greater than 90%. Self-reported and physician-presumed adherence data were collected. Kruskall-Wallis and Fisher's exact tests were applied. RESULTS: Thirty-two patients (54.2%) were treated with T. Age, sex, level of schooling, presence of systemic comorbidities, duration of current therapy and IOP were similar between T and TTFC. Seventeen subjects (30.3%) recorded high adherence at every visit, 13 (23.2%) at two visits, 26 (46.4%) otherwise. Adherence was maintained over time with a slight decrease from month 1 to month 6 without statistical differences within and between groups. Adherence was statistically influenced by age (p = 0.007) and duration of therapy (p = 0.004). CONCLUSION: The typical nonadherent patient is elderly. TDA records indicate that only a minority of patients are really adherent: predictive models to screen for poor adherence are needed.

Dry eye syndrome-related quality of life in glaucoma patients.

PURPOSE: To verify the presence of dry eye syndrome (DES) in treated patients with glaucoma and to analyze DES's impact on the patients' quality of life (QOL) versus the control group. METHODS: In this observational cross-sectional study, 61 patients were enrolled at a clinical practice. Patients were divided into three groups by number of glaucoma drops instilled per day (G1=1 drop/day, G2=2 drops/day, G3=3 drops/day). A control group of 20 subjects was also selected (G0). All subjects were submitted to a complete ocular examination (including tear function and ocular surface status) and completed the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ), Glaucoma Symptom Scale (GSS) questionnaire, and Ocular Surface Disease Index (OSDI). DES was defined as presence of punctate keratitis and decreased break-up time. Statistical analysis was performed applying the Kruskal-Wallis analysis of variance and Mann-Whitney U tests (to compare median values between groups) as well as the chi2 and Fisher test (to verify significant differences). RESULTS: A total of 40% of G3 and 39% of G2 patients presented DES versus 11% of G1 and 5% of G0 (p=0.01). QOL was significantly influenced and altered (NEI-VFQ 25 total mean and GSS total mean and symptoms average: p=0.0085, p=0.006, and p=0.03, respectively). OSDI pointed out differences by group: 26% of G2 and 15% of G3 presented moderate OSDI and 15% of G3 and 8.7% of G2 severe OSDI (p>0.05). CONCLUSIONS: Patients with topically treated glaucoma present DES more often than a similar control group (p=0.01). The presence of DES negatively influences the patient's QOL. The patients with glaucoma's ocular surface status should be evaluated regularly to ensure the timely detection and treatment of pathologic signs on the ocular surface.

Changes in the optic disc excavation of children affected by cerebral visual impairment: a tomographic analysis.

PURPOSE: To obtain quantitative data on the optic disc excavation in children affected by cerebral visual impairment (CVI) by using the Heidelberg Retinal Tomograph (HRT)-II (Heidelberg Engineering, Heidelberg, Germany). METHODS: A total of 24 subjects affected by CVI (mean age, 7.28 years) were examined: 16 in alert conditions and 8 under general anesthesia. The following parameters of the optic nerve head were examined: disc area, cup area, rim area, cup volume, rim volume, cup-to-disc area ratio, mean cup depth, maximum cup depth, cup shape measure, and mean retinal nerve fiber layer (RNFL) thickness. The tomographic results in children with CVI were compared with those of 88 normal, alert subjects of similar age. RESULTS: The optic disc of patients with CVI appeared smaller than normal. Its excavation, however, was more pronounced. Several tomographic parameters were altered in CVI-affected subjects. Statistical analysis showed a highly significant probability in cup-to-disc area ratio (P < 0.01, both eyes), rim area (P < 0.01, both eyes), cup shape measure (P < 0.01, right eye; P < 0.01, left eye), and mean RNFL thickness (P < 0.01, right eye; P < 0.01, left eye). A novel observation was temporal atrophy of the optic nerve head in CVI. CONCLUSIONS: The data provide a tridimensional, objective evaluation of the anatomic alterations of the optic nerve head in children with CVI. Furthermore, tomographic standards for optic disc shape in normal children are set for the first time.

The Italian version of the 25-item National Eye Institute Visual Function Questionnaire: translation, validity, and reliability.

OBJECTIVE: To test the Italian adaptation of the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) and to investigate its validity and reliability. METHODS: This prospective observational study enrolled nonhospitalized patients with 1 of 5 chronic eye diseases, and a reference sample of subjects without eye diseases. Eligible participants had to be cognitively able to respond to a health status interview and be affected by 1 of the following eye conditions: senile cataract, age-related macular degeneration, glaucoma, diabetic retinopathy, and cytomegalovirus retinitis or low vision. A control group was composed of subjects with no evidence of underlying eye diseases. The Italian self-administered versions of Medical Outcomes Study Short Form and of the NEI-VFQ 25 were administered to all participants. Reliability and validity of the Italian translation of the NEI-VFQ 25 were tested using statistical methods. RESULTS: Statistical analysis points out that the Italian version of the NEI-VFQ 25 has good validity, discriminatory power, internal consistency, and reliability. CONCLUSIONS: This Italian version of the NEI-VFQ 25 shows psychometric properties comparable to those of the American version, and thus can be used in clinical research as a specific measure of quality of life in patients with chronic eye diseases.