Trends in prescriptions for glaucoma and ocular hypertension in France between 2014 and 2019.

PURPOSE: To explore the national trend in prescriptions for glaucoma and ocular hypertension (OHT) in France between 2014 and 2019. METHODS: This is a retrospective descriptive study based on prescription data from the Primary Health Insurance Fund databases. All patients with a social security number who received one or more glaucoma/OHT prescriptions between 2014 and 2019 were identified. Figures for 2020 are not yet available as of the date of submission of this article. Demographic characteristics from Common Classification of Medical Acts information and from National Institute of Statistics and Economic Studies were analyzed. The data analysis was carried out using the R version 3.6.2.software from the available databases of the Information Systems Medicalization Program. RESULTS: Our results suggest an increase in the number of patients treated with glaucoma drugs, which cannot be explained simply by demographic growth. There is also a change in drug prescription habits, both in the class of medication used and in the use of fixed combinations. We also note the increasing use of SLT (Selective Laser Trabeculoplasty), a relatively newer tool in the therapeutic arsenal. Over the same time period, demographic characteristics remained stable; age and sex distribution for each year remained constant. In addition, the phenomenon of poor therapeutic compliance, which we attempted to explore, remained stable. DISCUSSION: This study updates the French epidemiologic data available on prescriptions for glaucoma and ocular hypertension, a true public health concern. CONCLUSION: On the one hand, prescribing practices have evolved over the study period. On the other hand, the number of patients treated has increased faster than the growth of the French population over the same period. These findings are consistent with trends observed in previous studies.

[SARS-CoV-2, COVID-19 and the eye: An update on published data]. / SARS-CoV-2, COVID-19 et œil : le point sur les données publiées.

The COVID-19 pandemic has dramatically changed our daily lives as ophthalmologists. This general review firstly provides a better understanding of the virus responsible for the pandemic: the SARS-CoV-2, and the clinical manifestations of the COVID-19 disease. The second part is detailing the pathophysiology, clinical signs and challenges of ocular involvement, which seems rare and not functionally severe, but which may be a potential source of contamination. Finally, we discuss the preventive measures that need to be implemented in our daily practice to avoid any viral dissemination.

Glaucoma progression analysis by Spectral-Domain Optical Coherence Tomography (SD-OCT).

Spectral domain optical coherence tomography (SD-OCT) provides an objective quantification of the lesions of various target tissue structures in glaucoma, with unprecedented resolution, which has now demonstrated its interest in controlling the progression of glaucomatous neuropathy, from early stages to late stages. A certain number of well-established proofs state that a progressive modification in OCT is a common predictor of functional loss, and that patients with rapid OCT changes have an increased risk of developing glaucomatous scotoma. Follow-up of the progression goes through three stages. It consists first of all in detecting the evolution of damage to the retinal nerve fiber layer (RNFL), then that of the macular ganglion cell complex (GCC), in order to better define this progression of the damage to the target structures and, thirdly, to complete its analysis by integrating it with the analysis of the functional impairment. We note today that there is a greater risk of developing a future functional deficit of the visual field in subjects with a RNFL loss slope greater than -1/year, for all clinical stages of glaucoma. The characteristics of GCC progression are much better specified. Often earlier than that of the progress of the thinning of the RNFL and much faster in the subjects considered as "progressors", its cartography is better defined, with a particular interest for the follow-up of diversion maps and "wide field" acquisitions offering better visibility of deficits and their progression. To date, a certain number of suspicious indicators of short-term progress can be retained, highlighting the essential precaution of having two or more basic measures and a confirmation of the change on at least one new OCT acquisition. Finally, if the interpretation of the progression must always be based on clinical examination data, and the macula in particular, it remains crucial to confront the progression of the RNFL with that of the GCC and with that of the visual field.

[Reliability and reproducibility of introcular pressure (IOP) measurement with the Icare® Home rebound tonometer (model TA022) and comparison with Goldmann applanation tonometer in glaucoma patients]. / Fiabilité et reproductibilité des mesures de la pression intraoculaire par le tonomètre Icare® Home (modèle TA022) et comparaison avec les mesures au tonomètre à aplanation de Goldmann chez des patients glaucomateux.

PURPOSE: The Icare® Home tonometer is a new rebound tonometer, developed for intraocular pressure (IOP) self-monitoring. The main objective of our study was to evaluate the reliability and reproducibility of measurements taken with the Icare® Home tonometer in glaucoma patients compared to the Goldmann applanation tonometer. A secondary objective was to investigate factors that could influence the reproducibility of these measurements. MATERIALS AND METHODS: Fifty-two glaucoma patients were included in this prospective, non-randomized, monocentric study. IOP measurements were performed on the right eye and then on the left eye in the following order (3 measurements of IOP for each method): air tonometer (T-Air), Icare® Home tonometer by the patient (RT-P), Icare® Home tonometer by an ophthalmologist (RT-O), Goldmann applanation tonometer (GAT). RESULTS: Forty-four patients (85%) managed to take their IOP on both eyes with the Icare® Home tonometer. Mean IOPs were 14.35±3.93mmHg (T-Air), 13.43±4.65mmHg (RT-P), 14.13±4.29mmHg (RT-O), 14.74±3.84mmHg (GAT). The intraclass correlation indices (ICC) on the 3 repeated IOP measurements were 0.924, 0.872, 0.947 and 0.957, respectively. Bland-Altman analysis found a mean difference (bias) between GAT and RT-P, between GAT and RT-O, and between RT-O and RT-P, respectively, of 1.31, 0.61 and 0.70mmHg, with a 95% confidence interval of -3.34 to 5.96, -3.91 to 5.14 and -3.44 to 4.84mmHg, respectively. The reproducibility of the measurements taken with the Icare® Home tonometer did not vary according to corneal thickness or age of the patients. CONCLUSION: The Icare® Home tonometer provides reliable and reproducible IOP values in glaucoma patients, although it appears to slightly underestimate the IOP measurements compared to the Goldmann applanation tonometer.

[Selective laser trabeculoplasty: Effect of number of preoperative topical glaucoma medications on pressure lowering and success rate]. / Trabéculoplastie sélective au laser : effet du nombre de traitements antiglaucomateux topiques préopératoires sur la baisse pressionnelle et le taux de succès.

PURPOSE: To evaluate the lowering of intraocular pressure (IOP) one year after SLT and to assess if differences are related to number of pre-SLT topical treatments in ocular hypertension (OHT) and primary open angle glaucoma (POAG) patients. METHODS: Retrospective review of 106 eyes of 13 OHT and 93 POAG patients treated by SLT for insufficient IOP control, allergy, discomfort or non-compliance to glaucoma medications, excluding patients with less than 1 year of follow-up after SLT. IOP was measured by applanation before and at 1, 6 and 12 months after SLT. RESULTS: Hundred and six eyes untreated (n=13), or treated with one (n=25), two (n=40) or three or more (n=28) glaucoma medications were included. Mean IOP decreased from 19.4±3.6mmHg preoperatively to 15.7±3.1mmHg at 12 months, which corresponds to an average decrease of 18.8%. At 1 year, 62.2% (n=66) were responders (IOP reduction≥3mmHg): 92.3% without medications (n=12), 68% with one (n=17), 57.5% with two (n=23) and 50% with three or more medications (n=14). Their average IOP decreased from 20.7±3.4 to 15.2±2.9mmHg (26.6%), respectively from 20.8±2.6 to 15.8±3.2 (25%) without medications, 20.6±3.2 to 14.9±3.7 (27.3%) with one, 20.8±4.1 to 15.5±3.3 (25.1%) with two and 20.7±3.2 to 14.4±2.4mmHg (29.7%) with three medications. CONCLUSIONS: The number of responders seems to be greater in OHT and POAG patients without or with few glaucoma medications, but the IOP reduction seems to be similar regardless of the number of glaucoma medications.

[Evaluation of the new Canon HS-100 SD-OCT: Reproducibility of macular ganglion cell complex (GCC) thickness measurement in normal, hypertensive and glaucomatous eyes]. / Évaluation du nouvel OCT SD Canon HS-100: reproductibilité de la mesure de l'épaisseur du complexe cellulaire ganglionnaire maculaire pour des yeux normaux, hypertones et glaucomateux.

PURPOSE: To evaluate intra- and interobserver reproducibility of macular GCC thickness measurement by automated segmentation on the Canon HS-100 SD-OCT (Tokyo, Japan) in normal (N), hypertensive (OHT) and glaucomatous eyes. METHODS: A total of 179 eyes of 93 patients were included: 90 N, 28 OHT and 36 early glaucoma and 25 advanced glaucoma. All patients underwent a complete ophthalmologic exam, central corneal thickness and 24-2 standard automated perimetry (HFA SITA standard). Each of two observers performed three macular acquisitions with the Canon OCT HS-100. Acquisitions were analyzed with the Glaucoma 3D mode, which estimated the macular GCC thickness in global, superior and inferior hemisectors, and in eight separate macular areas. Reproducibility was assessed by intraclass correlation coefficient (ICC), coefficient of variation (CV) and test-retest variability (TRTV) calculated as 1.96 times the standard deviation. RESULTS: Mean GCC thickness was respectively 92.4 µm, 89.0 µm, 80.7 µm and 71.2 µm in N, OHT, early and advanced glaucomatous eyes. In all groups, intra- and interobserver reproducibility ranged respectively for ICC from 89.8 to 99.8% and from 90.2 to 99.4%, for CV from 0.43 to 1.95% and from 0.58 to 2.16% and for TRTV from 0.8 to 3.22 µm and from 1.04 to 3.53 µm. GCC thickness measurements using the new HS-100 SD-OCT were highly reproducible. However, in the advanced glaucoma group, while the reproducibility of GCC thickness measurement is good in the average, superior and inferior hemisectors of the macula, it was slightly less for the paracentral sectors, especially inferior. These sectors correspond generally to the areas most affected by glaucoma. CONCLUSION: The reproducibility of GCC thickness measurements using the new Canon HS-100 SD-OCT is high for normal, OHT, and glaucomatous eyes. It is thus a reliable and reproducible ancillary test available to the clinician for the examination of glaucomatous optic neuropathies.

[New neuroretinal rim analysis with spectral domain optical coherence tomography, Spectralis (Heidelberg Engineering, Germany). Preliminary study]. / Une nouvelle analyse de l'anneau neuro-rétinien en tomographie par cohérence optique en domaine spectral, Spectralis (Heidelberg Engineering, Germany). Étude préliminaire.

INTRODUCTION: Clinical determination of the outer limits of the optic disk (OD) doesn't always correspond to the true anatomic limits of the optic nerve head (ONH) defined by the Bruch's membrane opening (BMO). A new index analyzing the OD with optical coherence tomography (OCT), "minimal rim width" (BMO-MRW), evaluates the smallest thickness of the neuroretinal rim between the BMO and the internal limiting membrane. The purpose of this study was to evaluate new software for automatic measurement of the BMO-MRW. MATERIALS AND METHODS: This study investigated 95 eyes: 40 control eyes and 55 eyes followed and treated for primary open angle glaucoma (42 early glaucoma, 7 moderate glaucoma and 6 advanced glaucoma). After a precise localization of the OD center, 24 radial scans of the ONH are taken with the Spectralis OCT (Heidelberg Engineering, Germany). From the 48 measurements of BMO-MRW, the mean thickness as well as that in each of the 6 papillary sectors of this new index are calculated. ROC curves analysis (receiver operating characteristic) was used to assess the diagnostic capabilities of the various parameters. RESULTS: Thicknesses of all parameters were statistically lower in glaucoma than in controls. The mean value and inferotemporal sector (IT) had the best diagnostic capabilities without significant difference between them (BMO-MRW-average = 0.890 ± 0.062, BMO-MRW-IT = 0.881 ± 0.066, P = 0.59). The area under the curve was lowest in the temporal sector (0.820 ± 086 statistically lower than the average value, P = 0.04). CONCLUSIONS: This preliminary study of a new automated analysis of the neuroretinal rim highlights the diagnostic value of the BMO-MRW index. This evaluation appears to be best correlated with the anatomy of the ONH with good diagnostic sensitivity.

[Management of presbyopic hyperopes by centered presbyLASIK]. / Prise en charge de patients hypermétropes presbytes par chirurgie cornéenne de type presbylasik centré.

PURPOSE: To evaluate efficacy and patient satisfaction of presbyopic hyperopes treated with centered PresbyLASIK (multifocality centered on near vision) by the SUPRACOR technique (Technolas Perfect Vision). MATERIALS AND METHODS: This is a retrospective study carried out at Percy Army Teaching Hospital from September 2011 through September 2013. Fifty-nine eyes of 29 patients were included and underwent PresbyLASIK. Study parameters included uncorrected binocular distance (DVA) and near (NVA) visual acuity, aberrometry, central corneal curvature by corneal topography (bump), and patient satisfaction (questionnaire). RESULTS: Mean uncorrected binocular visual acuity was found to be 0.09 logmar for DVA and 0.22 for NVA on post-operative day one, 0.04 logmar for DVA and 0.17 for NVA at 1 month post-operatively, 0.15 logmar for DVA and 0.19 for NVA at 3 months post-operatively, and -0.02 logmar for DVA and 0.18 for NVA at 6 months post-operatively. Mean central corneal curvature was found to be 2.56±0.9 diopters. There were significantly more higher-order aberrations in the central 5mm post-operatively (P<0.01). Among the patients undergoing bilateral SUPRACOR LASIK, 79% were entirely satisfied with the surgery, and all patients would recommend the procedure to their family and friends. Eighty-six percent of these patients acheived total spectacle independence at distance and near. CONCLUSION: SUPRACOR PresbyLASIK is a method of choice in overcoming spectacle dependence in presbyopic hyperopes.

[Imaging of the iridocorneal angle in glaucoma]. / Imagerie de l'angle iridocornéen dans le glaucome.

Iridocorneal angle assessment is essential in glaucoma diagnosis and management, and gonioscopy remains the clinical reference standard for its evaluation. However, performance and interpretation of gonioscopy requires experience and has several limitations. Ultrasound biomicroscopy (UBM) and more recently anterior segment OCT (AS-OCT) and Scheimpflug camera have contributed to a better understanding of the mechanisms of angle-closure, screening of patients at risk for angle-closure glaucoma, and understanding of angle structures in secondary open angle glaucomas. Rapid and non-contact, AS-OCT has made this analysis easier than with UBM, but it is limited by its weak penetration through iris and scleral tissues.

[Analysis of macular ganglion cell complex (GCC) with spectral-domain optical coherence tomography (SD-OCT) in glaucoma]. / Analyse du complexe cellulaire ganglionnaire maculaire (GCC) en tomographie par cohérence optique (SD-OCT) dans le glaucome.

Early detection of ganglion cell loss is possible with new algorithms for the assessment of the Macular Ganglion Cell Complex (GCC) by SD-OCT. The various data acquisition protocols used by the various versions of software, as well as their accuracy and reproducibility, must be taken into account. Current results show similar ability to detect glaucoma as compared to Retinal Nerve Fiber Layer thickness (RNFL), with some limitations, possible artifacts, and interpretation pitfalls which must be taken into account. The role of the significance map and of various indices (Focal Loss Volume, Global Loss Volume, GCIPL minimum...); data obtained in the setting of various clinical entities (tilted disc, peripapillary atrophy, large and small optic discs, high myopia...); and detection of progression, especially in advanced glaucoma, underline the role of macular GCC analysis as a complementary method to peripapillary RNFL thickness. The diagnostic precision and better reproducibility of these new software protocols offer new perspectives in the detection and management of progression in various stages of the management of glaucomatous optic neuropathy.

[A rare trauma-associated cause of central retinal vein occlusion in a young subject]. / Une cause rare d'occlusion de la veine centrale de la rétine chez le sujet jeune dans un contexte traumatique.

INTRODUCTION: Retinal vein occlusions are the second leading cause of retinal vascular disease, after diabetic retinopathy. In the case of young subjects, a thorough etiological investigation must be conducted in order to diagnose rare etiologies, such as this heterozygous mutation of the factor II gene associated with a central retinal vein occlusion (CRVO), occurring in a young subject within the context of trauma. OBSERVATION: The case deals with a 35-year-old soldier on a mission in a conflict zone. He was the victim of blast injury as a result of the explosion of an improvised explosive device (IED) or homemade bomb, and presented a sudden decline in visual acuity in his left eye associated with the clinical picture of a CRVO. Analysis showed a heterozygous factor II G20210A gene mutation. CONCLUSION: Retinal vein occlusions are always serious visual events. In the case of young subjects, a thorough etiological investigation must be conducted in search of rare abnormalities likely to lead to retinal vein occlusion.

[Enhanced depth imaging of the choroid in open-angle glaucoma: a preliminary study]. / Évaluation de l'épaisseur choroïdienne par tomographie en cohérence optique (SD-OCT). Étude préliminaire dans le glaucome à angle ouvert.

INTRODUCTION: Choroidal thickness (CT) can be evaluated with spectral domain OCT. The authors report the results from a preliminary study comparing CT in normal and glaucomatous eyes. PATIENTS AND METHOD: The aim of this study was to measure subfoveolar CT in normal and glaucomatous eyes and to evaluate the recent enhanced depth imaging technique (EDI SD-OCT). Seventeen eyes of nine healthy subjects where compared with 23 eyes of 14 glaucomatous patients. CT was evaluated using a Spectralis™ OCT. A section was obtained within a 30° scan centered on the fovea, with 100 scans averaged for each section. Two acquisitions were made for each eye by the same operator to obtain an average CT measurement. The results were compared with clinical examination data (refractive error, peripapillary atrophy, and age). RESULTS: There was a strong correlation between the two measurements r=0.99 (p<0.001). The mean age of the healthy group was 72.76±7.71 years, the mean refractive error was 0.71±0.74 D, and peripapillary atrophy was present in 29% of the eyes. The mean subfoveal CT was 224.38µm. The mean age of the glaucomatous group was 71.39±11.37, the mean refractive error was-1.37±2.74 D, and peripapillary atrophy was present in 70% of the eyes. The mean subfoveal CT was 219.98µm. There was no significant difference between the two populations for the subfoveolar CT or refractive errors. In both groups, there was a negative correlation between CT and peripapillary atrophy. In healthy eyes, peripapillary atrophy was correlated with age (p<0.001), whereas it was not in the glaucomatous population (p=0.795). DISCUSSION: This is the first study, to our knowledge, evaluating EDI OCT in glaucomatous eyes. Reproducibility was excellent. There was always a negative correlation between CT and peripapillary atrophy. There was no CT difference between the normal and glaucomatous group, but the number of patients was small. CONCLUSION: Further studies are required to evaluate the possible relationship between CT and peripapillary atrophy and the link with the evolutive stage of the glaucomatous neuropathy.

[Adherence to glaucoma therapy]. / L'adhérence au traitement dans le glaucome.

Adherence to glaucoma therapy is a major factor of therapeutic efficacy. It reflects the patient's perception of the glaucoma disease and its treatment. Evaluation of adherence, often underestimated, is simple with a four-step strategy underscoring the importance of informing and educating the patient. The quality of the physician-patient relationship is essential for a good adapted assessment with every patient and at all stages of the disease so as to enhance adherence to glaucoma treatment and help patients.

[Analysis of a new visual field index, the VFI, in Ocular Hypertension and Glaucoma]. / Analyse d'un nouvel indice d'évaluation du champ visuel, le VFI, dans l'hypertonie oculaire et le glaucome.

OBJECTIVE: The Visual Field Index -VFI- is a new perimetric index allowing evaluation of visual function level and progression. In this study, we analysed this new index, that provides a trend analysis of visual field loss progression in Ocular Hypertension and Glaucoma. We also compared results with event analysis. METHODS: Retrospective study on 94 eyes of 54 patients: 35 OHT(ocular hypertension), 34 early POAG (primary open angle glaucoma) (0>MD>-6 dB), 13 moderate POAG (-6>MD>-12 dB) and 12 advanced POAG (MD<-12 dB), with a mean follow-up of 6.5 years (4 to 8 years). Each subject performed a mean number of 10 standard automated perimetry visual field tests (Humphrey SITA Standard 24-2), excluding tests without reliable indices. VFI progression rate was analysed. VFI progression during the first half period of follow up was compared with that during the second half period. VFI progression was confronted with script alert messages delivered by the last GPA (Guided Progression Analysis) event analysis program. RESULTS: VFI values were "stable or with low progression" in 100% of OHT patients, 88% of early POAG, 38.5% of moderate POAG, 33% of advanced POAG. Progression during the first half period (mean of 3 years) of follow-up could be extrapolated for the second half period in 97% of OHT patients, 76% of early POAG, 70% of moderate POAG, 75% of advanced POAG. Results from VFI trend analysis and GPA event analysis corresponded in 97% of OHT patients, 85% of early POAG, 85% of moderate POAG, and 87% of advanced POAG. DISCUSSION: VFI seems to be a useful indicator for glaucoma evaluation and progression follow-up. It completes the event analysis. Some very advanced POAG cannot be analysed by GPA event analysis. VFI should be able to be used for further follow-up. All these results require validation in larger population. The purpose would be to assess if VFI is able to detect different profiles of progression to help treatment decisions.