[Changes in quality of life of glaucoma patients over a period of 8 years]. / Veränderungen der Lebensqualität von Glaukompatienten über einen Zeitraum von 8 Jahren.

PURPOSE: The quality of life (QoL) of glaucoma patients is affected by many factors. In particular, patient activity is compromised by the chronicity of the disease. In this study, we evaluated the change in QoL and its impact on activities over a period of 8 years. METHODS: A total of 43 patients with glaucomatous optic nerve damage were enrolled in this retrospective longitudinal observational study. Changes in intraocular pressure (IOP), best-corrected visual acuity (BCVA) and visual field (VF) parameters, number of IOP-lowering eye drops and IOP-lowering surgery were assessed over a period of 8 years. Assessment of QoL was obtained by patient-reported visual functioning using the Rasch-calibrated glaucoma activity limitation 9 (GAL-9) questionnaire at baseline and after 8 years. RESULTS: The BCVA of the better eye changed from 0.16 ± 0.22 to 0.21 ± 0.14 logMAR, whereas there was a change from 0.27 ± 0.25 to 1.39 ± 1.1 logMAR in the worse eye. The VF parameter mean deviation (MD) of the better eye changed from -2.39 ± 4.55 dB to -4.83 ± 5.09 dB, while it altered significantly from -8.86 ± 5.86 dB to -12.05 ± 8.07 dB in the worse eye. Values of GAL­9 changed from -2.39 ± 2.14 to -1.38 ± 2.78 (in the Rasch analysis, more negative values account for a better QoL), according to a sum score change from 79.17 ± 19.63 to 69.22 ± 27.95. This change showed a highly significant correlation with the MD at follow-up, especially with the worse eye (r = 0.43). The impact of the MD at follow-up on QoL could also be well predicted in a regression model. CONCLUSION: The QoL of glaucoma patients decreased significantly over time. Changes in the VF, particularly of the worse eye, have a great impact on reported functioning. Careful treatment, especially of the eye with greater glaucomatous damage, is mandatory.

[STARflo-a suprachoroidal drainage implant in glaucoma surgery]. / STARflo ­ ein suprachoroidales Drainageimplantat in der Glaukomchirurgie.

BACKGROUND: The STARflo Glaucoma Device (iSTAR Medical, Wavre, Belgium) offers a new approach to bleb-free filtering surgery in which the intraocular pressure (IOP) is lowered by supporting outflow of the aqueous humor into the suprachoroidal space. MATERIALS AND METHODS: On the basis of a case series of 9 patients with open-angle glaucoma (OAG) unmanageable by drug-based treatment, intra- and postoperative experiences with the implant are presented. The implant, the implantation procedure, and the first results 6 months postoperatively are described. RESULTS: No intraoperative complications were observed. Postoperative complications such as increased astigmatism or ocular hypotony were rare and transient. After 6 months there was an IOP reduction from 29.1 mm Hg ± 6.1 mm Hg with 2.7 ± 1.1 local IOP-lowering medications to 16.1 ± 4.1 mm Hg (IOP reduction of 44.7%) with additional 2.0 ± 0.8 local IOP-lowering medications. DISCUSSION: The new STARflo Glaucoma Device shows promising results in reducing the IOP of medically uncontrolled OAG. Further investigations concerning the long-time efficacy of the implant and additional IOP-lowering medication are still ongoing.

[Smart eye data : Development of a foundation for medical research using Smart Data applications]. / "Smart eye data" : Entwicklung eines Fundaments für medizinische Forschung mittels Smart-Data-Applikationen.

BACKGROUND: Smart Data means intelligent data accumulation and the evaluation of large data sets. This is particularly important in ophthalmology as more and more data are being created. Increasing knowledge and personalized therapies are expected by combining clinical data from electronic health records (EHR) with measurement data. OBJECTIVE: In this study we investigated the possibilities to consolidate data from measurement devices and clinical data in a data warehouse (DW). MATERIAL AND METHODS: An EHR was adjusted to the needs of ophthalmology and the contents of referral letters were extracted. The data were imported into a DW overnight. Measuring devices were connected to the EHR by an HL7 standard interface and the use of a picture archiving and communications system (PACS). Data were exported from the review software using a self-developed software. For data analysis the software was modified to the specific requirements of ophthalmology. RESULTS: In the EHR 12 graphical user interfaces were created and the data from 32,234 referral letters were extracted. A total of 23 diagnostic devices could be linked to the PACS and 85,114 optical coherence tomography (OCT) scans, 19,098 measurements from IOLMaster as well as 5,425 pentacam examinations were imported into the DW including over 300,000 patients. Data discovery software was modified providing filtering methods. CONCLUSION: By building a DW a foundation for clinical and epidemiological studies could be implemented. In the future, decision support systems and strategies for personalized therapies can be based on such a database.

[Quality of Life in Patients with Glaucoma]. / Lebensqualität bei Glaukompatienten.

BACKGROUND: The goal of glaucoma treatment is to maintain the patient's visual function and related quality of life, at a sustainable cost. In this review, methods of measuring quality of life are presented, together with their impact in clinical practice. METHODS: Searches were from the inception of the database to date. Electronic databases searched included Medline (Ovid), Medline In-Process (Ovid), and Embase (Ovid). In a semistructured approach, the articles were checked for their eligibility to provide information about the measurement and application of quality of life in glaucoma patients. RESULTS: Well established questionnaires are available to measure quality of life in glaucoma patients, as well as instruments to measure benefits. Performance-based measures are more time-consuming. The Glaucoma Activity Limitation-9 Questionnaire (GAL-9) is a glaucoma-specific questionnaire in German, with a Rasch analysis. In eye diseases with central visual field defects, it is the better eye that determines the patient's quality of life, whereas in glaucoma patients with peripheral defects, it is the worse eye that has a stronger influence. Structural changes in glaucoma are less well correlated with quality of life than are functional impairments. There have been a few initial reports of patterns of visual field defects that correlate with subjective impairments. CONCLUSIONS: The data can help to improve our understanding of individual patient impairment and support our efforts to improve the medical advice and therapy that these patients receive.

[Screening in ophthalmology : Stay healthy, recognize diseases early]. / Screening in der Ophthalmologie : Gesund bleiben, Krankheiten frühzeitig erkennen.

Screening is a strategy used in a systematic approach to identify an unrecognized disease or risk factors in individuals in a population without signs or symptoms. The test characteristics (specificity and sensitivity) and the prevalence of the disease are of vital importance for the achievable quality of prediction. Multidimensional decision-making must not only consider the benefits of screening but also its potential disadvantages, such as overtreatment, diagnostics of unclear findings and the psychological impact on healthy individuals. Besides medical, ethical and test theoretical considerations, economic considerations also have to be included in decision-making on a screening program. In Germany, a nationwide screening for diabetic retinopathy and regional programs for amblyopia screening exist. Screening for glaucoma or age-related macular degeneration is currently not funded by the statutory health insurance.

[Macroeconomic costs of eye diseases]. / Volkswirtschaftliche Kosten von Augenerkrankungen.

BACKGROUND: Eye diseases that are relevant regarding their macroeconomic costs and their impact on society include cataract, diabetic retinopathy, age-related maculopathy, glaucoma and refractive errors. OBJECTIVES: The aim of this article is to provide a comprehensive overview of direct and indirect costs for major eye disease categories for Germany, based on existing literature and data sources. METHODS: A semi-structured literature search was performed in the databases Medline and Embase and in the search machine Google for relevant original papers and reviews on costs of eye diseases with relevance for or transferability to Germany (last research date October 2013). In addition, manual searching was performed in important national databases and information sources, such as the Federal Office of Statistics and scientific societies. RESULTS: The direct costs for these diseases add up to approximately 2.6 billion Euros yearly for the Federal Republic of Germany, including out of the pocket payments from patients but excluding optical aids (e.g. glasses). In addition to those direct costs there are also indirect costs which are caused e.g. by loss of employment or productivity or by a reduction in health-related quality of life. These indirect costs can only be roughly estimated. Including the indirect costs for the eye diseases investigated, a total yearly macroeconomic cost ranging between 4 and 12 billion Euros is estimated for Germany. CONCLUSION: The costs for the eye diseases cataract, diabetic retinopathy, age-related maculopathy, glaucoma and refractive errors have a macroeconomic relevant dimension. Based on the predicted demographic changes with an ageing society an increase of the prevalence and thus also an increase of costs for eye diseases is expected in the future.

[Differences in the measurement results of Goldmann applanation tonometry with and without fluorescein]. / Unterschiede in den Messergebnissen nach Goldmann-Applanationstonometrie mit und ohne Fluoreszein.

BACKGROUND: Goldmann applanation tonometry (GAT) is still the gold standard for measuring the intraocular pressure (IOP). Usually fluorescein eye drops are used additional to topical anesthesia to gain the best visualization results. The present study evaluated the differences in the results of GAT with and without fluorescein. METHODS: A total of 400 eyes of 200 patients without known glaucoma were enrolled in this study and randomized to two groups: group A (first measurement without, second measurement with fluorescein) and group B (first measurement with fluorescein, second without). All measurements were performed by the same examiner with the same slit lamp. Results were analyzed by Bland-Altman plots and Spearman's correlation test. RESULTS: The examined groups showed no significant differences regarding patient age, astigmatism or reason for consulting. In both groups performing GAT without the application of fluorescein led to significantly lower measurement results. The differences were 1.5 ± 1.7 mmHg SD in group A, 1.2 ± 1.6 mmHg SD in group B and 1.4 ± 1.65 mmHg SD for all eyes. The intraocular pressure (IOP) and the differences between the groups were independent of patient age, astigmatism, reason of consulting or IOP level. Both groups showed outliers up to 10 mmHg difference because of corneal edema. CONCLUSIONS: Measurements from GAT without fluorescein differed significantly from measurements with fluorescein, independently of patient age, astigmatism, reason for consulting or IOP level. The mean difference of 1.4 mmHg may seem negligible in daily routine but can lead to serious consequences in borderline cases.

[Navigated focal retinal laser therapy using the NAVILAS® system for diabetic macula edema]. / Navigierte fokale retinale Lasertherapie mit dem NAVILAS®-System bei diabetischem Makulaödem.

PURPOSE: The aim of this study was to investigate the accuracy of a navigated laser photocoagulator in clinically significant macular edema (CSME). METHODS: Focal laser treatment for diabetic macular edema (DME) in 36 patients was digitally planned on fundus images and performed with navigation using NAVILAS® (OD-OS, Teltow, Germany). Treatment intensity was controlled visually during treatment so the laser spots applied were barely directly visible after treatment. Using color images (CI) and optical coherence tomography (OCT) 4,137 laser spots (mean 115 per eye) were analyzed at 1 month follow-up and accuracy of spot placement was determined. RESULTS: In total 79% of laser spots were visible on CI of which 96% were within 100 µm of the planned target position. On an intention-to-treat (ITT) basis, 76% of the laser spots were placed and visible within the 100 µm target and OCT confirmed that laser effects were limited to the outer retina. The mean time for focal treatment was < 7 min (±3 min). CONCLUSIONS: After NAVILAS treatment for DME a high percentage of laser effects could be visualized on post-treatment color images and the location showed high concordance with the preplanning target.

[Measurement of glaucoma-specific functionality with the GQL-15 and correlation with parameters of visual function]. / Messung der glaukomspezifischen Funktionsfähigkeit mit dem GQL-15 und Korrelation mit Funktionsparametern des Sehens.

INTRODUCTION: Glaucoma is one of the leading causes of irreversible blindness worldwide and can have a significant impact on patient quality of life and vision-related functioning. The Glaucoma Quality of Life 15 (GQL-15) questionnaire is a disease-specific instrument to evaluate and quantify functional impairment of patients with glaucoma. This study evaluated the German version of the GQL-15 including correlations with perimetric parameters. METHODS: A German version of the GQL-15 containing 15 items was developed and evaluated in 98 patients with glaucoma in different stages of the disease. The GQL-15 results were correlated with the perimetric parameters mean deviation (MD) and pattern standard deviation (PSD) of the better and worse eye. Classical and probabilistic test analyses (Rasch model) were performed. RESULTS: The mean GQL-15 value was 77.3 ± 21.7 (SD) and most items of the GQL-15 correlated significantly with the MD of the worse eye (r = -0.416; p = 0.0014) and the better eye (r = -0.304; p = 0.02). There was also a highly significant correlation between glaucoma-specific QoL and visual acuity. A short version containing nine items yielding a higher psychometric performance can also be used. CONCLUSIONS: The German version of the GQL-15 is a potent instrument to evaluate impairment in vision-specific functioning of patients with glaucoma. The GQL-15 values are better correlated with the sensitivity of the eye with the more severe glaucomatous damage. The data can help for a better understanding of individual patient impairment to improve medical advice and therapy of patients with glaucoma.

[The role of light in the developement of RPE degeneration in AMD and potential cytoprotection of minocycline]. / Altersbedingte Makuladegeneration: die Rolle von Licht bei der Entstehung degenerativer Veränderungen im menschlichen RPE und möglicher Zell-Schutz durch Minocyclin.

BACKGROUND: Light-induced oxidative stress is an suggested reason for retinal pigment epithelium (RPE) degeneration in age-related macular degeneration (AMD). This study investigates the influence of light on intracellular reactive oxygen species (ROS) and apoptosis in the human RPE and potential cytoprotective effects of the tetracycline antibiotic minocycline. METHODS: Primary human RPE cells were either pre- or post-incubated with minocycline and then exposed to white light or oxidative stress (600 µM, H(2)O(2)). Then viability, induction of intracellular reactive oxygen species (ROS), apoptosis and cell death was determined. Expression of apoptotic BAX and anti-apoptotic Bcl-2 protein and their mRNA were determined by RT-PCR and Western blot analysis. RESULTS: Both light exposure and oxidative stress decreased RPE cell viability and Bcl-2 expression and increased intracellular ROS, apoptotic cell death, and BAX expression. Minocycline reduced these effects under certain conditions. CONCLUSIONS: This study demonstrates that minocycline effectively protects human RPE cells against oxidative damage. However, in the light of minocycline's photosensitising properties its potential role in AMD treatment needs further evaluation.

[Cytoprotective and antiangiogenic effects of the multikinase inhibitor sorafenib on human retinal pigmentepithelium]. / Zytoprotektive und antiangiogene Wirkung des Multikinaseinhibitors Sorafenib im retinalen Pigmentepithel.

BACKGROUND: Cumulative light exposure is significantly associated with progression of age-related macular degeneration (AMD). Inhibition of vascular endothelial growth factor A (VEGF) is the main target of current antiangiogenic treatment strategies for AMD. Previous reports indicated that sorafenib, an oral multikinase inhibitor, might have beneficial effects on exudative AMD. This study investigates the effects of sorafenib on light-induced overexpression of VEGF and its receptors VEGFR1 and 2 in human retinal pigment epithelial (RPE) cells. METHODS: The effects of sorafenib on VEGFR1 and 2 expression of primary human RPE cells was investigated by reverse transcription polymerase chain reaction (RT-PCR), immunohistochemistry and western blotting. In addition, RPE cells were exposed to white light and incubated with sorafenib. Viability, expression of VEGF and its mRNA were determined by RT-PCR, immunohistochemistry, western blotting, and enzyme-linked immunosorbent assays. RESULTS: Sorafenib reduced VEGFR1 and 2 expression of RPE cells. Light exposure decreased cell viability and increased expression and secretion of VEGF. These light-induced effects were significantly reduced when cells were treated with sorafenib at a dose of 1 µg/ml. CONCLUSION: The results show that sorafenib has promising properties as a potential antiangiogenic treatment for AMD.

[Diabetic retinopathy: comparison of the diagnostic features of ultra-widefield scanning laser ophthalmoscopy Optomap with ETDRS 7-field fundus photography]. / Diabetische Retinopathie: Vergleich der diagnostischen Eigenschaften des Ultraweitwinkel-Scanning-Laser-Ophthalmoskops Optomap mit der ETDRS-7-Feld-Fundusfotografie.

OBJECTIVE: The aim of the study was to compare the diagnostic properties of a non-mydriatic 200° ultra-widefield scanning laser ophthalmoscope (SLO) with mydriatic ETDRS 7-field fundus photography for diabetic retinopathy screening. METHODS: A consecutive series of 66 eyes from 34 patients with different levels of diabetic retinopathy (DR) were examined. Grading of DR and macular edema (ME) obtained from mydriatic ETDRS 7-field fundus photography were compared with grading obtained from Optomap Panoramic 200MA SLO images. All SLOs were performed with an undilated pupil and no additional clinical information was used for evaluation of images by two independent, masked experts. RESULTS: A total of 14 eyes from ETDRS 7-field fundus photography and 11 eyes from Optomap could not be graded by at least one grader due to poor image quality, yielding 48 eyes for comparison purposes. Of the 48 ETDRS 7-field fundus photographs, 9 (11 for grader 2) eyes had no or mild DR (ETDRS levels ≤20) and 17 (23 for grader 2) eyes had no ME. Agreement of Optomap retinopathy grading with ETDRS 7-field fundus photography was good, kappa 0.70 for grader 1 and kappa 0.66 for grader 2. There was good agreement between both techniques for ME, grader 1 kappa 0.68 and grader 2 kappa 0.74. CONCLUSIONS: Grading of DR levels from Optomap Panoramic 200MA non-mydriatic images showed a good correlation with mydriatic ETDRS 7-field fundus photography. Both techniques are of sufficient quality for a valid assessment of DR. Optomap Panoramic 200MA images cover a larger retinal area and might therefore offer additional diagnostic properties.

Sorafenib prevents human retinal pigment epithelium cells from light-induced overexpression of VEGF, PDGF and PlGF.

BACKGROUND: Cumulative light exposure is significantly associated with progression of age-related macular degeneration (AMD). Inhibition of vascular endothelial growth factor is the main target of current antiangiogenic treatment strategies in AMD. However, other growth factors, such as platelet-derived growth factor (PDGF) and placenta growth factor (PlGF), have a substantial impact on development of AMD. Previous reports indicate that sorafenib, an oral multikinase inhibitor, might have beneficial effects on exudative AMD. This study investigates the effects of sorafenib on light-induced overexpression of growth factors in human retinal pigment epithelial (RPE) cells. METHODS: Primary human RPE cells were exposed to white light and incubated with sorafenib. Viability, expression, and secretion of VEGF-A, PDGF-BB, and PlGF and their mRNA were determined by reverse transcription-polymerase chain reactions, immunohistochemistry and enzyme-linked immunosorbent assays. RESULTS: Light exposure decreased cell viability and increased expression and secretion of VEGF-A, PDGF-BB and PlGF. These light-induced effects were significantly reduced when cells were treated with sorafenib at a dose of 1 µg/ml. CONCLUSION: The results show that sorafenib has promising properties as a potential antiangiogenic treatment for AMD.

Minocycline is cytoprotective in human corneal endothelial cells and induces anti-apoptotic B-cell CLL/lymphoma 2 (Bcl-2) and X-linked inhibitor of apoptosis (XIAP).

INTRODUCTION: Loss of corneal endothelial cells (CECs) is one major factor limiting transplant clarity and survival after keratoplasty. Amongst other factors, apoptosis due to cellular stress is responsible for these problems. This study investigates the possible anti-apoptotic and cytoprotective effects of minocycline on a human corneal endothelial cell line (HCEC-SV40) cultured under oxidative stress and with transforming growth factor beta (TGF-beta). METHODS: CECs were treated with 1-150 microM minocycline. Cell viability and the median inhibitory concentration (IC(50)) were evaluated after 48 h and after H(2)O(2) treatment (tetrazolium dye reduction assay and live-dead assay). Expression of B-cell CLL/lymphoma 2 (Bcl-2) and X-linked inhibitor of apoptosis (XIAP) and their mRNA were assessed by reverse transcriptase (RT)-PCR and western blot analysis after treatment with minocycline alone and consecutive incubation with 200 microM H(2)O(2) and TGF-beta2. A quantitative detection of histone-associated DNA fragmentation by ELISA was performed. RESULTS: Minocycline concentrations from 1-50 microM showed no toxic effects on CECs. Pre-treatment with 10-40 microM minocycline led to an increase in viability after H(2)O(2) treatment. In addition, minocycline pre-treatment attenuated the increase of histone-associated DNA fragmentation after treatment with H(2)O(2) and TGF-beta2 significantly. When CECs were treated with minocycline and then consecutively with H(2)O(2) or TGF-beta2, RT-PCR and western blot analysis yielded an overexpression of Bcl-2 and XIAP. CONCLUSION: In this study minocycline prevented apoptotic cell death in cultured CECs in vitro. Our results suggest that minocycline might offer cytoprotective properties that might help to prevent loss of corneal endothelial cells in vivo.

[Modeling in value-based medicine]. / Modellierung in der "value-based medicine"

Modeling plays an important role in value-based medicine (VBM). It allows decision support by predicting potential clinical and economic consequences, frequently combining different sources of evidence. Based on relevant publications and examples focusing on ophthalmology the key economic modeling methods are explained and definitions are given. The most frequently applied model types are decision trees, Markov models, and discrete event simulation (DES) models. Model validation includes besides verifying internal validity comparison with other models (external validity) and ideally validation of its predictive properties. The existing uncertainty with any modeling should be clearly stated. This is true for economic modeling in VBM as well as when using disease risk models to support clinical decisions. In economic modeling uni- and multivariate sensitivity analyses are usually applied; the key concepts here are tornado plots and cost-effectiveness acceptability curves. Given the existing uncertainty, modeling helps to make better informed decisions than without this additional information.

[Value-based medicine for glaucoma]. / "Value-based medicine" bei Glaukom.

The application of value-based medicine (VBM) tenets in the area of glaucoma research requires valid and reliable data concerning the quality of life with glaucoma. A multitude of instruments for measuring quality of life of patients with glaucoma have been employed in the past. Any instrument used would need to capture peripheral vision loss and its influence on patient-reported quality of life as this is one of the hallmarks of this disease. Cost-utility analyses can then be based on the reported quality of life and the cost of glaucoma therapy. Several cost-utility analyses have been applied in the field of glaucoma screening as well as treating ocular hypertension and based on this a recommendation regarding population subgroups which can be treated cost efficiently can be made.

[Intracameral moxifloxacin: a safe option for endophthalmitis prophylaxis? In vitro safety profile for intraocular application]. / Moxifloxacin intrakameral: Eine sichere Option zur Endophthalmitisprophylaxe? In-vitro-Sicherheitsprofil zur intraokularen Anwendung.

BACKGROUND: Moxifloxacin (Vigamox), a 4th-generation fluoroquinolone, covers most isolates causing endophthalmitis. It is safe and effective for systemic and topical use; however, only very limited data are available on prophylactic intracameral administration to prevent endophthalmitis. This study investigated the safety of Vigamox for intracameral application in a cell-culture model. METHODS: The endothelial toxicity of moxifloxacin (Vigamox) was evaluated in cultured human corneas. Primary human retinal pigment epithelium cells (RPEs), trabecular meshwork cells (TMCs), lens epithelium cells (LECs), and corneal endothelial cells (CECs) were treated with concentrations of Vigamox. Toxic effects were evaluated after 24 h (MTT assay and live-dead assay). By treating TMC, CEC, and RPE cells either with oxidative stress or tumor necrosis factor-alpha (TNF-a), lipopolysaccharide (LPS), and interleukin-6 (IL-6), the effects of moxifloxacin on cellular viability under conditions of inflammation were investigated. RESULTS: No corneal endothelial toxicity could be detected after 30 days of treatment with moxifloxacin 500 microg/ml. Primary RPEs, TMCs, LECs, and CECs showed adverse effects on proliferation and viability only at concentrations higher than 150 microg/ml moxifloxacin. After preincubation with TNF-a, LPS, and IL-6 for 24 h and subsequent treatment with moxifloxacin at concentrations of 10-150 microg/ml for 24 h, no significant decrease in proliferation or viability was observed. H2O2 exposure did not increase cellular toxicity CONCLUSION: Vigamox did not show significant toxicity on primary RPEs, TMCs, LECs, CECs, or human corneal endothelium at concentrations up to 150 microg/ml. The MIC90 of moxifloxacin for pathogens commonly encountered in endophthalmitis is known to be in the range of 0.25-2.5 microg/ml. Therefore, intracameral use of Vigamox at concentrations up to 150 microg/ml may be safe and effective for preventing endophthalmitis after intraocular surgery.

[Protective effect of blue light-absorbing IOLs on the human retinal pigment epithelium]. / Protektive Wirkung Blaulicht absorbierender IOLs auf das menschliche retinale Pigmentepithel.

METHODS: Primary human RPE cells were exposed to white light and either a SN60AT or SA60AT IOL was placed in the light beam. After 15-60 min of irradiation, viability, induction of apoptosis and cell death were determined in primary human RPE cells. Expression of vascular endothelial growth factor A (VEGF-A) and the anti-apoptotic XIAP protein and their mRNA were determined by RT-PCR, Western blot analysis and ELISA. RESULTS: Light exposure decreased cell viability depending on the duration of irradiation. Light-induced cell death and apoptosis as well as decrease of XIAP expression and cellular viability were significantly reduced by both the SN60AT and SA60AT IOL. In addition, these protective effects regarding light-induced cell damage were significantly stronger in the presence of the blue light-filtering SN60AT IOL compared to the SA60AT IOL. CONCLUSION: Both UV-filtering and blue light-absorbing IOLs reduce light-induced RPE damage. The blue light-absorbing IOL further reduced damage compared to the conventional IOL, which supports the hypothesis of possibly also preventing retinal damage in clinical use.

[Health-economic aspects of glaucoma screening]. / Gesundheitsökonomische Aspekte des Glaukomscreenings.

PURPOSE: Screening for glaucoma can detect undiagnosed patients, and treatment can prevent blindness. There are defined criteria for screening programs, but economic aspects of screening programs and cost utility estimations are of increasing importance. METHODS: Medical databases (CDSR, HTA, MEDLINE, EMBASE) were searched on the topics of glaucoma screening, screening strategies and tools, and relevant health-economic analyses for glaucoma screening. In this article, the most important findings are presented and discussed using epidemiological data. RESULTS: Glaucoma screening meets most of the relevant criteria for screening strategies. The best single screening test at this time is the frequency doubling technique. The cost-effectiveness depends mainly on the prevalence of the disease, the specificity of the screening test, the costs of screening and disease, and the impairment of quality of life due to glaucoma. Two recently published cost utility studies from Finland and the United Kingdom are presented. A common result is that a population screening is not cost-effective, whereas targeted screening of high-risk groups is. CONCLUSION: Glaucoma screening of the general population is not cost-effective, but screening of groups at risk (e.g., those of a certain age, family history, or ethnicity) may be cost-effective. Clear cutoff points regarding whom to screen can be determined by economic analyses using high-quality data. These data influence health policy decision makers.