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PURPOSE: To evaluate the diagnostic test properties of the Palm Scan VF2000â Virtual Reality Visual Field Analyzer for diagnosis and classification of the severity of glaucoma. METHODS: This study was a prospective cross-sectional analysis of 166 eyes from 97 participants. All of them were examined by the Humphreyâ Field Analyzer (used as the gold standard) and the Palm Scan VF 2000â Virtual Reality Visual Field Analyzer on the same day by the same examiner. We estimated the kappa statistic (including 95% confidence interval [CI]) as a measure of agreement between these two methods. The diagnostic test properties were assessed using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: The sensitivity, specificity, PPV, and NPV for the Virtual Reality Visual Field Analyzer for the classification of individuals as glaucoma/non-glaucoma was 100%. The general agreement for the classification of glaucoma between these two instruments was 0.63 (95% CI: 0.56-0.78). The agreement for mild glaucoma was 0.76 (95% CI: 0.61-0.92), for moderate glaucoma was 0.37 (0.14-0.60), and for severe glaucoma was 0.70 (95% CI: 0.55-0.85). About 28% of moderate glaucoma cases were misclassified as mild and 17% were misclassified as severe by the virtual reality visual field analyzer. Furthermore, 20% of severe cases were misclassified as moderate by this instrument. CONCLUSION: The instrument is 100% sensitive and specific in detection of glaucoma. However, among patients with glaucoma, there is a relatively high proportion of misclassification of severity of glaucoma. Thus, although useful for screening of glaucoma, it cannot replace the Humphreyâ Field Analyzer for the clinical management in its current form.
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Purpose: Presence of diabetes in glaucoma patients may influence findings while documenting the progression of glaucoma. We conducted the study to compare individual and combined effects of diabetes and glaucoma on macular thickness and ganglion cell complex thickness. Methods: The present study is a cross-sectional analysis of 172 eyes of 114 individuals. The groups were categorized according to the following conditions: glaucoma, diabetes mellitus, both glaucoma and diabetes (`both' group), and none of these conditions (`none' group). Patients with diabetes did not have diabetic retinopathy (DR). We compared retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, foveal loss of volume (FLV), and global loss of volume (GLV) among the groups. We used random effects multivariate analysis to adjust for potential confounders. Results: The mean (SD) age of these individuals was 60.7 (10.1) years. The total average RNFL and GCC were significantly lower in the glaucoma group (RNFL: -36.27, 95% confidence intervals [CI]: -42.79 to -29.74; P < 0.05, and GCC: -26.24, 95% CI: -31.49 to -20.98; P < 0.05) and the `both' group (RNFL: -24.74, 95% CI: -32.84 to -16.63; P < 0.05, and GCC: -17.92, 95% CI: -24.58 to -11.26; P < 0.05) as compared with the `none' group. There were no significant differences in the average RNFL values and total average GCC between the diabetes group and the `none' group. The values of FLV and GLV were significantly higher in the `glaucoma' group and the `both' group as compared with the `none' group. The foveal values were not significantly different across these four groups. Among the glaucoma cases, 25% were mild, 30% were moderate, and 45% were severe; there was no significant difference in the proportion of severity of glaucoma between the `glaucoma only' and `both' groups (p=0.32). After adjusting for severity and type of glaucoma, there were no statistically significant differences in the values of average RNFL (6.6, 95% CI: -1.9 to 15.2; P=0.13), total average GCC (3.6, -95% CI: -2.4 to 9.6; P=0.24), and GLV (-3.9, 95% CI: -9.5 to 1.6; P=0.16) in the `both group' as compared with the glaucoma only group. Conclusion: We found that diabetes with no DR did not significantly affect the retinal parameters in patients with glaucoma. Thus, it is less likely that thickness of these parameters will be overestimated in patients with glaucoma who have concurrent diabetes without retinopathy.
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INTRODUCTION: The present study compared visual outcomes in eyes with bilateral implantation of two multifocal intraocular lenses (MFIOLs)-the Eyecryl™ ACTV diffractive multifocal IOL (group 1) and AcrySof® IQ ReSTOR® multifocal IOL (group 2). METHODS: This was a prospective, two-group observational longitudinal study of 118 eyes from 59 patients conducted at Laxmi Eye Institute, Panvel, India. We evaluated the patients at 1, 3, and 6 months. We assessed visual acuity, contrast sensitivity, higher-order aberrations, reading speed, defocus curve, stereopsis, quality of life (QOL), and adverse events in these participants. RESULTS: The median (interquartile range) best-corrected distance visual acuity was 0.18 (0, 0.18) in group 1 and 0.18 (0, 0.18) in group 2 at 1, 3, and 6 months; the difference was not statistically significant (p = 0.48). The binocular defocus curve in both groups showed two peaks at 0.0 to -0.5 D and at -2.5 D. The mean (95% confidence interval) critical print size was significantly different between groups 1 and 2 at low illumination (0.918 [0.905, 0.931] vs 1.154 [1.128, 1.180]; p = 0.004). Contrast sensitivity was significantly better in group 1 under mesopic conditions but not under scotopic conditions. Though total QOL did not differ significantly between groups, the psychosocial quality of life was significantly better in group 1. About 23% of patients in group 2 reported unwanted images, compared with 0% in group 1 (p = 0.01). CONCLUSION: We found that the Eyecryl and AcrySof groups were comparable for best-corrected visual acuity, photopic contrast sensitivity, defocus curve, reading parameters, stereopsis, and quality of vision. However, the Eyecryl group had better mesopic contrast and a lower proportion of unwanted images. Psychosocial quality of life was significantly better in the Eyecryl group; however, satisfaction was similar between groups. The cost of one of the lenses is less than the other. Thus, individuals with limited resources may opt for the Eyecryl™ ACTV, with similar visual outcomes.
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PURPOSE: To compare incision size enlargement at different times of cataract surgery and visual outcomes after surgery in 2 different intraocular lens (IOL) delivery systems (Vivinex iSert and UltraSert Preloaded IOL Delivery System). SETTING: Tertiary care eye institution. DESIGN: Prospective nonrandomized comparison study. METHODS: All eyes had uneventful temporal clear corneal phacoemulsification cataract surgery. The surgery was done by standard direct horizontal chop with a bimanual irrigation aspiration of the cortex. The primary incision size was measured after clear corneal incision, after the completion of phacoemulsification, and after IOL implantation. RESULTS: The study comprised 276 eyes of 220 patients. The mean initial corneal incision was similar in both groups (2.2 mm). There was no significant difference in the mean incision size after phacoemulsification between the 2 groups (2.250 mm ± 0.068 mm [SD] vs 2.251 ± 0.066 mm [SD], P > .99). There was no significant difference in the mean (SD) incision size after IOL insertion between the 2 groups (2.367 ± 0.066 mm vs 2.369 ± 0.062 mm [SD], P = .815. The corrected distance visual acuity was 6/6 at 1 month in 80% of the participants in the UltraSert group and 86% in the Vivinex group. After adjusting for age, sex, grade of cataract, and IOL power, no significant difference was found in the magnitude of surgically induced astigmatism (SIA) in the Vivinex group compared with the UltraSert group (0.06, 95% CI, -0.11 to 0.24; P = .47). CONCLUSIONS: No significant difference was found in the change in the incision size, visual acuity, and SIA between UltraSert and Vivinex IOL delivery systems. This suggests that both IOL delivery systems are comparable in terms of post-IOL delivery incision enlargement for incisions of 2.2 mm.
