Guía de estilos de vida y glaucoma (i). Deporte y actividades / Lifestyles guide and glaucoma (i). Sports and activities

Objetivos: El aumento de la calidad y de la esperanza de vida y el hecho de que el glaucoma se diagnostique cada vez más precozmente hace preguntarse a muchos pacientes si afectan a su enfermedad determinados deportes, actividades o aficiones. El objetivo de este trabajo es establecer unas guías para aconsejar a los pacientes con base en la evidencia científica de los trabajos publicados. Métodos: Revisión de todos los trabajos publicados sobre glaucoma y deportes u otras actividades. Los trabajos fueron clasificados según el nivel de evidencia científica basada en la clasificación del Oxford Centre for Evidence-Based Medicine. Resultados: Las actividades aeróbicas son beneficiosas para el paciente. Se han de evitar deportes o técnicas de relajación tipo yoga con maniobras de Valsalva o colocación de la cabeza en posición inferior. También se deben evitar los cambios bruscos en altura. El calor intenso no parece influir en el glaucoma, pero el frío intenso puede afectar a pacientes con disregulación vascular. Las actividades de visión próxima disminuyen levemente la presión intraocular. El uso de instrumentos de viento puede elevar la presión intraocular dependiendo de la técnica utilizada. Conclusiones: Ciertos deportes y actividades pueden tener una influencia en la aparición o la progresión del glaucoma. Los especialistas en glaucoma deben tener información adecuada sobre la evidencia científica de las publicaciones para poder aconsejar apropiadamente a los pacientes (AU)

Purposes: The increase in quality and life expectancy, often leads to many patients asking the glaucoma specialist whether some sports, activities or hobbies would affect their illness. The aim of this article is to establish guidelines for patients, based on the scientific evidence of published papers. Methods: Review of all published articles on glaucoma and sports or other activities. The papers were classified according to the level of scientific evidence based on the Oxford Centre for Evidence-Based Medicine classification. Results: Aerobic sports are beneficial for the patient. Yoga indoor sports or relaxation techniques should be avoided if Valsalva manoeuvres are performed or the head is placed very low. Also, the patients must avoid sudden changes in height. Intense heat does not seem to lead to progression of glaucoma, but intense cold can affect patients with vascular dysregulation. Activities using the near vision slightly reduce the intraocular pressure. The use of wind instruments may raise intraocular pressure, depending on the technique used. Conclusions: Certain sports and activities may have an influence on the onset or progression of glaucoma. Glaucoma specialists should have adequate information about the scientific evidence in the publications, in order to properly advise the patients (AU)

Guía de estilos de vida y glaucoma (II). Dieta, suplementos, drogas, sueño, embarazo e hipertensión arterial / Lifestyles guide and glaucoma (II). Diet, supplements, drugs, sleep, pregnancy, and systemic hypertension

Objetivos: Establecer guías para aconsejar a los pacientes respecto a la relación entre dieta y hábitos de vida y glaucoma. Métodos: Revisión de los trabajos publicados sobre glaucoma y la dieta, la ingesta de suplementos, el consumo de drogas o el tabaco, el sueño, el embarazo y la hipertensión. Los trabajos fueron clasificados según el Oxford Center for Evidence-Based Medicine. Resultados: La evidencia sobre la relación entre la dieta o el uso de suplementos y la incidencia o la progresión del glaucoma es insuficiente para justificar una recomendación. Si bien algunos estudios en glaucoma de tensión normal sugieren que el Ginkgo biloba podría reducir la progresión, no permiten recomendar su uso generalizado. Los estudios sobre tabaco no demuestran claramente una relación entre consumo de tabaco e incidencia del glaucoma. La marihuana no es un tratamiento útil para el glaucoma. Los resultados sobre la relación entre la apnea del sueño y glaucoma son heterogéneos, pero sí parece conveniente que los pacientes con grado moderado o severo de apnea sean evaluados para descartar glaucoma. El embarazo no suele afectar al curso de la enfermedad, pero varios medicamentos hipotensores pueden ser nocivos para el feto. La hipotensión nocturna es un factor de riesgo de empeoramiento del glaucoma. Conclusiones: Ciertas costumbres, circunstancias o enfermedades pueden tener una influencia en la aparición o progresión del glaucoma. Es importante conocer la evidencia científica existente para poder aconsejar adecuadamente a los pacientes (AU)

To establish evidence based guidelines to advise patients on the relationship between habits, diet, certain circumstances, diseases and glaucoma. Methods: Review of all published articles on glaucoma and sports or other activities. The papers were classified according to the level of scientific evidence based on the Oxford Centre for Evidence-based Medicine classification. Results: The evidence on the relationship between diet or supplements and the incidence or progression of glaucoma is insufficient to make a general recommendation for glaucoma patients. Although some studies on normal tension glaucoma suggest that Gingko biloba could reduce glaucoma progression, the results do not allow a general recommendation for all these patients. Similarly, the evidence on the usefulness of vitamin supplements is not conclusive. The studies on smoking do not clearly demonstrate the relationship between this habit and incidence of glaucoma. Marihuana is not a useful treatment for glaucoma. Although the results on the relationship between sleep apnoea and glaucoma are heterogeneous, it is recommended that patients with moderate to intense apnoea are tested for glaucoma. Pregnancy does not influence the course of the disease, but several hypotensive drugs may be harmful for the foetus. Nocturnal systemic hypotension is a risk factor for glaucoma progression. Conclusions: Certain habits, circumstances, or diseases may have an influence on the onset or progression of glaucoma. It is important to have adequate information about the scientific evidence in the publications in order to properly advise patients (AU)

Lifestyles guide and glaucoma (i). Sports and activities. / Guía de estilos de vida y glaucoma (i). Deporte y actividades.

PURPOSES: The increase in quality and life expectancy, often leads to many patients asking the glaucoma specialist whether some sports, activities or hobbies would affect their illness. The aim of this article is to establish guidelines for patients, based on the scientific evidence of published papers. METHODS: Review of all published articles on glaucoma and sports or other activities. The papers were classified according to the level of scientific evidence based on the Oxford Centre for Evidence-Based Medicine classification. RESULTS: Aerobic sports are beneficial for the patient. Yoga indoor sports or relaxation techniques should be avoided if Valsalva manoeuvres are performed or the head is placed very low. Also, the patients must avoid sudden changes in height. Intense heat does not seem to lead to progression of glaucoma, but intense cold can affect patients with vascular dysregulation. Activities using the near vision slightly reduce the intraocular pressure. The use of wind instruments may raise intraocular pressure, depending on the technique used. CONCLUSIONS: Certain sports and activities may have an influence on the onset or progression of glaucoma. Glaucoma specialists should have adequate information about the scientific evidence in the publications, in order to properly advise the patients.

Lifestyles guide and glaucoma (II). Diet, supplements, drugs, sleep, pregnancy, and systemic hypertension. / Guía de estilos de vida y glaucoma (II). Dieta, suplementos, drogas, sueño, embarazo e hipertensión arterial.

PURPOSE: To establish evidence based guidelines to advise patients on the relationship between habits, diet, certain circumstances, diseases and glaucoma. METHODS: Review of all published articles on glaucoma and sports or other activities. The papers were classified according to the level of scientific evidence based on the Oxford Centre for Evidence-based Medicine classification. RESULTS: The evidence on the relationship between diet or supplements and the incidence or progression of glaucoma is insufficient to make a general recommendation for glaucoma patients. Although some studies on normal tension glaucoma suggest that Gingko biloba could reduce glaucoma progression, the results do not allow a general recommendation for all these patients. Similarly, the evidence on the usefulness of vitamin supplements is not conclusive. The studies on smoking do not clearly demonstrate the relationship between this habit and incidence of glaucoma. Marihuana is not a useful treatment for glaucoma. Although the results on the relationship between sleep apnoea and glaucoma are heterogeneous, it is recommended that patients with moderate to intense apnoea are tested for glaucoma. Pregnancy does not influence the course of the disease, but several hypotensive drugs may be harmful for the foetus. Nocturnal systemic hypotension is a risk factor for glaucoma progression. CONCLUSIONS: Certain habits, circumstances, or diseases may have an influence on the onset or progression of glaucoma. It is important to have adequate information about the scientific evidence in the publications in order to properly advise patients.

Utilidad de los métodos de imagen en el glaucoma / Usefulness of imaging devices in glaucoma

No disponible

No disponible

[Light-induced maculopathy in cataract surgery]. / Ototraumatismo macular en cirugía de catarata.

CASE REPORT: Case 1: An 82-year-old man who underwent an uncomplicated phacoemulsification and IOL implantation (Tecnis Z 9000 lens) in his right eye under topical anaesthesia. Surgery lasted 14 minutes. Case 2: A 60-year-old woman with bilateral advanced primary open angle glaucoma who underwent an uncomplicated phacoemulsification and IOL implantation (Tecnis Z 9000 lens) in her right eye under peribulbar anaesthesia. Surgery lasted 36 minutes. One month after surgery both patients noted a para-central scotoma and impaired vision. Fluorescein angiography in both cases revealed retinal pigment epithelial changes compatible with intra-operative light-induced maculopathy. DISCUSSION: Light-induced maculopathy has been reported following cataract surgery. Whether physical properties of these new polysiloxane lenses contribute to retinal susceptibility to phototoxicity under certain light conditions needs to be elucidated.

Fototraumatismo macular en cirugía de catarata / Light-induced maculopathy in cataract surgery

Casos clínicos:Caso 1: varón de 82 años intervenido de catarata mediante facoemulsificación e implante de lente Tecnis® Z 9000 en su ojo derecho (OD), bajo anestesia tópica. La duración de la cirugía fue de 14 minutos sin complicaciones.Caso 2: mujer de 60 años con glaucoma primario de ángulo abierto (GPAA) bilateral avanzado, intervenida sin complicaciones de catarata mediante facoemulsificación e implante de lente Tecnis® Z 9000 en su ojo derecho, bajo anestesia peribulbar. La duración de la cirugía fue de 36 minutos.Al mes de la cirugía ambos pacientes evidenciaron escotoma paracentral inferior y escasa mejora de la agudeza visual (AV). La angiografía fluoresceínica (AGF) de ambos casos reveló cambios en el epitelio pigmentario de la retina compatibles con un posible fototraumatismo macular intraoperatorio.Discusión: La maculopatía por fototoxicidad es una complicación descrita tras cirugía de catarata.El que las propiedades físicas de estas nuevas lentes de polisiloxano favorezcan el fototraumatismo retiniano en determinadas condiciones lumínicas han de ser aclaradas (AU)

Case report: Case 1: An 82-year-old man who underwent an uncomplicated phacoemulsification and IOL implantation (Tecnis® Z 9000 lens) in his right eye under topical anaesthesia. Surgery lasted 14 minutes. Case 2: A 60-year-old woman with bilateral advanced primary open angle glaucoma who underwent an uncomplicated phacoemulsification and IOL implantation (Tecnis® Z 9000 lens) in her right eye under peribulbar anaesthesia. Surgery lasted 36 minutes. One month after surgery both patients noted a para-central scotoma and impaired vision. Fluorescein angiography in both cases revealed retinal pigment epithelial changes compatible with intra-operative light-induced maculopathy. Discussion: Light-induced maculopathy has been reported following cataract surgery. Whether physical properties of these new polysiloxane lenses contribute to retinal susceptibility to phototoxicity under certain light conditions needs to be elucidated (AU)

[Comparative study of two portable tonometers: Tono-Pen XL and Perkins]. / Estudio comparativo de dos tonómetros portátiles: Tono-Pen XL y Perkins.

PURPOSE: To evaluate the reproducibility of two portable tonometers and to compare the intraocular pressure (IOP) measurements obtained with both instruments taking into account the level of experience of the examiner with this technique. METHOD: Cross-sectional study. IOP was measured in 35 eyes of 35 normal subjects and 20 eyes of 20 ocular hypertensive patients with Perkins aplanation tonometer and Tono-Pen XL digital tonometer. Five measurements were made with Perkins (by an ophthalmologist) and 10 with Tono-Pen (5 by an ophthalmologist and 5 by a general practitioner). RESULTS: Considering the sample as a whole there was no statistically significant difference, and there was a significant correlation between the mean measurements obtained with Perkins tonometer and Tono-Pen and between the mean obtained by doctors with and without previous tonometric experience (p<0.001, ANOVA). Variability of Tono-Pen measurements is greater than the Perkins measurements and it is considerable in both cases (coefficient of variation 7-9%). Tono-Pen measurements tend to show a greater variability in hypertensive subjects, and tend to underestimate high IOP when compared with Perkins measurements. Tono-Pen identified IOP > or =21 mmHg with a sensitivity of 40% and a specificity of 94-97%. CONCLUSION: Tono-Pen allows measurement of IOP to personal with no tonometric experience. There is a strong correlation between measurements obtained with both tonometers. Tono-Pen shows a tendency to underestimate high IOP and offers low sensitivity in detecting IOP greater than 21 mmHg.

Estudio comparativo de dos tonómetros portátiles: Tono-Pen XL y Perkins / Comparative study of two portable tonometers: Tono-Pen XL and Perkins

Objetivo: Valorar la reproducibilidad de dos tonómetros portátiles y comparar las medidas de presión intraocular (PIO) obtenidas con ambos instrumentos y por facultativos con y sin formación tonométrica previa. Método: Estudio transversal. Se midió la PIO de 35 ojos de 35 sujetos normales y de 20 ojos de 20 sujetos hipertensos oculares con el tonómetro de aplanación Perkins y el tonómetro digital Tono-Pen XL. Se realizaron 5 medidas con Perkins (oftalmólogo) y 10 con Tono-Pen (5 por el oftalmólogo y 5 por el médico general).Resultados: Considerando las medidas medias y todos los sujet os en conjunto no se observaron diferencias significativas, y sí una correlación estadísticamente significativa entre las medidas medias obtenidas con ambos tonómetros y entre facultativos (p<0,001, ANOVA). La variabilidad de las medidas realizadas con el Tono-Pen es mayor que la conseguida con el Perkins y en ambos casos es considerable (coeficiente de variación 7 por ciento a 9 por ciento). En los hipertensos oculares existe una tendencia a una mayor variabilidad de las medidas realizadas con el Tono-Pen, así como a una infravaloración de las PIO elevadas al compararlas con el Perkins. El Tono-Pen identificó PIO = 21 mmHg con una sensibilidad del 40 por ciento y una especificidad del 94-97 por ciento. Conclusión: El Tono-Pen permite medir la PIO a facultativos sin experiencia tonométrica previa. Se observó una elevada correlación entre las medidas realizadas con ambos tonómetros y por cada facultativo. El Tono-Pen presenta una tendencia a infravalorar las PIO elevadas y una baja sensibilidad para detectar PIO superiores a 21 mmHg (AU)

Purpose: To evaluate the reproducibility of two portable tonometers and to compare the intraocular pressure (IOP) measurements obtained with both instruments taking into account the level of experience of the examiner with this technique. Method: Cross-sectional study. IOP was measured in 35 eyes of 35 normal subjects and 20 eyes of 20 ocular hypertensive patients with Perkins aplanation tonometer and Tono-Pen XL digital tonometer. Five measurements were made with Perkins (by an ophthalmologist) and 10 with Tono-Pen (5 by an ophthalmologist and 5 by an general practitioner). Results: Considering the sample as a whole there was no statistically significant difference, and there was a significant correlation between the mean measurements obtained with Perkins tonometer and Tono-Pen and between the mean obtained by doctors with and without previous tonometric experience (p< 0.001, ANOVA). Variability of Tono-Pen measurements is greater than the Perkins measurements and it is considerable in both cases (coefficient of variation 7-9%). Tono-Pen measurements tend to show a greater variability in hypertensive subjects, and tend to underestimate high IOP when compared with Perkins measurements. Tono-Pen identified IOP ≥ 21 mmHg with a sensitivity of 40% and a specificity of 94-97%. Conclusion: Tono-Pen allows measurement of IOP to personal with no tonometric experience. There is a strong correlation between measurements obtained with both tonometers. Tono-Pen shows a tendency to underestimate high IOP and offers low sensitivity in detecting IOP greater than 21 mmHg (AU)

Optic nerve assessment: a clinical endpoint of optic neuropathy.

Objective, quantitative, and reproducible methods of optic nerve assessment need to be utilized during research that measures the capability of pharmacological agents to prevent or decrease the rate of progressive ganglion cell atrophy occurring with glaucoma. Confocal scanning laser ophthalmoscopy has recently been developed, and offers objective, quantitative, and three-dimensional evaluation of the optic nerve head and peripapillary retina. This article reviews the use, application, and parameters of one such instrument, the Heidelberg Retina Tomograph (HRT). Although HRT offers several methods to evaluate changes in optic nerve topography, these applications are still continually evolving. Therefore, confocal scanning laser ophthalmoscopy may be particularly useful for assessing the neuroprotective effect of new medications for glaucoma.