Caregiver Burden in Primary Congenital Glaucoma.

PURPOSE: To evaluate the demographic, clinical, and socioeconomic factors associated with variation in the quality of life (QOL) in caregivers of children with primary congenital glaucoma (PCG) in south India. DESIGN: Cross-sectional survey. METHODS: Caregivers of children younger than 18 with diagnosed PCG were prospectively enrolled at Aravind Eye Hospital in Madurai and Coimbatore, India. Participants completed 2 questionnaires, the PHQ-9 (9-item Patient Health Questionnaire) and the CarCGQoL (Caregivers Congenital Glaucoma QOL Questionnaire). Clinical, demographic, and socioeconomic data were obtained for each child-caregiver dyad. Rasch-calibrated scores were calculated for patient-reported outcome measures. Spearman correlation and linear regression were used to analyze data to determine associations with caregiver QOL. RESULTS: There were 70 caregivers (mean age 32.1, 77.1% female) of 70 children with PCG (mean age 7.7, 37.1% female) included in the study. In univariate and multivariable analyses, child's age (ß = -0.04; 95% confidence interval, -0.08 to -0.01) and duration of disease (ß = - 0.03; 95% confidence interval, -0.07 to -0.01) were the only factors associated with CarCGQoL. Survey items related to anger, self-confidence, irritability, appetite, and interest in leisure activities had the lowest scores. There was a negative correlation between CarCGQoL and PHQ-9 scores (r = -0.66, P < .01), indicating that worse caregiver QOL was significantly correlated with more depressive symptoms. CONCLUSION: This study identified traits associated with QOL decline, as well as the QOL issues most likely to affect caregivers of children with PCG in south India. Findings from this study may be important for designing interventions to improve caregivers' QOL, thereby maximizing their ability to care for children with PCG.

Could adverse effects and complications of selective laser trabeculoplasty be decreased by low-power laser therapy?

Selective laser trabeculoplasty (SLT) has been used for treatment of primary open-angle glaucoma, ocular hypertension, pigmenter and pseudoexfoliative glaucoma being considered a low-risk procedure. Therefore, transitory and permanent adverse effects have been reported, including corneal changes, subclinical edema, and reduction in endothelial cells and in central corneal thickness. Despite rarer, serious corneal complications after SLT can be permanent and lead to visual impairment, central corneal haze, opacity and narrowing. The mechanism involves increase of vasoactive and chemotactic cytokines causing inflammatory infiltrate, destruction of stromal collagen by fibroblasts and increase of matrix metalloproteinases type 2, which impair reepithelization. SLT also increases free radical production and reduces antioxidant enzymes, resulting in endothelium damages. Low-power laser therapy (LPLT) has been used in regenerative medicine based on its biostimulatory and anti-inflammatory effects. Biostimulation occurs through the interaction of laser photons with cytochrome C oxidase enzyme, which activates intracellular biochemical cascades causing synthesis of a number of molecules related to anti-inflammatory, regenerative effects, pain relief and reduction in edema. It has been showed that LPLT reduces gene expression related to pro-inflammatory cytokines and matrix metalloproteinases, and it increases expression of growth factors related to its proliferative and healing actions. Although radiations emitted by low-power lasers are considered safe and able to induce therapeutic effects, researches based on experimental models for glaucoma could bring important data if LPLT could be an alternative approach to improve acceptation for patients undergoing SLT.

Fitness Level Modulates Intraocular Pressure Responses to Strength Exercises.

Purpose/Aim: The execution of strength exercises has demonstrated to increase the intraocular pressure (IOP) levels, and it may have a negative impact on the ocular health. We aimed to explore the influence of fitness level on the acute IOP response to strength exercises performed under different loading conditions, as well as to test whether the IOP responses differ between the bench press and jump squat when performed against the same relative loads. MATERIALS AND METHODS: Forty military personnel males were divided in two subgroups (20 high-fit and 20 low-fit) based on their relative to body mass one-repetition maximum (1-RM). Participants performed an incremental loading test in the bench press and jump squat exercises, and IOP was assessed before and after each repetition by rebound tonometry. RESULTS: IOP increased immediately after executing both exercises (p < 0.01 in both cases), being the magnitude of the IOP increment positively and linearly associated with the increment of the load in both groups (i.e., high-fit and low-fit) and in both exercises (R2 range: 0.81-1.00). Higher fitness level attenuated the IOP rise produced by both exercises (p < 0.01 in both cases). The bench press induced higher IOP increments than the jump squat for both groups at relative loads of ~50%1-RM and ~60%1-RM (p < 0.01 in all cases). CONCLUSIONS: These data indicate that IOP increases as a consequence of performing strength exercises, being the increment accentuated with the increase of the load and in the bench press compared to the jump squat exercise. Of special importance would be that the IOP responses were significantly reduced in high-fit individuals. These findings should be addressed in glaucoma patients.

Predicting Vision-Related Disability in Glaucoma.

PURPOSE: To present a new methodology for investigating predictive factors associated with development of vision-related disability in glaucoma. DESIGN: Prospective, observational cohort study. PARTICIPANTS: Two hundred thirty-six patients with glaucoma followed up for an average of 4.3±1.5 years. METHODS: Vision-related disability was assessed by the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) at baseline and at the end of follow-up. A latent transition analysis model was used to categorize NEI VFQ-25 results and to estimate the probability of developing vision-related disability during follow-up. Patients were tested with standard automated perimetry (SAP) at 6-month intervals, and evaluation of rates of visual field change was performed using mean sensitivity (MS) of the integrated binocular visual field. Baseline disease severity, rate of visual field loss, and duration of follow-up were investigated as predictive factors for development of disability during follow-up. MAIN OUTCOME MEASURES: The relationship between baseline and rates of visual field deterioration and the probability of vision-related disability developing during follow-up. RESULTS: At baseline, 67 of 236 (28%) glaucoma patients were classified as disabled based on NEI VFQ-25 results, whereas 169 (72%) were classified as nondisabled. Patients classified as nondisabled at baseline had 14.2% probability of disability developing during follow-up. Rates of visual field loss as estimated by integrated binocular MS were almost 4 times faster for those in whom disability developed versus those in whom it did not (-0.78±1.00 dB/year vs. -0.20±0.47 dB/year, respectively; P < 0.001). In the multivariate model, each 1-dB lower baseline binocular MS was associated with 34% higher odds of disability developing over time (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.06-1.70; P = 0.013). In addition, each 0.5-dB/year faster rate of loss of binocular MS during follow-up was associated with a more than 3.5 times increase in the risk of disability developing (OR, 3.58; 95% CI, 1.56-8.23; P = 0.003). CONCLUSIONS: A new methodology for classification and analysis of change in patient-reported quality-of-life outcomes allowed construction of models for predicting vision-related disability in glaucoma.

[Music and Glaucoma]. / Musik und Glaukom.

Music may have multiple influences on the human organism. A possible therapeutic effect for patients with glaucoma has been postulated, aside from the known impact of music on the cardiovascular system, psychogenic effects and a short-term improvement in mental performance (Mozart effect). The higher level of mental stress in patients with glaucoma and type-A personality behaviour may be related to higher intraocular pressure in patients with glaucoma. Relaxing music may have a positive impact in these patients, related to a reduction in intraocular pressure or its fluctuations. However, only limited data exist on the effects of music on intraocular pressure. No clinical studies have yet been performed to investigate the effect of music or music therapy on glaucoma progression. The music of Mozart may influence visual field examinations, possibly due to a positive short term effect on mental performance. This factor needs to be addressed in studies dealing with the effect of music in glaucoma. The relevance of intraocular pressure increases in professional wind instrument players is controversial. An increased level of care might be advisable in patients with advanced glaucoma. The influences of music on humans, altered personality profiles in patients with glaucoma and the studies showing some effect of stress on intraocular pressure stress the relevance of psychological support for glaucoma patients, who are confronted with a disease with a high longterm risk of blindness.

[Sport and Glaucoma]. / Sport und Glaukom.

Traumatic changes in the iridocorneal angle, e.g. in ball sports, can lead to secondary glaucoma. High intensity resistance exercise or yoga exercises - such as the headstand - can increase IOP, and deterioration in the visual field and acute narrow angle glaucoma attacks have been described in some case reports. Glaucoma therapy of professional athletes with steroids, carbonic anhydrase inhibitors and beta-blockers can result in positive doping tests. In manifest glaucoma, moderate aerobic exercise is presumably of use because of the IOP lowering effect, improved retinal perfusion and reduction in oxidative stress.

Referral to Low Vision Services for Glaucoma Patients: Referral Patterns and Characteristics of Those Who Refer.

PURPOSE: To identify characteristics of ophthalmologists and practices who refer glaucoma patients to low vision services (LVS). MATERIALS AND METHODS: An online survey was distributed to members of the American Glaucoma Society. The survey queried demographics of responders and their clinical practices, criteria and barriers to referral to LVS. Survey responders were categorized as high referrers if they reported referring >5 patients to LVS and low referrers if they referred ≤5. χ and Fischer exact tests were used to compare characteristics between high and low referrers. Logistic regression analyses were used to calculate odds ratios and 95% confidence intervals and determine factors associated with referrer status. RESULTS: High referrers to LVS tended to have >10 patients per month who had already seen a low vision provider (53% vs. 10%, P<0.001), reported following the American Academy of Ophthalmology's Preferred Practice Pattern (PPP) recommendations for LVS referrals (38% vs. 18%, P=0.011), and expressed satisfaction with their current referral practices (86% vs. 70%, P=0.049). In the fully adjusted model those who followed PPP were 2.5 times more likely to report being a high referrer as compared with a low referrer (95% confidence interval, 1.1-5.3). However, only 22% of ophthalmologists reported following these guidelines in their practice. The number of years in practice, practice location or type, volume of patients seen each week, and distance to a low vision clinic were not associated with referral. CONCLUSIONS: Familiarity with PPP guidelines may positively influence LVS referral practices.

[Trabeculotomy Combined with Cataract Surgery in Glaucoma: Outcome in a Rural Setting]. / Trabekulotomie kombiniert mit Phakoemulsifikation als operative Glaukomtherapie: Ergebnisse im ländlichen Versorgungsbereich.

Purpose: Intensive postoperative care is essential for the outcome of trabeculectomy. However, in a rural setting, repeated visits to the operating theatre are often not requested or possible. The objective of this study was to examine the outcome of trabeculotomy combined with cataract surgery in patients with glaucoma. Patients and Methods: 142 patients with glaucoma and cataract were included in a retrospective clinical study. All patients were operated on from November 2005 to December 2008 by a single surgeon and with a minimum follow-up of 2 months. Intraocular pressure (IOP), number of antiglaucomatous medications and surgical success rate were assessed at 2 months and at the longest follow-up (at least 1 year). Results: IOP was significantly reduced from 24.1 ± 8.3 mmHg preoperatively to 14.9 ± 3.3 mmHg at 2 months (p < 0.0001) and to 15.1 ± 3 mmHg at the longest follow-up (3.71 ± 1.5 years). The number of IOP-lowering medications was lowered from 1.35 ± 1 preoperatively to 0.73 ± 1 at the longest follow-up. Complete surgical success (no IOP-lowering medications, longest follow-up) was achieved in 51.3 % (IOP < 22 mmHg) and 47.5 % (IOP < 19 mmHg) of patients, respectively. Conclusions: Trabeculotomy combined with cataract surgery is a safe and effective surgical option to treat combined cataract and glaucoma without the need of intensified postoperative treatment.

[Self-relaxation techniques for glaucoma patients. Significance of autogenic training, hypnosis and music therapy]. / Entspannungsmethoden beim Glaukom. Stellenwert von autogenem Training, Hypnose und Musikmedizin.

BACKGROUND: Glaucoma is currently the second most common cause of severe visual impairment and blindness worldwide. Standard pharmaceutical and surgical interventions often fail to prevent progression of glaucomatous optic neuropathy. OBJECTIVES: To evaluate whether adjuvantly applied self-relaxation techniques can significantly impact intraocular pressure, ocular perfusion and the overall mental state of affected patients. MATERIAL AND METHODS: A search of the literature was carried out and a comprehensive overview of currently available data is presented. RESULTS: Autogenic training, hypnosis and music therapy can significantly impact intraocular pressure, ocular perfusion and overall mental state of patients suffering from glaucoma. CONCLUSION: As all of these adjuvant therapeutic options are cost-effective, available almost everywhere and at anytime as well as without any known side effects, they can be useful additional techniques in the overall concept for treating glaucoma patients. Regular ocular examinations by an ophthalmologist are, however, mandatory.

El examen del anillo neurorretiniano: ¿fenómeno vintage o revolución? / Neuroretinal rim examination: A vintage phenomenon or a revolution?

No disponible

The role of occupational therapy in vision rehabilitation of individuals with glaucoma.

PURPOSE: Specific to individuals with glaucoma: (1) provide an overview of the role of occupational therapists (OTs) as part of the vision rehabilitation team, (2) outline evaluation and intervention approaches provided by OTs, and (3) summarize the evidence to support those intervention approaches. METHODS: Literature on vision rehabilitation and the typical practice patterns of OTs working with individuals with glaucoma are reviewed and the occupational therapy process is applied to evaluation and intervention approaches. The evidence which supports intervention approaches for individuals with glaucoma is presented. RESULTS: The strength of the evidence to support common intervention approaches employed by OTs is weak or inconclusive; many studies lack quality methodological rigor. Moderate evidence supports patient education programs and strong evidence supports problem-solving and self-management strategies; this evidence is based on a limited number of studies. CONCLUSION: The prevalence of eye diseases is increasing; knowledge of how visual impairment affects disability will inform resource allocation and development of rehabilitation programs that address the unique needs of individuals with glaucoma. Rehabilitation specialists are key members of the healthcare team aligned to proactively recognize and develop comprehensive rehabilitation programs to maximize individuals' function, quality of life and independence in everyday living. IMPLICATIONS FOR REHABILITATION: Glaucoma is one of the four major eye diseases that may result in visual impairment leading to disability. Research supports intervention approaches and vision rehabilitation techniques used by occupational therapists to optimize the health and well-being of individuals with glaucoma. Rehabilitation specialists are key members of the healthcare team who need to be alert to subtle behaviors that may be indicative of visual impairment versus attributed to other client factors.

Reevaluación de pacientes débiles visuales tras intervención quirúrgica: presentación de cuatro casos / Reassessment of visually impaired patients after surgery: a four-case report

La pérdida visual causa un enorme sufrimiento tanto para aquellos que la padecen como para sus familiares. Cerca del 80 por ciento de la ceguera es evitable (prevenible o curable). Por tales razones se presentan cuatro casos atendidos durante varios años en la consulta de baja visión del Hospital General Universitario Gustavo Aldereguía Lima de Cienfuegos, por ser pacientes clasificados con una diversidad funcional secundaria a diferentes entidades oftalmológicas: hipermetropía elevada, miopía elevada, glaucoma crónico simple en estadio 4 y afaquia no corregida. Se empleó la técnica quirúrgica de extracción extracapsular con implante de lente intraocular, en uno de ellos Piggy Back primario; en todos los casos hubo resultados satisfactorios en diversos parámetros como agudeza visual, campo visual y disminución del defecto refractivo, por lo que se logró mejorar la calidad de vida de los pacientes, así como su inclusión social y escolar(AU)

Visual loss causes enormous suffering to both the patients and their families. About 80 percent of blindness is avoidable (preventable or curable). Therefore, we present four cases treated for several years in the low vision consultation of the Gustavo Aldereguía Lima University General Hospital of Cienfuegos due to a functional diversity secondary to various ophthalmologic conditions including high hyperopia, high myopia, chronic simple glaucoma at stage 4 and uncorrected aphakia. An extracapsular extraction with intraocular lens implantation was performed, using a primary Piggyback in one of them. All cases showed satisfactory results in various parameters such as visual acuity, visual field and reduced refractive error; thus, it was possible to improve the quality of life of these patients as well as their social and school inclusion(AU)

Evaluation of various machine learning methods to predict vision-related quality of life from visual field data and visual acuity in patients with glaucoma.

BACKGROUND/AIMS: We investigated whether it was useful to use machine learning algorithms to predict patients' vision related quality of life (VRQoL) from visual field (VF) and visual acuity (VA). METHODS: VRQoL was surveyed in 164 glaucomatous patients using the Sumi questionnaire. Their VRQoL score was predicted using machine learning algorithms (Random Forest, gradient boosting, support vector machine) based on total deviation (TD) values from integrated VF (IVF), VA, age and gender. For comparison, VRQoL score was predicted using standard linear regression with mean of IVF, TD values, and VA, and also the stepwise model selection by Akaike Information Criterion. Prediction error was calculated as root mean of the squared prediction error (RMSE) associated with the leave one out cross validation. RESULTS: RMSEs associated with general VRQoL score were smaller for the machine learning algorithms (1.99 to 2.21) compared with the standard linear model and the stepwise model selection (2.35 to 3.20). A similar tendency was found in each individual VRQoL task score. CONCLUSIONS: We found that it was advantageous to use machine learning methods to predict VRQoL accurately. These statistical methods could be used to help clinicians better understand patients' VRQoL without the need for extra tests other than standard VA and VF.

Vision restoration training for glaucoma: a randomized clinical trial.

IMPORTANCE Visual field loss due to retinal damage is considered irreversible, and methods are needed to achieve vision restoration. Behavioral vision training, shown to improve visual fields in hemianopia and optic nerve damage, might comprise such a method. OBJECTIVE To determine if behavioral activation of areas of residual vision using daily 1-hour vision restoration training for glaucoma for 3 months improves detection accuracy compared with placebo. DESIGN AND SETTING Prospective, double-blind, randomized, placebo-controlled clinical trial in an ambulatory care and home training setting. PARTICIPANTS Volunteer sample of patients with glaucoma (mean age, 61.7 years; age range, 39-79 years) with stable visual fields and well-controlled intraocular pressure. After randomization, 4 patients withdrew from the trial because of mild headaches (n = 2) or lack of time to complete the schedule (n = 2). INTERVENTIONS Computer-based vision restoration training for glaucoma (n = 15) or visual discrimination placebo training in the intact visual field (n = 15). MAIN OUTCOMES AND MEASURES The primary end point was change in detection accuracy in high-resolution perimetry. Secondary end points were 30° white-on-white and 30° blue-on-yellow near-threshold perimetry, as well as reaction time, eye movements, and vision-related and health-related quality of life. RESULTS Vision restoration training for glaucoma led to significant detection accuracy gains in high-resolution perimetry (P = .007), which were not found with white-on-white or blue-on-yellow perimetry. Furthermore, the pre-post differences after vision restoration training for glaucoma were greater compared with placebo in all perimetry tests (P = .02 for high-resolution perimetry, P = .04 for white on white, and P = .04 for blue on yellow), and these results were independent of eye movements. Vision restoration training for glaucoma (but not placebo) also led to faster reaction time (P = .009). Vision-related quality of life was unaffected, but the health-related quality-of-life mental health domain increased in both groups. CONCLUSIONS AND RELEVANCE Visual field defects caused by glaucoma can be improved by repetitively activating residual vision through training the visual field borders and areas of residual vision, thereby increasing their detection sensitivity. Our randomized clinical trial revealed evidence that visual field loss is in part reversible by behavioral, computer-based, online controlled vision training, comprising a new rehabilitation treatment option in glaucoma. Neuroplasticity of the visual cortex or higher cortical areas is the proposed mechanism of action. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01799707.

A necklace sonar with adjustable scope range for assisting the visually impaired.

A sonar based device with tactile feedback was developed to improve the mobility and independence of visually impaired individuals. It features a transceiver/receiver, a potentiometer, a microcontroller, a rechargeable polymer lithium ion battery, and a Nokia Cell phone vibrator. All components are commercially available and housed in a custom acrylic package with 86 mm × 34 mm × 12 mm in dimension, and 120 grms in weight. Additionally, the device features an adjustable detection scheme for user customization of distance range, and a tactile feedback system that avoids interference with auditory sensory information. The device was tested for its navigational efficacy in an artificial indoor environment, and in a live outdoor setting. Ten subjects (9 males and 1 female), with a mean age of 35 years-old (range: 17 to 52) were presented with a series of navigational tasks resulting in considerable reduction of head, shoulder, chest, and arms collisions during their locomotion. We conclude that this device greatly improves the mobility and safety of visually impaired individuals.

[New concepts for pressure-controlled glaucoma implants]. / Neue Konzepte für druckgesteuerte Glaukomimplantate.

In industrialized countries glaucoma is one of the most common causes that leads to blindness. It is also the most common cause of irreversible blindness worldwide. In addition to local treatment of intraocular pressure and filtering glaucoma surgery, alloplastic implants are increasingly being used in glaucoma therapy. As long-term results published in the literature of commonly used implants are unsatisfactory, it seems useful to search for new concepts. In order to avoid the well-known short-term and long-term postoperative complications a pressure-controlled microstent with antiproliferative surface modifications was developed. Additionally, the functionality of such a microstent should be investigated using an animal glaucoma model. This paper describes the concept of a microstent which drains aquous humour from the anterior chamber into the suprachoroidal space. In addition, the glaucoma models described in the literature are discussed. Unfortunately, none of the methods could be reproduced permanently. First results show a correct implantation of a coated microstent with valve where the anti-proliferative effect could be demonstrated histologically. The promising results should lead to further investigations and the final goal will be the testing of the stent in the human eye.

Rehabilitación visual en baja visión / Visual rehabilitation in low vision

No disponible

Targets for rehabilitation: an evidence base for adaptive coping with visual disability.

PURPOSE: This study examined the role of assimilative and accommodative coping dimensions for the mental health of people with visual impairment, with the aim of informing rehabilitation planning. RESEARCH METHOD: Telephone interviews were conducted with 216 middle-aged adults with vision loss. Assimilative and accommodative coping were assessed both in terms of general coping tendencies and goal-specific coping. RESULTS: Assimilation was used more than accommodation in goal-specific coping. In contrast, endorsement levels of general coping tendencies were higher for accommodative compared with assimilative coping. The strongest beneficial effects on mental health emerged for accommodative coping as a general coping tendency and assimilative coping as a goal-specific strategy. CONCLUSIONS: Results suggest that vision rehabilitation programs should encourage accommodative coping as a general life approach. However, for specific goals, rehabilitation should help individuals determine their feasibility, and focus on developing assimilative strategies for feasible goals, while reevaluating and letting go of unfeasible goals.

Association of vision loss in glaucoma and age-related macular degeneration with IADL disability.

PURPOSE: To determine if glaucoma and/or age-related macular degeneration (AMD) are associated with disability in instrumental activities of daily living (IADLs). METHODS: Glaucoma subjects (n = 84) with bilateral visual field (VF) loss and AMD subjects (n = 47) with bilateral or severe unilateral visual acuity (VA) loss were compared with 60 subjects with normal vision (controls). Subjects completed a standard IADL disability questionnaire, with disability defined as an inability to perform one or more IADLs unassisted. RESULTS: Disability in one or more IADLs was present in 18.3% of controls as compared with 25.0% of glaucoma subjects (P = 0.34) and 44.7% of AMD subjects (P = 0.003). The specific IADL disabilities occurring more frequently in both AMD and glaucoma subjects were preparing meals, grocery shopping, and out-of-home travelling (P < 0.05 for both). In multivariate logistic regression models run adjusting for age, sex, mental status, comorbidity, and years of education, AMD (odds ratio [OR] = 3.4, P = 0.02) but not glaucoma (OR = 1.4, P = 0.45) was associated with IADL disability. However, among glaucoma and control patients, the odds of IADL disability increased 1.6-fold with every 5 dB of VF loss in the better-seeing eye (P = 0.001). Additionally, severe glaucoma subjects (better-eye MD worse than -13.5 dB) had higher odds of IADL disability (OR = 4.2, P = 0.02). Among AMD and control subjects, every Early Treatment of Diabetic Retinopathy Study line of worse acuity was associated with a greater likelihood of IADL disability (OR = 1.3). CONCLUSIONS: VA loss in AMD and severe VF loss in glaucoma are associated with self-reported difficulties with IADLs. These limitations become more likely with increasing magnitude of VA or VF loss.