Optometry Commons^™

Effect Of Pre-Training Patients Using A Self-Directed Slideshow Presentation On Visual Field Reliability In First-Time Test Takers, Lillian M. Centlivre B.S., Derek Zahnleuter B.S., Rahul Babu B.S., Chaesik Kim, Kaitlin Ziadeh Md, Hanna Simmons Md, Vivian Rajeswaren Md, Aleskey Parker Williams Do, Jacob Im Md, Aleksey Mishulin Md, Faisal Ridha Al-Timimi Md, Hassan Tokko

Medical Student Research Symposium

Title: Effect of Pre-Training Patients Using a Self-Directed Slideshow Presentation on Visual Field Reliability in First-Time Test Takers

Authors: Lillian Centlivre BS, Derek Zahnleuter BS, Rahul Babu BS, Chaesik Kim BSEE, Kaitlin Ziadeh MD, Hanna Simmons MD, Vivian Rajeswaren MD, Aleksey Parker Williams DO, Jacob Im MD, Aleksey Mishulin MD, Faisal Ridha Al-Timimi MD, Hassan Tokko MD

Background: Visual field (VF) testing is essential for detecting glaucoma, but reliability is limited by patient inexperience and poor fixation. Prior studies report VF test reliability around 59%, primarily attributed to increased fixation loss (FL). Other studies note 75.9% reliability using training videos …

Ocular Myasthenia Gravis: A Case Report, Erica Vanderpool Od, Carla Gilbertson Kuiken Od

Optometric Clinical Practice

Background: Myasthenia gravis (MG) is an autoimmune disease caused by faulty transmission at the neuromuscular junction leading to fatigable muscular weakness. Ocular MG is distressing in that it can cause visual difficulties, but generalized MG can be life-threatening. MG is an acquired disorder that can easily be overlooked in clinic and is commonly misdiagnosed. Providers should be aware of the clinical features of this condition, as well as the critical testing needed to confirm the diagnosis so the appropriate management course can be implemented.

Case Report: This case features a 67-year-old Caucasian male diagnosed with ocular myasthenia gravis …

Treatment Considerations For Early Primary Open Angle Glaucoma In Active-Duty Military, Ridwan Carim-Sanni Od, Danielle Kalberer Od, Mba

Optometric Clinical Practice

Background: Glaucoma is one of the leading causes of blindness in the United States. The tools available to treat glaucoma via intraocular pressure (IOP) reduction include pharmacological therapy or surgical intervention.

Case Report: This case study explores these tools in the context of glaucoma in active-duty military personnel. It involves an active-duty army patient diagnosed with early Primary Open Angle Glaucoma (POAG) who was initially prescribed IOP-lowering medication. Barriers in treatment compliance occurred while the patient was deployed that led to significant glaucomatous changes detected when the patient returned stateside.

Conclusion: This report suggests a shift from the traditional pharmacological …

Understanding The Treatment Paradigm And The Sequencing Of Antiglaucoma Fixed-Dose Combinations In A Tertiary Center In South India, Ronnie George, Praggya Mishra, Balekudaru Shantha, Lingam Vijaya, Nitin Maksane, Neha Gurha

Faculty, Staff and Student Publications

PURPOSE: To analyze the medical management of primary open-angle glaucoma (POAG) and ocular hypertension (OHT) and the placement of fixed-drug combination drugs (FDC) in the treatment paradigm at a tertiary eye care center in South India.

METHODS: Retrospective study (January 2011-December 2015) of newly diagnosed POAG and OHT patients (≥18 years) with ≥5 years follow-up. Primary outcome included percentage use of different antiglaucoma drugs (at initiation) and FDCs at the first, second, and third progression (sequencing). Secondary outcomes: Percentage discontinuation for different FDCs, efficacy parameters (decrease in intraocular pressure (IOP)/visual field), adverse events, and the median number of antiglaucoma medications …

Integrating Genetic Regulation And Single-Cell Expression With Gwas Prioritizes Causal Genes And Cell Types For Glaucoma, Andrew R Hamel, Wenjun Yan, John M Rouhana, Aboozar Monovarfeshani, Xinyi Jiang, Puja A Mehta, Jayshree Advani, Yuyang Luo, Qingnan Liang, Skanda Rajasundaram, Arushi Shrivastava, Katherine Duchinski, Sreekar Mantena, Jiali Wang, Tavé Van Zyl, Louis R Pasquale, Anand Swaroop, Puya Gharahkhani, Anthony P Khawaja, Stuart Macgregor, Rui Chen, Veronique Vitart, Joshua R Sanes, Janey L Wiggs, Ayellet V Segrè

Faculty, Staff and Students Publications

Primary open-angle glaucoma (POAG), characterized by retinal ganglion cell death, is a leading cause of irreversible blindness worldwide. However, its molecular and cellular causes are not well understood. Elevated intraocular pressure (IOP) is a major risk factor, but many patients have normal IOP. Colocalization and Mendelian randomization analysis of >240 POAG and IOP genome-wide association study (GWAS) loci and overlapping expression and splicing quantitative trait loci (e/sQTLs) in 49 GTEx tissues and retina prioritizes causal genes for 60% of loci. These genes are enriched in pathways implicated in extracellular matrix organization, cell adhesion, and vascular development. Analysis of single-nucleus RNA-seq …

Quantitative Raman Analysis Of Human Blood Serum Of Glaucoma Patients Supplemented With Macular Pigment Carotenoids., Joy Udensi, Ekaterina Loskutova, James Loughman, Hugh J. Byrne

Datasets

Carotenoids have been widely studied for their high dietary, antioxidant, and vision protection roles in the human body. Blood contains all major dietary carotenoids and hence presents as a suitable and efficient substrate for the estimation of dietary carotenoids in vivo. Following the 18-month supplementation of open angle glaucoma patients with macula pigment carotenoids (Lutein, Zeaxanthin and Meso-Zeaxanthin) in the European Nutrition in Glaucoma Management (ENIGMA) trial, Raman spectroscopic analysis of the pre-supplementation baseline and 18-month supplemented blood serum carotenoids from participants was carried out, to investigate the systemic impact of supplementation in the blood and explore a more direct …

Long-Term Effects Of Obstructive Sleep Apnea And Its Treatment On Open-Angle Glaucoma: A Big-Data Cohort Study, Tae-Eun Lee, Jong Seung Kim, Sang Woo Yeom, Min Gyu Lee, Jong Hwan Lee, Haeng-Jin Lee

Faculty, Staff and Student Publications

STUDY OBJECTIVES: The relationship between open-angle glaucoma (OAG) and obstructive sleep apnea (OSA) is unclear. The long-term risk for OAG after OSA diagnosis has not been investigated. Therefore, we assessed the risk for OAG among patients with OSA over a 12-year follow-up period using nationwide, population-based data.

METHODS: The OSA group was randomly selected from among 3.5 million individuals registered with the National Health Insurance Service. The non-OSA group was obtained through propensity score matching considering several variables. The primary endpoint was glaucoma diagnosis.

RESULTS: The OSA and non-OSA groups both included 6,369 individuals. The overall hazard ratio for OAG …

Chatgpt: Is It Good For Our Glaucoma Patients?, Gloria Wu, David A Lee, Weichen Zhao, Adrial Wong, Sahej Sidhu

Faculty, Staff and Student Publications

Purpose: Our study investigates ChatGPT and its ability to communicate with glaucoma patients.

Methods: We inputted eight glaucoma-related questions/topics found on the American Academy of Ophthalmology (AAO)'s website into ChatGPT. We used the Flesch-Kincaid test, Gunning Fog Index, SMOG Index, and Dale-Chall readability formula to evaluate the comprehensibility of its responses for patients. ChatGPT's answers were compared with those found on the AAO's website.

Results: ChatGPT's responses required reading comprehension of a higher grade level (average = grade 12.5 ± 1.6) than that of the text on the AAO's website (average = 9.4 grade ± 3.5), (0.0384). For the eight …

Minimum Rim Width And Lamina Cribrosa Depth In Non-Glaucomatous And Glaucomatous U.S. Veterans, Jacob Hillard Od, Rachel Druckenbrod Od, Baharak Asefzadeh Od

Optometric Clinical Practice

Purpose: Assess the utility of the MRW and lamina cribrosa depth measurements for detecting differences between non-glaucomatous and glaucomatous U.S. Veterans. Compare inter-eye differences of individuals with glaucoma.

Method: 38 subjects were recruited per group: Group 1 included one eye of non-glaucomatous participants, and Group 2 included each qualifying eye of participants with glaucoma. Analysis compared Group 1 with the more affected eye only of Group 2 participants, and separately between the more and less affected eyes of group 2 participants. MRW measurements were obtained with Heidelberg Eye Explorer© (HEYEX). Average lamina cribrosa depths were measured manually utilizing HEYEX.

Results: …

Book Review: The Ophthalmic Laser Handbook, William L. Miller Od, Ms, Phd

Optometric Clinical Practice

Book Review: Freisberg L, Lighthizer N, Skorin, Jr. L, Stonecipher K, and Zimmerman A. The Ophthalmic Laser Handbook. First Edition. Wolters Kluwer Health; 2021. $102.00, 350 pages, Paperback ISBN: 978-1975170172, e-book ISBN: 978-1975170219

Clinical Presentation, Treatment, And Genetic And Histopathological Analysis Of Juvenile Cataracts And Secondary Glaucoma In A Rhesus Macaque (Macaca Mulatta), M Isabel Casanova, Rui Chen, Laura M Garzel, Katherine J Olstad, Soohyun Kim, Ronald Alan Harris, Yumei Li, Muthuswamy Raveendran, Qingnan Liang, Jun Wang, Glenn Yiu, John Timothy Stout, Jeffrey A Roberts, Jeffrey Rogers, Ala Moshiri, Sara M Thomasy

Faculty, Staff and Students Publications

This report describes the clinical and histological findings, genetic study, and treatment in a 1.3-year-old rhesus macaque with bilateral cataracts and unilateral secondary glaucoma. Intravitreal injection of gentamicin decreased the intraocular pressure from 56 to <2 mm Hg. A putative genetic cause of the cataracts was not identified.

Abnormal Perception Of Pattern-Induced Flicker Colors In Subjects With Glaucoma, Padmapriya Ramamoorthy, Nicole L Alexander, Benjamin J Frankfort

Faculty, Staff and Students Publications

Pattern-induced flicker colors (PIFCs) are subjective colors that can be elicited with rotation of an achromatic stimulus such as the Benham disk. The perceptive mechanisms underlying PIFCs are not well-understood, but are thought to be generated primarily by retinal cell types which may be dysfunctional in glaucoma. Using a custom computer-based system, we tested PIFC perception across several Benham disk parameters, including the rates of acceleration and deceleration, rotational direction, and image contrast in both control and glaucoma subjects. We defined the Benham perception limit (BPL) during acceleration as the rotational speed at which PIFCs were first detected (Benham perception …

Normative Data On The Foveal Avascular Zone In A Young Healthy Irish Population Using Optical Coherence Tomography Angiography, Susan M. O'Shea, Veronica O'Dwyer, Grainne Scanlon

Articles

Purpose: To establish normative data on the size, shape and vascular profile of the foveal avascular zone (FAZ) in a young, healthy, Irish population, using the Cirrus 5000 HD-OCT. Certain diseases may alter FAZ appearance. Normative databases provide normal baseline values for comparison, thus improving diagnostic ability.

Methods: One hundred and fifty-four subjects aged 18–35 years old were recruited. Superficial FAZ area, diameter, circularity, ganglion cell layer, central macular thickness (CMT), vascular perfusion and density were measured using the Cirrus 5000. Axial length was measured with the IOL Master and blood pressure was measured using the Omron sphygmomanometer. …

Problems In Csf And Ophthalmic Disease Research, Ryan Machiele, Benjamin Jay Frankfort, Hanspeter Esriel Killer, David Fleischman

Faculty, Staff and Students Publications

There has been significant interest and progress in the understanding of cerebrospinal fluid pressure and its relationship to glaucoma and other ophthalmic diseases. However, just as every physiologic fluid pressure fluctuates, cerebrospinal fluid pressure (CSFP) is similarly dynamic. Coupling this with the difficulty in measuring the pressure, there are many obstacles in furthering this field of study. This review highlights some of the difficulties in CSFP research, including fluid compartmentalization, estimation equations, and pressure fluctuation. Keeping these limitations in mind will hopefully improve the quality and context of this burgeoning field.

Selective Vulnerability Of The Intermediate Retinal Capillary Plexus Precedes Retinal Ganglion Cell Loss In Ocular Hypertension, Priyamvada M Pitale, Guofu Shen, Rohini R Sigireddi, Maria Polo-Prieto, Yong H Park, Solomon E Gibson, Peter D Westenskow, Roomasa Channa, Benjamin J Frankfort

Faculty, Staff and Students Publications

Introduction: Glaucoma, a disease of retinal ganglion cell (RGC) injury and potentially devastating vision loss, is associated with both ocular hypertension (OHT) and reduced ocular blood flow. However, the relationship between OHT and retinal capillary architecture is not well understood. In this project, we studied microvasculature damage in mice exposed to mild levels of induced OHT.

Methods: Mild OHT was induced with the microbead model for 2 weeks. At this time point, some retinas were immunostained with CD31 (endothelium), Collagen IV (basement membrane), and RBPMS (RGCs) for z-stack confocal microscopy. We processed these confocal images to distinguish the three retinal …

Patterns Of Medication Adherence In Glaucoma, Shervonne Poleon

All ETDs from UAB

Over 60 million persons globally are affected by primary open angle glaucoma (POAG)—an optic neuropathy characterized by distinctive patterns of vision loss. Glaucoma is a leading cause of irreversible blindness worldwide, and eye drops that delay vision loss are a common treatment modality. In glaucoma, the proportion of patients with good adherence to recommended therapy is reported to be low. High treatment cost, forgetfulness, and regimen complexity have been identified as key determinants of poor adherence. However, addressing these factors in the clinic is not as simple, as patient and provider values and priorities may differ. Without concordance, it can …

Case Series: Discordance Between Visible Retinal Nerve Fiber Layer Defects And Spectral Domain Optical Coherence Tomographic Analysis In Patients With Glaucoma, Joseph Sowka Od, Leticia Rousso Od

Optometric Clinical Practice

Background: Spectral domain optical coherence tomography (SD-OCT) has become a common modality in glaucoma diagnosis. Ease of use, comfort, and a comparative normative database makes this technology very popular with patients and practitioners. However, despite the sophistication of this technology, it may miss pathologic abnormalities of the retinal nerve fiber layer (RNFL) or be misinterpreted by practitioners based upon comparisons to a normative database.

Purpose: To illustrate discordance between clinical examination and SD-OCT analysis in patients with glaucoma.

Case Reports: Examples of three patients with glaucoma who had photographically and ophthalmoscopically visible RNFL defects who had SD-OCT analyses that fell …

Toward The Mechanism Underlying Latanoprost- And Benzalkonium Chloride-Induced Meibomian Gland Dysfunction In Patients Treated For Glaucoma, Jillian Ziemanski

All ETDs from UAB

Once thought to be no more than a vexing eye condition, ocular surface disease (OSD) is now being viewed as a differentiating factor between sight and no sight. In the setting of glaucoma, OSD can interfere with treatment success, potentially allowing the visually devastating pathology of glaucoma to plow onward with little restraint. Compounding the clinical challenge is the growing awareness that glaucoma-associated OSD appears to be iatrogenically induced by topical ophthalmic medications. Daily, topical instillation of preserved prostaglandin analogs (PGAs), the most common first-line treatment for glaucoma, has been linked to a variety of OSD subtypes, including meibomian gland …

Characterization Of Intraocular Pressure Fluctuations, Intracranial Pressure And Translaminar Pressure Measured With Wireless Telemetry In Nonhuman Primates, Jessica Violet Jasien

All ETDs from UAB

Glaucoma is the second leading cause of blindness and third leading cause of visual impairment worldwide; 180 million people suffer from a glaucomatous visual disability. Glaucoma is an ocular neurodegenerative disease with several risk factors. The major identified risk factors of glaucoma are intraocular pressure (IOP), age, race, central cornea thickness, family history, and low diastolic blood pressure. The lowering of IOP is the only modifiable risk factor for the disease. However, we know little about the true character of IOP. Periodic IOP measurements are obtained every few months or at the discretion of the clinician during office hours and …

Developing An Assessment Of Reading Impairment And Its Impact On Occupational Performance In Older Adults With Glaucoma In A Metropolitan Area Of The Southeastern Us: A Mixed Methods Approach, Robin Deacy

All ETDs from UAB

According to the United States Administration on Aging (AOA, 2014), the population of individuals over 65 will be 98 million by the year 2060, doubling its 2014 estimates. As our population ages, the prevalence of glaucoma increases. Vision loss resulting from glaucoma can limit participation in valued occupations including engagement in reading. It has long been thought that mobility issues and glare sensitivity were the main factors that characterized glaucoma. In the late 1990s and early 2000s researchers began to examine quality of life (QoL) in those with glaucoma. It was during these early QoL studies that the first reports …

Genetic Analysis Localizes A Novel Locus On Chromosome 4q For The Glaucoma Endophenotype, Cup-To-Disc Ratio: The Jiri Eye Study, Sarah E. Miller, Nicholas B. Blackburn, Suman S. Thapa, Sandra Laston, Satish Kumar, Juan M. Peralta, Janardan Subedi, John Blangero, Sarah Williams-Blangero, Matthew P. Johnson

School of Medicine Publications

Purpose: Glaucoma is a heterogeneous disease influenced by genetic risk factors. However, not all genetic risk factors have been identified. The aim of this project is to localize genetic factors influencing known glaucoma endophenotypes: intraocular pressure (IOP), central corneal thickness (CCT), and vertical cup-to-disc ratio (VCDR).

Methods: This family-based study design utilizes phenotypic and genomic data from a single well-characterized pedigree residing in the Jiri region of Nepal. Measures of IOP, CCT and VCDR were obtained by Goldmann applanation tonometry, OCT, and slit lamp biomicroscopy, respectively. Using a genome-wide genotype data set (~550,000 SNPs), we performed a genome-wide linkage scan …

Long Term Efficacy Of A Supraciliary Micro-Stent Combined With Cataract Surgery In The Treatment Of Glaucoma, Michael Robert Mcfarland

Student Theses, Dissertations and Capstones

Purpose: The purpose of this study is to evaluate the long-term efficacy of supraciliary micro-stent implantation in combination with phacoemulsification in the treatment of mild-moderate primary open angle glaucoma (POAG). Methods: Retrospective data of patients previously enrolled in the “Study of an Implantable Device for Lowering Intraocular Pressure in Glaucoma Patients Undergoing Cataract Surgery” (COMPASS trial), in which patients with mild-moderate POAG had undergone either cataract surgery alone or cataract surgery combined with implantation of a supraciliary micro-stent, were collected. Eligible patients had since exited the trial and had 5-8 years of postoperative data available. The primary outcome measure was …

Intraocular Pressure Dynamics, Daniel Coleman Turner

All ETDs from UAB

While cataracts (the leading cause of blindness worldwide) can be reversed surgical-ly, glaucoma is the leading cause of irreversible blindness, affecting over 70 million people worldwide [1]. Elevated intraocular pressure (IOP) and age are the primary risk factors for glaucoma [2] and lowering IOP is the only proven treatment for the disease [3]. IOP and its fluctuations affect nearly every aspect of ocular physiology and homeo-stasis, as well as playing a dominant role in glaucoma pathophysiology, yet very little is known about IOP due to the current clinical standard of measuring mean IOP during infre-quent clinic visits. We use a …

Nutritional Supplementation In The Treatment Of Glaucoma: A Systematic Review, Ekaterina Loskutova, Colm O’Brien, Igor Loskutov, James Loughman

Articles

Current treatment strategies for glaucoma are limited to halting disease progression and do not restore lost visual function. Intraocular pressure is the main risk factor for glaucoma, and intraocular pressure–lowering treatment remains the mainstay of glaucoma treatment, but even successful intraocular pressure reduction does not stop the progression of glaucoma in all patients. We review the literature to determine whether nutritional interventions intended to prevent or delay the progression of glaucoma could prove to be a valuable addition to the mainstay of glaucoma therapy. A total of 33 intervention trials were included in this review, including 21 randomized controlled …

Barriers To Glaucoma Case Finding As Perceived By Optometrists In Ireland, Catriona Barrett, Colm O'Brien, John Butler, James Loughman

Articles

Background: This research was designed to provide an in-depth exploration of the perceptions of optometrists relating to the challenges of glaucoma case finding in the Irish health-care system.

Methods: A survey was developed, piloted and distributed for anonymous completion by optometrists registered to practice in Ireland. The survey included 10 five-level Likert items exploring potential barriers to glaucoma detection and a free-text box for participants to comment more broadly.

Results: One hundred and ninety-nine optometrists (27 per cent of registrants) responded to the survey. Among the barriers identified, there was notable agreement (71 per cent) with the need for extra …

Perceived Barriers Of Optometrists To Glaucoma Case Findings In Ireland, James Loughman, Catriona Barrett, Colm O’Brien, John S. Butler

Articles

Background:

This research was designed to provide an in-depth exploration of the perceptions of optometrists relating to the challenges of glaucoma case finding in the Irish health-care system.

Methods: A survey was developed, piloted and distributed for anonymous completion by optometrists registered to practise in Ireland. The survey included 10 five-level Likert items exploring potential barriers to glaucoma detection and a free-text box for participants to comment more broadly.

Results: One hundred and ninety-nine optometrists (27 per cent of registrants) responded to the survey. Among the barriers identified, there was notable agreement (71 per cent) with the need for extra …

Evidence Of Lower Macular Pigment Optical Density In Chronic Open Angle Glaucoma, Estera Igras, James Loughman, Matthew Ratzlaff, Ronal O'Caoimh, Colm O'Brien

Articles

Background/aims Macular pigment (MP) plays an important role in visual function and in the protection of the retina from oxidative damage. It is not known whether glaucoma, a progressive neurodegenerative disease of the optic nerve, is associated with alterations in MP. This study was designed to investigate the relationship, if any, between the optical density of MP optical density (MPOD) and glaucoma.

Methods 40 subjects (23 males, 17 females) with open angle glaucoma (mean age 69 ±11), and 54 normal controls (23 males, 31 females) without ocular disease (mean age 66 ±11), visual acuity (VA) >6/18, were recruited, and underwent …

Impact Of Computer Experience On The Viability And Repeatablity Of The Moorfields Motion Displacement Test In A Developing And Underserved African Setting, James Loughman, Carmen Gonzalez Alvarez, Gay Mary Verdon-Roe, Roger Anderson, Ramos Antonio Manuel, Kovin Naidoo

Articles

Background: The current study was designed to explore the effect of computer experience on the viability and testretest repeatability of the Moorfields Motion Displacement Test (MMDT), a novel computer-driven glaucoma screening device, in an African community setting. Methods: 164 healthy subjects were recruited from a semi-rural Mozambican environment, and stratified according to computer experience (computer naïve: n=85, computer familiar: n=79). A suprathreshold screening test algorithm was employed, and the global probability of true damage (GPTD), testing time (TT) and false positive (FP) response rate were recorded. The visual field test was conducted twice on the same eye, and results compared …

Preattentive Visual Search (Pavs): A Clinical Tool For Glaucoma, James Loughman

Books/Book chapters

Glaucoma is known to cause peripheral field loss but its impact is often underestimated. The inability to detect a target in an isolated area of the visual field may not be perceived as a significant disability. The determination here however that glaucoma adversely affects an individual’s capacity to deploy attention is an important one. This can be applied to infer the potential impact of the condition on lifestyle, even in the absence of diffuse perimetric field loss. Everyday tasks such as searching for car keys may prove more tedious and require more serial inspection. The ability to guide attention is …

Image Processing Of Oct Glaucoma Images And Information Theory Analysis, Shuting Wang

Electronic Theses and Dissertations

Glaucoma is a group of optic nerve disease with progressive structural changes leading to loss of visual function. A careful examination and detection of changes in the optic nerve is the key to early diagnosis of glaucoma. Optical Coherence Tomography (OCT) is one of the known techniques of diagnosis of glaucoma. The patients' eyes are scanned and sub-surface images are captured from optical nerves. Captured OCT images usually suffer from noise and therefore image enhancement techniques can help doctors in better analysis of OCT images and diagnosis of glaucoma. In this thesis, we propose three successful algorithms for enhancing the …