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Glaucoma: HELP
Articles by Fábio B. Daga
Based on 16 articles published since 2010
(Why 16 articles?)
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Between 2010 and 2020, Fabio B. Daga wrote the following 16 articles about Glaucoma.
 
+ Citations + Abstracts
1 Article Visual Crowding in Glaucoma. 2019

Ogata, Nara G / Boer, Erwin R / Daga, Fábio B / Jammal, Alessandro A / Stringham, James M / Medeiros, Felipe A. ·Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina, United States. · Entropy Control, La Jolla, California, United States. ·Invest Ophthalmol Vis Sci · Pubmed #30716149.

ABSTRACT: Purpose: Crowding refers to the phenomenon in which objects that can be recognized when viewed in isolation are unrecognizable in clutter. Crowding sets a fundamental limit to the capabilities of the peripheral vision and is essential in explaining performance in a broad array of daily tasks. Due to the effects of glaucoma on peripheral vision, we hypothesized that neural loss in the disease would lead to stronger effects of visual crowding. Methods: Subjects were asked to discriminate the orientation of a target letter when presented with surrounding flankers. The critical spacing value (scritical), which was required for correct discrimination of letter orientation, was obtained for each quadrant of the visual field. scritical values were correlated with standard automated perimetry (SAP) mean sensitivity (MS) and optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness measurements. Results: The study involved 13 subjects with mild glaucomatous visual field loss and 13 healthy controls. Glaucomatous eyes had significantly greater (worse) scritical than controls (170.4 ± 27.1 vs. 145.8 ± 28.0 minimum of visual angle, respectively; P = 0.007). scritical measurements were significantly associated with RNFL thickness measurements (R2 = 26%; P < 0.001) but not with SAP MS (P = 0.947). Conclusions: In glaucoma patients, a pronounced visual crowding effect is observed, even in the presence of mild visual field loss on standard perimetry. scritical was associated with the amount of neural loss quantified by OCT. These results may have implications for understanding how glaucoma patients are affected in daily tasks where crowding effects may be significant.

2 Article What Is the Amount of Visual Field Loss Associated With Disability in Glaucoma? 2019

Jammal, Alessandro A / Ogata, Nara G / Daga, Fábio B / Abe, Ricardo Y / Costa, Vital P / Medeiros, Felipe A. ·Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina, USA. · Department of Ophthalmology, State University of Campinas, Campinas, São Paulo, Brazil. · Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina, USA. Electronic address: felipe.medeiros@duke.edu. ·Am J Ophthalmol · Pubmed #30236774.

ABSTRACT: PURPOSE: To propose a new methodology for classifying patient-reported outcomes in glaucoma and for quantifying the amount of visual field damage associated with disability in the disease. DESIGN: Cross-sectional study. METHODS: A total of 263 patients with glaucoma were included. Vision-related disability was assessed by the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). A latent class analysis (LCA) model was applied to analyze NEI VFQ-25 data and patients were divided into mutually exclusive classes according to their responses to the questionnaires. Differences in standard automated perimetry (SAP) mean deviation (MD) and integrated binocular mean sensitivity (MS) values between classes were investigated. The optimal number of classes was defined based on goodness-of-fit criteria, interpretability, and clinical utility. RESULTS: The model with 2 classes, disabled and nondisabled, had the best fit with an entropy of 0.965, indicating excellent separation of classes. The disabled group had 48 (18%) patients, whereas 215 (82%) patients were classified as nondisabled. The average MD of the better eye in the disabled group was -5.98 dB vs -2.51 dB in the nondisabled group (P < .001). For the worse eye, corresponding values were -13.36 dB and -6.05 dB, respectively (P < .001). CONCLUSION: Application of an LCA model allowed categorization of patient-reported outcomes and quantification of visual field levels associated with disability in glaucoma. A damage of approximately -6 dB for SAP MD, indicating relatively early visual field loss, may already be associated with significant disability if occurring in the better eye.

3 Article Association between Rates of Visual Field Progression and Intraocular Pressure Measurements Obtained by Different Tonometers. 2019

Susanna, Bianca N / Ogata, Nara G / Daga, Fábio B / Susanna, Carolina N / Diniz-Filho, Alberto / Medeiros, Felipe A. ·Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Ophthalmology, University of California, San Diego, La Jolla, California; ABC Foundation School of Medicine, Santo André, Brazil. · Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina. · Department of Ophthalmology, University of California, San Diego, La Jolla, California. · Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Ophthalmology, University of California, San Diego, La Jolla, California. Electronic address: felipe.medeiros@duke.edu. ·Ophthalmology · Pubmed #30114419.

ABSTRACT: PURPOSE: To investigate the associations between intraocular pressure (IOP) measurements obtained by different tonometric methods and rates of visual field loss in a cohort of patients with glaucoma followed over time. DESIGN: Prospective, observational cohort study. PARTICIPANTS: This study included 213 eyes of 125 glaucomatous patients who were followed for an average of 2.4±0.6 years. METHODS: At each visit, IOP measurements were obtained using Goldmann applanation tonometry (GAT), the Ocular Response Analyzer (ORA) (Reichert, Inc., Depew, NY), corneal-compensated IOP (IOP MAIN OUTCOME MEASURES: Strength of associations (R RESULTS: Average values for mean IOP over time measured by GAT, ORA, and RBT were 14.4±3.3, 15.2±4.2, and 13.4±4.2 mmHg, respectively. Mean IOP CONCLUSIONS: Mean ORA IOP

4 Article Is vision-related quality of life impaired in patients with preperimetric glaucoma? 2019

Daga, Fábio B / Gracitelli, Carolina P B / Diniz-Filho, Alberto / Medeiros, Felipe A. ·Department of Ophthalmology, Duke Eye Center, Duke University, Durham, North Carolina, USA. · Department of Ophthalmology and Vision Science, Federal University of São Paulo, São Paulo, Brazil. · Department of Ophthalmology, University of California, San Diego, California, USA. · Department of Ophthalmology, Duke Eye Center, Duke University, Durham, North Carolina, USA felipe.medeiros@duke.edu. ·Br J Ophthalmol · Pubmed #30049801.

ABSTRACT: BACKGROUND/AIMS: To investigate whether subjects with preperimetric glaucoma exhibit decline in patient-reported vision-related quality of life (QoL) compared with healthy individuals. METHODS: This cross-sectional study included 45 patients with preperimetric glaucoma, 102 patients with perimetric glaucoma and 81 healthy controls. Perimetric glaucoma was defined by the presence of repeatable abnormal standard automated perimetry tests and corresponding optic nerve damage in at least one eye. Preperimetric glaucoma was defined based on the presence of retinal nerve fibre layer (RNFL) loss as detected by spectral-domain optical coherence tomography in the absence of visual field loss. Patient-reported QoL was measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). RESULTS: Patients with preperimetric glaucoma had significantly thinner average RNFL in the better eye compared with controls (79.9±9.2 µm vs 97.8±8.6 µm; p<0.001). There was no significant difference in Rasch-calibrated NEI VFQ-25 scores between the preperimetric and control groups (72.8±16.8 vs 73.7±20.2, respectively; p=0.964). The average NEI VFQ-25 score in the perimetric glaucoma group was 58.9±18.6 and was significantly different than the average score in the preperimetric glaucoma and healthy groups (p<0.001 for both comparisons). CONCLUSION: Contrary to patients with perimetric damage, preperimetric glaucoma does not seem to be associated with loss in QoL. Prevention of disability from glaucoma may benefit from early diagnosis during a 'window of opportunity' given by detecting structural loss before visual field damage.

5 Article Macular Pigment and Visual Function in Patients With Glaucoma: The San Diego Macular Pigment Study. 2018

Daga, Fábio B / Ogata, Nara G / Medeiros, Felipe A / Moran, Rachel / Morris, Jeffrey / Zangwill, Linda M / Weinreb, Robert N / Nolan, John M. ·Hamilton Glaucoma Center and Shiley Eye Institute and Department of Ophthalmology, University of California San Diego, La Jolla, California, United States. · Department of Ophthalmology, Duke Eye Center, Duke University, Durham, North Carolina, United States. · Nutrition Research Centre Ireland, School of Health Sciences, Carriganore House, Waterford Institute of Technology, West Campus, Carriganore, Waterford, Ireland. · Morris Eye Group, Encinitas, Vista, California, United States. ·Invest Ophthalmol Vis Sci · Pubmed #30193322.

ABSTRACT: Purpose: Although recent studies have shown that macular pigment (MP) is significantly lower in glaucoma patients, this relationship merits further investigation. Methods: This cross-sectional study included 85 glaucoma patients and 22 controls. All subjects had standard automated perimetry (SAP) and retinal nerve fiber layer (RNFL) thickness measurements. Intake of lutein (L) and zeaxanthin (Z) was estimated using a novel dietary screener. The Heidelberg Spectralis dual-wavelength autofluorescence (AF) technology was employed to study the relationship between MP and glaucoma. The association between MP volume and glaucoma was investigated using linear regression models accounting for potential confounding factors. Results: Glaucoma patients had significantly worse SAP mean deviation (MD) and lower RNFL thickness in the study eye compared to control subjects (P < 0.001 for both). MP (volume) was comparable between groups (P = 0.436). In the univariable model, diagnosis of glaucoma was not associated with MP volume (R2 = 1.22%; P = 0.257). Dietary intake of L and Z was positively and significantly related to MP in the univariable (P = 0.022) and multivariable (P = 0.020) models. Conclusions: These results challenge previous studies that reported that glaucoma is associated with low MP. Dietary habits were found to be the main predictor of MP in this sample. Further research is merited to better understand the relationship between glaucoma, MP, and visual performance in these patients.

6 Article Optical Coherence Tomography Angiography Macular Vascular Density Measurements and the Central 10-2 Visual Field in Glaucoma. 2018

Penteado, Rafaella C / Zangwill, Linda M / Daga, Fábio B / Saunders, Luke J / Manalastas, Patricia I C / Shoji, Takuhei / Akagi, Tadamichi / Christopher, Mark / Yarmohammadi, Adeleh / Moghimi, Sasan / Weinreb, Robert N. ·Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, La Jolla, CA. · Department of Ophthalmology, Saitama Medical University, Saitama. · Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan. ·J Glaucoma · Pubmed #29664832.

ABSTRACT: PURPOSE: To evaluate the association between macula vascular density assessed by optical coherence tomography angiography (OCT-A) and central visual field (VF) threshold sensitivities in healthy, glaucoma suspect, and glaucoma patients. METHODS: A total of 185 eyes from 38 healthy participants, 31 glaucoma suspects, 72 mild glaucoma patients, and 44 moderate/severe glaucoma patients from the Diagnostic Innovations in Glaucoma Study who underwent OCT-A images of the macula and 10-2 VF testing were enrolled in this observational cross-sectional study. The relationship between central VF mean sensitivity (MS) and superficial macula whole-image vessel density (wiVD), and the relationship between the MS of the 4 central points of the 10-2 VF (MS4) and parafoveal vessel density (pfVD), were assessed using linear regression models. RESULTS: Mean wiVD (52.5%, 49.8%, 49.4% and 45.2%, respectively) and mean pfVD (54.9%, 52.1%, 51.8% and 47.7%, respectively) were found to be significantly higher in healthy eyes and glaucoma suspect eyes compared with glaucoma eyes with mild and moderate/severe disease [analysis of covariance (ANCOVA) P<0.001]. The univariate associations between 10-2 MS and wiVD (R=26.9%) and between 10-2 MS4 and pfVD (R=16.8%) were statistically significant (P<0.001 for both). After adjusting for scan quality, age, sex and intraocular pressure, superficial macula wiVD and pfVD were still independently associated with central VF loss. Macula wiVD performed better [area under the receiver operator characteristic (AUROC)=0.70] than ganglion cell complex thickness (AUROC=0.50) for differentiating between glaucoma suspect and healthy eyes (P=0.010). CONCLUSIONS: Loss of OCT-A macula vessel density is associated with central 10-2 VF defects. Macula vessel density is a clinically relevant parameter that may enhance monitoring of glaucoma suspects and patients.

7 Article Event-based analysis of visual field change can miss fast glaucoma progression detected by a combined structure and function index. 2018

Zhang, Chunwei / Tatham, Andrew J / Daga, Fábio B / Jammal, Alessandro A / Medeiros, Felipe A. ·Visual Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University School of Medicine, 2310 Erwin Rd, Durham, NC, 27710, USA. · Department of Ophthalmology, the First Affiliated Hospital, Harbin Medical University, Harbin, China. · Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, Edinburgh, UK. · Visual Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University School of Medicine, 2310 Erwin Rd, Durham, NC, 27710, USA. felipe.medeiros@duke.edu. ·Graefes Arch Clin Exp Ophthalmol · Pubmed #29623461.

ABSTRACT: PURPOSE: To investigate the relationship between progression assessed by the visual field guided progression analysis (GPA) and rates of structural and functional change in glaucoma eyes. METHODS: This was a longitudinal observational study of 135 eyes of 97 patients with glaucoma followed for an average of 3.5 ± 0.9 years. All patients had standard automated perimetry (SAP) and retinal nerve fiber layer (RNFL) analysis with spectral domain optical coherence tomography (SDOCT), with an average of 6.8 ± 2.3 visits. A control group of healthy eyes followed longitudinally was used to estimate age-related change. Visual field progression was assessed using the Humphrey Field Analyzer GPA. Estimates of retinal ganglion cell counts from SAP and SDOCT were used to obtain a combined index of glaucomatous damage (RGC index) according to a previously described algorithm. Progression by SDOCT and the retinal ganglion cell (RGC) index were defined as statistically significant (P < 0.05) slopes of change that were also faster than age-related change estimated from healthy eyes. RESULTS: From the 135 eyes, 15 (11%) progressed by GPA, 21 (16%) progressed by SDOCT, and 31 (23%) progressed by the RGC index. Twenty-one eyes showed progression by the RGC index that was missed by the GPA. These eyes had an average rate of change in estimated RGC counts of - 28,910 cells/year, ranging from two to nine times faster than expected age-related losses. CONCLUSION: Many glaucomatous eyes that are not found to be progressing by GPA may actually have fast rates of change as detected by a combined index of structure and function.

8 Article A Prospective Longitudinal Study to Investigate Corneal Hysteresis as a Risk Factor for Predicting Development of Glaucoma. 2018

Susanna, Carolina N / Diniz-Filho, Alberto / Daga, Fábio B / Susanna, Bianca N / Zhu, Feilin / Ogata, Nara G / Medeiros, Felipe A. ·Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Ophthalmology, University of California San Diego, La Jolla, California. · Department of Ophthalmology, University of California San Diego, La Jolla, California. · Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina. · Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Ophthalmology, University of California San Diego, La Jolla, California. Electronic address: felipe.medeiros@duke.edu. ·Am J Ophthalmol · Pubmed #29305310.

ABSTRACT: PURPOSE: To investigate the role of corneal hysteresis (CH) as a risk factor for development of glaucoma. DESIGN: Prospective observational cohort study. METHODS: Two hundred and eighty-seven eyes of 199 patients suspected of having glaucoma were followed for an average of 3.9 ± 1.8 years. All eyes had normal visual fields at baseline. Development of glaucoma was defined as occurrence of 3 consecutive abnormal standard automated perimetry tests during follow-up, defined as pattern standard deviation (PSD) < 5%, and/or Glaucoma Hemifield Test outside normal limits. Measurements of CH were acquired at baseline using the Ocular Response Analyzer (ORA). Univariable and multivariable Cox regression models were used to investigate baseline factors associated with development of visual field loss over time. RESULTS: Fifty-four (19%) eyes developed repeatable visual field defects during follow-up. Measurements of CH at baseline were significantly lower in patients who developed glaucoma vs those who did not (9.5 ± 1.5 mm Hg vs 10.2 ± 2.0 mm Hg; P = .012). Each 1-mm Hg lower CH was associated with an increase of 21% in the risk of developing glaucoma during follow-up (95% confidence interval [CI]: 1.04-1.41; P = .013). In a multivariable model adjusting for age, intraocular pressure, central corneal thickness, PSD, and treatment, CH was still predictive of development of glaucoma (hazard ratio = 1.20; 95% CI: 1.01-1.42; P = .040). CONCLUSION: Baseline lower CH measurements were significantly associated with increased risk of developing glaucomatous visual field defects over time. The prospective longitudinal design of this study supports a role of CH as a risk factor for developing glaucoma.

9 Article The Association Between Macula and ONH Optical Coherence Tomography Angiography (OCT-A) Vessel Densities in Glaucoma, Glaucoma Suspect, and Healthy Eyes. 2018

Manalastas, Patricia I C / Zangwill, Linda M / Daga, Fabio B / Christopher, Mark A / Saunders, Luke J / Shoji, Takuhei / Akagi, Tadamichi / Penteado, Rafaella C / Yarmohammadi, Adeleh / Suh, Min H / Medeiros, Felipe A / Weinreb, Robert N. ·Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, CA. · Department of Ophthalmology, Saitama Medical University, Iruma, Saitama. · Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan. · Department of Ophthalmology, Haeundae Paik Hospital, Inje University, Busan, South Korea. ·J Glaucoma · Pubmed #29303870.

ABSTRACT: PURPOSE: To evaluate strength of associations between optical coherence tomography (OCT)-angiography vessel density (VD) measurements in the macula and peripapillary region of the optic nerve head (ONH) with standard structural OCT thickness measures. MATERIALS AND METHODS: This cross-sectional study included 333 eyes of 219 primary open-angle glaucoma patients, 41 glaucoma suspects, and 73 healthy participants from the Diagnostic Innovations in Glaucoma Study (DIGS) with good quality OCT angiography images. The strength of associations between microvasculature measures in the ONH retinal nerve fiber layer (RNFL) and superficial macula layer was assessed using linear regression models. Associations between ONH and macula VD, and circumpapillary (cp) RNFL thickness and macular ganglion cell complex (mGCC) measures were also evaluated. RESULTS: The strength (r) of associations among VD and thickness measures of ONH and macula ranged from 14.1% to 69.4%; all were statistically significant (P<0.001). The association between ONH and macula whole-image VD (r=41.0%) was significantly weaker than the relationship between mGCC and cpRNFL thickness (r=69.4%, P<0.001). Although both cpRNFL and mGCC thicknesses tended to be more strongly associated with ONH VD (r=39.2% and 26.7%, respectively) than macula VD (r=27.5% and 17.7%, respectively), differences did not reach statistical significance (P=0.050 and P=0.113, respectively). CONCLUSIONS: The strength of the association of VD with cpRNFL and mGCC thicknesses varies by retinal layer. The weaker association of macula VD compared with ONH VD with tissue thickness may be due to differences in micorovasculature between the macula and ONH.

10 Article Fear of falling and postural reactivity in patients with glaucoma. 2017

Daga, Fábio B / Diniz-Filho, Alberto / Boer, Erwin R / Gracitelli, Carolina P B / Abe, Ricardo Y / Medeiros, Felipe A. ·Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina, United States of America. · Department of Ophthalmology and Vision Science, Federal University of São Paulo, São Paulo, Brazil. · Department of Ophthalmology, University of California, San Diego, La Jolla, California, United States of America. ·PLoS One · Pubmed #29211742.

ABSTRACT: PURPOSE: To investigate the relationship between postural metrics obtained by dynamic visual stimulation in a virtual reality environment and the presence of fear of falling in glaucoma patients. METHODS: This cross-sectional study included 35 glaucoma patients and 26 controls that underwent evaluation of postural balance by a force platform during presentation of static and dynamic visual stimuli with head-mounted goggles (Oculus Rift). In dynamic condition, a peripheral translational stimulus was used to induce vection and assess postural reactivity. Standard deviations of torque moments (SDTM) were calculated as indicative of postural stability. Fear of falling was assessed by a standardized questionnaire. The relationship between a summary score of fear of falling and postural metrics was investigated using linear regression models, adjusting for potentially confounding factors. RESULTS: Subjects with glaucoma reported greater fear of falling compared to controls (-0.21 vs. 0.27; P = 0.039). In glaucoma patients, postural metrics during dynamic visual stimulus were more associated with fear of falling (R2 = 18.8%; P = 0.001) than static (R2 = 3.0%; P = 0.005) and dark field (R2 = 5.7%; P = 0.007) conditions. In the univariable model, fear of falling was not significantly associated with binocular standard perimetry mean sensitivity (P = 0.855). In the multivariable model, each 1 Nm larger SDTM in anteroposterior direction during dynamic stimulus was associated with a worsening of 0.42 units in the fear of falling questionnaire score (P = 0.001). CONCLUSION: In glaucoma patients, postural reactivity to a dynamic visual stimulus using a virtual reality environment was more strongly associated with fear of falling than visual field testing and traditional balance assessment.

11 Article Wayfinding and Glaucoma: A Virtual Reality Experiment. 2017

Daga, Fábio B / Macagno, Eduardo / Stevenson, Cory / Elhosseiny, Ahmed / Diniz-Filho, Alberto / Boer, Erwin R / Schulze, Jürgen / Medeiros, Felipe A. ·Visual Performance Laboratory, University of California San Diego, La Jolla, California, United States. · Division of Biological Sciences, University of California San Diego, La Jolla, California, United States 3Department of Bioengineering, University of California San Diego, La Jolla, California, United States. · Visual Performance Laboratory, University of California San Diego, La Jolla, California, United States 4California Institute for Telecommunications and Information Technology (Calit2), University of California San Diego, La Jolla, California, United States. · California Institute for Telecommunications and Information Technology (Calit2), University of California San Diego, La Jolla, California, United States 5Department of Computer Science and Engineering, University of California San Diego, La Jolla, California, United States. ·Invest Ophthalmol Vis Sci · Pubmed #28687845.

ABSTRACT: Purpose: Wayfinding, the process of determining and following a route between an origin and a destination, is an integral part of everyday tasks. The purpose of this study was to investigate the impact of glaucomatous visual field loss on wayfinding behavior using an immersive virtual reality (VR) environment. Methods: This cross-sectional study included 31 glaucomatous patients and 20 healthy subjects without evidence of overall cognitive impairment. Wayfinding experiments were modeled after the Morris water maze navigation task and conducted in an immersive VR environment. Two rooms were built varying only in the complexity of the visual scene in order to promote allocentric-based (room A, with multiple visual cues) versus egocentric-based (room B, with single visual cue) spatial representations of the environment. Wayfinding tasks in each room consisted of revisiting previously visible targets that subsequently became invisible. Results: For room A, glaucoma patients spent on average 35.0 seconds to perform the wayfinding task, whereas healthy subjects spent an average of 24.4 seconds (P = 0.001). For room B, no statistically significant difference was seen on average time to complete the task (26.2 seconds versus 23.4 seconds, respectively; P = 0.514). For room A, each 1-dB worse binocular mean sensitivity was associated with 3.4% (P = 0.001) increase in time to complete the task. Conclusions: Glaucoma patients performed significantly worse on allocentric-based wayfinding tasks conducted in a VR environment, suggesting visual field loss may affect the construction of spatial cognitive maps relevant to successful wayfinding. VR environments may represent a useful approach for assessing functional vision endpoints for clinical trials of emerging therapies in ophthalmology.

12 Article Impact of Normal Aging and Progression Definitions on the Specificity of Detecting Retinal Nerve Fiber Layer Thinning. 2017

Wu, Zhichao / Saunders, Luke J / Zangwill, Linda M / Daga, Fábio B / Crowston, Jonathan G / Medeiros, Felipe A. ·Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia. · Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California. · Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia. · Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California. Electronic address: fmedeiros@ucsd.edu. ·Am J Ophthalmol · Pubmed #28669780.

ABSTRACT: PURPOSE: To evaluate the specificity of current definitions used to identify progressive change of the average peripapillary retinal nerve fiber layer (RNFL) thickness measurements obtained on optical coherence tomography (OCT) imaging. DESIGN: Prospective observational cohort study. METHODS: Setting: University of California, San Diego. STUDY POPULATION: Seventy-five eyes from 45 normal participants. OBSERVATION PROCEDURE: Patients were seen at an average of 5.7 visits over 3.2 years, to determine the age-related average RNFL thickness changes and longitudinal measurement variability. Slope and variability estimates were used to reconstruct "real-world" OCT imaging measurements with computer simulations. MAIN OUTCOME MEASURE: False-positive rates for progression in normal eyes using different definitions. RESULTS: The estimated normal average RNFL thickness change over time was -0.54 ± 0.23 μm/year (P < .001). Even with a recent definition of progression that appeared to guarantee a high level of specificity by accounting for normal aging (requiring a significant negative slope that was more negative than the 5% lower limit of aging), 18% simulated normal eyes were still falsely identified as having progressed after 5 years of annual testing in a clinical practice scenario. However, this was reduced to 8% and 4% when trend-based analysis of progression was performed after adjustments using the mean and 5% lower limit of normal rates of aging, respectively. CONCLUSIONS: This study highlights how current definitions for detecting RNFL thinning have an unacceptably poor level of specificity, and that more stringent definitions are required to avoid misleading interpretations of progression on OCT imaging in clinical practice.

13 Article Association Between Neurocognitive Decline and Visual Field Variability in Glaucoma. 2017

Diniz-Filho, Alberto / Delano-Wood, Lisa / Daga, Fábio B / Cronemberger, Sebastião / Medeiros, Felipe A. ·Visual Performance Laboratory, University of California-San Diego, La Jolla2Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. · Veterans Affair San Diego Healthcare System, La Jolla, California4Department of Psychiatry, University of California-San Diego, La Jolla. · Visual Performance Laboratory, University of California-San Diego, La Jolla. · Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. ·JAMA Ophthalmol · Pubmed #28520873.

ABSTRACT: Importance: Visual field variability may impair detection of glaucoma progression over time. Despite the possible overlap between neurocognitive disorders and glaucoma in older individuals, no study has investigated the association between cognitive changes and visual field variability. Objective: To evaluate the association between global neurocognitive impairment and visual field variability in patients diagnosed as having glaucoma or glaucoma suspects. Design, Setting, and Participants: This prospective observational cohort study was conducted at the Visual Performance Laboratory, University of California, San Diego. The study involved 211 eyes of 115 patients followed up for a mean (SD) period of 2.5 (0.8) years, ranging from 1.2 to 4.7 years. Data were obtained during the period extending from March 2011 to April 2015, with data analysis conducted from November 2015 to May 2016. Main Outcomes and Measures: Association between cognitive decline and visual field variability. Patients were monitored with standard automated perimetry (SAP) and had longitudinal assessment of cognitive ability using the Montreal Cognitive Assessment (MoCA). Visual field variability was estimated by the SD of the residuals of ordinary least squares linear regressions of SAP mean deviation (MD) values over time. Linear regression models were used to investigate the association between cognitive decline and visual field variability, adjusting for potentially confounding factors. Results: Among the 115 patients, the mean (SD) age at baseline was 67.4 (10.1) years, 63 were men (54.8%), and 86 were white (74.8%). There was a statistically significant association between change in MoCA scores and visual field variability over time. In a univariable model, a 5-point decline in MoCA score was associated with an increase of 0.18 dB in the SD of residuals of SAP MD (R2 = 4.3%; 95% CI, 0.06-0.30; P = .003). In a multivariable model adjusting for baseline MoCA score, mean SAP MD, age, sex, race/ethnicity, educational level, income, and number of SAP tests, each 5-point decline in MoCA score was associated with an increase of 0.23 dB in the SD of residuals of SAP MD (95% CI, 0.11-0.35; P < .001). Conclusions and Relevance: Cognitive decline was associated with increased visual field variability during follow-up. These findings suggest that screening and monitoring of cognitive dysfunction may be important in the assessment of visual field progression in the context of glaucoma.

14 Article Detecting Glaucoma With a Portable Brain-Computer Interface for Objective Assessment of Visual Function Loss. 2017

Nakanishi, Masaki / Wang, Yu-Te / Jung, Tzyy-Ping / Zao, John K / Chien, Yu-Yi / Diniz-Filho, Alberto / Daga, Fabio B / Lin, Yuan-Pin / Wang, Yijun / Medeiros, Felipe A. ·Visual Performance Laboratory, University of California-San Diego, La Jolla. · Swartz Center for Computational Neuroscience, University of California-San Diego, La Jolla. · Department of Computer Science, National Chiao Tung University, Hsinchu, Taiwan. · Swartz Center for Computational Neuroscience, University of California-San Diego, La Jolla3Department of Computer Science, National Chiao Tung University, Hsinchu, Taiwan. ·JAMA Ophthalmol · Pubmed #28448641.

ABSTRACT: Importance: The current assessment of visual field loss in diseases such as glaucoma is affected by the subjectivity of patient responses and the lack of portability of standard perimeters. Objective: To describe the development and initial validation of a portable brain-computer interface (BCI) for objectively assessing visual function loss. Design, Setting, and Participants: This case-control study involved 62 eyes of 33 patients with glaucoma and 30 eyes of 17 healthy participants. Glaucoma was diagnosed based on a masked grading of optic disc stereophotographs. All participants underwent testing with a BCI device and standard automated perimetry (SAP) within 3 months. The BCI device integrates wearable, wireless, dry electroencephalogram and electrooculogram systems and a cellphone-based head-mounted display to enable the detection of multifocal steady state visual-evoked potentials associated with visual field stimulation. The performances of global and sectoral multifocal steady state visual-evoked potentials metrics to discriminate glaucomatous from healthy eyes were compared with global and sectoral SAP parameters. The repeatability of the BCI device measurements was assessed by collecting results of repeated testing in 20 eyes of 10 participants with glaucoma for 3 sessions of measurements separated by weekly intervals. Main Outcomes and Measures: Receiver operating characteristic curves summarizing diagnostic accuracy. Intraclass correlation coefficients and coefficients of variation for assessing repeatability. Results: Among the 33 participants with glaucoma, 19 (58%) were white, 12 (36%) were black, and 2 (6%) were Asian, while among the 17 participants with healthy eyes, 9 (53%) were white, 8 (47%) were black, and none were Asian. The receiver operating characteristic curve area for the global BCI multifocal steady state visual-evoked potentials parameter was 0.92 (95% CI, 0.86-0.96), which was larger than for SAP mean deviation (area under the curve, 0.81; 95% CI, 0.72-0.90), SAP mean sensitivity (area under the curve, 0.80; 95% CI, 0.69-0.88; P = .03), and SAP pattern standard deviation (area under the curve, 0.77; 95% CI, 0.66-0.87; P = .01). No statistically significant differences were seen for the sectoral measurements between the BCI and SAP. Intraclass coefficients for global and sectoral parameters ranged from 0.74 to 0.92, and mean coefficients of variation ranged from 3.03% to 7.45%. Conclusions and Relevance: The BCI device may be useful for assessing the electrical brain responses associated with visual field stimulation. The device discriminated eyes with glaucomatous neuropathy from healthy eyes in a clinically based setting. Further studies should investigate the feasibility of the BCI device for home-based testing as well as for detecting visual function loss over time.

15 Article Frequency of Testing to Detect Visual Field Progression Derived Using a Longitudinal Cohort of Glaucoma Patients. 2017

Wu, Zhichao / Saunders, Luke J / Daga, Fábio B / Diniz-Filho, Alberto / Medeiros, Felipe A. ·Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California. · Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California. Electronic address: fmedeiros@ucsd.edu. ·Ophthalmology · Pubmed #28268099.

ABSTRACT: PURPOSE: To determine the time required to detect statistically significant progression for different rates of visual field loss using standard automated perimetry (SAP) when considering different frequencies of testing using a follow-up scheme that resembles clinical practice. DESIGN: Observational cohort study. PARTICIPANTS: One thousand seventy-two eyes of 665 patients with glaucoma followed up over an average of 4.3±0.9 years. METHODS: Participants with 5 or more visual field tests over a 2- to 5-year period were included to derive the longitudinal measurement variability of SAP mean deviation (MD) using linear regressions. Estimates of variability then were used to reconstruct real-world visual field data by computer simulation to evaluate the time required to detect progression for various rates of visual field loss and different frequencies of testing. The evaluation was performed using a follow-up scheme that resembled clinical practice by requiring a set of 2 baseline tests and a confirmatory test to identify progression. MAIN OUTCOME MEASURES: Time (in years) required to detect progression. RESULTS: The time required to detect a statistically significant negative MD slope decreased as the frequency of testing increased, albeit not proportionally. For example, 80% of eyes with an MD loss of -2 dB/year would be detected after 3.3, 2.4, and 2.1 years when testing is performed once, twice, and thrice per year, respectively. For eyes with an MD loss of -0.5 dB/year, progression can be detected with 80% power after 7.3, 5.7, and 5.0 years, respectively. CONCLUSIONS: This study provides information on the time required to detect progression using MD trend analysis in glaucoma eyes when different testing frequencies are used. The smaller gains in the time to detect progression when testing is increased from twice to thrice per year suggests that obtaining 2 reliable tests at baseline followed by semiannual testing and confirmation of progression through repeat testing in the initial years of follow-up may provide a good compromise for detecting progression, while minimizing the burden on health care resources in clinical practice.

16 Minor Reply. 2018

Susanna, Carolina N / Susanna, Bianca N / Diniz-Filho, Alberto / Zhu, Feilin / Daga, Fábio B / Ogata, Nara G / Medeiros, Felipe A. ·Durham, North Carolina, USA, and La Jolla, California, USA. · La Jolla, California, USA. · Durham, North Carolina, USA. ·Am J Ophthalmol · Pubmed #30205896.

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