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Glaucoma: HELP
Articles by Henry D. Jampel
Based on 45 articles published since 2008
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Between 2008 and 2019, H. Jampel wrote the following 45 articles about Glaucoma.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Screening for glaucoma using intraocular pressure alone. 2017

Jampel, Henry D. ·Johns Hopkins Wilmer Eye Institute, 600 N Wolfe St, Baltimore, MD 21287-9205, USA. ·BMJ · Pubmed #28903917.

ABSTRACT: -- No abstract --

2 Editorial Imaging the Posterior Pole in Glaucoma: Necessary But Not Sufficient. 2016

Li, Tianjing / Jampel, Henry D. ·Baltimore, Maryland. Electronic address: tli19@jhu.edu. · Baltimore, Maryland. ·Ophthalmology · Pubmed #27107350.

ABSTRACT: -- No abstract --

3 Editorial A Quarter Century's Progress in the Treatment of Open-Angle Glaucoma. 2015

Jampel, Henry D. ·Baltimore, Maryland. ·Ophthalmology · Pubmed #26111778.

ABSTRACT: -- No abstract --

4 Editorial Imaging the optic nerve and posterior pole in glaucoma. 2014

Jampel, Henry D. ·Baltimore, Maryland. ·Ophthalmology · Pubmed #25444943.

ABSTRACT: -- No abstract --

5 Editorial Glaucoma surgery: as easy as ABC? 2011

Jampel, Henry D. · ·Ophthalmology · Pubmed #21376241.

ABSTRACT: -- No abstract --

6 Editorial Glaucoma screening in the real world. 2010

Maul, Eugenio A / Jampel, Henry D. · ·Ophthalmology · Pubmed #20816246.

ABSTRACT: -- No abstract --

7 Editorial American glaucoma society position statement: marijuana and the treatment of glaucoma. 2010

Jampel, Henry. · ·J Glaucoma · Pubmed #20160576.

ABSTRACT: -- No abstract --

8 Editorial Trabeculectomy: more effective at causing cataract surgery than lowering intraocular pressure? 2009

Jampel, Henry. · ·Ophthalmology · Pubmed #19187821.

ABSTRACT: -- No abstract --

9 Review Combined surgery versus cataract surgery alone for eyes with cataract and glaucoma. 2015

Zhang, Mingjuan Lisa / Hirunyachote, Phenpan / Jampel, Henry. ·Johns Hopkins University School of Medicine, 929 N. Wolfe St, Apt. 615, Baltimore, Maryland, USA, 21205. ·Cochrane Database Syst Rev · Pubmed #26171900.

ABSTRACT: BACKGROUND: Cataract and glaucoma are leading causes of blindness worldwide, and their co-existence is common in elderly people. Glaucoma surgery can accelerate cataract progression, and performing both surgeries may increase the rate of postoperative complications and compromise the success of either surgery. However, cataract surgery may independently lower intraocular pressure (IOP), which may allow for greater IOP control among patients with co-existing cataract and glaucoma. The decision between undergoing combined glaucoma and cataract surgery versus cataract surgery alone is complex. Therefore, it is important to compare the effectiveness of these two interventions to aid clinicians and patients in choosing the better treatment approach. OBJECTIVES: To assess the relative effectiveness and safety of combined surgery versus cataract surgery (phacoemulsification) alone for co-existing cataract and glaucoma. The secondary objectives include cost analyses for different surgical techniques for co-existing cataract and glaucoma. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 10), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to October 2014), EMBASE (January 1980 to October 2014), PubMed (January 1948 to October 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to October 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 3 October 2014.We checked the reference lists of the included trials to identify further relevant trials. We used the Science Citation Index to search for references to publications that cited the studies included in the review. We also contacted investigators and experts in the field to identify additional trials. SELECTION CRITERIA: We included randomized controlled trials (RCTs) of participants who had open-angle, pseudoexfoliative, or pigmentary glaucoma and age-related cataract. The comparison of interest was combined cataract surgery (phacoemulsification) and any type of glaucoma surgery versus cataract surgery (phacoemulsification) alone. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, collected data, and judged risk of bias for included studies. We used standard methodological procedures expected by the Cochrane Collaboration. MAIN RESULTS: We included nine RCTs, with a total of 655 participants (657 eyes), and follow-up periods ranging from 12 to 30 months. Seven trials were conducted in Europe, one in Canada and South Africa, and one in the United States. We graded the overall quality of the evidence as low due to observed inconsistency in study results, imprecision in effect estimates, and risks of bias in the included studies.Glaucoma surgery type varied among the studies: three studies used trabeculectomy, three studies used iStent® implants, one study used trabeculotomy, and two studies used trabecular aspiration. All of these studies found a statistically significant greater decrease in mean IOP postoperatively in the combined surgery group compared with cataract surgery alone; the mean difference (MD) was -1.62 mmHg (95% confidence interval (CI) -2.61 to -0.64; 489 eyes) among six studies with data at one year follow-up. No study reported the proportion of participants with a reduction in the number of medications used after surgery, but two studies found the mean number of medications used postoperatively at one year was about one less in the combined surgery group than the cataract surgery alone group (MD -0.69, 95% CI -1.28 to -0.10; 301 eyes). Five studies showed that participants in the combined surgery group were about 50% less likely compared with the cataract surgery alone group to use one or more IOP-lowering medications one year postoperatively (risk ratio (RR) 0.47, 95% CI 0.28 to 0.80; 453 eyes). None of the studies reported the mean change in visual acuity or visual fields. However, six studies reported no significant differences in visual acuity and two studies reported no significant differences in visual fields between the two intervention groups postoperatively (data not analyzable). The effect of combined surgery versus cataract surgery alone on the need for reoperation to control IOP at one year was uncertain (RR 1.13, 95% CI 0.15 to 8.25; 382 eyes). Also uncertain was whether eyes in the combined surgery group required more interventions for surgical complications than those in the cataract surgery alone group (RR 1.06, 95% CI 0.34 to 3.35; 382 eyes). No study reported any vision-related quality of life data or cost outcome. Complications were reported at 12 months (two studies), 12 to 18 months (one study), and two years (four studies) after surgery. Due to the small number of events reported across studies and treatment groups, the difference between groups was uncertain for all reported adverse events. AUTHORS' CONCLUSIONS: There is low quality evidence that combined cataract and glaucoma surgery may result in better IOP control at one year compared with cataract surgery alone. The evidence was uncertain in terms of complications from the surgeries. Furthermore, this Cochrane review has highlighted the lack of data regarding important measures of the patient experience, such as visual field tests, quality of life measurements, and economic outcomes after surgery, and long-term outcomes (five years or more). Additional high-quality RCTs measuring clinically meaningful and patient-important outcomes are required to provide evidence to support treatment recommendations.

10 Review Endoscopic ophthalmic surgery of the anterior segment. 2014

Francis, Brian A / Kwon, Julie / Fellman, Ronald / Noecker, Robert / Samuelson, Thomas / Uram, Martin / Jampel, Henry. ·Doheny Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California. Electronic address: bfrancis@usc.edu. · University of Medicine and Dentistry New Jersey-Robert Wood Johnson Medical School, Piscataway, New Jersey. · Glaucoma Associates of Texas, Dallas, Texas. · Ophthalmic Consultants of Connecticut, Fairfield, Connecticut. · Minnesota Eye Consultants, Minneapolis, Minnesota. · Retina Consultants of New Jersey, Attending Surgeon, Manhattan Eye, Ear and Throat Hospital, New York, New York. · Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland. ·Surv Ophthalmol · Pubmed #23931901.

ABSTRACT: We summarize the uses of anterior segment endoscopic techniques and the basic science and technology of endoscopic cyclophotocoagulation (ECP) as compared with transscleral cyclophotocoagulation. This is followed by an analysis of patient selection for ECP, a description of surgical techniques, and clinical results. In addition, the ophthalmic endoscope has other uses in anterior segment surgeries. We discuss the techniques for these endoscope-assisted surgeries.

11 Review Evaluation of the anterior chamber angle in glaucoma: a report by the american academy of ophthalmology. 2013

Smith, Scott D / Singh, Kuldev / Lin, Shan C / Chen, Philip P / Chen, Teresa C / Francis, Brian A / Jampel, Henry D. ·Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. ·Ophthalmology · Pubmed #23978623.

ABSTRACT: OBJECTIVE: To assess the published literature pertaining to the association between anterior segment imaging and gonioscopy and to determine whether such imaging aids in the diagnosis of primary angle closure (PAC). METHODS: Literature searches of the PubMed and Cochrane Library databases were last conducted on July 6, 2011. The searches yielded 371 unique citations. Members of the Ophthalmic Technology Assessment Committee Glaucoma Panel reviewed the titles and abstracts of these articles and selected 134 of possible clinical significance for further review. The panel reviewed the full text of these articles and identified 79 studies meeting the inclusion criteria, for which the panel methodologist assigned a level of evidence based on a standardized grading scheme adopted by the American Academy of Ophthalmology. Three, 70, and 6 studies were rated as providing level I, II, and III evidence, respectively. RESULTS: Quantitative and qualitative parameters defined from ultrasound biomicroscopy (UBM), anterior segment optical coherence tomography (OCT), Scheimpflug photography, and the scanning peripheral anterior chamber depth analyzer (SPAC) demonstrate a strong association with the results of gonioscopy. There is substantial variability in the type of information obtained from each imaging method. Imaging of structures posterior to the iris is possible only with UBM. Direct imaging of the anterior chamber angle (ACA) is possible using UBM and OCT. The ability to acquire OCT images in a completely dark environment allows greater sensitivity in detecting eyes with appositional angle closure. Noncontact imaging using OCT, Scheimpflug photography, or SPAC makes these methods more attractive for large-scale PAC screening than contact imaging using UBM. CONCLUSIONS: Although there is evidence suggesting that anterior segment imaging provides useful information in the evaluation of PAC, none of these imaging methods provides sufficient information about the ACA anatomy to be considered a substitute for gonioscopy. Longitudinal studies are needed to validate the diagnostic significance of the parameters measured by these instruments for prospectively identifying individuals at risk for PAC. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

12 Review Comparative effectiveness of treatments for open-angle glaucoma: a systematic review for the U.S. Preventive Services Task Force. 2013

Boland, Michael V / Ervin, Ann-Margret / Friedman, David S / Jampel, Henry D / Hawkins, Barbara S / Vollenweider, Daniela / Chelladurai, Yohalakshmi / Ward, Darcy / Suarez-Cuervo, Catalina / Robinson, Karen A. ·Johns Hopkins University School of Medicine, Baltimore, MD, USA. ·Ann Intern Med · Pubmed #23420235.

ABSTRACT: BACKGROUND: Glaucoma is an acquired degeneration of the optic nerve and a leading cause of blindness worldwide. Medical and surgical treatments that decrease intraocular pressure may prevent visual impairment and blindness. PURPOSE: To compare the effectiveness of medical, laser, and surgical treatments in adults with open-angle glaucoma with regard to decreasing intraocular pressure and preventing optic nerve damage, vision loss, and visual impairment. DATA SOURCES: MEDLINE, CENTRAL, and an existing database for systematic reviews (through 2 March 2011); MEDLINE, EMBASE, LILACS, and CENTRAL for primary studies (through 30 July 2012). STUDY SELECTION: English-language systematic reviews; randomized, controlled trials; and quasi-randomized, controlled trials for most outcomes and observational studies for quality of life and harms. DATA EXTRACTION: Two investigators abstracted or checked information about study design, participants, and outcomes and assessed risk of bias and strength of evidence. DATA SYNTHESIS: High-level evidence suggests that medical, laser, and surgical treatments decrease intraocular pressure and that medical treatment and trabeculectomy reduce the risk for optic nerve damage and visual field loss compared with no treatment. The direct effect of treatments on visual impairment and the comparative efficacy of different treatments are not clear. Harms of medical treatment are primarily local (ocular redness, irritation); surgical treatment carries a small risk for more serious complications. LIMITATION: Heterogeneous outcome definitions and measurements among the included studies; exclusion of many treatment studies that did not stratify results by glaucoma type. CONCLUSION: Medical and surgical treatments for open-angle glaucoma lower intraocular pressure and reduce the risk for optic nerve damage over the short to medium term. Which treatments best prevent visual disability and improve patient-reported outcomes is unclear.

13 Review Novel glaucoma procedures: a report by the American Academy of Ophthalmology. 2011

Francis, Brian A / Singh, Kuldev / Lin, Shan C / Hodapp, Elizabeth / Jampel, Henry D / Samples, John R / Smith, Scott D. ·University of Southern California, Los Angeles, CA, USA. ·Ophthalmology · Pubmed #21724045.

ABSTRACT: OBJECTIVE: To review the published literature and summarize clinically relevant information about novel, or emerging, surgical techniques for the treatment of open-angle glaucoma and to describe the devices and procedures in proper context of the appropriate patient population, theoretic effects, advantages, and disadvantages. DESIGN: Devices and procedures that have US Food and Drug Administration clearance or are currently in phase III clinical trials in the United States are included: the Fugo blade (Medisurg Ltd., Norristown, PA), Ex-PRESS mini glaucoma shunt (Alcon, Inc., Hunenberg, Switzerland), SOLX Gold Shunt (SOLX Ltd., Boston, MA), excimer laser trabeculotomy (AIDA, Glautec AG, Nurnberg, Germany), canaloplasty (iScience Interventional Corp., Menlo Park, CA), trabeculotomy by internal approach (Trabectome, NeoMedix, Inc., Tustin, CA), and trabecular micro-bypass stent (iStent, Glaukos Corporation, Laguna Hills, CA). METHODS: Literature searches of the PubMed and the Cochrane Library databases were conducted up to October 2009 with no date or language restrictions. MAIN OUTCOME MEASURES: These searches retrieved 192 citations, of which 23 were deemed topically relevant and rated for quality of evidence by the panel methodologist. All studies but one, which was rated as level II evidence, were rated as level III evidence. RESULTS: All of the devices studied showed a statistically significant reduction in intraocular pressure and, in some cases, glaucoma medication use. The success and failure definitions varied among studies, as did the calculated rates. Various types and rates of complications were reported depending on the surgical technique. On the basis of the review of the literature and mechanism of action, the authors also summarized theoretic advantages and disadvantages of each surgery. CONCLUSIONS: The novel glaucoma surgeries studied all show some promise as alternative treatments to lower intraocular pressure in the treatment of open-angle glaucoma. It is not possible to conclude whether these novel procedures are superior, equal to, or inferior to surgery such as trabeculectomy or to one another. The studies provide the basis for future comparative or randomized trials of existing glaucoma surgical techniques and other novel procedures.

14 Clinical Trial Effectiveness of intraocular pressure-lowering medication determined by washout. 2014

Jampel, Henry D / Chon, Brian H / Stamper, Robert / Packer, Mark / Han, Ying / Nguyen, Quang H / Ianchulev, Tsontcho. ·Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland. · medical student at Duke University, Durham, North Carolina. · University of California, San Francisco. · Oregon Health & Science University, Portland. · Scripps Clinic, La Jolla, California. · University of California, San Francisco6Transcend Medical, Menlo Park, California. ·JAMA Ophthalmol · Pubmed #24481483.

ABSTRACT: IMPORTANCE While medication efficacy is well documented in clinical trials, less is known of medication effectiveness in real-world clinical settings. OBJECTIVE To assess the effectiveness of intraocular pressure (IOP)-lowering medications in patients with open-angle glaucoma. DESIGN, SETTING, AND PARTICIPANTS Prospective, multicenter, interventional cohort from the prerandomization phase of a randomized clinical trial at multiple ophthalmology clinics. A total of 603 patients (603 eyes) with primary open-angle glaucoma who were using up to 3 glaucoma medications were included. INTERVENTIONS One IOP measurement was made while the patient was using his or her usual medications to lower IOP (ON IOP). Eligible participants underwent washout of all IOP-lowering drops, and the diurnal IOP was measured 2 to 4 weeks later (OFF IOP). MAIN OUTCOMES AND MEASURES Difference between OFF IOP and ON IOP. The hypothesis was formulated after data collection. RESULTS The mean (SD) ON IOPs for participants using 0 (n = 102), 1 (n = 272), 2 (n = 147), or 3 (n = 82) medications were 24.2 (3.2), 17.5 (3.2), 17.2 (3.1), and 17.2 (3.1) mm Hg, respectively. Patients not using medication had a mean (SD) IOP decrease of 0.2 (2.8) mm Hg at the OFF visit. Patients using 1, 2, and 3 medications had mean (SD) IOP increases of 5.4 (3.0), 6.9 (3.3), and 9.0 (3.8) mm Hg, respectively, at the OFF visit. The percentages of patients with less than a 25% increase in IOP were 38%, 21%, and 13% for those using 1, 2, and 3 medications, respectively. CONCLUSIONS AND RELEVANCE Discontinuation of 1, 2, and 3 medications was associated with a clinically significant increase in IOP, although with smaller effects for the second and third medications compared with the first medication. A substantial proportion of patients showed only small changes in IOP after medication washout, suggesting either that they were not using the medication effectively or that the medication itself, although used properly, was not lowering the IOP. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01085357.

15 Article Comparison of Clinical Trial and Systematic Review Outcomes for the 4 Most Prevalent Eye Diseases. 2017

Saldanha, Ian J / Lindsley, Kristina / Do, Diana V / Chuck, Roy S / Meyerle, Catherine / Jones, Leslie S / Coleman, Anne L / Jampel, Henry D / Dickersin, Kay / Virgili, Gianni. ·Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. · Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California. · Department of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York. · Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland. · Department of Ophthalmology, Howard University Hospital, Washington, DC. · Frank and Ray Stark Foundation, David Geffen School of Medicine at UCLA, Los Angeles, California. · Eye Clinic, Department of Translational Surgery and Medicine, University of Florence, Careggi Hospital, Florence, Italy. ·JAMA Ophthalmol · Pubmed #28772305.

ABSTRACT: Importance: Suboptimal overlap in outcomes reported in clinical trials and systematic reviews compromises efforts to compare and summarize results across these studies. Objectives: To examine the most frequent outcomes used in trials and reviews of the 4 most prevalent eye diseases (age-related macular degeneration [AMD], cataract, diabetic retinopathy [DR], and glaucoma) and the overlap between outcomes in the reviews and the trials included in the reviews. Design, Setting, and Participants: This cross-sectional study examined all Cochrane reviews that addressed AMD, cataract, DR, and glaucoma; were published as of July 20, 2016; and included at least 1 trial and the trials included in the reviews. For each disease, a pair of clinical experts independently classified all outcomes and resolved discrepancies. Outcomes (outcome domains) were then compared separately for each disease. Main Outcomes and Measures: Proportion of review outcomes also reported in trials and vice versa. Results: This study included 56 reviews that comprised 414 trials. Although the median number of outcomes per trial and per review was the same (n = 5) for each disease, the trials included a greater number of outcomes overall than did the reviews, ranging from 2.9 times greater (89 vs 30 outcomes for glaucoma) to 4.9 times greater (107 vs 22 outcomes for AMD). Most review outcomes, ranging from 14 of 19 outcomes (73.7%) (for DR) to 27 of 29 outcomes (93.1%) (for cataract), were also reported in the trials. For trial outcomes, however, the proportion also named in reviews was low, ranging from 19 of 107 outcomes (17.8%) (for AMD) to 24 of 89 outcomes (27.0%) (for glaucoma). Only 1 outcome (visual acuity) was consistently reported in greater than half the trials and greater than half the reviews. Conclusions and Relevance: Although most review outcomes were reported in the trials, most trial outcomes were not reported in the reviews. The current analysis focused on outcome domains, which might underestimate the problem of inconsistent outcomes. Other important elements of an outcome (ie, specific measurement, specific metric, method of aggregation, and time points) might have differed even though the domains overlapped. Inconsistency in trial outcomes may impede research synthesis and indicates the need for disease-specific core outcome sets in ophthalmology.

16 Article Measurement of Gamma-Irradiated Corneal Patch Graft Thickness After Aqueous Drainage Device Surgery. 2017

de Luna, Regina A / Moledina, Ameera / Wang, Jiangxia / Jampel, Henry D. ·Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland. · Royal College of Surgeons in Ireland, Dublin, Ireland. · Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. ·JAMA Ophthalmol · Pubmed #28772298.

ABSTRACT: Importance: Exposure of the tube of an aqueous drainage device (ADD) through the conjunctiva is a serious complication of ADD surgery. Although placement of gamma-irradiated sterile cornea (GISC) as a patch graft over the tube is commonly performed, exposures still occur. Objectives: To measure GISC patch graft thickness as a function of time after surgery, estimate the rate of graft thinning, and determine risk factors for graft thinning. Design, Setting, and Participants: Cross-sectional study of graft thickness using anterior segment optic coherence tomography (AS-OCT) was conducted at the Wilmer Eye Institute at Johns Hopkins Hospital. A total of 107 patients (120 eyes, 120 ADDs) 18 years or older who underwent ADD surgery at Johns Hopkins with GISC patch graft between July 1, 2010, and October 31, 2016, were enrolled. Intervention: Implantation of ADD with placement of GISC patch graft over the tube. Main Outcomes and Measures: Graft thickness vs time after ADD surgery and risk factors for undetectable graft. Results: Of the 107 patients included in the analysis, the mean (SD) age of the cohort was 64 (16.2) years, 49 (45.8%) were male, and 43 (40.2%) were African American. The mean time of measurement after surgery was 1.7 years (range, 1 day to 6 years). Thinner grafts were observed as the time after surgery lengthened (β regression coefficient, -60 µm per year since surgery; 95% CI, -80 µm to -40 µm). The odds ratio of undetectable grafts per year after ADD surgery was 2.1 (95% CI, 1.5-3.0; P < .001). Age, sex, race, type of ADD, quadrant of ADD placement, diagnosis of uveitis or dry eye, and prior conjunctival surgery were not correlated with the presence or absence of the graft. Conclusions and Relevance: Gamma-irradiated sterile corneal patch grafts do not always retain their integrity after ADD surgery. Data from this cross-sectional study showed that on average, the longer the time after surgery, the thinner the graft. These findings suggest that placement of a GISC patch graft is no guarantee against tube exposure, and that better strategies are needed for preventing this complication.

17 Article Clinical outcomes of gamma-irradiated sterile cornea in aqueous drainage device surgery: a multicenter retrospective study. 2017

Pan, Q / Jampel, H D / Ramulu, P / Schwartz, G F / Cotter, F / Cute, D / Daoud, Y J / Murakami, P / Stark, W J. ·Eye Center, Zhejiang Provincial People's Hospital, Hangzhou, China. · Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA. · Glaucoma Consultants, Baltimore, MD, USA. · Vistar Eye Center, Roanoke, VA, USA. · Walter Reed National Military Medical Center, Bethesda, MD, USA. · Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. ·Eye (Lond) · Pubmed #27834965.

ABSTRACT: PurposeThe purpose of the study was to evaluate the safety and efficacy of gamma-irradiated sterile cornea (GISC) for covering the tube in aqueous drainage device (ADD) surgery in a retrospective, multicenter case series.Patients and methodsParticipants included 297 patients (321 procedures) who had undergone ADD surgery for the first time using GISC patch at three clinic centers in the United States between April 2009 and July 2012. The medical records of those consecutive patients were reviewed. Preoperative, intraoperative, and postoperative parameters about GISC were collected and analyzed. The main outcome measures were patch graft failure (PGF) and postoperative complications related to GISC.ResultsThree hundred and nineteen eyes in 295 patients were included in the current analysis. Ten out of the 319 eyes experienced PGF with a mean follow-up of 15.4±9.8 (SD) months. The overall cumulative PGF proportion from Kaplan-Meier analysis was 2.6% (95% CI: 0.6-4.7%) at 18 months. We detected two cases of presumed endophthalmitis related to PGF.ConclusionsGISC appears to have a reasonable success rate for preventing tube exposure related to PGF over an 18-month period. This success rate, in combination with other features of GISC (transparency and storage at room temperature), makes it a viable choice for patch graft material during ADD.

18 Article Unilateral Glaucoma Associated with Conjunctival Angioma and Choroidal Thickening without Facial Angioma. 2016

Saeedi, Osamah J / Chang, Luke Y / Arora, Karun S / Jampel, Henry D / Quigley, Harry A. ·Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA. · Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA. ·Middle East Afr J Ophthalmol · Pubmed #27555719.

ABSTRACT: We report a case of a suspected Sturge-Weber syndrome variant diagnosed at the age of 58 with the help of enhanced depth imaging spectral-domain ocular coherence tomography (EDI-SDOCT). A 58-year-old female with unilateral glaucoma was suspected to have choroidal vascular lesion, conjunctival angioma, and no facial port-wine stain who presented to the clinic with bleb dysesthesia many years after trabeculectomy. EDI-SDOCT was performed and revealed markedly increased choroidal thickness in the affected eye. EDI-SDOCT may be helpful in diagnosing Sturge-Weber variants without facial involvement and may aid in the investigation of the pathogenesis of this disease.

19 Article Single vs multiple intraocular pressure measurements in glaucoma surgical trials. 2014

Zhang, Mingjuan L / Chon, Brian H / Wang, Jiangxia / Smits, Gerard / Lin, Shan C / Ianchulev, Tsontcho / Jampel, Henry D. ·Medical student, School of Medicine, The Johns Hopkins University, Baltimore, Maryland. · medical student, School of Medicine, Duke University, Durham, North Carolina. · Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland. · Transcend Medical Inc, Menlo Park, California. · Department of Ophthalmology, School of Medicine, University of California, San Francisco. · Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland. ·JAMA Ophthalmol · Pubmed #24831204.

ABSTRACT: IMPORTANCE: Little is known about the necessity of multiple same-day intraocular pressure (IOP) measurements in describing the effect of IOP-lowering surgical procedures, and such evidence could affect surgical trial recruitment and retention of participants. OBJECTIVE: To determine whether a single IOP measurement might adequately approximate the mean of several measurements in glaucoma surgical trials. DESIGN, SETTING, AND PARTICIPANTS: A prospective, multicenter, interventional cohort from the prerandomization phase of a randomized clinical trial evaluating use of a supraciliary implant for treatment of IOP was conducted at multiple ophthalmology clinics. A total of 609 patients (609 eyes) with primary open-angle glaucoma and cataract were included. INTERVENTIONS: One IOP measurement was made while patients were receiving their usual medications to lower IOP, and 3 IOP measurements were made at 8 am, 12 pm, and 4 pm after patients underwent washout of all IOP-lowering eyedrops. MAIN OUTCOMES AND MEASURES: The proportion of eyes in which the increase in IOP after washout, using the mean of the 3 measurements, differed by more than 0.5, 1.0, 1.5, or 2.0 mm Hg from the increase in IOP after washout using only 1 of the postwashout measurements. A proportion of 10% or less at the 1.5-mm Hg cutoff was considered clinically acceptable. The hypothesis was formulated after data collection but before the data were examined. RESULTS: The mean (SD) IOP before washout was 18.5 (4.0) mm Hg. The mean increase in IOP after washout, using the mean of the 3 measurements, was 5.3 (4.2) mm Hg. The percentage of eyes in which the increase in IOP using a single postwashout IOP differed from the increase in IOP using the mean of 3 measurements by more than 1.5 mm Hg was 35.1%, 25.6%, 34.2%, 30.0%, and 31.4% when the single measurement was made at 8 am, 12 pm, 4 pm, a randomly chosen single measure of those 3 times, and the time closest to that of the prewashout IOP, respectively. By logistic regression, the 12 pm postwashout IOP had the lowest proportion of eyes differing from the mean (P < .001) and thus most closely approximated the mean diurnal IOP. CONCLUSIONS AND RELEVANCE: Although eliminating multiple IOP measurements would simplify the conduct of surgical trials in glaucoma, our data show that using a single IOP measurement after washout does not adequately approximate the mean of multiple IOP measurements.

20 Article Trends over time and regional variations in the rate of laser trabeculoplasty in the Medicare population. 2014

Jampel, Henry D / Cassard, Sandra D / Friedman, David S / Shekhawat, Nakul S / Whiteside-de Vos, Julia / Quigley, Harry A / Gower, Emily W. ·Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland. · Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland. · Vanderbilt University School of Medicine, Nashville, Tennessee4Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. · Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. · Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland5Department of Epidemiology, Wake Forest School of Medicine, Winston-Salem, North Carolina6Department of Ophthalmology, Wake Forest School of Medicin. ·JAMA Ophthalmol · Pubmed #24744059.

ABSTRACT: IMPORTANCE: Laser trabeculoplasty (LTP) is routinely used to treat open-angle glaucoma; hence, understanding variations in its use over time and region is important. OBJECTIVE: To determine trends over time and the regional variation in the performance of LTP. DESIGN, SETTING, AND PARTICIPANTS: Database analysis of a 5% random sample of all Medicare beneficiaries 65 years or older with continuous Part B (medical insurance) coverage and no enrollment in a health maintenance organization for each year from 2002 through 2009. INTERVENTIONS: We counted unique claims with a Current Procedural Terminology code of 65855 (LTP) submitted by ophthalmologists, optometrists, ambulatory surgery centers, or outpatient hospitals by region for each year. We examined trends over time and regional variation in LTP rates in 9 large geographic regions. MAIN OUTCOMES AND MEASURES: Rate of LTP per 10,000 Medicare beneficiary person-years and per 10,000 diagnosed open-angle glaucoma (OAG) person-years. RESULTS: The LTP rates per 10,000 Medicare beneficiary person-years were 36.3, 60.1, and 53.5 for 2002, 2006, and 2009, respectively. The 65.6% increase between 2002 and 2006 and the 11.0% decrease between 2006 and 2009 were statistically significant (tests for linear trend, P = .009 and P < .001, respectively). Similarly, the LTP rate among Medicare beneficiaries with OAG increased from 507.9 per 10,000 person-years in 2002 to 824.3 per 10,000 person-years in 2006 (62.3% increase; P = .009) and then decreased to 741 per 10,000 person-years by 2009 (10.1% decrease; P = .004). The rates per 10,000 OAG person-years differed significantly by region, ranging from 314 in the East South-Central region to 607 in the East North-Central region in 2002 (93.2% higher; P < .001). A similar range of variation was observed in subsequent years. CONCLUSIONS AND RELEVANCE: The rate of LTP for Medicare patients with OAG peaked in 2006 and then decreased through 2009. Nearly twice as many LTP procedures per Medicare beneficiary were performed in some regions compared with others throughout the period.

21 Article Risk factors for adverse consequences of low intraocular pressure after trabeculectomy. 2014

Saeedi, Osamah J / Jefferys, Joan L / Solus, Jason F / Jampel, Henry D / Quigley, Harry A. ·*Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine †Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD ‡Department of Pathology, Massachusetts General Hospital, Boston, MA and Glaucoma Center of Excellence, Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, MD. ·J Glaucoma · Pubmed #24145291.

ABSTRACT: PURPOSE: To determine the risk factors for low intraocular pressure (IOP) and its detrimental consequences after trabeculectomy. PATIENTS AND METHODS: We performed a retrospective chart review of consecutive patients aged 12 years and above undergoing trabeculectomy alone by 1 of 2 surgeons between May 2000 and October 2008 at the Wilmer Institute. RESULTS: Among 753 eyes of 596 patients, 112 eyes (14.9%) of 103 patients had an IOP of ≤5 mm Hg at ≥3 months postoperatively (late low IOP). Physical signs related to low IOP occurred in 61 eyes of 58 patients, and 40 eyes of 37 patients had revision surgery for low IOP. Physical signs of low IOP included 34 eyes with choroidal detachment or shallow anterior chamber, 10 with hypotony maculopathy, and 7 with both. Compared with 187 control eyes of 165 patients, risk factors for late low IOP included: surgeon 2 (P=0.0003), left eyes (P=0.03), and secondary glaucoma (P=0.05). Physical signs of low IOP were more common in phakic eyes (P=0.03), whereas need for revision surgery was associated with younger age (P=0.01). The presence of hypotony maculopathy significantly decreased the risk of choroidal detachment/shallow anterior chamber (P=0.003). Hypotony maculopathy was associated with younger age (P=0.02). CONCLUSIONS: Late low IOP was more common with techniques used by 1 of 2 surgeons and in eyes with secondary glaucoma. Clinical signs of low IOP were more common in phakic eyes. Younger age was a risk factor for hypotony maculopathy. Hypotony maculopathy and choroidal detachment tend to occur in different eyes.

22 Article Calculating the "threshold to treat" in ocular hypertension. 2014

Jampel, Henry / Boland, Michael V. ·Glaucoma Center of Excellence, Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, MD. ·J Glaucoma · Pubmed #23775096.

ABSTRACT: -- No abstract --

23 Article The cost of glaucoma care provided to Medicare beneficiaries from 2002 to 2009. 2013

Quigley, Harry A / Cassard, Sandra D / Gower, Emily W / Ramulu, Pradeep Y / Jampel, Henry D / Friedman, David S. ·Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Dana Center for Preventive Ophthalmology, Baltimore, Maryland. ·Ophthalmology · Pubmed #23769330.

ABSTRACT: PURPOSE: To estimate payments for glaucoma care among Medicare beneficiaries from 2002 to 2009. DESIGN: Database study. PARTICIPANTS: Data from a 5% random sample of Medicare billing information from 2002 to 2009. METHODS: Medicare beneficiaries, aged 65 years or older, with both Parts A and B fee-for-service (FFS) enrollment comprised the annual denominator. For each year, we included those with a defined glaucoma diagnostic code linked to a glaucoma visit, diagnostic test, or laser/surgical procedure. Open-angle, angle-closure, and other glaucoma were categorized separately. Claims were classified into glaucoma care, other eye care, and other medical care. MAIN OUTCOME MEASURES: Cost of glaucoma care in the Medicare Fee-for-Service Population. RESULTS: In 2009, total glaucoma payments by Medicare were $37.4 million for this subset, for an overall estimated cost of $748 million, or 0.4% of an estimated cost of $192 billion for all Medicare FFS payments. Office visits comprised approximately one half, diagnostic testing was approximately one-third, and surgical and laser procedures were approximately 10% of glaucoma-related costs. Coded open-angle glaucoma (OAG) and OAG suspects accounted for 87.5% of glaucoma costs, whereas cost per person was highest in "other glaucoma." In 2009, <3% of patients with OAG underwent incisional surgery and approximately 5% had laser trabeculoplasty. Laser iridotomy was the highest cost category among patients with angle-closure glaucoma, whereas office visits was the highest cost category among the "other glaucoma" group. The total cost of nonglaucoma eye care for patients with glaucoma was 67% higher than their glaucoma care costs; these were chiefly costs for cataract surgery and treatment of retinal diseases. From 2002 to 2009, FFS glaucoma care costs calculated in 2009 dollars were stable and cost per person per year in 2009 dollars decreased from $242 to $228 (P = 0.01 by test for linear trend). CONCLUSIONS: Annual glaucoma care costs per person decreased in constant dollars from 2002 to 2009. Cataract and retinal eye care for patients with glaucoma substantially exceeded the cost of their glaucoma care each year. Visit payments represented the largest category of costs.

24 Article Reduction in intraocular pressure after cataract extraction: the Ocular Hypertension Treatment Study. 2012

Mansberger, Steven L / Gordon, Mae O / Jampel, Henry / Bhorade, Anjali / Brandt, James D / Wilson, Brad / Kass, Michael A / Anonymous4180726. ·Devers Eye Institute/Discoveries in Sight, Legacy Health System, Portland, Oregon, USA. smansberger@deverseye.org ·Ophthalmology · Pubmed #22608478.

ABSTRACT: PURPOSE: To determine the change in intraocular pressure (IOP) after cataract extraction in the observation group of the Ocular Hypertension Treatment Study. DESIGN: Comparative case series. PARTICIPANTS: Forty-two participants (63 eyes) who underwent cataract surgery in at least 1 eye during the study and a control group of 743 participants (743 eyes) who did not undergo cataract surgery. METHODS: We defined the "split date" as the study visit date at which cataract surgery was reported in the cataract surgery group and a corresponding date in the control group. Preoperative IOP was defined as the mean IOP of up to 3 visits before the split date. Postoperative IOP was the mean IOP of up to 3 visits including the split date (0, 6, and 12 months' with "0 months" equaling the split date). In both groups, we censored data after initiation of ocular hypotensive medication or glaucoma surgery of any kind. MAIN OUTCOME MEASURES: Difference in preoperative and postoperative IOP. RESULTS: In the cataract group, postoperative IOP was significantly lower than the preoperative IOP (19.8 ± 3.2 mmHg vs. 23.9 ± 3.2 mmHg; P<0.001). The postoperative IOP remained lower than the preoperative IOP for at least 36 months. The average decrease in postoperative IOP from preoperative IOP was 16.5%, and 39.7% of eyes had postoperative IOP ≥ 20% below preoperative IOP. A greater reduction in postoperative IOP occurred in the eyes with the highest preoperative IOP. In the control group, the corresponding mean IOPs were 23.8 ± 3.6 before the split date and 23.4 ± 3.9 after the split date. CONCLUSIONS: Cataract surgery decreases IOP in patients with ocular hypertension over a long period of time.

25 Article Regional variations and trends in the prevalence of diagnosed glaucoma in the Medicare population. 2012

Cassard, Sandra D / Quigley, Harry A / Gower, Emily W / Friedman, David S / Ramulu, Pradeep Y / Jampel, Henry D. ·Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. scassar1@jhmi.edu ·Ophthalmology · Pubmed #22480741.

ABSTRACT: PURPOSE: To determine the prevalence of diagnosed glaucoma in the Medicare population and to assess regional variations and trends. DESIGN: Retrospective, cross-sectional study. PARTICIPANTS: A 5% random sample of Medicare beneficiaries aged ≥ 65 years, excluding those in health maintenance organizations. METHODS: All claims with a glaucoma diagnosis code submitted by ophthalmologists, optometrists, or ambulatory surgery centers were used to estimate prevalence of the diagnosis of glaucoma for each year from 2002 to 2008. Regional variation in diagnosed glaucoma was examined in 9 large geographic regions and in 179 smaller subregions, controlling for patient characteristics and provider supply. MAIN OUTCOME MEASURES: The prevalence of diagnosed open-angle glaucoma suspect (OAG-s), open-angle glaucoma (OAG), angle-closure glaucoma suspect (ACG-s), and angle-closure glaucoma (ACG), trends over time, and regional variations in prevalence. RESULTS: The overall prevalence increased from 10.4% in 2002 to 11.9% by 2008, largely owing to increase in diagnosed OAG-s (from 3.2% to 4.5%; P<0.001). The relative prevalence of diagnosed OAG compared with diagnosed ACG was 32:1. In 2008, multivariable models showed that the New England and Mid-Atlantic regions had 1.7 times more diagnosed OAG-s than the reference region (East South Central; New England: odds ratio [OR], 1.66; 95% confidence interval [CI], 1.58-1.75; Mid-Atlantic: OR, 1.66; 95% CI, 1.59-1.73). The odds of diagnosed OAG was 36% higher in New England (OR, 1.36; 95% CI, 1.30-1.42) and 31% higher in the Mid-Atlantic (OR, 1.31; 95% CI, 1.26-1.36) than in the reference region. The New England and Mid-Atlantic regions had the highest odds of diagnosed ACG-s and the Mid-Atlantic region had the highest odds of diagnosed ACG. Among 179 subregions, the New York area had high diagnosis rates of all glaucoma types. CONCLUSIONS: The relative prevalence of diagnosed ACG compared with diagnosed OAG was lower than expected from population-based data, possibly owing to failure to perform gonioscopy. Substantial regional differences in diagnosed rates existed for all types of glaucoma, even after adjusting for patient characteristics and provider concentration, suggesting possible overdiagnosis in some areas and/or underdiagnosis in other areas. Regionally higher diagnosis rates in the New York area deserve further study.

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