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Glaucoma: HELP
Articles by Carlos Gustavo Vasconcelos de Moraes
Based on 105 articles published since 2008
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Between 2008 and 2019, C. G. de Moraes wrote the following 105 articles about Glaucoma.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5
1 Editorial The importance of combining structure and function to measure rates of progression in glaucoma. 2018

De Moraes, Carlos Gustavo. ·Columbia University Medical Center, New York, NY, USA. demoraesmd@gmail.com. ·Graefes Arch Clin Exp Ophthalmol · Pubmed #29623459.

ABSTRACT: -- No abstract --

2 Editorial Bridging the major prospective National Eye Institute-sponsored glaucoma clinical trials and clinical practice. 2011

De Moraes, Carlos Gustavo / Ritch, Robert / Liebmann, Jeffrey M. · ·J Glaucoma · Pubmed #20436371.

ABSTRACT: -- No abstract --

3 Review Detection and measurement of clinically meaningful visual field progression in clinical trials for glaucoma. 2017

De Moraes, C Gustavo / Liebmann, Jeffrey M / Levin, Leonard A. ·Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Medical Center, 635 W. 165th Street, New York, NY 10032, USA. · Department of Ophthalmology, McGill University, McGill Academic Eye Centre, 5252 Boul de Maisonneuve West, 4th Floor, Montreal, Quebec H4A 3S5, Canada; Department of Ophthalmology and Visual Sciences, University of Wisconsin, 2880 University Avenue, Madison, WI, USA. Electronic address: leonard.levin@mcgill.ca. ·Prog Retin Eye Res · Pubmed #27773767.

ABSTRACT: Glaucomatous visual field progression has both personal and societal costs and therefore has a serious impact on quality of life. At the present time, intraocular pressure (IOP) is considered to be the most important modifiable risk factor for glaucoma onset and progression. Reduction of IOP has been repeatedly demonstrated to be an effective intervention across the spectrum of glaucoma, regardless of subtype or disease stage. In the setting of approval of IOP-lowering therapies, it is expected that effects on IOP will translate into benefits in long-term patient-reported outcomes. Nonetheless, the effect of these medications on IOP and their associated risks can be consistently and objectively measured. This helps to explain why regulatory approval of new therapies in glaucoma has historically used IOP as the outcome variable. Although all approved treatments for glaucoma involve IOP reduction, patients frequently continue to progress despite treatment. It would therefore be beneficial to develop treatments that preserve visual function through mechanisms other than lowering IOP. The United States Food and Drug Administration (FDA) has stated that they will accept a clinically meaningful definition of visual field progression using Glaucoma Change Probability criteria. Nonetheless, these criteria do not take into account the time (and hence, the speed) needed to reach significant change. In this paper we provide an analysis based on the existing literature to support the hypothesis that decreasing the rate of visual field progression by 30% in a trial lasting 12-18 months is clinically meaningful. We demonstrate that a 30% decrease in rate of visual field progression can be reliably projected to have a significant effect on health-related quality of life, as defined by validated instruments designed to measure that endpoint.

4 Review Management of advanced glaucoma: Characterization and monitoring. 2016

de Moraes, C Gustavo / Liebmann, Jeffrey M / Medeiros, Felipe A / Weinreb, Robert N. ·Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York, USA. Electronic address: gustavo.demoraes@columbia.edu. · Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York, USA. · Shiley Eye Institute, Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, La Jolla, California, USA. ·Surv Ophthalmol · Pubmed #27018149.

ABSTRACT: Recent advances in glaucoma diagnosis focus on diagnosing the disease in early stages. Despite the importance of such efforts, a meaningful proportion of patients present in advanced stages. The cost for treatment and monitoring of advanced glaucoma often exceeds that with earlier disease, not to mention the significant effect of visual impairment on quality of life. Moreover, structural and functional tests used to monitor changes encounter technical limitations in advanced cases that can delay detection of true progression. New technologies and methods to analyze longitudinal data may prove helpful for monitoring patients with advanced glaucoma and reduce the burdens of the disease.

5 Review Discussion: future directions. 2013

De Moraes, Carlos Gustavo. ·Department of Ophthalmology, New York University School of Medicine, New York, NY, USA. ·J Glaucoma · Pubmed #23733130.

ABSTRACT: -- No abstract --

6 Review Glaucomatous damage of the macula. 2013

Hood, Donald C / Raza, Ali S / de Moraes, Carlos Gustavo V / Liebmann, Jeffrey M / Ritch, Robert. ·Department of Psychology, Columbia University, New York, NY 10027-7004, USA. dch3@columbia.edu ·Prog Retin Eye Res · Pubmed #22995953.

ABSTRACT: There is a growing body of evidence that early glaucomatous damage involves the macula. The anatomical basis of this damage can be studied using frequency domain optical coherence tomography (fdOCT), by which the local thickness of the retinal nerve fiber layer (RNFL) and local retinal ganglion cell plus inner plexiform (RGC+) layer can be measured. Based upon averaged fdOCT results from healthy controls and patients, we show that: 1. For healthy controls, the average RGC+ layer thickness closely matches human histological data; 2. For glaucoma patients and suspects, the average RGC+ layer shows greater glaucomatous thinning in the inferior retina (superior visual field (VF)); and 3. The central test points of the 6° VF grid (24-2 test pattern) miss the region of greatest RGC+ thinning. Based upon fdOCT results from individual patients, we have learned that: 1. Local RGC+ loss is associated with local VF sensitivity loss as long as the displacement of RGCs from the foveal center is taken into consideration; and 2. Macular damage is typically arcuate in nature and often associated with local RNFL thinning in a narrow region of the disc, which we call the macular vulnerability zone (MVZ). According to our schematic model of macular damage, most of the inferior region of the macula projects to the MVZ, which is located largely in the inferior quadrant of the disc, a region that is particularly susceptible to glaucomatous damage. A small (cecocentral) region of the inferior macula, and all of the superior macula (inferior VF), project to the temporal quadrant, a region that is less susceptible to damage. The overall message is clear; clinicians need to be aware that glaucomatous damage to the macula is common, can occur early in the disease, and can be missed and/or underestimated with standard VF tests that use a 6° grid, such as the 24-2 VF test.

7 Review Posture-induced intraocular pressure changes: considerations regarding body position in glaucoma patients. 2010

Prata, Tiago Santos / De Moraes, Carlos G V / Kanadani, Fabio N / Ritch, Robert / Paranhos, Augusto. ·Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil. ·Surv Ophthalmol · Pubmed #20637484.

ABSTRACT: Although glaucoma is a multifactorial disease, elevated intraocular pressure (IOP) remains the most important known risk factor. Different systemic and local factors are thought to influence an individual's IOP. There can be a clinically significant rise in IOP when going from upright to horizontal or inverted body positions. Although there is a significant interindividual variability, the magnitude of the IOP change is greater in glaucomatous eyes. As patients usually spend a significant portion of their lives in the horizontal position, mainly during sleep, this is highly relevant. In this review we discuss the relationship between postural changes and IOP fluctuation, including changes in both body and head position. The possible mechanisms involved and the main implications for glaucomatous eyes are discussed. Finally, considerations with regard to sleep position in glaucoma patients are made based on evidence in the literature.

8 Clinical Trial Intraocular Pressure Rise in Subjects with and without Glaucoma during Four Common Yoga Positions. 2015

Jasien, Jessica V / Jonas, Jost B / de Moraes, C Gustavo / Ritch, Robert. ·Einhorn Clinical Research Center, New York Ear Eye and Ear Infirmary of Mount Sinai, New York, New York, United States of America. · Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Seegartenklinik Heidelberg, Germany. · Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States of America. ·PLoS One · Pubmed #26698309.

ABSTRACT: PURPOSE: To measure changes in intraocular pressure (IOP) in association with yoga exercises with a head-down position. METHODS: The single Center, prospective, observational study included 10 subjects with primary open-angle glaucoma and 10 normal individuals, who performed the yoga exercises of Adho Mukha Svanasana, Uttanasana, Halasana and Viparita Karani for two minutes each. IOP was measured by pneumatonometry at baseline and during and after the exercises. RESULTS: All yoga poses were associated with a significant (P < 0.01) rise in IOP within one minute after assuming the yoga position. The highest IOP increase (P < 0.01) was measured in the Adho Mukha Svanasana position (IOP increase from 17 ± 3.2 mmHg to 28 ± 3.8 mmHg in glaucoma patients; from 17 ± 2.8 mmHg to 29 ± 3.9 mmHg in normal individuals), followed by the Uttanasana position (17 ± 3.9 mmHg to 27 ± 3.4 mmHg (glaucoma patients) and from 18 ± 2.5 mmHg to 26 ± 3.6 mmHg normal individuals)), the Halasana position (18 ± 2.8 mmHg to 24 ± 3.5 mmHg (glaucoma patients); 18 ± 2.7 mmHg to 22 ± 3.4 mmHg (normal individuals)), and finally the Viparita Kirani position (17 ± 4 mmHg to 21 ± 3.6 mmHg (glaucoma patients); 17 ± 2.8 to 21 ± 2.4 mmHg (normal individuals)). IOP dropped back to baseline values within two minutes after returning to a sitting position. Overall, IOP rise was not significantly different between glaucoma and normal subjects (P = 0.813), all though glaucoma eyes tended to have measurements 2 mm Hg higher on average. CONCLUSIONS: Yoga exercises with head-down positions were associated with a rapid rise in IOP in glaucoma and healthy eyes. IOP returned to baseline values within 2 minutes. Future studies are warranted addressing whether yoga exercise associated IOP changes are associated with similar changes in cerebrospinal fluid pressure and whether they increase the risk of glaucoma progression. TRIAL REGISTRATION: ClinicalTrials.gov #NCT01915680.

9 Clinical Trial Risk factors for optic disc hemorrhage in the low-pressure glaucoma treatment study. 2014

Furlanetto, Rafael L / De Moraes, Carlos Gustavo / Teng, Christopher C / Liebmann, Jeffrey M / Greenfield, David S / Gardiner, Stuart K / Ritch, Robert / Krupin, Theodore / Anonymous3200784. ·Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York. · Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York. Electronic address: demoraesmd@gmail.com. · Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York. · Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, Florida. · Devers Eye Institute, Legacy Health, Portland, Oregon. · Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York; Department of Ophthalmology, New York Medical College, Valhalla, New York. · Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; The Chicago Center for Vision Research, Chicago, Illinois. ·Am J Ophthalmol · Pubmed #24513094.

ABSTRACT: PURPOSE: To investigate risk factors for disc hemorrhage detection in the Low-Pressure Glaucoma Treatment Study. DESIGN: Cohort of a randomized, double-masked, multicenter clinical trial. METHODS: Low-Pressure Glaucoma Treatment Study patients with at least 16 months of follow-up were included. Exclusion criteria included untreated intraocular pressure (IOP) of more than 21 mm Hg, visual field mean deviation worse than -16 dB, or contraindications to study medications. Patients were randomized to topical treatment with timolol 0.5% or brimonidine 0.2%. Stereophotographs were reviewed independently by 2 masked graders searching for disc hemorrhages. The main outcomes investigated were the detection of disc hemorrhage at any time during follow-up and their recurrence. Ocular and systemic risk factors for disc hemorrhage detection were analyzed using the Cox proportional hazards model and were tested further for independence in a multivariate model. RESULTS: Two hundred fifty-three eyes of 127 subjects (mean age, 64.7 ± 10.9 years; women, 58%; European ancestry, 71%) followed up for an average ± standard deviation of 40.6 ± 12 months were included. In the multivariate analysis, history of migraine (hazard ratio [HR], 5.737; P = .012), narrower neuroretinal rim width at baseline (HR, 2.91; P = .048), use of systemic β-blockers (HR, 5.585; P = .036), low mean systolic blood pressure (HR, 1.06; P = .02), and low mean arterial ocular perfusion pressure during follow-up (HR, 1.172; P = .007) were significant and independent risk factors for disc hemorrhage detection. Treatment randomization was not associated with either the occurrence or recurrence of disc hemorrhages. CONCLUSIONS: In this cohort of Low-Pressure Glaucoma Treatment Study patients, migraine, baseline narrower neuroretinal rim width, low systolic blood pressure and mean arterial ocular perfusion pressure, and use of systemic β-blockers were risk factors for disc hemorrhage detection. Randomization assignment did not influence the frequency of disc hemorrhage detection.

10 Article Spatial correlation between localized decreases in exploratory visual search performance and areas of glaucomatous visual field loss. 2019

Senger, Cassia / da Silva, Marcelo Jordão Lopes / De Moraes, Carlos Gustavo / Messias, André / Paula, Jayter Silva. ·Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School- University of São Paulo, Av. Bandeirantes, 3900 - 12°. Andar. Ribeirão Preto, São Paulo, Brazil. · Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA. · Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School- University of São Paulo, Av. Bandeirantes, 3900 - 12°. Andar. Ribeirão Preto, São Paulo, Brazil. jspaula@fmrp.usp.br. ·Graefes Arch Clin Exp Ophthalmol · Pubmed #30368564.

ABSTRACT: BACKGROUND: Visual search is a critical skill for several daily tasks and may be compromised in patients with impaired vision. The objective of this study was to study the relationships between exploratory visual search performance (EVSP) visual field (VF) sensitivity in patients with glaucoma. METHODS: Primary open-angle glaucoma patients (POAG; n = 29) and healthy (Control; n = 28) individuals with best corrected visual acuity better than 0.2 logMAR underwent a comprehensive ophthalmological examination, including Humphrey VF tests (24-2 SITA-Standard), and a monocular exploratory visual search digit-based task performed using a software that quantifies the time spent to find a targert on a random array of digits distributed on nine sequential screens. The screens were divided into five areas to topographically match with five VF sectors. RESULTS: As expected, POAG eyes had worse VF mean deviation (MD) sensitivity and EVSP than Controls (MD - 8.02 ± 7.88 dB vs - 1.43 ± 1.50 dB, p < 0.0001; and total EVSP time 106.42 ± 59.64 s vs 52.75 ± 19.07 s, p < 0.0001). MD sensitivity of both groups significantly correlated with total EVSP time (POAG r = - 0.45, p = 0.01; and Control r = 0.37, p = 0.049). A significant relationship was observed between EVSP (individual time) and both visual acuity (p = 0.006) and glaucoma diagnosis (p = 0.005). The mean sensitivity of the peripheral VF areas of the POAG group showed significant correlation with the individual search time in the corresponding spatial areas, except in the peripheral superior temporal area (r = - 0.35, p = 0.06). CONCLUSION: These data indicate that POAG patients' EVSP is impaired in topographically-correspondent VF areas with sensitivity loss. Visual search may be considered as a measure of impairment of daily activities in glaucoma patients, if further similar tests using binocular conditions corroborate our findings.

11 Article Challenges to the Common Clinical Paradigm for Diagnosis of Glaucomatous Damage With OCT and Visual Fields. 2018

Hood, Donald C / De Moraes, Carlos Gustavo. ·Department of Psychology, Columbia University, New York, New York, United States. · Department of Ophthalmology, Columbia University, New York, New York, United States. ·Invest Ophthalmol Vis Sci · Pubmed #29392325.

ABSTRACT: The most common clinical paradigm (CCP) for diagnosing glaucoma includes a visual field (VF) with a 6° test grid (e.g., the 24-2 or 30-2 test pattern) and an optical coherence tomography (OCT) scan of the optic disc. Furthermore, these tests are assessed based upon quantitative metrics (e.g., the pattern standard deviation [PSD] of the VF and the global retinal nerve fiber thickness of the OCT disc scan). This CCP is facing three challenges. First, the macular region (i.e., ±8° from fixation) is affected early in the glaucomatous process, and the CCP can miss and/or underestimate the damage. Second, use of the typical VF and OCT metrics underestimates the degree of agreement between structural (OCT) and functional (VF) damage. Third, resolution of the OCT scan has improved, and local glaucomatous damage can be visualized like never before. However, the clinician often does not look at the OCT scan image. Together these challenges argue for a modification of the VF test pattern and OCT protocol, replacement of metrics with a comparison of abnormal regions on VF and OCT, and careful inspection of actual OCT scan images. In principle, the CCP could be modified easily. In practice, change is facing a number of impediments.

12 Article Deep Defects Seen on Visual Fields Spatially Correspond Well to Loss of Retinal Nerve Fiber Layer Seen on Circumpapillary OCT Scans. 2018

Mavrommatis, Maria A / Wu, Zhichao / Naegele, Saskia I / Nunez, Jason / De Moraes, Carlos Gustavo / Ritch, Robert / Hood, Donald C. ·Department of Psychology, Columbia University Visual Science Lab, New York, New York, United States. · Department of Ophthalmology, Columbia University, New York, New York, United States. · Department of Ophthalmology, New York Eye and Ear Infirmary, New York, New York, United States. ·Invest Ophthalmol Vis Sci · Pubmed #29392306.

ABSTRACT: Purpose: To examine the structure-function relationship in glaucoma between deep defects on visual fields (VF) and deep losses in the circumpapillary retinal nerve fiber layer (cpRNFL) on optical coherence tomography (OCT) circle scans. Methods: Thirty two glaucomatous eyes with deep VF defects, as defined by at least one test location worse than ≤ -15 dB on the 10-2 and/or 24-2 VF pattern deviation (PD) plots, were included from 87 eyes with "early" glaucoma (i.e., 24-2 mean deviation better than -6 dB). Using the location of the deep VF points and a schematic model, the location of local damage on an OCT circle scan was predicted. The thinnest location of cpRNFL (i.e., deepest loss) was also determined. Results: In 19 of 32 eyes, a region of complete or near complete cpRNFL loss was observed. All 19 of these had deep VF defects on the 24-2 and/or 10-2. All of the 32 eyes with deep VF defects had abnormal cpRNFL regions (red, 1%) and all but 2 had a region of cpRNFL thickness <21 μm. The midpoint of the VF defect and the location of deepest cpRNFL had a 95% limit of agreement within approximately two-thirds of a clock-hour (or 30°) sector (between -22.1° to 25.2°). Individual fovea-to-disc angle (FtoDa) adjustment improved agreement in one eye with an extreme FtoDa. Conclusions: Although studies relating local structural (OCT) and functional (VF) measures typically show poor to moderate correlations, there is good qualitative agreement between the location of deep cpRNFL loss and deep defects on VFs.

13 Article Baseline 24-2 Central Visual Field Damage Is Predictive of Global Progressive Field Loss. 2018

Garg, Aakriti / De Moraes, C Gustavo / Cioffi, George A / Girkin, Christopher A / Medeiros, Felipe A / Weinreb, Robert N / Zangwill, Linda M / Liebmann, Jeffrey M. ·Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York. · Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York. Electronic address: gustavo.demoraes@columbia.edu. · School of Medicine, University of Alabama-Birmingham, Birmingham, Alabama. · Hamilton Glaucoma Center, Department of Ophthalmology, University of California-San Diego, San Diego, California. ·Am J Ophthalmol · Pubmed #29317211.

ABSTRACT: PURPOSE: Central visual field (VF) damage in glaucoma patients can significantly hinder daily activities. The present study investigates whether the presence of localized baseline damage to the central 10 degrees of the VF is predictive of faster global mean deviation (MD) progression. DESIGN: Prospective cohort study. METHODS: Eyes from the multicenter African Descent and Glaucoma Evaluation Study (ADAGES) with established glaucoma and VF loss and a minimum of 5 24-2 VFs were eligible. Baseline central 24-2 damage was defined as any of the 12 central-most points with total deviation (TD) values at P < 0.5% on 2 consecutive examinations. Progression was determined using trend-based and event-based criteria: (1) rates of MD change significantly faster than zero and (2) >-5 dB MD loss over the entire follow-up. RESULTS: A total of 827 eyes of 584 patients were studied. Mean rate of MD change of the entire sample was -0.15 dB/year (95% CI: -0.19 to -0.12, P < .001). Eyes with baseline central damage progressed faster than those without (difference: β CONCLUSION: The presence of central VF damage at baseline is significantly associated with more rapid global progression. Detection of central VF damage aids in stratification of high-risk patients who may need intensive surveillance and aggressive treatment.

14 Article Reversal of Glaucoma Hemifield Test Results and Visual Field Features in Glaucoma. 2018

Wang, Mengyu / Pasquale, Louis R / Shen, Lucy Q / Boland, Michael V / Wellik, Sarah R / De Moraes, Carlos Gustavo / Myers, Jonathan S / Wang, Hui / Baniasadi, Neda / Li, Dian / Silva, Rafaella Nascimento E / Bex, Peter J / Elze, Tobias. ·Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts. · Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. · Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts. · Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland. · Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida. · Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York. · Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania. · Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts; Institute for Psychology and Behavior, Jilin University of Finance and Economics, Changchun, China. · Department of Psychology, Northeastern University, Boston, Massachusetts. · Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts; Max Planck Institute for Mathematics in the Sciences, Leipzig, Germany. Electronic address: tobias-elze@tobias-elze.de. ·Ophthalmology · Pubmed #29103791.

ABSTRACT: PURPOSE: To develop a visual field (VF) feature model to predict the reversal of glaucoma hemifield test (GHT) results to within normal limits (WNL) after 2 consecutive outside normal limits (ONL) results. DESIGN: Retrospective cohort study. PARTICIPANTS: Visual fields of 44 503 eyes from 26 130 participants. METHODS: Eyes with 3 or more consecutive reliable VFs measured with the Humphrey Field Analyzer (Swedish interactive threshold algorithm standard 24-2) were included. Eyes with ONL GHT results for the 2 baseline VFs were selected. We extracted 3 categories of VF features from the baseline tests: (1) VF global indices (mean deviation [MD] and pattern standard deviation), (2) mismatch between baseline VFs, and (3) VF loss patterns (archetypes). Logistic regression was applied to predict the GHT results reversal. Cross-validation was applied to evaluate the model on testing data by the area under the receiver operating characteristic curve (AUC). We ascertained clinical glaucoma status on a patient subset (n = 97) to determine the usefulness of our model. MAIN OUTCOME MEASURES: Predictive models for GHT results reversal using VF features. RESULTS: For the 16 604 eyes with 2 initial ONL results, the prevalence of a subsequent WNL result increased from 0.1% for MD < -12 dB to 13.8% for MD ≥-3 dB. Compared with models with VF global indices, the AUC of predictive models increased from 0.669 (MD ≥-3 dB) and 0.697 (-6 dB ≤ MD < -3 dB) to 0.770 and 0.820, respectively, by adding VF mismatch features and computationally derived VF archetypes (P < 0.001 for both). The GHT results reversal was associated with a large mismatch between baseline VFs. Moreover, the GHT results reversal was associated more with VF archetypes of nonglaucomatous loss, severe widespread loss, and lens rim artifacts. For a subset of 97 eyes, using our model to predict absence of glaucoma based on clinical evidence after 2 ONL results yielded significantly better prediction accuracy (87.7%; P < 0.001) than predicting GHT results reversal (68.8%) with a prescribed specificity 67.7%. CONCLUSIONS: Using VF features may predict the GHT results reversal to WNL after 2 consecutive ONL results.

15 Article Hybrid Deep Learning on Single Wide-field Optical Coherence tomography Scans Accurately Classifies Glaucoma Suspects. 2017

Muhammad, Hassan / Fuchs, Thomas J / De Cuir, Nicole / De Moraes, Carlos G / Blumberg, Dana M / Liebmann, Jeffrey M / Ritch, Robert / Hood, Donald C. ·Department of Physiology, Biophysics, and Systems Biology, Weill Cornell Medicine. · Departments of Medical Physics. · Computational Biology. · Pathology, Memorial Sloan Kettering Cancer Center. · Departments of Psychology. · The College of Physicians and Surgeons, Columbia University. · Ophthalmology. · Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY. ·J Glaucoma · Pubmed #29045329.

ABSTRACT: PURPOSE: Existing summary statistics based upon optical coherence tomographic (OCT) scans and/or visual fields (VFs) are suboptimal for distinguishing between healthy and glaucomatous eyes in the clinic. This study evaluates the extent to which a hybrid deep learning method (HDLM), combined with a single wide-field OCT protocol, can distinguish eyes previously classified as either healthy suspects or mild glaucoma. METHODS: In total, 102 eyes from 102 patients, with or suspected open-angle glaucoma, had previously been classified by 2 glaucoma experts as either glaucomatous (57 eyes) or healthy/suspects (45 eyes). The HDLM had access only to information from a single, wide-field (9×12 mm) swept-source OCT scan per patient. Convolutional neural networks were used to extract rich features from maps derived from these scans. Random forest classifier was used to train a model based on these features to predict the existence of glaucomatous damage. The algorithm was compared against traditional OCT and VF metrics. RESULTS: The accuracy of the HDLM ranged from 63.7% to 93.1% depending upon the input map. The retinal nerve fiber layer probability map had the best accuracy (93.1%), with 4 false positives, and 3 false negatives. In comparison, the accuracy of the OCT and 24-2 and 10-2 VF metrics ranged from 66.7% to 87.3%. The OCT quadrants analysis had the best accuracy (87.3%) of the metrics, with 4 false positives and 9 false negatives. CONCLUSIONS: The HDLM protocol outperforms standard OCT and VF clinical metrics in distinguishing healthy suspect eyes from eyes with early glaucoma. It should be possible to further improve this algorithm and with improvement it might be useful for screening.

16 Article Intraocular Pressure Responses to Maximal Cycling Sprints Against Different Resistances: The Influence of Fitness Level. 2017

Vera, Jesús / Jiménez, Raimundo / Redondo, Beatriz / Cárdenas, David / De Moraes, Carlos Gustavo / Garcia-Ramos, Amador. ·*Department of Optics, Faculty of Science †Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain ‡Department of Ophthalmology, Columbia University Medical Centre, New York, NY §Universidad Católica de la Santísima Concepción, Facultad de Educación, Concepción, Chile. ·J Glaucoma · Pubmed #28834828.

ABSTRACT: PURPOSE: This study investigated the acute effect of maximal cycling sprint against difference resistances on intraocular pressure (IOP) depending on participants' fitness level. METHODS: In total, 26 physically active collegiate men performed 5 maximal cycling sprints against different resistances in a randomized order, and IOP was measured immediately before and after each sprint. Participants were divided in 2 subgroups (low fit and high fit) according to their maximum power output relative to body weight to assess the influence of fitness level. Two identical testing sessions were performed to assess the repeatability of IOP values. RESULTS: We found that IOP decreases with the lightest resistance (P<0.01), whereas IOP increases with heavier resistances (P<0.01), and it showed a positive linear tendency (r=0.99). Our results suggest that participants' fitness level seems to influence IOP responses, with a more stable response in the high-fit group. A strong intersession repeatability of IOP values was observed (intraclass correlation coefficient range, 0.82 to 0.98; coefficients of variations range, 1.76% to 6.23%). CONCLUSIONS: We conclude that (1) IOP is sensitive to cycling resistance in all-out sprints, with a lowering effect on the lightest resistance and an increasing effect with medium and heavy resistances, (2) high fitness level is beneficial to avoid IOP fluctuations during sprints, and (3) these changes are comparable when measured on 2 different days under the same experimental conditions. A progressive involvement in physical activity may be desirable to avoid IOP peaks during highly demanding physical effort. Future studies are needed to clarify the consequences of exercise in glaucoma patients.

17 Article Impact of Natural Blind Spot Location on Perimetry. 2017

Wang, Mengyu / Shen, Lucy Q / Boland, Michael V / Wellik, Sarah R / De Moraes, Carlos Gustavo / Myers, Jonathan S / Bex, Peter J / Elze, Tobias. ·Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA. · Mass. Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA. · Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL, USA. · Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA. · Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA. · Department of Psychology, Northeastern University, Boston, MA, USA. · Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA. tobias_elze@meei.harvard.edu. ·Sci Rep · Pubmed #28733615.

ABSTRACT: We study the spatial distribution of natural blind spot location (NBSL) and its impact on perimetry. Pattern deviation (PD) values of 11,449 reliable visual fields (VFs) that are defined as clinically unaffected based on summary indices were extracted from 11,449 glaucoma patients. We modeled NBSL distribution using a two-dimensional non-linear regression approach and correlated NBSL with spherical equivalent (SE). Additionally, we compared PD values of groups with longer and shorter distances than median, and larger and smaller angles than median between NBSL and fixation. Mean and standard deviation of horizontal and vertical NBSL were 14.33° ± 1.37° and -2.06° ± 1.27°, respectively. SE decreased with increasing NBSL (correlation: r = -0.14, p < 0.001). For NBSL distances longer than median distance (14.32°), average PD values decreased in the upper central (average difference for significant points (ADSP): -0.18 dB) and increased in the lower nasal VF region (ADSP: 0.14 dB). For angles in the direction of upper hemifield relative to the median angle (-8.13°), PD values decreased in lower nasal (ADSP: -0.11 dB) and increased in upper temporal VF areas (ADSP: 0.19 dB). In conclusion, we demonstrate that NBSL has a systematic effect on the spatial distribution of VF sensitivity.

18 Article Predictive Value of the Water Drinking Test and the Risk of Glaucomatous Visual Field Progression. 2017

De Moraes, Carlos G / Susanna, Remo / Sakata, Lisandro M / Hatanaka, Marcelo. ·*Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Columbia University Medical Center, Edward S. Harkness Eye Institute, New York, NY †Department of Ophthalmology, University of Sao Paulo School of Medicine, Avenue Dr. Enéas de Carvalho Aguiar, São Paulo, SP ‡Department of Ophthalmology, Federal University of Parana School of Medicine, Rua Gen. Carneiro, Curitiba, PR, Brazil. ·J Glaucoma · Pubmed #28731935.

ABSTRACT: PURPOSE: The purpose of this is to test the hypothesis the intraocular pressure (IOP) peaks during a stress test [the water drinking test (WDT)] can estimate the risk of future visual field progression in treated primary open-angle glaucoma (POAG) patients. PATIENTS AND METHODS: Design: Prospective, longitudinal study. SETTING: Clinical practice. STUDY POPULATION: Treated POAG patients whose IOP was ≤18 mm Hg and who had no IOP-lowering interventions between the date of the WDT and the last eligible visual field. INTERVENTION: At baseline examination, patients underwent the WDT and were then followed at regular intervals with office-based IOP measurements and visual field testing. MAIN OUTCOME MEASURE: Cox-proportional hazards survival analysis testing the predictive value of IOP peaks during the WDT versus IOP measurements during office hours on visual field progression. RESULTS: A total of 144 eyes of 96 patients with baseline visual field damage ranging from mild to severe followed for a mean of 28 months were analyzed. In the multivariable analysis adjusting for potential confounders, higher IOP peaks during the WDT were predictive of future visual field progression (hazard ratio=1.11; 95% confidence interval, 1.02 to 1.21; P=0.013). The average and peak IOP during office hours over the same follow-up period were not significantly associated with progression (P=0.651 and 0.569, respectively). CONCLUSIONS: IOP peaks detected with the WDT were predictive of future visual field progression in a treated POAG population. This stress test could be a useful tool for risk assessment in daily practice.

19 Article Measuring Rates of Visual Field Progression in Linear Versus Nonlinear Scales: Implications for Understanding the Relationship Between Baseline Damage and Target Rates of Glaucoma Progression. 2017

Liebmann, Kevin / De Moraes, Carlos Gustavo / Liebmann, Jeffrey M. ·*Department of Biology, University of Miami, Miami, FL †Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Columbia University Medical Center, New York, NY. ·J Glaucoma · Pubmed #28692594.

ABSTRACT: PURPOSE: The purpose of this study is to test the hypothesis that the relationship between baseline visual field damage and the rate of progression depends upon the use of logarithmic (dB) versus linear (1/Lambert) scale. METHODS: A total of 60 eyes (60 patients) with treated, established glaucoma and at least 5 reliable 24-2 visual fields were included. Baseline visual field mean deviation (MD) in dB was transformed to 1/Lambert using standard equation. Mixed effects linear regression was used to calculate the slopes (MD rates of progression over time) with linear and nonlinear scales. We tested the relationship between baseline MD and MD slopes for each scale of measure. RESULTS: In dB scale, worse baseline visual field loss was associated with faster MD slopes (P=0.037), whereas the opposite effect was seen in 1/Lambert (P=0.001). For a similar rate of progression in dB/y, eyes with mild visual field damage lost more linear sensitivity over a given period of time than those with more severe baseline damage. CONCLUSIONS: There is a significant relationship between baseline visual field severity and rates of MD progression, although the direction of this association depends on the scale sensitivity is measured. The definition of fast versus slow visual field progression should be revised and take into account that sensitivity in linear scales show a better correlation with structural loss than when conventionally measured in nonlinear scale.

20 Article Association of Glaucoma-Related, Optical Coherence Tomography-Measured Macular Damage With Vision-Related Quality of Life. 2017

Prager, Alisa J / Hood, Donald C / Liebmann, Jeffrey M / De Moraes, C Gustavo / Al-Aswad, Lama A / Yu, Qi / Cioffi, George A / Blumberg, Dana M. ·Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York. · Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York2Department of Psychology, Columbia University, New York, New York. ·JAMA Ophthalmol · Pubmed #28594977.

ABSTRACT: Importance: Little is known about the association between structural macular damage and self-reported visual function of people with glaucoma. Objective: To determine the association between vision-related quality of life among patients with primary open-angle glaucoma with structural macular retinal ganglion cell plus inner plexiform layer (RGC+IPL) loss identified by spectral-domain optical coherence tomography (SD-OCT) machine-generated deviation maps and thickness measurements. Design, Setting, and Participants: This cross-sectional prospective study was conducted from March 1, 2014, to March 30, 2015, at the Department of Ophthalmology at Columbia University Medical Center. The participants were 107 patients who were enrolled in the study and represented the entire range of glaucomatous damage. All 214 eyes of the 107 participants underwent 10-2 visual field tests and SD-OCT scans, and all participants completed the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). They also received ophthalmologic examination, including medical history review, best-corrected visual acuity, slitlamp biomicroscopy, intraocular pressure measurement, gonioscopy, dilated ophthalmoscopy, and standard automated perimetry. Macular RGC+IPL loss was determined by diffuse or focal patterns on SD-OCT-generated deviation maps (probability map that compared patients with aged-matched normative database) and thickness measurements. Main Outcomes and Measures: Regression analyses to assess the association of NEI VFQ-25 scores (score range: 41.9-99.5; higher scores indicate better functioning) with patterns of RGC+IPL loss and with RGC+IPL thickness measurements. Results: Of the 107 patients, 48 (45%) were men and the mean (SD) age was 65 (11) years. The self-reported race/ethnicity of participants consisted of 45 (46%) black, 47 (48%) white, and 6 (6%) "other" individuals. In the univariable analyses, patients with diffuse macular RGC+IPL loss had mean composite Rasch-calibrated NEI VFQ-25 scores that were 6.15 points lower than the scores of patients with focal damage (β = -6.15; 95% CI, -11.7 to -0.59; P = .03). The effect remained significant even after controlling for mean RGC+IPL thickness (β = -7.64; 95% CI, -14.2 to -1.03; P = .02). Conclusions and Relevance: Characteristic patterns of glaucoma-related macular RGC+IPL loss appeared to be more important predictors of vision-related quality of life than thickness measures, with diffuse RGC+IPL loss as an indicator for diminished vision-related quality of life.

21 Article 24-2 Visual Fields Miss Central Defects Shown on 10-2 Tests in Glaucoma Suspects, Ocular Hypertensives, and Early Glaucoma. 2017

De Moraes, C Gustavo / Hood, Donald C / Thenappan, Abinaya / Girkin, Christopher A / Medeiros, Felipe A / Weinreb, Robert N / Zangwill, Linda M / Liebmann, Jeffrey M. ·Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York. Electronic address: gustavo.demoraes@columbia.edu. · Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York; Columbia University, New York, New York. · Columbia University, New York, New York. · School of Medicine, University of Alabama-Birmingham, Birmingham, Alabama. · Hamilton Glaucoma Center, Department of Ophthalmology, University of California-San Diego, San Diego, California. · Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York. ·Ophthalmology · Pubmed #28551166.

ABSTRACT: PURPOSE: To investigate the prevalence of visual field defects in glaucomatous eyes, glaucoma suspects, and ocular hypertensives with 24-2 and 10-2 visual fields. DESIGN: Prospective, cross-sectional study. PARTICIPANTS: Patients with or suspected glaucoma tested with 24-2 and 10-2. Patients were classified into 3 groups on the basis of the presence of glaucomatous optic neuropathy (GON) and 24-2 visual field abnormalities: early glaucoma (GON and abnormal visual field, mean deviation >-6 decibels [dB]), glaucoma suspects (GON and normal visual field), and ocular hypertensives (normal disc, normal visual field, and intraocular pressure >22 mmHg). For the classification of visual field abnormalities, 24-2 and 10-2 tests performed on the same visit were analyzed. MAIN OUTCOME MEASURES: Comparison of the prevalence of abnormal 24-2 versus 10-2 visual field results based on cluster criteria in each diagnostic group. RESULTS: A total of 775 eyes (497 patients) were evaluated. A total of 364 eyes had early glaucoma, 303 eyes were glaucoma suspects, and 108 eyes were ocular hypertensives. In the glaucoma group, 16 of the 26 eyes (61.5%) classified as normal based on cluster criteria on 24-2 tests were classified as abnormal on 10-2 visual fields. In eyes with suspected glaucoma, 79 of the 200 eyes (39.5%) classified as normal on the 24-2 test were classified as abnormal on 10-2 visual fields. In ocular hypertensive eyes, 28 of the 79 eyes (35.4%) classified as normal on the 24-2 were classified as abnormal on the 10-2. Patients of African descent were more likely to have an abnormal 10-2 result (67.3 vs. 56.8%, P = 0.009). CONCLUSIONS: Central visual field damage seen on the 10-2 test is often missed with the 24-2 strategy in all groups. This finding has implications for the diagnosis of glaucoma and classification of severity.

22 Article Association Between Undetected 10-2 Visual Field Damage and Vision-Related Quality of Life in Patients With Glaucoma. 2017

Blumberg, Dana M / De Moraes, Carlos Gustavo / Prager, Alisa J / Yu, Qi / Al-Aswad, Lama / Cioffi, George A / Liebmann, Jeffrey M / Hood, Donald C. ·Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York. · Columbia University Medical Center, College of Physicians and Surgeons, New York, New York. · Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York3Department of Psychology, Columbia University, New York, New York. ·JAMA Ophthalmol · Pubmed #28542692.

ABSTRACT: Importance: Recent evidence supports the presence of macular damage (within 8° of the central field) to retinal ganglion cells and associated central visual field (VF) defects in glaucoma, even in early stages. Despite this, to our knowledge, the association of 10-2 VF damage with vision-related quality of life (QOL) has not been well studied. Objective: To determine the association between QOL and visual function as measured by 24-2 and 10-2 VFs in patients with primary open-angle glaucoma and to test the hypothesis that patients with vision-related QOL disproportionate to their 24-2 VF status may exhibit 10-2 damage overlooked by the 24-2 test. Design, Setting, and Participants: In this cross-sectional analysis of observational cohort study data taken from a tertiary care specialty practice, 113 patients with glaucoma with the entire range of 24-2 VF damage completed the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Data were collected from May 2014 to January 2015 and were analyzed from March 2016 to May 2016. Interventions: Standardized binocular 24-2 and 10-2 VF sensitivities were calculated for each patient. Main Outcomes and Measures: Association of binocular 24-2 and 10-2 VF sensitivity with Rasch-calibrated NEI VFQ-25 scores. Detection of outliers was based on Cook distance of the regression of binocular 24-2 and NEI VFQ-25 score. Outlier association with QOL was then assessed using a linear regression model, with binocular 10-2 VF sensitivity as the independent variable. Results: Of the 113 patients, the mean (SD) age was 70.1 (10.9) years, and 51 (45.1%) were male and 71 (62.8%) were white. The composite NEI VFQ-25 score was associated with both binocular 24-2 (β = 1.95; 95% CI, 0.47-3.43; P = .01) and 10-2 (β = 2.57; 95% CI, 1.12-4.01; P = .001) sensitivities, but the 10-2 VF univariable model showed an almost 2-fold better fit to the data (R2 = 9.2% vs 4.9%). However, the binocular 10-2 sensitivities of 24-2 outliers had the strongest association with the composite NEI VFQ-25 scores (β = 2.78; 95% CI, 0.84-4.72; P = .006.) and the best fit to the data (R2 = 18.2%.). Conclusions and Relevance: The 10-2 VF model showed a stronger association with NEI VFQ-25 score than the 24-2 VF model. Patients with disproportionately low quality of vision relative to patients with 24-2 VF damage may have damage on the central field missed by the 24-2 grid. Future prospective testing, including additional dimensions of quality of life, is indicated.

23 Article β-Zone Parapapillary Atrophy and Rates of Glaucomatous Visual Field Progression: African Descent and Glaucoma Evaluation Study. 2017

De Moraes, C Gustavo / Murphy, James T / Kaplan, Chad M / Reimann, Jeremy J / Skaat, Alon / Blumberg, Dana M / Al-Aswad, Lama / Cioffi, George A / Girkin, Christopher A / Medeiros, Felipe A / Weinreb, Robert N / Zangwill, Linda / Liebmann, Jeffrey M. ·Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York. · Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. · Department of Ophthalmology, School of Medicine, University of Alabama, Birmingham. · Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego. ·JAMA Ophthalmol · Pubmed #28494060.

ABSTRACT: Importance: β-zone parapapillary atrophy (βPPA) has been reported as a risk factor for glaucoma onset and progression. Previous studies have shown that the prevalence of βPPA differs between individuals of African descent (AD) and European descent (ED). Objective: To test whether the association between the presence and progression of βPPA vs visual field progression of glaucoma differs between these 2 ancestry groups. Design, Setting, and Participants: In a prospective, multicenter, longitudinal cohort study, 634 individuals (1090 eyes) enrolled in the African Descent and Evaluation Study (ADAGES) with a diagnosis of glaucomatous optic neuropathy (GON) or ocular hypertension (OHT) and at least 2 disc stereophotographs were included. Two graders masked to clinical and ancestry data reviewed and graded the baseline and last disc stereophotographs for the presence of βPPA at baseline and βPPA progression (development or enlargement). Mixed-effects linear models were tested with visual field mean deviation as a dependent variable and time (alone and with interaction terms) as independent variables. ADAGES enrollment began in January 2003 and ended in July 2006; follow-up ended in 2016. Exposures: Disc stereophotographs. Main Outcomes and Measures: Progression of βPPA in AD and ED individuals. Results: In 634 patients, a total of 814 eyes of AD (395 eyes) and ED (419) patients with GON and 276 eyes of AD (106) and ED (170) patients with OHT who were enrolled in ADAGES were analyzed. There were 336 (53.0%) women in the study; mean (SD) age was 61.9 (12.7) years. In the OHT group, the association between βPPA at baseline and visual field progression was not significantly different between AD and ED eyes (β = 0.071; 95% CI, -0.016 to 0.158; P = .11), nor was the association between βPPA progression and visual field progression (β = 0.020; 95% CI, -0.465 to 0.506; P = .93). In the GON group, ED eyes with baseline βPPA progressed faster than did AD eyes with baseline βPPA (β = -0.124; 95% CI, -0.241 to -0.007; P = .04), although the association between βPPA progression and visual field progression did not differ significantly between race groups (β = -0.101; 95% CI, -0.323 to 0.119; P = .37). Conclusions and Relevance: Race had a significant effect on the association between baseline βPPA and rates of visual field progression in eyes with GON. Progression of βPPA was not associated with faster visual field progression in either racial group.

24 Article Evaluation of a Novel Visual Field Analyzer Application for Automated Classification of Glaucoma Severity. 2017

Germano, Renato A S / de Moraes, Carlos Gustavo / Susanna, Remo / Dantas, Daniel O / Neto, Edson D S. ·*Department of Ophthalmology, University of Sao Paulo School of Medicine, Sao Paulo, SP ‡Department of Computer Science, Federal University of Sergipe (UFS), Sao Cristovao, Brazil †Department of Ophthalmology, Columbia University Medical Center, New York, NY. ·J Glaucoma · Pubmed #28368999.

ABSTRACT: PURPOSE: To describe the Glaucoma Staging Application (GSA), a new application for automated classification of visual field (VF) severity that can be used in any Humphrey perimeters. We also tested and validated its performance in staging glaucomatous VFs defects and assessed its reproducibility. MATERIALS AND METHODS: The GSA is based upon the modified University of São Paulo Glaucoma Visual Field Staging System, and consists of 3 sections: severity based on the visual field index; defect location based on eccentricity; and extent of topographic damage by hemifields. We analyzed 612 VFs of 32 patients. VFs were analyzed by a glaucoma expert and then compared with the output of the GSA. To evaluate the repeatability, the same search criteria were repeated 1 week later using the same GSA. The classification given by the software was considered correct if it completely agreed in all variables (severity, location, and extent of topographic damage) with the classification performed manually by the glaucoma expert. RESULTS: One hundred seventy-eight eyes were classified as early VF damage, 148 moderate, and 156 severe. One hundred thirty-one VFs were classified as normal. When repeated, 1 week later, the GSA showed excellent repeatability. The automated classification agreed with the expert's grading in 100% of cases. CONCLUSIONS: The GSA allows an automated, fast, reproducible, and objective classification system for multiple 24-2 VFs of Humphrey perimetry. This study is a proof-of-concept that could translate into a useful tool to analyze and stage VFs more objectively and thus help detecting progression of different types of VFs defects.

25 Article The Association Between Clinical Features Seen on Fundus Photographs and Glaucomatous Damage Detected on Visual Fields and Optical Coherence Tomography Scans. 2017

Alhadeff, Paula A / De Moraes, Carlos G / Chen, Monica / Raza, Ali S / Ritch, Robert / Hood, Donald C. ·*Einhorn Clinical Research Center, New York Eye and Ear Infirmary of the Mount Sinai Health System ‡Columbia University Medical Center Departments of §Ophthalmology ∥Psychology ¶Neurobiology and Behavior, Columbia University, New York, NY †Hospital do Servidor Publico Estadual, Sao Paulo, Brazil. ·J Glaucoma · Pubmed #28333890.

ABSTRACT: PURPOSE: To classify the appearance of the optic disc seen on fundus photographs of healthy subjects and patients with or suspected glaucoma whose diagnosis was based upon visual fields (VFs) and spectral-domain optical coherence tomography (sdOCT) results. PATIENTS AND METHODS: One eye of 100 patients with or suspected glaucoma and 62 healthy subjects were prospectively tested with 24-2 and 10-2 VF and macular and disc sdOCT cube scans. All eyes with or suspected glaucoma had a 24-2 mean deviation better than -6.0 dB and an abnormal appearing disc on stereophotographs. The retinal ganglion cell plus inner plexiform layer (RGC+) from the macular scans and the retinal nerve fiber layer (RNFL) from the macular and disc scans were segmented and converted to probabilities plots. An eye was considered "glaucoma" if the sdOCT probability plots showed an abnormality in a region that corresponded to a defect seen on the 24-2 and/or 10-2 VF total deviation plot. Similarly, an eye was considered "suspect" only if both the sdOCT and VF plots were normal. Healthy subjects (normal VFs and sdOCT) were classified as "controls" and used as reference for comparisons. Glaucoma specialists reviewed the stereophotographs and classified eyes based on the presence of signs suggestive of glaucomatous optic neuropathy. RESULTS: The pattern of clinical signs of glaucomatous optic neuropathy seen on stereophotographs was statistically different between glaucoma (P<0.001) and suspects (P<0.001) vs. controls and explained up to 68% of the total variance of the diagnosis based upon sdOCT and VFs. Vertical cup-to-disc>0.6, focal neuroretinal rim thinning, focal RNFL loss, and violation of the ISNT rule had the best performance to differentiate glaucoma and suspects from controls. Compared with the suspect group, glaucoma eyes (abnormal sdOCT and VF tests) were more likely to have vertical cup-to-disc>0.6 (92% vs. 69%, P=0.003), diffuse rim (53% vs. 9%, P<0.001) and RNFL (61% vs. 26%, P<0.001) thinning, and β-zone parapapillary atrophy (68% vs. 17%, P<0.001). CONCLUSIONS: Focal and diffuse signs of glaucoma damage seen on stereophotographs often match damage shown on VFs and sdOCT. In addition, damage shown on VFs and sdOCT is often missed during clinical evaluation. Longitudinal studies ought to differentiate focal signs of glaucoma damage seen on stereophotography from false-positives or very early loss.

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