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Glaucoma: HELP
Articles from Duke University
Based on 230 articles published since 2008
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These are the 230 published articles about Glaucoma that originated from Duke University during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10
1 Guideline Staying away from the optic nerve: a formula for modifying glaucoma drainage device surgery in pediatric and other small eyes. 2017

Margeta, Milica A / Kuo, Anthony N / Proia, Alan D / Freedman, Sharon F. ·Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina. · Department of Pathology, Duke University Medical Center, Durham, North Carolina. · Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina. Electronic address: sharon.freedman@duke.edu. ·J AAPOS · Pubmed #28104502.

ABSTRACT: PURPOSE: To provide guidelines for safe implantation of glaucoma drainage devices (GDDs) in small and pediatric eyes to avoid contact between the optic nerve (ON) and the posterior edge of the GDD plate. METHODS: We developed a formula for calculating limbus-to-ON distance to estimate the available "real estate" for GDD placement in small eyes. The formula was validated using eyes of pediatric decedents undergoing clinical autopsy, with axial lengths (AL) of 15-24 mm. For each autopsy eye, we measured AL, anterior chamber depth, corneal diameter, and limbus-to-ON distances for the four eye quadrants. The main outcome measure was the degree of agreement between measured and calculated limbus-to-ON distances. RESULTS: A total of 15 autopsy eyes were divided into derivation (n = 10) and validation (n = 5) groups. A formula was derived to estimate superotemporal limbus-to-ON distance (D CONCLUSIONS: Our formula accurately predicts limbus-to-ON distances across a wide range of clinically relevant ALs. Based on this information, GDD surgery in small eyes can be adjusted by positioning the GDD closer to the limbus or by trimming the posterior edge of the GDD plate. To our knowledge, this is the first set of guidelines developed to promote safe implantation of GDDs in small eyes.

2 Guideline Primary Open-Angle Glaucoma Suspect Preferred Practice Pattern(®) Guidelines. 2016

Prum, Bruce E / Lim, Michele C / Mansberger, Steven L / Stein, Joshua D / Moroi, Sayoko E / Gedde, Steven J / Herndon, Leon W / Rosenberg, Lisa F / Williams, Ruth D. ·Department of Ophthalmology, University of Virginia Health System, Charlottesville, Virginia. · UC Davis Eye Center, University of California, Davis, Sacramento, California. · Legacy Devers Eye Institute, Portland, Oregon. · W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan. · Bascom Palmer Eye Institute, University of Miami, Miami, Florida. · Duke Eye Center, Duke University Medical Center, Durham, North Carolina. · Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Wheaton Eye Clinic, Wheaton, Illinois. ·Ophthalmology · Pubmed #26581560.

ABSTRACT: GUIDELINES: Evidence-based update of the Primary Open-Angle Suspect Glaucoma Preferred Practice Pattern® (PPP) guidelines, describing the diagnosis and management of patients with primary open-angle glaucoma suspect with detailed recommendations for evaluation and treatment options.

3 Guideline Primary Angle Closure Preferred Practice Pattern(®) Guidelines. 2016

Prum, Bruce E / Herndon, Leon W / Moroi, Sayoko E / Mansberger, Steven L / Stein, Joshua D / Lim, Michele C / Rosenberg, Lisa F / Gedde, Steven J / Williams, Ruth D. ·Department of Ophthalmology, University of Virginia Health System, Charlottesville, Virginia. · Duke Eye Center, Duke University Medical Center, Durham, North Carolina. · W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan. · Legacy Devers Eye Institute, Portland, Oregon. · UC Davis Eye Center, University of California, Davis, Sacramento, California. · Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Bascom Palmer Eye Institute, University of Miami, Miami, Florida. · Wheaton Eye Clinic, Wheaton, Illinois. ·Ophthalmology · Pubmed #26581557.

ABSTRACT: GUIDELINES: Evidence-based update of the Primary Angle Closure Preferred Practice Pattern® (PPP) guidelines, describing the diagnosis and management of patients with primary angle closure with detailed recommendations for evaluation and treatment options.

4 Guideline Primary Open-Angle Glaucoma Preferred Practice Pattern(®) Guidelines. 2016

Prum, Bruce E / Rosenberg, Lisa F / Gedde, Steven J / Mansberger, Steven L / Stein, Joshua D / Moroi, Sayoko E / Herndon, Leon W / Lim, Michele C / Williams, Ruth D. ·Department of Ophthalmology, University of Virginia Health System, Charlottesville, Virginia. · Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Bascom Palmer Eye Institute, University of Miami, Miami, Florida. · Legacy Devers Eye Institute, Portland, Oregon. · W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan. · Duke Eye Center, Duke University Medical Center, Durham, North Carolina. · UC Davis Eye Center, University of California, Davis, Sacramento, California. · Wheaton Eye Clinic, Wheaton, Illinois. ·Ophthalmology · Pubmed #26581556.

ABSTRACT: GUIDELINES: Evidence-based update of the Primary Open-Angle Glaucoma Preferred Practice Pattern® (PPP) guidelines, describing the diagnosis and management of patients with primary open-angle glaucoma with an algorithm for patient management and detailed recommendations for evaluation and treatment options.

5 Editorial Introduction to Gedenkschrift for David L. Epstein, MD. 2017

Stamer, W Daniel / Schuman, Joel S. ·Dept. of Ophthalmology, Duke University School of Medicine, DUMC 3802, Durham, NC 27710, NC, USA. Electronic address: dan.stamer@duke.edu. · Dept. of Ophthalmology, NYU Langone Ophthalmology Associates, 240 E 38th St, New York, NY 10016, USA. Electronic address: Joel.Schuman@med.nyu.edu. ·Exp Eye Res · Pubmed #28159541.

ABSTRACT: -- No abstract --

6 Editorial The Value of Mouse Models for Glaucoma Drug Discovery. 2016

Dismuke, W Michael / Overby, Darryl R / Civan, Mortimer M / Stamer, W Daniel. ·1 Department of Ophthalmology, Duke University, Durham , North Carolina. · 2 Department of Bioengineering, Imperial College London , London, England, UK . · 3 Department of Physiology, University of Pennsylvania , Perelman School of Medicine, Philadelphia, Pennsylvania. · 4 Department of Medicine, University of Pennsylvania , Perelman School of Medicine, Philadelphia, Pennsylvania. · 5 Department of Ophthalmology, Duke University , Durham, North Carolina. · 6 Department of Biomedical Engineering, Duke University , Durham, North Carolina. ·J Ocul Pharmacol Ther · Pubmed #26982549.

ABSTRACT: -- No abstract --

7 Review New classification system for pediatric glaucoma: implications for clinical care and a research registry. 2018

Thau, Avrey / Lloyd, Maureen / Freedman, Sharon / Beck, Allen / Grajewski, Alana / Levin, Alex V. ·Sidney Kimmel Medical College at Thomas Jefferson University. · Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, Pennsylvania. · Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina. · Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia. · Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA. ·Curr Opin Ophthalmol · Pubmed #30096087.

ABSTRACT: PURPOSE OF REVIEW: The Childhood Glaucoma Research Network (CGRN) has created a new classification system for childhood glaucoma that has become the first International Consensus Classification. The purpose of this review is to present this classification system and share its use to date. RECENT FINDINGS: The diagnoses of the classification system include glaucoma and glaucoma suspect. The primary glaucomas include: primary congenital glaucoma and juvenile open-angle glaucoma. The secondary glaucomas include: glaucoma following cataract surgery, glaucoma associated with nonacquired systemic disease or syndrome, glaucoma associated with nonacquired ocular anomalies, and glaucoma associated with acquired conditions. This system reached consensus agreement at the Ninth World Glaucoma Association Consensus, which has been adopted by the American Board of Ophthalmology, and has been implemented in outcomes research, incidence studies, and review articles. The new Robison D. Harley, MD CGRN International Pediatric Glaucoma Registry uses this classification system as a shared language, allowing international clinicians and researchers to collaborate and make large-scale investigations of this otherwise rare disease possible. SUMMARY: The diagnoses in this system are assigned by following a logical and systematically approachable path. The ability to easily adopt and implement the system lends itself to international research.

8 Review Recent developments in visual field testing for glaucoma. 2018

Wu, Zhichao / Medeiros, Felipe A. ·Duke Eye Center and Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA. · Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne. · Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia. ·Curr Opin Ophthalmol · Pubmed #29256895.

ABSTRACT: PURPOSE OF REVIEW: Visual field testing remains one of the most important tools for characterizing and monitoring vision loss in glaucoma. Despite its current mainstream use, new developments continue to emerge on its current use and potentially better methods for its testing and analysis. This review summarizes new developments in visual field testing and, in particular, standard automated perimetry. RECENT FINDINGS: Evidence-based guidance has recently been provided on the impact of testing frequency on the ability to detect visual field progression. An increasing body of evidence also highlights numerous factors that can impact the interpretation of visual field results currently considered reliable (e.g. the reliability indices themselves, fixation tracking parameters, and cognitive decline). More targeted visual field testing paradigms for central and peripheral visual fields have been explored, although further work is needed to understand their role in clinical care. Exploiting retinal imaging during visual field testing with fundus-tracked perimetry shows promise for improving precision. Thresholding algorithms that account for spatial and structural information and novel analytical techniques for longitudinal data could also improve the ability to detect and monitor visual field loss. New promising methods for objective and portable assessment of visual function have also emerged. SUMMARY: New developments in visual field testing shows promise for improving this challenging, yet fundamental, clinical test for glaucoma management.

9 Review Drop instillation and glaucoma. 2018

Davis, Scott A / Sleath, Betsy / Carpenter, Delesha M / Blalock, Susan J / Muir, Kelly W / Budenz, Donald L. ·Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy. · Cecil G. Sheps Center for Health Services Research, Chapel Hill, North Carolina. · Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina. · Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. ·Curr Opin Ophthalmol · Pubmed #29140818.

ABSTRACT: PURPOSE OF REVIEW: To describe the current state of knowledge regarding glaucoma patients' eye drop technique, interventions attempting to improve eye drop technique, and methods for assessing eye drop technique. RECENT FINDINGS: In observational studies, between 18.2 and 80% of patients contaminate their eye drop bottle by touching their eye or face, 11.3-60.6% do not instill exactly one drop, and 6.8-37.3% miss the eye with the drop. Factors significantly associated with poorer technique include older age, lack of instruction on eye drop technique, female sex, arthritis, more severe visual field defect, lack of positive reinforcement to take eye drops, lower educational level, low self-efficacy, and being seen at a clinic rather than a private practice. Among intervention studies, four of five studies using a mechanical device and three of four studies using educational interventions to improve technique showed positive results, but none of the studies were randomized controlled trials. SUMMARY: Poor eye drop technique is a significant impediment to achieving good control of intraocular pressure in glaucoma. Both mechanical device interventions and educational interventions offer promise to improve patients' technique, but studies with stronger designs need to be done followed by introduction into clinical practice.

10 Review Systematic Review of Knowledge Assessments for Glaucoma Patients. 2018

Peralta, Esteban / Muir, Kelly W / Rosdahl, Jullia A. ·a Duke University , Durham , NC , USA. ·Semin Ophthalmol · Pubmed #27960573.

ABSTRACT: Glaucoma is a chronic eye disease affecting millions of people worldwide; it is frequently treated with daily eyedrop medications when patients are asymptomatic. Patient education is an essential feature for adherence to treatments. Developing useful patient education interventions is predicated on understanding what glaucoma patients know about their disease and identifying gaps in their knowledge. Thirteen studies that have measured and described glaucoma patient knowledge using questionnaires were identified from the literature, including cross-sectional studies of disease knowledge and studies evaluating the efficacy of an educational intervention, both randomized controlled and observational. All studies found significant knowledge gaps in glaucoma patients. Both the controlled studies and the observational studies supported the efficacy of various educational interventions for improving glaucoma knowledge.

11 Review Detecting Structural Progression in Glaucoma with Optical Coherence Tomography. 2017

Tatham, Andrew J / Medeiros, Felipe A. ·Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, Edinburgh, United Kingdom. · Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina. Electronic address: felipe.medeiros@duke.edu. ·Ophthalmology · Pubmed #29157363.

ABSTRACT: Optical coherence tomography (OCT) is increasingly used to obtain objective measurements of the retinal nerve fiber layer (RNFL), optic nerve head, and macula for assessing glaucoma progression. Although OCT has been adopted widely in clinical practice, uncertainty remains concerning its optimal role. Questions include: What is the best structure to measure? What quantity of change is significant? Are structural changes relevant to the patient? How are longitudinal measurements affected by aging? How can changes resulting from aging be differentiated from true progression? How best should OCT be used alongside visual fields, and how often should OCT be performed? Recent studies have addressed some of these questions. Important developments include appreciation of the need to use a consistent point of reference for structural measurements, leading to the introduction of Bruch's membrane opening (BMO)-based measurements, including BMO-minimum rim width and BMO-minimum rim area. Commercially available OCT devices also permit analysis of macular changes over time, for example, changes in the ganglion cell and inner plexiform layers, the sites of the retinal ganglion cell bodies and dendrites, respectively. Several longitudinal studies have compared rates of change in RNFL and macular measurements, with some suggesting that the relative value of each parameter may differ at different stages of disease. In early disease, looking for change over time also may be useful for glaucoma diagnosis, with advantages over classifying eyes using cross-sectional normative databases. Optimal glaucoma management requires information from imaging and visual fields, and efforts have been made to combine information, reducing the noise inherent in both tests to benefit from their different performances according to the stage of disease. Combining information from different structural measurements may also be useful. There is now substantial evidence that progressive structural changes are of direct clinical relevance, with progressive changes on OCT often preceding functional loss and patients with faster change on OCT at increased risk of worsening visual losses. Identification of such patients offers the possibility of commencing or escalating treatment at an earlier stage. This review appraises recent developments in the use of OCT for assessing glaucoma progression.

12 Review Major review: Molecular genetics of primary open-angle glaucoma. 2017

Liu, Yutao / Allingham, R Rand. ·Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA, United States; James & Jean Culver Vision Discovery Institute, Augusta University, Augusta, GA, United States; Center for Biotechnology and Genomic Medicine, Augusta University, Augusta, GA, United States. · Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States; Duke - National University of Singapore (Duke-NUS), Singapore. Electronic address: rand.allingham@duke.edu. ·Exp Eye Res · Pubmed #28499933.

ABSTRACT: Glaucoma is a leading cause of irreversible blindness worldwide. Primary open-angle glaucoma (POAG), the most common type, is a complex inherited disorder that is characterized by progressive retinal ganglion cell death, optic nerve head excavation, and visual field loss. The discovery of a large, and growing, number of genetic and chromosomal loci has been shown to contribute to POAG risk, which carry implications for disease pathogenesis. Differential gene expression analyses in glaucoma-affected tissues as well as animal models of POAG are enhancing our mechanistic understanding in this common, blinding disorder. In this review we summarize recent developments in POAG genetics and molecular genetics research.

13 Review Feasibility of laser trabeculoplasty in angle closure glaucoma: a review of favourable histopathological findings in narrow angles. 2017

Matos, Alexis Galeno / Asrani, Sanjay G / Paula, Jayter Silva. ·Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. · Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA. ·Clin Exp Ophthalmol · Pubmed #28245337.

ABSTRACT: Selective laser trabeculoplasty (SLT) has been indicated as a safe and efficient treatment for primary open-angle glaucoma; however, recent studies have also shown positive results with the use of SLT in some clinical conditions related to primary angle-closure glaucoma (PACG). Despite the potential benefits of SLT in selected cases of PACG, the mechanisms underlying the modifications in the trabecular meshwork tissue of patients with PACG are poorly understood. This narrative review approached both the current, limited knowledge about the histological changes observed in different forms of PACG and the clinical results of SLT treatment for PACG. Favourable outcomes of SLT in patients with PACG, specifically in areas of non-occluded angle, need further substantiation through large controlled clinical trials. A deeper understanding of the biomolecular changes of those areas is essential to improve both laser technical details and the clinical efficacy of SLT therapy.

14 Review Steroid-induced ocular hypertension/glaucoma: Focus on pharmacogenomics and implications for precision medicine. 2017

Fini, M Elizabeth / Schwartz, Stephen G / Gao, Xiaoyi / Jeong, Shinwu / Patel, Nitin / Itakura, Tatsuo / Price, Marianne O / Price, Francis W / Varma, Rohit / Stamer, W Daniel. ·USC Institute for Genetic Medicine and Department of Cell & Neurobiology, Keck School of Medicine of USC, University of Southern California, 2250 Alcatraz St., Suite 240, Los Angeles, CA, 90089, USA. Electronic address: efini@med.usc.edu. · Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 3880 Tamiami Trail North, Naples, FL, 34103, USA. Electronic address: sschwartz2@med.miami.edu. · Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1905 W Taylor St., Suite 235, Chicago, IL, 60612, USA. Electronic address: rgao@uic.edu. · USC Institute for Genetic Medicine, USC Roski Eye Institute and Department of Ophthalmology, Keck School of Medicine of USC, University of Southern California, 2250 Alcatraz St., Suite 240, Los Angeles, CA, 90089, USA. Electronic address: shinwuje@med.usc.edu. · USC Institute for Genetic Medicine, Keck School of Medicine of USC, University of Southern California, 2250 Alcatraz St., Suite 240, Los Angeles, CA, 90089, USA. Electronic address: nitinusc@gmail.com. · USC Institute for Genetic Medicine, Keck School of Medicine of USC, University of Southern California, 2250 Alcatraz St., Suite 240, Los Angeles, CA, 90089, USA. Electronic address: itakura@med.usc.edu. · Cornea Research Foundation of America, 9002 North Meridian Street, Indianapolis, IN, 46260, USA. Electronic address: marianneprice@cornea.org. · Price Vision Group, 9002 North Meridian Street, Indianapolis, IN, 46260, USA. Electronic address: francisprice@pricevisiongroup.net. · Office of the Dean, USC Roski Eye Institute and Department of Ophthalmology, Keck School of Medicine of USC, University of Southern California, 1975 Zonal Ave., KAM 500, Los Angeles, CA, 90089, USA. Electronic address: Rohit.Varma@med.usc.edu. · Department of Ophthalmology and Department of Biomedical Engineering, Duke University, AERI Room 4008, 2351 Erwin Rd, Durham, NC, 27705, USA. Electronic address: dan.stamer@duke.edu. ·Prog Retin Eye Res · Pubmed #27666015.

ABSTRACT: Elevation of intraocular pressure (IOP) due to therapeutic use of glucocorticoids is called steroid-induced ocular hypertension (SIOH); this can lead to steroid-induced glaucoma (SIG). Glucocorticoids initiate signaling cascades ultimately affecting expression of hundreds of genes; this provides the potential for a highly personalized pharmacological response. Studies attempting to define genetic risk factors were undertaken early in the history of glucocorticoid use, however scientific tools available at that time were limited and progress stalled. In contrast, significant advances were made over the ensuing years in defining disease pathophysiology. As the genomics age emerged, it appeared the time was right to renew investigation into genetics. Pharmacogenomics is an unbiased discovery approach, not requiring an underlying hypothesis, and provides a way to pinpoint clinically significant genes and pathways that could not have been discovered any other way. Results of the first genome-wide association study to identify polymorphisms associated with SIOH, and follow-up on two novel genes linked to the disorder, GPR158 and HCG22, is discussed in the second half of the article. However, knowledge of genetic variants determining response to steroids in the eye also has value in its own right as a predictive and diagnostic tool. This article concludes with a discussion of how the Precision Medicine Initiative

15 Review Role of the Rho GTPase/Rho kinase signaling pathway in pathogenesis and treatment of glaucoma: Bench to bedside research. 2017

Rao, Ponugoti Vasantha / Pattabiraman, Padmanabhan P / Kopczynski, Casey. ·Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA; Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC, USA. Electronic address: p.rao@dm.duke.edu. · Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA. · Aerie Pharmaceuticals, Durham, NC, USA. ·Exp Eye Res · Pubmed #27593914.

ABSTRACT: Glaucoma is a leading cause of irreversible blindness worldwide. Elevated intraocular pressure (IOP) is considered to be a predominant risk factor for primary open angle glaucoma, the most prevalent form of glaucoma. Although the etiological mechanisms responsible for increased IOP are not completely clear, impairment in aqueous humor (AH) drainage through the conventional or trabecular pathway is recognized to be a primary cause in glaucoma patients. Importantly, lowering of IOP has been demonstrated to reduce progression of vision loss and is a mainstay of treatment for all types of glaucoma. Currently however, there are limited therapeutic options available for lowering IOP especially as it relates to enhancement of AH outflow through the trabecular pathway. Towards addressing this challenge, bench and bedside research conducted over the course of the last decade and a half has identified the significance of inhibiting Rho kinase for lowering IOP. Rho kinase is a downstream effector of Rho GTPase signaling that regulates actomyosin dynamics in numerous cell types. Studies from several laboratories have demonstrated that inhibition of Rho kinase lowers IOP via relaxation of the trabecular meshwork which enhances AH outflow. By contrast, activation of Rho GTPase/Rho kinase signaling in the trabecular outflow pathway increases IOP by altering the contractile, cell adhesive and permeability barrier characteristics of the trabecular meshwork and Schlemm's canal tissues, and by influencing extracellular matrix production and fibrotic activity. This article, written in honor of the late David Epstein, MD, summarizes findings from both basic and clinical studies that have been instrumental for recognition of the importance of the Rho/Rho kinase signaling pathway in regulation of AH outflow, and in the development of Rho kinase inhibitors as promising IOP- lowering agents for glaucoma treatment.

16 Review The many faces of the trabecular meshwork cell. 2017

Stamer, W Daniel / Clark, Abbot F. ·Departments of Ophthalmology and Biomedical Engineering, Duke University, Durham, NC, United States. · North Texas Eye Research Institute, University of North Texas Health Science Center, Ft. Worth, TX, United States. Electronic address: abe.clark@unthsc.edu. ·Exp Eye Res · Pubmed #27443500.

ABSTRACT: With the combined purpose of facilitating useful vision over a lifetime, a number of ocular cells have evolved specialized features not found elsewhere in the body. The trabecular meshwork (TM) cell at the irido-corneal angle, which is a key regulator of intraocular pressure, is no exception. Examination of cells in culture isolated from the human TM has shown that they are unique in many ways, displaying characteristic features of several different cell types. Thus, these neural crest derived cells display expression patterns and behaviors typical of endothelia, fibroblasts, smooth muscle and macrophages, owing to the multiple roles and two distinct environments where they operate to maintain intraocular pressure homeostasis. In most individuals, TM cells function normally over a lifetime in the face of persistent stressors, including phagocytic, oxidative, mechanical and metabolic stress. Study of TM cells isolated from ocular hypertensive eyes has shown a compromised ability to perform their daily duties. This review highlights the many responsibilities of the TM cell and its challenges, progress in our understanding of TM biology over the past 30 years, as well as discusses unanswered questions about TM dysfunction that results in IOP dysregulation and glaucoma.

17 Review Life under pressure: The role of ocular cribriform cells in preventing glaucoma. 2016

Paula, Jayter S / O'Brien, Colm / Stamer, W Daniel. ·Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA. · Ophthalmology, UCD School of Medicine, Mater Hospital, Dublin, Ireland. · Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA. Electronic address: dan.stamer@duke.edu. ·Exp Eye Res · Pubmed #27567558.

ABSTRACT: Primary open-angle glaucoma is a multifactorial blinding disease often impacting the two pressure-sensitive regions of the eye: the conventional outflow pathway and the optic nerve head (ONH). The connective tissues that span these two openings in the globe are the trabecular meshwork of the conventional outflow pathway and the lamina cribrosa of the ONH. Resident cribiform cells of these two regions are responsible for actively remodeling and maintaining their connective tissues. In glaucoma, aberrant maintenance of the juxtacanalicular tissues (JCT) of the conventional outflow pathway results in ocular hypertension and pathological remodeling of the lamina cribrosa results in ONH cupping, damaging retinal ganglion cell axons. Interestingly, cells cultured from the lamina cribrosa and the JCT of the trabecular meshwork have similarities regarding gene expression, protein production, plus cellular responses to growth factors and mechanical stimuli. This review compares and contrasts the current knowledge of these two cell types, whose health is critical for protecting the eye from glaucomatous changes. In response to pressure gradients across their respective cribiform tissues, the goal is to better understand and differentiate healthy from pathological behavior of these two cell types.

18 Review Readability of patient education materials in ophthalmology: a single-institution study and systematic review. 2016

Williams, Andrew M / Muir, Kelly W / Rosdahl, Jullia A. ·Michigan State University College of Human Medicine, Grand Rapids, MI, USA. · Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. · Duke University Department of Ophthalmology, Durham, NC, USA. · Durham VA Medical Center, Health Services Research and Development, Durham, NC, USA. · Duke University Department of Ophthalmology, Durham, NC, USA. jullia.rosdahl@duke.edu. ·BMC Ophthalmol · Pubmed #27487960.

ABSTRACT: BACKGROUND: Patient education materials should be written at a level that is understandable for patients with low health literacy. The aims of this study are (1) to review the literature on readability of ophthalmic patient education materials and (2) to evaluate and revise our institution's patient education materials about glaucoma using evidence-based guidelines on writing for patients with low health literacy. METHODS: A systematic search was conducted on the PubMed/MEDLINE database for studies that have evaluated readability level of ophthalmic patient education materials, and the reported readability scores were assessed. Additionally, we collected evidence-based guidelines for writing easy-to-read patient education materials, and these recommendations were applied to revise 12 patient education handouts on various glaucoma topics at our institution. Readability measures, including Flesch-Kincaid Grade Level (FKGL), and word count were calculated for the original and revised documents. The original and revised versions of the handouts were then scored in random order by two glaucoma specialists using the Suitability Assessment of Materials (SAM) instrument, a grading scale used to evaluate suitability of health information materials for patients. Paired t test was used to analyze changes in readability measures, word count, and SAM score between original and revised handouts. Finally, five glaucoma patients were interviewed to discuss the revised materials, and patient feedback was analyzed qualitatively. RESULTS: Our literature search included 13 studies that evaluated a total of 950 educational materials. Among the mean FKGL readability scores reported in these studies, the median was 11 (representing an eleventh-grade reading level). At our institution, handouts' readability averaged a tenth-grade reading level (FKGL = 10.0 ± 1.6), but revising the handouts improved their readability to a sixth-grade reading level (FKGL = 6.4 ± 1.2) (p < 0.001). Additionally, the mean SAM score of our institution's handouts improved from 60 ± 7 % (adequate) for the original versions to 88 ± 4 % (superior) for the revised handouts (p < 0.001). CONCLUSIONS: Our systematic review of the literature reveals that ophthalmic patient education materials are consistently written at a level that is too high for many patients to understand. Our institution's experience suggests that applying guidelines on writing easy-to-understand material can improve the readability and suitability of educational materials for patients with low health literacy.

19 Review Glaucoma. 2016

Gupta, Divakar / Chen, Philip P. ·Duke University School of Medicine, Durham, NC, USA. · University of Washington Medical Center, Seattle, WA, USA. ·Am Fam Physician · Pubmed #27175839.

ABSTRACT: Glaucoma is a set of irreversible, progressive optic neuropathies that can lead to severe visual field loss and blindness. The two most common forms of glaucoma, primary open-angle glaucoma and primary angle-closure glaucoma, affect more than 2 million Americans and are increasing in prevalence. Many patients with glaucoma are asymptomatic and do not know they have the disease. Risk factors for primary open-angle glaucoma include older age, black race, Hispanic origin, family history of glaucoma, and diabetes mellitus. Risk factors for primary angle-closure glaucoma include older age, Asian descent, and female sex. Advanced disease at initial presentation and treatment nonadherence put patients with glaucoma at risk of disease progression to blindness. The U.S. Preventive Services Task Force has concluded that the evidence is insufficient to assess the potential benefits and harms of screening for glaucoma in the primary care setting. Regular eye examinations for adults are recommended by the American Academy of Ophthalmology, with the interval depending on patient age and risk factors. Diagnosis of glaucoma requires careful optic nerve evaluation and functional studies assessing a patient's visual field. The goal of treatment with eye drops, laser therapy, or surgery is to slow visual field loss by lowering intraocular pressure. Family physicians can contribute to lowering morbidity from glaucoma through early identification of high-risk patients and by emphasizing treatment adherence in patients with glaucoma.

20 Review The autophagic lysosomal system in outflow pathway physiology and pathophysiology. 2016

Liton, Paloma B. ·Duke University, Department of Ophthalmology, Durham, NC, USA. Electronic address: paloma.liton@duke.edu. ·Exp Eye Res · Pubmed #26226231.

ABSTRACT: Malfunction of the trabecular meshwork (TM)/schlemm's canal (SC) conventional outflow pathway is associated with elevated intraocular pressure (IOP) and, therefore, increased risk of developing glaucoma, a potentially blinding disease affecting more than 70 million people worldwide. This TM/SC tissue is subjected to different types of stress, including mechanical, oxidative, and phagocytic stress. Long-term exposure to these stresses is believed to lead to a progressive accumulation of damaged cellular and tissue structures causing permanent alterations in the tissue physiology, and contribute to the pathologic increase in aqueous humor (AH) outflow resistance. Autophagy is emerging as an essential cellular survival mechanism against a variety of stressors. In addition to performing basal functions, autophagy acts as a cellular survival pathway and represents an essential mechanism by which organisms can adapt to acute stress conditions and repair stress-induced damage. A decline in autophagy has been observed in most tissues with aging and has been considered responsible, at least in part, for the accumulation of damaged cellular components in almost all tissues of aging organisms. Dysfunction in the autophagy pathway is associated with several human diseases, from infectious diseases to cancer and neurodegeneration. In this review, we will summarize our current knowledge of the emerging roles of autophagy in outflow tissue physiology and pathophysiology, including novel evidence suggesting compromised autophagy in the glaucomatous outflow pathway.

21 Review Rho kinase inhibitors for glaucoma treatment - Review. 2015

Germano, Renato Antunes Schiave / Finzi, Simone / Challa, Pratap / Susanna Junior, Remo. ·Ophthalmology Department, Universidade de São Paulo, São Paulo, SP, Brazil. · Duke University Eye Center, Durham, NC, USA. ·Arq Bras Oftalmol · Pubmed #26677046.

ABSTRACT: Glaucoma is a progressive optic neuropathy characterized by the loss of ganglion cells and their axons. A major risk factor for glaucomatous visual field loss is elevated intraocular pressure (IOP), and several studies have shown that lowering IOP reduces the risk of glaucomatous progression. Currently, an increasing number of researches involve Rho kinase inhibitors, which are a new pharmacological class of hypotensive agents specifically targeting the diseased trabecular outflow pathway. Rho kinase inhibitors reduce IOP by increasing aqueous humor drainage through the primary outflow pathway in the eye, which is known as the trabecular meshwork. In addition to improving the outflow facility of the trabecular meshwork, Rho kinase inhibitors also enhance retinal ganglion cell survival after ischemic injury and increase ocular blood flow.

22 Review Aqueous humor outflow: dynamics and disease. 2015

Roy Chowdhury, Uttio / Hann, Cheryl R / Stamer, W Daniel / Fautsch, Michael P. ·Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States. · Department of Ophthalmology, Duke University, Durham, North Carolina, United States. ·Invest Ophthalmol Vis Sci · Pubmed #26024085.

ABSTRACT: -- No abstract --

23 Review Biomechanics of Schlemm's canal endothelium and intraocular pressure reduction. 2015

Stamer, W Daniel / Braakman, Sietse T / Zhou, Enhua H / Ethier, C Ross / Fredberg, Jeffrey J / Overby, Darryl R / Johnson, Mark. ·Department of Ophthalmology, Duke University, Durham, NC 27710, USA; Department of Biomedical Engineering, Duke University, Durham, NC, 27710, USA. Electronic address: dan.stamer@duke.edu. · Department of Bioengineering, Imperial College London, London SW7 2AZ, UK. · Department of Ophthalmology, Novartis Institutes of BioMedical Research, Cambridge, MA 02139, USA. · Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; Department of Biomedical Engineering, Emory University, Atlanta, GA 30322, USA; Department of Ophthalmology, Emory University, Atlanta, GA 30322, USA. · Program in Molecular and Integrative Physiological Sciences, Harvard School of Public Health, Boston, MA 02115, USA; Department of Environmental Health, Harvard School of Public Health, Boston, MA 02115, USA. · Department of Biomedical Engineering, Northwestern University, Evanston, IL, US; Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA; Department of Ophthalmology Engineering, Northwestern University, Chicago, IL, USA. ·Prog Retin Eye Res · Pubmed #25223880.

ABSTRACT: Ocular hypertension in glaucoma develops due to age-related cellular dysfunction in the conventional outflow tract, resulting in increased resistance to aqueous humor outflow. Two cell types, trabecular meshwork (TM) and Schlemm's canal (SC) endothelia, interact in the juxtacanalicular tissue (JCT) region of the conventional outflow tract to regulate outflow resistance. Unlike endothelial cells lining the systemic vasculature, endothelial cells lining the inner wall of SC support a transcellular pressure gradient in the basal to apical direction, thus acting to push the cells off their basal lamina. The resulting biomechanical strain in SC cells is quite large and is likely to be an important determinant of endothelial barrier function, outflow resistance and intraocular pressure. This review summarizes recent work demonstrating how biomechanical properties of SC cells impact glaucoma. SC cells are highly contractile, and such contraction greatly increases cell stiffness. Elevated cell stiffness in glaucoma may reduce the strain experienced by SC cells, decrease the propensity of SC cells to form pores, and thus impair the egress of aqueous humor from the eye. Furthermore, SC cells are sensitive to the stiffness of their local mechanical microenvironment, altering their own cell stiffness and modulating gene expression in response. Significantly, glaucomatous SC cells appear to be hyper-responsive to substrate stiffness. Thus, evidence suggests that targeting the material properties of SC cells will have therapeutic benefits for lowering intraocular pressure in glaucoma.

24 Review Bioactive lysophospholipids: role in regulation of aqueous humor outflow and intraocular pressure in the context of pathobiology and therapy of glaucoma. 2014

Rao, Ponugoti Vasantha. ·1 Department of Ophthalmology, Duke University School of Medicine , Durham, North Carolina. ·J Ocul Pharmacol Ther · Pubmed #24283588.

ABSTRACT: Homeostasis of aqueous humor (AH) outflow and intraocular pressure (IOP) is essential for normal vision. Impaired AH outflow through the trabecular meshwork (TM) and a resultant elevation in IOP are common changes in primary open-angle glaucoma (POAG), which is the most prevalent form of glaucoma. Although elevated IOP has been recognized as a definitive risk factor for POAG and lowering elevated IOP remains a mainstay for glaucoma treatment, little is known about the molecular mechanisms, especially external cues and intracellular pathways, involved in the regulation of AH outflow in both normal and glaucomatous eyes. In addition, despite the recognition that increased resistance to AH outflow via the conventional pathway consisting of TM and Schlemm's canal is the main cause for elevated IOP, there are no clinically approved drugs that target the conventional pathway to lower IOP in glaucoma patients. The aim of this article is to briefly review published work on the importance of bioactive lysophospholipids (eg, lysophosphatidic acid and sphingosine-1-phosphate), their receptors, metabolism, signaling, and role in the regulation of AH outflow via the TM and IOP, and to discuss pharmacological targeting of key proteins in the lysophospholipid signaling pathways to lower IOP in glaucoma patients.

25 Review Rho-kinase inhibitors offer a new approach in the treatment of glaucoma. 2014

Challa, Pratap / Arnold, John J. ·Duke University, Ophthalmology , 2351 Erwin Road, Durham 27710 , USA pratap.challa@duke.edu. ·Expert Opin Investig Drugs · Pubmed #24094075.

ABSTRACT: INTRODUCTION: Primary open-angle glaucoma (POAG) is a leading cause for worldwide blindness and is characterized by progressive optic nerve damage. The etiology of POAG is unknown, but elevated intraocular pressure (IOP) and advanced age have been identified as risk factors. IOP reduction is the only known treatment for glaucoma. Recently, drugs that inhibit rho-associated protein kinase (ROCK) have been studied in animals and people for their ability to lower IOP and potentially treat POAG. ROCK inhibitors lower IOP through a trabecular mechanism and may represent a new therapeutic paradigm for the treatment of POAG. AREAS COVERED: Exploring the place that ROCK inhibitors may occupy in our treatment of POAG requires a thorough understanding of pathophysiology and treatment. This article summarizes current research on the incidence, proposed etiologies and mechanisms of action for this drug class. ROCK inhibitor research is presented and considered in light of the current standard of pharmacologic care. EXPERT OPINION: ROCK inhibitors alter the cell shape and extracellular matrix (ECM) of the trabecular meshwork. Preclinical studies demonstrate that these drugs have the potential to become a new therapy for glaucoma. However, ROCK inhibitors can affect multiple cell types, and their utility can be proven only after clinical studies in patients.

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