Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Glaucoma: HELP
Articles from UCLA
Based on 210 articles published since 2008

These are the 210 published articles about Glaucoma that originated from UCLA during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9
1 Review Influence of new treatment modalities on adherence in glaucoma. 2019

Meier-Gibbons, Frances / Berlin, Michael S / Töteberg-Harms, Marc. ·Eye Center Rapperswil, Merkurstrasse, Rapperswil, Switzerland. · Glaucoma Institute of Beverly Hills, Professor of Clinical Ophthalmology University of California Los Angeles, Stein Eye Institute, Los Angeles, California, USA. · Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland. ·Curr Opin Ophthalmol · Pubmed #30562239.

ABSTRACT: PURPOSE OF REVIEW: It is well known that glaucoma patients are not adherent to their therapeutic regimens. The issue of nonadherence is multifactorial and includes inadequate communication between doctors and patients, resulting in significant costs associated with enhanced disease progression. Therapeutic regimens are risk factors which often influences adherence rates. Thus, alternative treatment modalities, especially those risk factors that do not rely on patients' cooperation, may enable improvements in long-term outcomes of glaucoma in patient. RECENT FINDINGS: The studies selected for this review were divided into new medications, especially advancements in pharmaceutical approaches to treat glaucoma and new ways of delivering the medication, new surgical methods, especially minimally invasive surgery methods for glaucoma, and new studies about adherence in glaucoma. SUMMARY: Surprisingly, a very few studies on glaucoma medication or surgery addressed the concept of adherence. However, adherence is discussed in studies which consider psychological aspects of patients or communication issues between doctors and patients. Although these studies were performed in clinical settings, the issue of adherence is not addressed; despite it has significant effect on long-term outpatient care. A combination of both aspects, adherence and miscommunication, should be considered in studies.

2 Review Potential applications of optical coherence tomography angiography in glaucoma. 2018

Dastiridou, Anna / Chopra, Vikas. ·Ophthalmology Department, University of Thessalia, Thessalia, Greece. · Doheny Image Reading Center, Doheny Eye Institute. · Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. ·Curr Opin Ophthalmol · Pubmed #29553952.

ABSTRACT: PURPOSE OF REVIEW: Optical coherence tomography angiography (OCTA) is a novel, noninvasive imaging modality that allows assessment of the retinal and choroidal vasculature. The scope of this review is to summarize recent studies using OCTA in glaucoma and highlight potential applications of this new technology in the field of glaucoma. RECENT FINDINGS: OCTA studies have shown that retinal vascular changes may not develop solely as a result of advanced glaucoma damage. OCTA-derived measurements have provided evidence for lower retinal vascular densities at the optic nerve head, peripapillary and macula in preperimetric-glaucoma and early-glaucoma, as well as, in more advanced glaucoma, in comparison to with normal eyes. SUMMARY: OCTA is a novel imaging modality that has already started to expand our knowledge base regarding the role of ocular blood flow in glaucoma. Future studies will better elucidate the role of OCTA-derived measurements in clinical practice, research, and clinical trials in glaucoma.

3 Review Structural and functional imaging of aqueous humour outflow: a review. 2018

Huang, Alex S / Francis, Brian A / Weinreb, Robert N. ·Doheny Eye Institute, Los Angeles, California, USA. · Doheny Eye Centers, Department of Ophthalmology, David Geffen School of Medicine at University of California, Los Angeles, California, USA. · Shiley Eye Institute and Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, California, USA. ·Clin Exp Ophthalmol · Pubmed #28898516.

ABSTRACT: Maintaining healthy aqueous humour outflow (AHO) is important for intraocular cellular health and stable vision. Impairment of AHO can lead to increased intraocular pressure, optic nerve damage and concomitant glaucoma. An improved understanding of AHO will lead to improved glaucoma surgeries that enhance native AHO as well as facilitate the development of AHO-targeted pharmaceuticals. Recent AHO imaging has evolved to live human assessment and has focused on the structural evaluation of AHO pathways and the functional documentation of fluid flow. Structural AHO evaluation is predominantly driven by optical coherence tomography, and functional evaluation of flow is performed using various methods, including aqueous angiography. Advances in structural and functional evaluation of AHO are reviewed with discussion of strengths, weaknesses and potential future directions.


Miele, Alba / Govetto, Andrea / Fumagalli, Carlo / Donati, Simone / Biagini, Ilaria / Azzolini, Claudio / Rizzo, Stanislao / Virgili, Gianni. ·Ophthalmology Clinic, Department of Surgery and Translational Medicine, University of Florence and AOU Careggi, Florence, Italy. · Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California. · Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy. · Department of Surgical and Morphological Sciences, University of Insurbia-Circolo Hospital, Varese, Italy. ·Retina · Pubmed #28426628.

ABSTRACT: PURPOSE: Pars plana vitrectomy has been reported to increase the risk of ocular hypertension and open-angle glaucoma. The authors conducted a systematic review of randomized and nonrandomized studies to compare the incidence of open-angle glaucoma and ocular hypertension in vitrectomized versus nonvitrectomized eyes. METHODS: A literature search was performed using MEDLINE and EMBASE until August 2016. Data on ocular hypertension and open-angle glaucoma incidence and mean intraocular pressure after at least 1 year were pooled using random-effects metaanalysis models. Because only nonrandomized studies were retrieved, ROBINS-I tool was used to assess risk of bias in the review. RESULTS: Seven included studies had a paired design to compare the outcomes of vitrectomized versus fellow eyes, with mean follow-up of least 12 months. Four studies (851 patients) provided data on open-angle glaucoma: incidence in vitrectomized versus non-vitrectomized eyes was 7.8% and 4.8%, respectively, yielding a metaanalytic odds ratio of 1.67 (95% CI: 1.08-2.57). Six studies (1,060 patients) reported on the occurrence of ocular hypertension, which was 5.8% in vitrectomized eyes versus 3.1% in fellow eyes (odds ratio: 2.03, 95% CI: 0.97-4.22), without significant differences in the mean postoperative intraocular pressure (mean difference 0.31 mmHg, 95% CI: -0.26 to 0.89). CONCLUSION: Although the review found increased risk of open-angle glaucoma with pars plana vitrectomy, the studies were heterogenous or inconsistent regarding ocular hypertension and intraocular pressure increase. Larger studies should be conducted in homogenous cohorts of patients undergoing macular surgery, excluding complex conditions such as retinal detachment or diabetic retinopathy.

5 Review Aqueous shunts for glaucoma. 2017

Tseng, Victoria L / Coleman, Anne L / Chang, Melinda Y / Caprioli, Joseph. ·Stein Eye Institute, UCLA, 100 Stein Plaza, Los Angeles, California, USA, 90025. ·Cochrane Database Syst Rev · Pubmed #28750481.

ABSTRACT: BACKGROUND: Aqueous shunts are employed to control intraocular pressure (IOP) for people with primary or secondary glaucomas who fail or are not candidates for standard surgery. OBJECTIVES: To assess the effectiveness and safety of aqueous shunts for reducing IOP in glaucoma compared with standard surgery, another type of aqueous shunt, or modification to the aqueous shunt procedure. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 8), MEDLINE Ovid (1946 to August 2016), Embase.com (1947 to August 2016), PubMed (1948 to August 2016), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to August 2016), ClinicalTrials.gov (www.clinicaltrials.gov); searched 15 August 2016, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 15 August 2016. We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 15 August 2016. We also searched the reference lists of identified trial reports and the Science Citation Index to find additional trials. SELECTION CRITERIA: We included randomized controlled trials that compared various types of aqueous shunts with standard surgery or to each other in eyes with glaucoma. DATA COLLECTION AND ANALYSIS: Two review authors independently screened search results for eligibility, assessed the risk of bias, and extracted data from included trials. We contacted trial investigators when data were unclear or not reported. We graded the certainty of the evidence using the GRADE approach. We followed standard methods as recommended by Cochrane. MAIN RESULTS: We included 27 trials with a total of 2099 participants with mixed diagnoses and comparisons of interventions. Seventeen studies reported adequate methods of randomization, and seven reported adequate allocation concealment. Data collection and follow-up times varied.Four trials compared an aqueous shunt (Ahmed or Baerveldt) with trabeculectomy, of which three reported one-year outcomes. At one-year, the difference in IOP between aqueous shunt groups and trabeculectomy groups was uncertain (mean difference (MD) 2.55 mmHg, 95% confidence interval (CI) -0.78 to 5.87; 380 participants; very low-certainty evidence). The difference in logMAR visual acuity was also uncertain (MD 0.12 units, 95% CI -0.07 to 0.31; 380 participants; very low-certainty evidence). In two trials, the difference in visual field score was uncertain (MD -0.25, 95% CI -1.91 to 1.40; 196 participants; very low-certainty evidence). The mean number of antiglaucoma medications was higher in the aqueous shunt group than the trabeculectomy group in one trial (MD 0.80, 95% CI 0.48 to 1.12; 184 participants; low-certainty evidence). The effect on needing additional glaucoma surgery was uncertain between groups in two trials (risk ratio (RR) 0.24, 95% CI 0.04 to 1.36; 329 participants; very low-certainty evidence). In one trial, fewer total adverse events were reported in the aqueous shunt group than the trabeculectomy group (RR 0.59, 95% CI 0.43 to 0.81; 212 participants; very low-certainty evidence). No trial reported quality-of-life outcomes at one-year follow-up.Two trials that compared the Ahmed implant with the Baerveldt implant for glaucoma found higher mean IOP in the Ahmed group at one-year follow-up (MD 2.60 mmHg, 95% CI 1.58 to 3.62; 464 participants; moderate-certainty evidence). The difference in logMAR visual acuity was uncertain between groups (MD -0.07 units, 95% CI -0.27 to 0.13; 501 participants; low-certainty evidence). The MD in number of antiglaucoma medications was within one between groups (MD 0.35, 95% CI 0.11 to 0.59; 464 participants; moderate-certainty evidence). More participants in the Ahmed group required additional glaucoma surgery than the Baerveldt group (RR 2.77, 95% CI 1.02 to 7.54; 514 participants; moderate-certainty evidence). The two trials reported specific adverse events but not overall number of adverse events. Neither trial reported visual field or quality-of-life outcomes at one-year follow-up.One trial compared the Ahmed implant with the Molteno implant for glaucoma over two-year follow-up. Mean IOP was higher in the Ahmed group than the Molteno group (MD 1.64 mmHg, 95% CI 0.85 to 2.43; 57 participants; low-certainty evidence). The differences in logMAR visual acuity (MD 0.08 units, 95% CI -0.24 to 0.40; 57 participants; very low-certainty evidence) and mean deviation in visual field (MD -0.18 dB, 95% CI -3.13 to 2.77; 57 participants; very low-certainty evidence) were uncertain between groups. The mean number of antiglaucoma medications was also uncertain between groups (MD -0.38, 95% CI -1.03 to 0.27; 57 participants; low-certainty evidence). The trial did not report the proportion needing additional glaucoma surgery, total adverse events, or quality-of-life outcomes.Two trials compared the double-plate Molteno implant with the Schocket shunt for glaucoma; one trial reported outcomes only at six-month follow-up, and the other did not specify the follow-up time. At six-months, mean IOP was lower in the Molteno group than the Schocket group (MD -2.50 mmHg, 95% CI -4.60 to -0.40; 115 participants; low-certainty evidence). Neither trial reported the proportion needing additional glaucoma surgery, total adverse events, or visual acuity, visual field, or quality-of-life outcomes.The remaining 18 trials evaluated modifications to aqueous shunts, including 14 trials of Ahmed implants (early aqueous suppression versus standard medication regimen, 2 trials; anti-vascular endothelial growth factor agent versus none, 4 trials; corticosteroids versus none, 2 trials; shunt augmentation versus none, 3 trials; partial tube ligation versus none, 1 trial; pars plana implantation versus conventional implantation, 1 trial; and model M4 versus model S2,1 trial); 1 trial of 500 mm AUTHORS' CONCLUSIONS: Information was insufficient to conclude whether there are differences between aqueous shunts and trabeculectomy for glaucoma treatment. While the Baerveldt implant may lower IOP more than the Ahmed implant, the evidence was of moderate-certainty and it is unclear whether the difference in IOP reduction is clinically significant. Overall, methodology and data quality among existing randomized controlled trials of aqueous shunts was heterogeneous across studies, and there are no well-justified or widely accepted generalizations about the superiority of one surgical procedure or device over another.

6 Review Increasing healthcare costs: can we influence the costs of glaucoma care? 2017

Töteberg-Harms, Marc / Berlin, Michael S / Meier-Gibbons, Frances. ·aDepartment of Ophthalmology, University Hospital Zurich, Zurich, Switzerland bGlaucoma Institute of Beverly Hills, West Hollywood cUniversity of California Los Angeles Stein Eye Institute, Los Angeles, California, USA dEye Center Rapperswil, Rapperswil, Switzerland. ·Curr Opin Ophthalmol · Pubmed #27828895.

ABSTRACT: PURPOSE OF REVIEW: Despite a decrease in real average growth rates per capita since 2009, healthcare costs continue to rise worldwide. Numerous patient-related and doctor-related factors have contributed to this rise. Glaucoma is the leading cause of irreversible blindness and requires chronic, usually lifelong treatment. As with other chronic diseases, the adherence to prescribed treatment is often low and maybe influenced by the cost of the therapy. The purpose of this review is to seek potential solutions to best control the escalating costs of glaucoma care. RECENT FINDINGS: The studies we selected for this review can be divided into four different categories: costs of diagnostic tests; costs of direct comparisons between drugs or laser and conventional surgery; patient-related factors (such as adherence); and general aspects regarding costs: theoretical models and calculations. SUMMARY: It is challenging to find reliable studies concerning this subject matter. As patients are under the umbrellas of variously organized healthcare systems which span different cultures, the costs between countries are difficult to compare. However, one common aspect to lower costs in glaucoma care is to improve patient adherence. Theoretical models with actual patient studies could enable cost reductions by comparing multiple diagnostic and therapeutic scenarios. VIDEO ABSTRACT: http://links.lww.com/COOP/A22.

7 Review Toward in vivo two-photon analysis of mouse aqueous outflow structure and function. 2017

Gonzalez, Jose M / Ko, Minhee K / Masedunskas, Andrius / Hong, Young-Kwon / Weigert, Roberto / Tan, James C H. ·Doheny Eye Institute and Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. · Intracellular Membrane Trafficking Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA. · Department of Surgery, Department of Biochemistry and Molecular Biology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. · Doheny Eye Institute and Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. Electronic address: oranghutan@aol.com. ·Exp Eye Res · Pubmed #27179411.

ABSTRACT: The promise of revolutionary insights into intraocular pressure (IOP) and aqueous humor outflow homeostasis, IOP pathogenesis, and novel therapy offered by engineered mouse models has been hindered by a lack of appropriate tools for studying the aqueous drainage tissues in their original 3-dimensional (3D) environment. Advances in 2-photon excitation fluorescence imaging (TPEF) combined with availability of modalities such as transgenic reporter mice and intravital dyes have placed us on the cusp of unlocking the potential of the mouse model for unearthing insights into aqueous drainage structure and function. Multimodality 2-photon imaging permits high-resolution visualization not only of tissue structural organization but also cells and cellular function. It is possible to dig deeper into understanding the cellular basis of aqueous outflow regulation as the technique integrates analysis of tissue structure, cell biology and physiology in a way that could also lead to fresh insights into human glaucoma. We outline recent novel applications of two-photon imaging to analyze the mouse conventional drainage system in vivo or in whole tissues: (1) collagen second harmonic generation (SHG) identifies the locations of episcleral vessels, intrascleral plexuses, collector channels, and Schlemm's canal in the distal aqueous drainage tract; (2) the prospero homeobox protein 1-green fluorescent protein (GFP) reporter helps locate the inner wall of Schlemm's canal; (3) Calcein AM, siGLO™, the fluorescent reporters m-Tomato and GFP, and coherent anti-Stokes scattering (CARS), are adjuncts to TPEF to identify live cells by their membrane or cytosolic locations; (4) autofluorescence and sulforhodamine-B to identify elastic fibers in the living eye. These tools greatly expand our options for analyzing physiological and pathological processes in the aqueous drainage tissues of live mice as a model of the analogous human system.

8 Review Promising alternative clinical uses of prostaglandin F2α analogs: beyond the eyelashes. 2015

Choi, Young M / Diehl, Joseph / Levins, Paul C. ·David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California. · Division of Dermatology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California. · Division of Dermatology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California. Electronic address: PLevins@mednet.ucla.edu. ·J Am Acad Dermatol · Pubmed #25601618.

ABSTRACT: Prostaglandin F2α analogs, commonly prescribed for glaucoma treatment, have been shown to induce side effects such as cutaneous hypertrichosis and hyperpigmentation. Therefore, these medications have theoretic applications in the treatment of alopecia and disorders of hypopigmentation. We reviewed the literature to find original studies assessing the use of prostaglandin F2α analogs in these settings. Studies and reports were analyzed in regards to androgenic alopecia, alopecia areata, chemotherapy-induced alopecia, vitiligo, and hypopigmented scarring. Based on the results of these studies, and consideration of pathophysiologic mechanism, the most promising applications for prostaglandin F2α analogs include androgenic alopecia, chemotherapy-induced alopecia, and alopecia areata concurrently treated with corticosteroids.

9 Review Measuring rates of structural and functional change in glaucoma. 2015

Nouri-Mahdavi, Kouros / Caprioli, Joseph. ·The Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. ·Br J Ophthalmol · Pubmed #25287369.

ABSTRACT: Glaucoma is a progressive optic neuropathy. Hence, most glaucomatous eyes demonstrate signs of deterioration over time despite what may appear to be adequate treatment. The main goal of glaucoma treatment is to slow the rate of disease so that patients can prolong their functional vision. Therefore, it is important for clinicians caring for patients with glaucoma to be able to estimate rates of change with structural and functional outcomes in their patients. Various trend analysis models have been previously used to estimate rates of decay in glaucoma. The authors discuss the relevant issues and the inherent caveats related to estimating structural and functional rates of change in glaucoma. Patterns of deterioration, testing frequency, and combing structural and functional rates of change are also addressed.

10 Review Selecting visual field tests and assessing visual field deterioration in glaucoma. 2014

Nouri-Mahdavi, Kouros. ·Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Calif.. Electronic address: nouri-mahdavi@jsei.ucla.edu. ·Can J Ophthalmol · Pubmed #25433738.

ABSTRACT: Testing the peripheral field of vision is the mainstay for detection of glaucoma deterioration. Various methods and algorithms are currently available for detection of early glaucoma or establishing disease progression. Alternative testing strategies such as frequency doubling technology perimetry or short-wavelength automated perimetry have been extensively explored over the last 2 decades. The former has been found most promising for detection of earliest evidence of functional glaucoma damage when the standard achromatic perimetry results are still within the normal range. However, standard achromatic perimetry remains the standard technique for establishing deterioration of the disease. Both trend and event analyses are used for establishing change within series of visual fields. Trend analyses provide the clinician with rates of progression, putting the speed of glaucoma progression in the context of patient longevity, whereas event analyses demonstrate a "step" change regardless of the length of time it took for this amount of change to occur. The two techniques are complementary and should be used concurrently.

11 Review Pediatric glaucoma surgery: a report by the American Academy Of Ophthalmology. 2014

Chen, Teresa C / Chen, Philip P / Francis, Brian A / Junk, Anna K / Smith, Scott D / Singh, Kuldev / Lin, Shan C. ·Harvard Medical School, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Glaucoma Service, Boston, Massachusetts. · Department of Ophthalmology, University of Washington, Seattle, Washington. · Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California. · Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida. · Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. · Stanford University School of Medicine, Stanford, California. · Department of Ophthalmology, University of California, San Francisco, San Francisco, California. ·Ophthalmology · Pubmed #25066765.

ABSTRACT: OBJECTIVE: To review the current published literature to evaluate the success rates and long-term problems associated with surgery for pediatric glaucoma. METHODS: Literature searches of the PubMed and Cochrane Library databases were last conducted in May 2012. The search yielded 838 potentially relevant citations, of which 273 were in non-English languages. The titles and abstracts of these articles were reviewed by the authors, and 364 were selected for possible further review. Members of the Ophthalmic Technology Assessment Committee Glaucoma Panel reviewed the full text of these articles and used the 36 that met inclusion and exclusion criteria for this Ophthalmic Technology Assessment. There were no studies on the topic that provided level I evidence. The assessment included only level II and level III studies. RESULTS: Surgeons treat pediatric glaucoma most commonly with goniotomy, trabeculotomy, trabeculectomy, combined trabeculotomy and trabeculectomy, tube shunt surgery, cyclodestruction, and deep sclerectomy. Certain surgical options seem better for specific diagnoses, such as primary congenital glaucoma, aphakic glaucoma, and glaucomas associated with other ocular or systemic anomalies. CONCLUSIONS: There are many surgical options for the treatment of the pediatric glaucomas. The relative efficacy of these various procedures for particular diagnoses and clinical situations should be weighed against the specific risks associated with the procedures for individual patients.

12 Review New directions in the treatment of normal tension glaucoma. 2014

Song, Brian J / Caprioli, Joseph. ·Jules Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, USA. ·Indian J Ophthalmol · Pubmed #24881596.

ABSTRACT: Glaucoma is a progressive optic neuropathy that causes characteristic changes of the optic nerve and visual field in relation to intraocular pressure (IOP). It is now known that glaucoma can occur at statistically normal IOPs and prevalence studies have shown that normal tension glaucoma (NTG) is more common than previously thought. While IOP is believed to be the predominant risk factor in primary open angle glaucoma (POAG), IOP-independent risk factors, such as vascular dysregulation, are believed to play an important part in the pathogenesis of NTG. Though certain distinguishing phenotypic features of NTG have been reported, such as an increased frequency of disc hemorrhages, acquired pits of the optic nerve and characteristic patterns of disc cupping and visual field loss, there is much overlap of the clinical findings in NTG with POAG, suggesting that NTG is likely part of a continuum of open angle glaucomas. However, IOP modification is still the mainstay of treatment in NTG. As in traditional POAG, reduction of IOP can be achieved with the use of medications, laser trabeculoplasty or surgery. Studies now show that the choice of medication may also be important in determining the outcomes of these patients. Though it is likely that future treatment of NTG will involve modification of both IOP and IOP-independent risk factors, current efforts to develop IOP-independent neuroprotective treatments have not yet proven to be effective in humans.

13 Review Endoscopic ophthalmic surgery of the anterior segment. 2014

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

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

14 Review Glaucoma: a disease of early cellular senescence. 2013

Caprioli, Joseph. ·Department of Ophthalmology, Jules Stein Eye Institute, University of California-Los Angeles, Los Angeles, California. ·Invest Ophthalmol Vis Sci · Pubmed #24335071.

ABSTRACT: -- No abstract --

15 Review National Eye Institute Visual Function Questionnaire: usefulness in glaucoma. 2013

Nassiri, Nariman / Mehravaran, Shiva / Nouri-Mahdavi, Kouros / Coleman, Anne L. ·Glaucoma Division, Jules Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, USA. ·Optom Vis Sci · Pubmed #23851305.

ABSTRACT: The National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) is the most commonly used patient-reported outcome measure to assess vision-related quality of life in patients with glaucoma. Glaucoma negatively affects the composite and several NEI-VFQ subscale scores; this effect is correlated with the severity of glaucomatous visual field loss. Contrast sensitivity, glare, and dark adaptation are potential items that could be added to the NEI-VFQ to make it more responsive to changes in vision-related quality of life in patients with glaucoma.

16 Review Acupuncture for glaucoma. 2013

Law, Simon K / Li, Tianjing. ·Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, USA. Law@jsei.ucla.edu. ·Cochrane Database Syst Rev · Pubmed #23728656.

ABSTRACT: BACKGROUND: Glaucoma is a multifactorial optic neuropathy characterized by an acquired loss of retinal ganglion cells at levels beyond normal age-related loss and corresponding atrophy of the optic nerve. Although many treatments are available to manage glaucoma, glaucoma is a chronic condition. Some patients may seek complementary or alternative medicine approaches such as acupuncture to supplement their regular treatment. The underlying plausibility of acupuncture is that disorders related to the flow of Chi (the traditional Chinese concept translated as vital force or energy) can be prevented or treated by stimulating relevant points on the body surface. OBJECTIVES: The objective of this review was to assess the effectiveness and safety of acupuncture in people with glaucoma. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2013), EMBASE (January 1980 to January 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to January 2013), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (January 1937 to January 2013), ZETOC (January 1993 to January 2013), Allied and Complementary Medicine Database (AMED) (January 1985 to January 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov), the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en) and the National Center for Complementary and Alternative Medicine web site (NCCAM) (http://nccam.nih.gov). We did not use any language or date restrictions in the search for trials. We last searched the electronic databases on 8 January 2013 with the exception of NCCAM which was last searched on 14 July 2010. We also handsearched Chinese medical journals at Peking Union Medical College Library in April 2007.We searched the Chinese Acupuncture Trials Register, the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS), and the Chinese Biological Database (CBM) for the original review; we did not search these databases for the 2013 review update. SELECTION CRITERIA: We included randomized controlled trials (RCTs) in which one arm of the study involved acupuncture treatment. DATA COLLECTION AND ANALYSIS: Two authors independently evaluated the search results and then full text articles against the eligibility criteria. We resolved discrepancies by discussion. MAIN RESULTS: We included one completed and one ongoing trial, and recorded seven trials awaiting assessment for eligibility. These seven trials were written in Chinese and were identified from a systematic review on the same topic published in a Chinese journal. The completed trial compared auricular acupressure-a nonstandard acupuncture technique-with the sham procedure for glaucoma. This trial is rated at high risk of bias for masking of outcome assessors, unclear risk of bias for selective outcome reporting, and low risk of bias for other domains. The difference in intraocular pressure (measured in mm Hg) in the acupressure group was significantly less than that in the sham group at four weeks (-3.70, 95% confidence interval [CI] -7.11 to -0.29 for the right eye; -4.90, 95% CI -8.08 to -1.72 for the left eye), but was not statistically different at any other follow-up time points, including the longest follow-up time at eight weeks. No statistically significant difference in visual acuity was noted at any follow-up time points. The ongoing trial was registered with the International Clinical Trials Registry Platform (ICTRP) of the World Health Organization. To date this trial has not recruited any participants. AUTHORS' CONCLUSIONS: At this time, it is impossible to draw reliable conclusions from available data to support the use of acupuncture for the treatment of glaucoma. Because of ethical considerations, RCTs comparing acupuncture alone with standard glaucoma treatment or placebo are unlikely to be justified in countries where the standard of care has already been established. Because most glaucoma patients currently cared for by ophthalmologists do not use nontraditional therapy, clinical practice decisions will have to be based on physician judgments and patient preferences, given this lack of data in the literature. Inclusion of the seven Chinese trials in future updates of this review may change our conclusions.

17 Review Crystallins in retinal ganglion cell survival and regeneration. 2013

Piri, Natik / Kwong, Jacky M K / Caprioli, Joseph. ·Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, 90095, USA, piri@jsei.ucla.edu. ·Mol Neurobiol · Pubmed #23709342.

ABSTRACT: Crystallins are heterogeneous proteins classified into alpha, beta, and gamma families. Although crystallins were first identified as the major structural components of the ocular lens with a principal function to maintain lens transparency, further studies have demonstrated the expression of these proteins in a wide variety of tissues and cell types. Alpha crystallins (alpha A and alpha B) share significant homology with small heat shock proteins and have chaperone-like properties, including the ability to bind and prevent the precipitation of denatured proteins and to increase cellular resistance to stress-induced apoptosis. Stress-induced upregulation of crystallin expression is a commonly observed phenomenon and viewed as a cellular response mechanism against environmental and metabolic insults. However, several studies reported downregulation of crystallin gene expression in various models of glaucomatous nerodegeneration suggesting that that the decreased levels of crystallins may affect the survival properties of retinal ganglion cells (RGCs) and thus, be associated with their degeneration. This hypothesis was corroborated by increased survival of axotomized RGCs in retinas overexpressing alpha A or alpha B crystallins. In addition to RGC protective functions of alpha crystallins, beta and gamma crystallins were implicated in RGC axonal regeneration. These findings demonstrate the importance of crystallin genes in RGC survival and regeneration and further in-depth studies are necessary to better understand the mechanisms underlying the functions of these proteins in healthy RGCs as well as during glaucomatous neurodegeneration, which in turn could help in designing new therapeutic strategies to preserve or regenerate these cells.

18 Review Advances in glaucoma treatment and management: surgery. 2012

Coleman, Anne Louise. ·Jules Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90095, USA. coleman@jsei.ucla.edu ·Invest Ophthalmol Vis Sci · Pubmed #22562849.

ABSTRACT: -- No abstract --

19 Review Role of phacoemulsification in angle closure glaucoma. 2011

Moghimi, Sasan / Lin, Shan. ·University of California, Los Angeles Medical School, Los Angeles, CA , USA. ·Eye Sci · Pubmed #21913342.

ABSTRACT: Cataract or clear Lens extraction has been suggested as a treatment option for different spectrums of primary angle closure diseases. It might reduce the risk of progression of angle closure and/or glaucoma by helping to open the angle and control the intraocular pressure (IOP). Conventionally, medically uncontrolled primary angle closure glaucoma was treated with trabeculectomy or phacotrabeculectomy and acute primary angle closure was treated with laser peripheral iridotomy. However, recent randomized controlled trials have demonstrated greater promise of phacoemulsification cataract surgery alone for control of the IOP. In this report we review the current literature to evaluate the impact of cataract surgery upon preventing and controlling primary angle closure diseases.

20 Review Detection of visual field progression in glaucoma with standard achromatic perimetry: a review and practical implications. 2011

Nouri-Mahdavi, Kouros / Nassiri, Nariman / Giangiacomo, Annette / Caprioli, Joseph. ·Glaucoma Division, Jules Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA. nouri-mahdavi@jsei.ucla.edu ·Graefes Arch Clin Exp Ophthalmol · Pubmed #21870086.

ABSTRACT: Detection of visual field progression remains a challenging task despite the recent advances for better handling of longitudinal visual field data, some of which are incorporated in currently available perimeters. Standard achromatic perimetry remains the gold standard for detection of visual field progression. The authors present a practical and clinically relevant review of the main issues involved in detection of early glaucoma as well as detection of visual field progression in eyes with pre-existing glaucomatous damage. After discussing some basic concepts in perimetry, the authors present evidence-based recommendations for criteria to detect earliest evidence of glaucomatous damage with perimetry. The authors will review different event- and trend-based criteria and present data with regard to comparative performance of such criteria. Relevance of using absolute versus corrected threshold data with regard to different criteria is also addressed. At the end, the authors provide practical guidelines for detection of visual field progression in a clinical setting and review issues related to clinical trials.

21 Review Intraocular pressure: modulation as treatment for glaucoma. 2011

Caprioli, Joseph / Varma, Rohit. ·Jules Stein Eye Institute, The David Geffen School of Medicine, Los Angeles, California. · Doheny Eye Institute, University of Southern California, Los Angeles, California. ·Am J Ophthalmol · Pubmed #21855671.

ABSTRACT: PURPOSE: To review the role of intervisit intraocular pressure (IOP) fluctuation as an independent risk factor for glaucoma. DESIGN: Perspective after literature review. METHODS: Analysis of pertinent publications in the peer-reviewed literature. RESULTS: Disparate findings regarding the role of intervisit IOP variation have been published. IOP variation was a significant risk factor in the Advanced Glaucoma Intervention Study (AGIS), the Collaborative Initial Glaucoma Treatment Study, and other smaller studies. These studies have in common low IOPs (often after surgery) and moderately advanced disease. In the AGIS, when patients were stratified by mean IOP, only those patients with low IOPs showed the detrimental effects of IOP variation. IOP variation was not a significant risk factor in the Early Manifest Glaucoma Treatment Trial, and in 2 separate studies of ocular hypertensives. These studies have in common generally higher IOPs and an earlier stage of glaucoma (or no glaucoma at all). We believe these results are complementary rather than contradictory: existing data suggest that the effects of IOP variation depend on the characteristics of the patient, the baseline IOP, their stage of damage, the type of glaucoma, and other as-yet unknown factors. CONCLUSIONS: Practitioners should consider whether patients who are progressing at low mean IOP may benefit from having IOP variation reduced. Single elevated measures of IOP may not be an anomaly or may not be related to compliance, but may identify patients who are at high risk for progressive glaucomatous damage, and thus should be monitored more carefully and potentially treated more aggressively.

22 Review Abnormalities of the optic disc. 2011

Sadun, Alfredo A / Wang, Michelle Y. ·Departments of Ophthalmology and Neurosurgery, Doheny Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA. asadun@usc.edu ·Handb Clin Neurol · Pubmed #21601065.

ABSTRACT: The optic disc represents the anterior end of the optic nerve, the most forward extension of the central nervous system (CNS). The optic disc gives a rare glimpse into the CNS. Hence, diseases of the CNS are often manifested on fundus examination. Abnormalities of the optic disc may reflect eye disease (such as glaucoma), problems in development (as in various syndromes), or CNS disease (such as increased intracranial pressure). Each optic nerve is composed of about 1.2 million axons deriving from the retinal ganglion cells of one eye. Optic atrophy is a morphological sequela reflecting the loss of many or all of these axons. Myriad diseases such as hereditary, metabolic, tumor, and increased intracranial pressure can lead to optic atrophy. Some diseases, such as optic disc drusen, intracranial masses, orbital tumors, ischemic optic neuropathies, inflammations, and infiltrations, can produce optic disc edema before leading to optic atrophy. A number of new imaging modalities, such as optical coherence tomography (OCT), quantitate the thickness of the peripapillary retinal nerve fiber layer as an indirect measure of axonal loss or swelling. OCT can therefore be used to quantitate pathology or the response to therapy in various generalized CNS conditions, such as multiple sclerosis.

23 Review Natural history of glaucoma. 2011

Pan, Ying / Varma, Rohit. ·Doheny Eye Institute, University of Southern California, Los Angeles, CA 90033, USA. ·Indian J Ophthalmol · Pubmed #21150029.

ABSTRACT: PURPOSE: To present an overview of the recent observations and research that shed light on the understanding of open and closed angle glaucoma. METHODS: Literature review. RESULTS: Glaucoma is a major eye problem afflicting millions of people worldwide. As the population increases, the number of people with glaucoma also increases, with glaucoma becoming an increasing public health concern. This paper presents the natural history of open angle and angle closure glaucoma. We examine the glaucomatous progression in terms of changes in optic disk morphology and visual fields as well as the risk factors for progression. CONCLUSIONS: This present review highlights the magnitude of glaucoma globally and the need for a greater understanding of this disease and its natural progression.

24 Review Blood pressure, perfusion pressure, and glaucoma. 2010

Caprioli, Joseph / Coleman, Anne L / Anonymous3170658. ·Jules Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. Caprioli@ucla.edu ·Am J Ophthalmol · Pubmed #20399924.

ABSTRACT: PURPOSE: To provide a critical review of the relationships between blood pressure, ocular blood flow, and glaucoma and the potential for glaucoma treatment through modulation of ocular perfusion. DESIGN: Summaries of the pertinent literature and input from glaucoma researchers and specialists with relevant experience. METHODS: Review and interpretation of selected literature and the results of a 1-day group discussion involving glaucoma researchers and specialists with expertise in epidemiology, blood flow measurements, and cardiovascular physiology. RESULTS: Accurate, reproducible, and clinically relevant measurements of blood flow within the optic nerve head and associated capillary beds are not fully achievable with current methodology. Autoregulation of blood flow in the retina and optic nerve head occurs over a large range of intraocular pressures and blood pressures. Regulation of choroidal blood flow is provided by a mix of neurohumoral and local mechanisms. Vascular factors may be important in a subgroup of patients with primary open-angle glaucoma, and particularly in patients with normal-tension glaucoma and evidence of vasospasm. Low ocular perfusion pressure and low blood pressure are associated with an increased risk of glaucoma in population-based studies. The physiologic nocturnal dip in blood pressure is protective against systemic end-organ damage, but its effects on glaucoma are not well elaborated or understood. Large-scale longitudinal studies would be required to evaluate the risk of glaucomatous progression in non-dippers, dippers, and extreme nocturnal blood pressure dippers. CONCLUSIONS: Decreases in perfusion pressure and blood pressure have been associated with glaucoma. However, there is no evidence to support the value of increasing a patient's blood pressure as therapy for glaucoma. Such recommendations are not currently warranted, since we lack crucial information about the microvascular beds in which perfusion is important in glaucoma, and the appropriate methods to evaluate their blood flow. There are also cardiovascular safety concerns associated with treatments designed to increase ocular perfusion pressure and blood flow by increasing blood pressure, especially in elderly patients. For these reasons and with present evidence it is unlikely that safe and effective glaucoma treatments based on altering optic nerve perfusion will soon be available.

25 Review Glaucoma in Latinos/Hispanics. 2010

Kim, Elma / Varma, Rohit. ·Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine of University of Southern California, Los Angeles, California 90033, USA. ·Curr Opin Ophthalmol · Pubmed #20040873.

ABSTRACT: PURPOSE OF REVIEW: Large differences exist in the prevalence of glaucoma among different racial and ethnic groups. The purpose of this article is to review the findings of the Los Angeles Latino Eye Study (LALES) with respect to the prevalence of glaucoma in Latinos and to identify factors associated with the development of glaucoma in this population. RECENT FINDINGS: LALES is the largest prevalence survey of eye disease in Latinos of Mexican origin to date. This review discusses the findings of LALES, including data that demonstrate specific risk factors and manifestations of open-angle glaucoma in this rapidly growing population. SUMMARY: The LALES data on ocular disease among Latinos of Mexican ancestry have crucial implications for effective clinical and public-health interventions. Understanding the particular characteristics of glaucoma in the Latino population is essential for correct diagnosis and management of this potentially blinding condition.