Enhanced Detection of Open-angle Glaucoma with an Anatomically Accurate Optical Coherence Tomography–Derived Neuroretinal Rim Parameter
TL;DR: The higher sensitivity at 95% specificity in early glaucoma of BMO-MRW compared with current BMO methods is significant, indicating a new structural marker for the detection and risk profiling of glau coma.
About: This article is published in Ophthalmology.The article was published on 2013-03-01 and is currently open access. It has received 315 citations till now. The article focuses on the topics: Optic disk.
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TL;DR: Primary care physicians can play an important role in the diagnosis of glaucoma by referring patients with positive family history or with suspicious optic nerve head findings for complete ophthalmologic examination and can improve treatment outcomes by reinforcing the importance of medication adherence and persistence.
Abstract: Importance Glaucoma is a worldwide leading cause of irreversible vision loss. Because it may be asymptomatic until a relatively late stage, diagnosis is frequently delayed. A general understanding of the disease pathophysiology, diagnosis, and treatment may assist primary care physicians in referring high-risk patients for comprehensive ophthalmologic examination and in more actively participating in the care of patients affected by this condition. Objective To describe current evidence regarding the pathophysiology and treatment of open-angle glaucoma and angle-closure glaucoma. Evidence Review A literature search was conducted using MEDLINE, the Cochrane Library, and manuscript references for studies published in English between January 2000 and September 2013 on the topics open-angle glaucoma and angle-closure glaucoma. From the 4334 abstracts screened, 210 articles were selected that contained information on pathophysiology and treatment with relevance to primary care physicians. Findings The glaucomas are a group of progressive optic neuropathies characterized by degeneration of retinal ganglion cells and resulting changes in the optic nerve head. Loss of ganglion cells is related to the level of intraocular pressure, but other factors may also play a role. Reduction of intraocular pressure is the only proven method to treat the disease. Although treatment is usually initiated with ocular hypotensive drops, laser trabeculoplasty and surgery may also be used to slow disease progression. Conclusions and Relevance Primary care physicians can play an important role in the diagnosis of glaucoma by referring patients with positive family history or with suspicious optic nerve head findings for complete ophthalmologic examination. They can improve treatment outcomes by reinforcing the importance of medication adherence and persistence and by recognizing adverse reactions from glaucoma medications and surgeries.
2,170 citations
22 Sep 2016
TL;DR: Primary open-angle glaucoma (POAG) is the most common type and management of POAG includes topical drug therapies and surgery to reduce IOP, although new therapies targeting neuroprotection of RGCs and axonal regeneration are under development.
Abstract: Glaucoma is an optic neuropathy that is characterized by the progressive degeneration of the optic nerve, leading to visual impairment. Glaucoma is the main cause of irreversible blindness worldwide, but typically remains asymptomatic until very severe. Open-angle glaucoma comprises the majority of cases in the United States and western Europe, of which, primary open-angle glaucoma (POAG) is the most common type. By contrast, in China and other Asian countries, angle-closure glaucoma is highly prevalent. These two types of glaucoma are characterized based on the anatomic configuration of the aqueous humour outflow pathway. The pathophysiology of POAG is not well understood, but it is an optic neuropathy that is thought to be associated with intraocular pressure (IOP)-related damage to the optic nerve head and resultant loss of retinal ganglion cells (RGCs). POAG is generally diagnosed during routine eye examination, which includes fundoscopic evaluation and visual field assessment (using perimetry). An increase in IOP, measured by tonometry, is not essential for diagnosis. Management of POAG includes topical drug therapies and surgery to reduce IOP, although new therapies targeting neuroprotection of RGCs and axonal regeneration are under development.
955 citations
TL;DR: The proposed 4-point paradigm change for clinical assessment of the ONH is designed to enhance the accuracy and consistency of rim width, as well as of peripapillary and macular intraretinal thickness measurements.
229 citations
Cites background from "Enhanced Detection of Open-angle Gl..."
...Currently, BMO is the most consistent SD OCT-detected outer border of the neuroretinal rim and a stable landmark that is visible readily in all but a few exceptional B-scans.(9,22) The minimum distance from BMO to the internal limiting membrane represents the geometrically correct width of the neuroretinal rim....
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...Currently, BMO is the most consistent SD OCT-detected outer border of the neuroretinal rim and a stable landmark that is visible readily in all but a few exceptional B-scans.9,22 The minimum distance from BMO to the internal limiting membrane represents the geometrically correct width of the neuroretinal rim....
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...Most recently, we showed that BMO-MRW significantly enhanced the ability to detect glaucomatous optic neuropathy compared with current confocal scanning laser tomography and current SD OCT analyses.(22) Automated algorithms for identifying (segmenting) BMO inB-scans of SDOCT images have been described and incorporated into commercial software....
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...The immediate consequence of the new quantitative measures proposed is that our ability to detect glaucoma is enhanced.(22) We anticipate that as data acquisition and analysis takes place according to the specific fovea-BMO center axis of an individual eye, interindividual variation in several important quantitative measures, including thickness of the peripapillary and macular RNFL and other segmented layers of the retina, will decrease and further will enhance detection of glaucoma....
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TL;DR: Speckle variance OCT-A allows visualization and quantification of RPCs and may be a useful tool for indirectly quantifying and monitoring retinal ganglion cell axonal injury in glaucoma.
161 citations
TL;DR: 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.
141 citations
References
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Book•
01 Jan 1985
TL;DR: Clinical Epidemiology is a book dedicated to H.L. Mencken, Kurt Vonnegut, Jr., Douglas Adams, and the Emperor's New Clothes and Physicians and others who wish to recognize key clinical epidemiologic features of the diagnosis and management of patients will benefit from reading.
Abstract: I might have guessed that a book dedicated to "H.L. Mencken, Kurt Vonnegut, Jr., Douglas Adams, and the Emperor's New Clothes" would be fun to read. It was! Readers will sense the authors' enthusiasm for their subject on each page, from the preface to the final chapter. The authors prepared this book for "users" rather than "doers" of clinical research. Physicians and others who wish to recognize key clinical epidemiologic features of the diagnosis and management of patients will benefit from reading Clinical Epidemiology. Those who wish to conduct actual research studies will need to look elsewhere for a detailed discussion of clinical epidemiologic methodology. In this review, I will mention
3,791 citations
Book•
01 Jan 2001
TL;DR: Without a way of critically appraising the information they receive, clinicians are relatively helpless in deciding what new information to learn and decide how to modify their practice.
Abstract: Medical practice is constantly changing. The rate of change is accelerating, and physicians can be forgiven if they often find it dizzying. How can physicians learn about new information and innovations, and decide how (if at all) they should modify their practice? Possible sources include summaries from the medical literature (review articles, practice guidelines, consensus statements, editorials, and summary articles in "throwaway" journals); consultation with colleagues who have special expertise; lectures; seminars; advertisements in medical journals; conversations with representatives from pharmaceutical companies; and original articles in journals and journal supplements. Each of these sources of information might be valuable, though each is subject to its own particular biases. 1,2 Problems arise when, as is often the case, these sources of information provide different suggestions about patient care. See also p 2093. Without a way of critically appraising the information they receive, clinicians are relatively helpless in deciding what new information
3,305 citations
TL;DR: The patient is a 28-year-old man whose acute onset of shortness of breath and vague chest pain began shortly after completing a 10-hour auto trip, and the physician is very apprehensive about his symptoms.
Abstract: CLINICAL SCENARIO You are back where we put you in the previous article1on diagnostic tests in this series on how to use the medical literature: in the library studying an article that will guide you in interpreting ventilation-perfusion (V/Q) lung scans. Using the criteria in Table 1, you have decided that the Prospective Investigation of Pulmonary Diagnosis (PIOPED) study2will provide you with valid information. Just then, another physician comes looking for an article to help with the interpretation of V/Q scanning. Her patient is a 28-year-old man whose acute onset of shortness of breath and vague chest pain began shortly after completing a 10-hour auto trip. He experienced several episodes of similar discomfort in the past, but none this severe, and is very apprehensive about his symptoms. After a normal physical examination, electrocardiogram and chest radiograph, and blood gas measurements that show a Pco2of
2,084 citations
TL;DR: You are back where you were in the previous article1 on diagnostic tests: in the library studying an article that will guide you in interpreting ventilation-perfusion (V/Q) lung scans.
Abstract: You are back where we put you in the previous article1 on diagnostic tests in this series on how to use the medical literature: in the library studying an article that will guide you in interpreting ventilation-perfusion (V/Q) lung scans. Using the criteria in Table 1, you have decided that the Prospective Investigation of Pulmonary Diagnosis (PIOPED) study2 will provide you with valid information. Just then, another physician
1,963 citations