Risk factors for first presentation of glaucoma with significant visual field loss

Purpose: To identify risk factors associated with visual field (VF) loss on first presentation of glaucoma. Methods: A case–control study of 107 consecutive newly diagnosed glaucoma patients was performed. Information collected included demographic data, reasons for referral, ophthalmological assessment and VF testing. VF grading was based on Advanced Glaucoma Intervention Study (AGIS) scoring and was additionally classified for the presence of a nasal step, paracentral scotoma and/or arcuate scotoma. Results: Demographic parameters were: mean age 59 years (standard deviation [SD] 14), mean deviation ?4.37 dB (SD 4.5), intraocular pressure 21.4 mmHg (SD 6.6) and cup:disc ratio 0.69 (SD 0.1). Thirty‐seven per cent of all participants had a positive family history of glaucoma. Older age was associated with a VF defect at presentation (mean age of 54 years with no VF defect, compared with 63 years for mild, moderate or severe VF defect, P = 0.0014). Multivariate logistic regression analysis identified positive family history (odds ratio [OR] 10.43; 95% confidence interval [CI] 1.67–67.49) and age (OR 1.15; 95% CI 1.06–1.26) as independent risk factors for VF loss at presentation. Fifty‐six per cent had a paracentral VF defect at first diagnosis and 29% of patients showed evidence of substantial VF loss with AGIS score of ≥6 on initial presentation. Conclusions: Patients who have a positive family history of glaucoma are 10 times more likely to have a VF defect at the time of glaucoma diagnosis. An increased focus on family history may help identify these patients earlier and prevent significant visual loss at the time of presentation.     

体位改变对开角型青光眼小梁切除术后眼压波动的影响

目的:研究体位改变对开角型青光眼小梁切除术后眼压波动的影响,并探讨这一影响对预测预后的价值。方法:选择51例62眼原发性开角型青光眼患者为研究对象。以Perkins压平眼压计检测患者坐位(初坐位)眼压后,要求患者平卧25min,检测眼压,继而要求患者行坐位(终坐位),持续15min,检测眼压。按眼压极差是否≥5mm Hg将其划分为高波动组和低波动组。统计视野进展情况(以AGIS得分评价)、HPA分期,评价眼压极差与其相关性。每3mo复查,持续1a,评价眼压极差与AGIS得分变化趋势。结果:初坐位眼压18.1±2.2mm Hg,同一体位多时点眼压无显著差异(P>0.05),眼压极差4.1±1.5mm Hg;低波动组AGIS视野稳定者及HPA早期者显著多于高波动组(P<0.001;P<0.05),眼压极差与AGIS显著正相关(r=0.412,P<0.001);随时间延长,视野进展人数上升,眼压极差上升,且任意时刻两者间均呈显著正相关(P<0.01)。结论:小梁切除术后患者体位改变下眼压波动与视野进展程度有关,可通过检测眼压波动简单预测患者预后,从而调整眼压控制方案。     

Gender‐related differences in cataract surgery outcome: a 5‐year follow‐up

Purpose: A prospective, longitudinal, population‐based cohort study was performed to analyse gender‐related differences in subjective and objective visual function 5 years after cataract surgery. Methods: All patients (n = 810) who underwent cataract surgery during a 1‐year period (1997–98) at Norrlands University Hospital in Umeå, Sweden, were studied with visual acuity (VA) data and questionnaires (VF‐14) before and after surgery, as well as 5 years later. Five hundred and thirty patients (177 men, 353 women) answered the questionnaire, constituting 90% (530/590) of the survivors. Four hundred and sixty‐seven (156 men, 311 women) also underwent an eye examination. Results: The women were significantly older (P = 0.009) and were more often operated on both eyes (P = 0.005). Before surgery and postoperatively, the women had a significantly lower age‐ and VA‐adjusted VF‐14 score (P = 0.000 and P = 0.036, respectively). This difference was not significant 5 years after surgery (P = 0.16). Five years after surgery, a significantly larger proportion of women had a decline of more than 0.1 logarithm of the minimum angle of resolution of the better‐seeing eye (P = 0.013). There were no significant gender‐related differences in the operated eye. Conclusion: Female cataract surgery patients assess their visual function worse than males after adjustment for age and VA preoperatively and postoperatively. These differences were not significant 5 years after surgery although the men had better best‐corrected visual acuity (BCVA) of their better eye. It is important to be aware of gender‐related differences in perception when performing questionnaire‐based outcome studies.     

Oximetry in glaucoma: correlation of metabolic change with structural and functional damage

Purpose: To determine whether retinal vessel oxygen saturation in patients with glaucoma is associated with structural optic disc and retinal nerve fibre layer (RNFL) changes and visual field (VF) defects. Methods: Fifty‐nine patients with confirmed glaucoma were recruited at University Hospitals Leuven. Retinal oxygen saturation in patients with glaucoma was measured with a noninvasive spectrophotometric retinal oximeter (Oxymap ehf, Reykjavik, Iceland). VF and Heidelberg retinal tomographies (HRTs) were performed on the same day. Statistical analysis was performed using Student’s t‐test and Pearson’s or Spearman correlation coefficient. Results: The mean oxygen saturation in venules was higher in patients with severe VF defects compared to those patients with mild VF defects (69 ± 3% versus 65 ± 6% respectively; p = 0.0003; n = 59). Accordingly, the arteriovenous (AV) difference in oxygen saturation was lower in patients with worse VF compared to those with better VF (29 ± 3% versus 33 ± 6% respectively; p = 0.002). The oxygen saturation in venules correlated with the VF mean defects (r = ?0.42; p = 0.001; n = 59) as well as with the structural HRT parameters rim area and RNFL thickness (r = ?0.39; p = 0.008 and r = ?0.26; p = 0.05 respectively; n = 53). The AV difference decreased significantly as the VF defect worsened (r = 0.38; p = 0.003), as the rim area diminished (r = 0.29; p = 0.03) and as the RNFL thickness decreased (r = 0.27; p = 0.05). No correlation was found between the oxygen saturation in retinal arterioles and either of these parameters. Conclusion: Severe glaucomatous damage is associated with increased oxygen saturation in retinal venules and decreased AV difference in oxygen saturation. These data suggest that in eyes with severe glaucomatous damage, reduced retinal oxygen consumption is consistent with tissue loss.     

Keratoconus in Asians: demographics, clinical characteristics and visual function in a hospital-based population

Background: To describe the demographics, clinical characteristics and visual function of Asian patients with keratoconus managed in a tertiary eye centre. Design: Prospective cross‐sectional study. Participants: 116 patients with clinically evident or suspected keratoconus (on videokeratography) recruited over 11 months. Methods: A standardised interview, full ophthalmic examination, refraction and corneal topography were performed. Visual function was assessed with the VF‐14 questionnaire. Main Outcome Measures: Demographics, clinical characteristics and visual function. Results: Mean age of our patients was 29.5 ± 9.40 years on enrolment, 62.9% were male, and the ethnic distribution was 60.3% Chinese, 13.8% Malays and 9.5% Indians. Clinically evident keratoconus was present bilaterally in 65 patients (56.0%) and unilateral keratoconus in five patients (4.3%). Five patients (4.3%) had a family history of keratoconus. The majority of patients were managed with contact lenses (60.8%) or glasses (24.5%). Eye rubbing was common (68%) as were asthma (26.3%) and eczema (18.4%). Conical protrusion was the commonest sign (75.3%). The mean cylinder was higher in keratoconus eyes compared with keratoconus suspect eyes (?4.01 vs. ?1.27, P < 0.001), and best‐corrected visual acuity was poorer (0.19 vs. 0.05, P < 0.001). Unaided visual acuity was significantly worse with increasing age (P = 0.016). On the VF‐14, 32% scored 90 or less (out of 100), reflecting difficulties with vision‐related daily activities. Conclusions: Our Asian patients with keratoconus had similar demographic and clinical characteristics to patients in Western populations. Even with apparently good visual acuity, some patients still experience substantial impairment in vision‐related activities.     

The Pyhäjärvi Cataract Study II. Criteria for cataract surgery

Purpose: It is necessary to develop tools for patient selection to target cataract surgery to patients with the best expected outcomes. We used visual acuity, visual functioning 14 (VF‐14) test, the 15‐dimension health‐related quality‐of‐life questionnaire (15D) and the New Zealand priority criteria to evaluate the criteria for cataract surgery in a post hoc setting. Material and methods: Ninety‐three consecutive patients living in a defined rural area in Finland had cataract surgery as a part of the Pyhäjärvi Cataract Study in 2003. Success of cataract surgery was defined as improvement of visual acuity by at least 2 lines and/or improvement of visual function measured by questionnaires. Results: The patients with a visual acuity of 0.30 logMAR (0.5 Snellen decimal) or worse in the better eye and/or 0.52 logMAR (0.3 Snellen decimal) in the worse eye had successful surgery in 59–83% of cases depending on the definition of success. When subjective judgement was added, the success rates varied between 63% and 91%. Conclusion: Setting indication criteria, it seems sufficient to use two global questions in addition to visual acuity: one on the subjective view on disability, and one on a more neutral view on visual function, such as the 15D item on vision. The VF‐14 did not perform any better than the single item counterparts.     

Relationship between asymmetric central corneal thickness and glaucomatous visual field loss within the same patient.

PURPOSE: Considering that thinner central corneal thickness (CCT) has been identified as a significant glaucoma risk factor, this study was designed to determine whether patients with glaucoma with asymmetric CCT demonstrate greater visual field loss in their thinner CCT eye compared with their thicker CCT eye. METHODS: Patient logs were used to retrospectively identify patients with primary open-angle glaucoma (POAG) and patients with normal-tension glaucoma (NTG) with CCT asymmetry of 10 microm or greater. Severity of glaucoma was determined using Advanced Glaucoma Intervention Study (AGIS) visual field scoring criteria. After statistical analysis was used to compare all thinner CCT eyes vs. corresponding thicker CCT eyes, subjects with worse visual field loss in the thinner CCT eye were compared with subjects with worse visual field loss in the thicker CCT eye. Subanalysis was then completed using only subjects with CCT asymmetry of 15 microm or greater. RESULTS: In the 52 subjects who met all criteria for study inclusion, mean AGIS score was significantly higher in the thinner CCT eyes compared with the thicker CCT eyes. Subjects with higher AGIS score in their thinner CCT eye outnumbered subjects with higher AGIS score in their thicker CCT eye, with the differences approaching statistical significance in the full sample (p = 0.06) and achieving significance when analysis was limited to subjects with CCT asymmetry of 15 microm or greater (p = 0.001). Multivariate logistic regression analysis identified thinner CCT as the primary risk factor associated with higher AGIS score in subjects with CCT asymmetry of 15 microm or greater. CONCLUSION: These results correspond to prior reports implicating CCT as an independent risk factor for glaucomatous visual field loss. When significant CCT asymmetry is present in patients with glaucoma, the thinner CCT eye is at greater risk for more advanced visual field loss. The underlying nature of this increased risk is unknown, but further study into structural vulnerabilities associated with thinner CCT seems justified.     

Associations between glaucomatous visual field loss and participation in activities of daily living

Purpose: This study investigated the association between visual field loss and participation in daily activities in individuals with glaucoma. Methods: Seventy‐nine patients were recruited from the Royal Victorian Eye and Ear Hospital. Visual fields were assessed using the Esterman binocular visual field tests and participation in daily activities was assessed using the Impact of Vision Impairment (IVI) questionnaire. Visual acuity and contrast sensitivity were also measured. Results: There was no independent relationship between visual field loss and IVI score (r = ?0.20; P = 0.09), except for the mobility domain (r = 0.25; P = 0.03). Mobility was the most affected domain of the IVI (mean = 1.2). Over a quarter of the patients reported experiencing moderate to severe restriction with mobility activities despite relatively minor binocular field loss. Conclusion: Mobility is the area in which glaucoma patients encounter difficulties even when the visual field and visual acuity are relatively good. Questions related to mobility could be asked to identify those patients who need rehabilitation.     

Which factors influence patients’ maximum acceptable waiting time for cataract surgery? – a questionnaire survey

Purpose: To evaluate patients’ maximum acceptable waiting time (MAWT) and to assess the determinants of patient perceptions of MAWT. Methods: A total of 500 consecutive patients with cataract were asked to fill out a preoperative questionnaire, addressing patients’ MAWT to undergo cataract surgery. Patients’ visual impairment (VF‐14 score), education, profession and social status were evaluated, and an ophthalmologic examination was performed. Univariate analysis included Spearman’s correlation test, unpaired Student’s t‐test and the Mann–Whitney U test. Univariate and multivariate associations were calculated using unconditional logistic regression. Results: The mean MAWT was 3.17 ± 2.12 months. The mean VF‐14 score was 72.10 ± 22.54. Between VF‐14 score and MAWT, there was a significant correlation (r = 0.180, p = 0.004). Patients with higher education (high school, university) accepted significantly longer MAWT (3.92 ± 2.38 months versus 3.02 ± 2.00 months, p = 0.009). Patients who had self‐noticed visual impairment were nearly four times (OR: 3.88, 95% CI = 2.07–7.28, p < 0.001) more likely to accept only MAWT of <3 months. Conclusions: Patients with low tolerance for waiting had greater self‐reported difficulty with vision. Patients’ acceptance of waiting was not associated with clinical visual acuity measures. Education, ability to work, living independently and taking care of dependents were also strong predictors from patients’ perspective. Considering the implementation of standards for waiting lists, these facts should be taken into account.     

Evaluation of Visual Field Test Parameters after Artificial Tear Administration in Patients with Glaucoma and Dry Eye

Purpose: To examine the effect of a single dose of artificial tear administration on automated visual field (VF) testing in patients with glaucoma and dry eye syndrome. Material and Methods: A total of 35 patients with primary open-angle glaucoma experienced in VF testing with symptoms of dry eye were enrolled in this study. At the first visit, standard VF testing was performed. At the second and third visits with an interval of one week, while the left eyes served as control, one drop of artificial tear was administered to each patient’s right eye, and then VF testing was performed again. The reliability parameters, VF indices, number of depressed points at probability levels of pattern deviation plots, and test times were compared between visits. Results: No significant difference was observed in any VF testing parameters of control eyes (P>0.05). In artificial tear administered eyes, significant improvement was observed in test duration, mean deviation, and the number of depressed points at probability levels (P?0.5%, P?1%, P?2) of pattern deviation plots (P?0.05). The post-hoc test revealed that artificial tear administration elicited an improvement in test duration, mean deviation, and the number of depressed points at probability levels (P?0.5%, P?1%, P?2%) of pattern deviation plots from first visit to second and third visits (P?0.01, for all comparisons). The intraclass correlation coefficient for the three VF test indices was found to be between 0.735 and 0.85 (P<0.001, for all). Discussion: A single dose of artificial tear administration immediately before VF testing seems to improve test results and decrease test time.     

Progression of visual field defects and visual loss in trabeculectomized eyes

Purpose To evaluate progression of visual field (VF) defects and development of visual impairment (low vision and blindness) after trabeculectomy.Methods We evaluated retrospectively 138 eyes of 138 consecutive patients over 40 years of age with primary open-angle glaucoma (POAG) or exfoliation glaucoma (EG) operated on by trabeculectomy without antimetabolites. The mean follow-up period was 3.5 years (range 2–5). In 83 eyes, pre- and postoperative VF measured by the same technique were compared to detect progression. Visual acuities (VA) were recorded as Snellen decimal notations. VA of <0.3 to 0.05 was defined as low vision and VA of <0.05 or VF constricted to less than 20° in diameter as blindness.Results In 34 (41%) of 83 eyes with comparable fields, VF defects progressed because of glaucoma. In logistic regression analysis, severity of preoperative VF loss (P=0.0047) and use of preoperative oral antiglaucomatous medication (P=0.047) correlated significantly with VF progression. In univariate analysis, also initial intraocular pressure (IOP) reduction after surgery (P=0.023) and IOP reduction from preoperative to last postoperative examination (P=0.036) were significantly smaller in eyes with VF progression. Defect progression did not, however, correlate significantly with the last IOP (P=0.58). Six eyes (4.3%) were blind due to glaucoma preoperatively and 14 eyes (10.1%) at the last follow-up. Visual impairment correlated with the severity of initial VF loss (P=0.008).Conclusions Progression of VF defects and development of visual impairment due to glaucoma was fairly common despite trabeculectomy. Both were associated with severity of initial VF defect. In this series, no significant correlation appeared between defect progression and the last IOP, but association between stability of VF and the amount of IOP reduction after surgery indicate that a lower target IOP level particularly in eyes with initially severe VF defect would, however, be needed.     

Visual field defects and vision-specific health-related quality of life in African Americans and whites with glaucoma

PURPOSE: To examine the relationship of visual field impairment to vision-specific health-related quality of life and symptoms in a large cohort (N=345) of African Americans and Whites of non-Hispanic origin diagnosed with glaucoma. MATERIALS AND METHODS: Participants consisted of persons > or =55 years of age recruited from university-affiliated ophthalmology and optometry practices in Birmingham, AL who had been diagnosed with glaucoma. Medical records were abstracted to collect information on demographics, visual acuity, and visual fields. A telephone survey was conducted to obtain information on vision-specific health-related quality of life [National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25)], glaucoma symptoms [Glaucoma Symptom Scale (GSS)], and cognitive status (Short Portable Mental Status Questionnaire). Visual fields were used to compute a visual field defect score for each eye based on the Advanced Glaucoma Intervention Study (AGIS) scoring system. RESULTS: Mean NEI VFQ-25 subscale scores ranged from the 50s to 80s. Scores for African Americans and Whites did not differ except for the general health and ocular pain subscales for which African Americans had slightly higher scores. For both African Americans and Whites, as the AGIS score became worse in the better and/or worse eye, there was a decrease in VFQ subscale score for most VFQ subscales including general vision, distance vision, near vision, social functioning, color vision, and peripheral vision (P<0.05). AGIS scores were unrelated to the GSS subscales in African Americans; for Whites, the visual but not the nonvisual subscale was related to AGIS score. CONCLUSIONS: Scores on most subscales of the NEI VFQ-25 and the 2 subscales of the GSS are highly similar in African Americans and Whites of non-Hispanic origin who have been diagnosed with glaucoma. In addition, for both African Americans and Whites, the VFQ subscales for the most part demonstrated good construct validity with respect to the extent of visual field impairment. Results imply that the NEI VFQ-25 and the GSS are appropriate instruments for studying the personal burden of glaucoma in studies whose samples involve both African American and White adults.     

The one-eye trial and fellow eye response to prostaglandin analogues

Background: To determine if the intraocular pressure (IOP) reduction in one‐eye trial correlates with the IOP reduction in the fellow eye when IOP variability during office hours is taken into account. Methods: This retrospective observational case series includes 50 high tension (primary open‐angle glaucoma, exfoliative glaucoma and ocular hypertension; Group 1) and 21 normal tension (Group 2) glaucoma patients. Charts of bilateral open‐angle glaucoma patients at Glaucoma Unit, School of Medicine, Adnan Menderes University who had pretreatment baseline office IOP measurements at 9:30, 11:30 and 15:30; were put on a one‐eye trial with prostaglandin analogues, and then subsequently received the same medication in the fellow eye were reviewed. Pretreatment baseline office IOP measurements and reductions in the first and second eyes were compared to determine variability and correlation, respectively. Results: Both groups showed significant variability in pretreatment baseline office IOP measurements. Peak IOP level was before noon in at least 70% of eyes in Group 1, 50% in Group 2. IOP dropped a mean of 8.8 ± 4.8 mmHg (34%, P = < 0.0001) in Group 1 and 4.9 ± 2.4 mmHg (30%, P = < 0.0001) in Group 2 during the one‐eye trial. Following bilateral use of the medication a mean drop of 7.5 ± 4.0 mmHg (31%, P = < 0.0001) in Group 1 and 2.9 ± 1.9 mmHg (18%, P = < 0.0001) in Group 2 were obtained. The IOP reduction between fellow‐eye pairs were significantly correlated in Group 1 (r = 0.541, P = < 0.0001) but not Group 2 (r =?0.310, P = 0.171). Conclusions: One‐eye trial is a feasible method to determine the effectiveness of prostaglandin analogues and to predict the amount of IOP reduction in the fellow eye in patients with high tension glaucoma.     

Lifetime visual prognosis of patients with glaucoma

Background: To investigate the visual outcome of glaucoma patients. Design: This is a retrospective study of case notes of patients who died while under follow up in a glaucoma clinic of a University Hospital in Scotland between 2006 and 2009. Participants: Seventy‐seven patients were identified. Methods: Data collected included type of glaucoma, coexisting pathology and best‐corrected visual acuity in Snellen (converted to decimal values) for the first and final clinic visit. The final visual status was evaluated based on the best‐corrected visual acuity of the better seeing eye at the last glaucoma clinic visit. Patients who had best‐corrected visual acuity of less than Snellen decimal 0.5 were considered not to meet the standards for driving. Main Outcome Measures: Snellen decimal best‐corrected visual acuity, fulfilment of driving standards, and eligibility for partial sight and blind registration at the last clinic visit. Results: The mean ages at presentation and death were 71.8 ± 10.3 years and 82.2 ± 8.7 years respectively. The mean Snellen decimal best‐corrected visual acuity of the better eye at presentation was 0.78, and at the final clinic visit was 0.61. At the final clinic visit, no patients were partial sight registrable, four (5.2%) were blind registrable, and 27 (35.1%) did not fulfil UK driving criteria. Glaucoma patients with other ocular pathologies were more likely to fail UK driving criteria at presentation (P = 0.02) and at last clinic visit (P = 0.03). Conclusion: The majority of glaucoma patients maintained good visual function at the end of their lifetime.     

Progression of visual field loss in untreated glaucoma patients and glaucoma suspects in St. Lucia,West Indies

PURPOSE: A 1986-1987 survey found 8.8% prevalence of open-angle glaucoma in the black population of St. Lucia, West Indies. This follow-up study assessed visual field loss progression in untreated glaucoma patients and glaucoma suspects 10 years later. DESIGN: Cohort study. METHODS: Subjects were 205 glaucoma patients and suspects; 1987 data included age, sex, visual acuity, and visual fields measured by automated threshold perimetry (Humphrey C 30-2 test), and 1997 data included intraocular pressure, visual acuity, and visual fields measured by the same test. Exclusion criteria included field unreliability, field improvement due to vision improvement, nonglaucomatous vision deterioration, glaucoma treatment since 1988, and scoring of a visual field as end stage in 1987. Visual fields were scored by algorithms for the Advanced Glaucoma Intervention Study (AGIS) and Collaborative Initial Glaucoma Treatment Study (CIGTS). RESULTS: By AGIS criteria, 55% of 146 right eyes and 52% of 141 left eyes showed progression of visual field loss. In linear regressions, progression severity was unassociated with sex, intraocular pressure, or baseline visual field score, but was positively associated with age (P <.001, right; P =.002, left). The cumulative probability of reaching end stage in 10 years in at least one eye was approximately 16% by AGIS criteria. By CIGTS criteria, 73% of 146 right eyes and 72% of 141 left eyes progressed. CONCLUSIONS: These data provide a unique opportunity to study progression of untreated glaucoma. The percentage of eyes showing visual field loss progression and the percentage reaching end stage were considerably higher than in studies of visual field progression in treated eyes.     

Visual field defects and the risk of motor vehicle collisions among patients with glaucoma

PURPOSE: To evaluate the association between visual field defects in the central 24 degrees field and the risk of motor vehicle collisions (MVCs) among patients with glaucoma. METHODS: A nested case-control study was conducted in patients with glaucoma aged 55 or more. Cases were patients who were involved in a police-reported motor vehicle collision (MVC) between January 1994 and June 2000; controls were those who had not experienced an MVC at the time of their selection. For each patient, an Advanced Glaucoma Intervention Study (AGIS) score was calculated on automated visual fields collected with the 24-2 or 3-2 programs. RESULTS: With respect to the better-eye AGIS score, compared with patients with no visual field defect, those with severe defects (scores 12-20) had an increased risk of an MVC (odds ratio [OR] 3.2, 95% CI 0.9-10.4), although the association was not statistically significant. Moderate (6-11) or minor field defects (1-5) in the better eye were not associated with the risk of involvement in a crash. In the worse eye, patients with moderate or severe field defects were at significantly increased risk of an MVC (OR 3.6, 95% CI 1.4-9.4 and OR 4.4, 95% CI 1.6-12.4, respectively) compared with those with no defects. Minor field defects in the worse eye did not increase risk of MVC (OR 1.3, 95% CI 0.5-3.4). CONCLUSIONS: Patients with glaucoma who have moderate or severe visual field impairment in the central 24 degrees radius field in the worse-functioning eye are at increased risk of involvement in a vehicle crash.     

Quality of life after corneal transplantation: a retrospective study

PURPOSE: To assess how clinical and social characteristics influence health-related quality of life among patients who have undergone corneal transplantation. METHODS: Sixty-eight patients followed up for at least 1 year after corneal transplantation participated in this study. Data were collected on social status, systemic co-morbidities, ocular history, best corrected visual acuity, and a detailed ocular examination. Questionnaires that allowed calculation of VF14 and the SF36 scores were filled out for each participant interview. The associations between questionnaire outcomes and social status, ophthalmic status, and general health were evaluated using one-way analysis of variance and multiple stepwise linear regression. RESULTS: The mean best-corrected visual acuity (BCVA) was significantly better in the operated eye for keratoconus and dystrophies than for bullous keratopathy. There is a strong relationship between BCVA in the operated eye and the VF14 score (beta=8.45, p=0.005) and also between BCVA of the contralateral eye and the VF14 score (beta=19.91, p<0.0001). Correlations between VF14 and SF36 were all positive (range r=0.29-0.49, p<0.01). CONCLUSION: This retrospective analysis provided strong evidence for the validity and reliability of the VF14 as an instrument for testing visual disabilities or satisfaction in patients who had corneal transplantation. Astigmatism or anisometropia did not affect VF14 and SF36 scores. The most important factors associated with the VF14 score and SF36 measures were the visual acuity of the operated eye as well as the contralateral one, including their physical function, vitality, and the patient's perception of mental and general health.     

Visual field progression in patients with initially unilateral visual field loss from chronic open-angle glaucoma

PURPOSE: To investigate visual field progression in patients with initially unilateral glaucomatous visual field loss, and to determine risk factors for progression. DESIGN: Retrospective observational case series. PARTICIPANTS: Forty-eight consecutive patients with primary open-angle glaucoma, pseudoexfoliative glaucoma, or pigmentary glaucoma, seen over an 18-month period, who initially had unilateral visual field loss as defined by use of modified Anderson criteria. Patients were followed with standard Humphrey perimetry for a minimum of 2 years. METHODS: Progression was defined by use of modified Anderson criteria, and Advanced Glaucoma Intervention Study (AGIS) and Collaborative Initial Glaucoma Treatment Study scores. MAIN OUTCOME MEASURE: Visual field progression. RESULTS: Three patients (6.2%) had fellow eye progression over a mean follow-up of 76 months and duration of disease of 8.7 years. Fellow eye progression correlated with progression of the first-affected eye (P = 0.044). Ten patients (21%) had progression of the first-affected eye; these eyes had a larger initial cup/disc ratio compared with stable eyes (P = 0.041). Increasing initial AGIS score was associated with progression (P: = 0.003). Kaplan-Meier survival analysis estimated the risk of progression at 5 years to be 25% in first-affected eyes and 7.2% in fellow eyes. CONCLUSIONS: In this population, the risk of fellow eye progression in patients with initially unilateral visual field loss from open-angle glaucoma is low. Progression is higher in eyes with visual field loss at initial testing, and the risk of progression increases as the level of initial visual field loss increases.     

Association between corneal biomechanical properties and optic nerve head morphology in newly diagnosed glaucoma patients

Background: To investigate the association between corneal biomechanics and optic nerve head morphology in newly diagnosed primary open‐angle glaucoma patients. Design: Hospital based prospective study. Participants: Forty‐two untreated newly diagnosed primary open‐angle glaucoma patients. Methods: Patients underwent corneal hysteresis measurement using the Ocular Response Analyzer and confocal scanning laser ophthalmoscopy for optic nerve head topography evaluation. One eye was selected randomly for analysis. Data collected included age, race, gender, intraocular pressure and central corneal thickness. Main Outcome Measures: Multiple regression analysis (controlling for baseline intraocular pressure and disc area) was used to investigate factors associated with the following optic nerve head topographic parameters: linear cup‐to‐disc ratio and mean cup depth. Results: Mean age of participants was 66.7 ± 11.8 years. Corneal hysteresis was the only factor significantly associated with both mean cup depth (correlation coefficient [r] = ?0.34, P = 0.03) and cup‐to‐disc ratio (r = ?0.41, P = 0.01). Central corneal thickness was significantly associated with mean cup depth (r = ?0.35, P = 0.02), but not with cup‐to‐disc ratio (r = ?0.25, P = 0.13). Although a trend towards a positive association between age and cup‐to‐disc ratio was identified (r = 0.26, P = 0.08), age was not significantly associated with mean cup depth (r = 0.06, P = 0.72). When comparing fellow eyes of patients with bilateral glaucoma, the eye with higher corneal hysteresis had smaller cup‐to‐disc ratio in 75% of the cases. Conclusions: In untreated newly diagnosed primary open‐angle glaucoma patients, those with thinner corneas and mainly lower corneal hysteresis values had a larger cup‐to‐disc ratio and deeper cup, independently of intraocular pressure values and disc size.     

The impact of penetrating keratoplasty in patients with keratoconus using the VF-14 questionnaire

To assess the visual function of patients with keratoconus who underwent penetrating keratoplasty with the use of the VF-14 questionnaire. Fourteen patients (9 male and 5 female) with a mean age of 38 years (SD 13.59) participated in the study. All patients had keratoconus, confirmed by corneal topography, and all had previously undergone penetrating keratoplasty in one eye. Their mean best-corrected visual acuity (BCVA) binocularly was 0.185 (SD 0.077) LogMAR. None of the grafted eyes had a BCVA <0.300 LogMAR. Fourteen healthy volunteers, age- and sex-matched, also participated in the study as control subjects. The VF-14 questionnaire was used to evaluate the effect of the ocular status in the daily life activities of the patients. The mean VF-14 result for the grafted patients with keratoconus was 62.37% (SD 22.60) and for the control group it was 100% (P < 0.001). There was only a weak correlation between the VF-14 score and the binocular BCVA (r = −0.394, P = 0.163). The mean VF-14 result in grafted patients with keratoconus is indicative of low functional ability despite the satisfactory postoperative BCVA. The absence of a significant correlation between the VF-14 score and the mean BCVA indicates that the low functional visual ability in these patients is probably associated more with the ‘perceived by themselves’ difficulty due to their ophthalmological condition.