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Biomedical subjects

Anne L Coleman

Publications and source records attributed to Anne L Coleman.

At least 19 recordsLinked to original sources
PubMed2006

Prevalence of age-related macular degeneration in Greece: the Thessaloniki Eye Study.

PURPOSE: To estimate the age- and gender-specific prevalence of age-related macular degeneration (AMD) in a population-based sample of subjects 60 years of age or older in Thessaloniki, Greece. DESIGN: Cross-sectional population-based study. METHODS: A total of 2554 subjects randomly identified from municipality registers in Thessaloniki underwent a complete ophthalmologic examination. RESULTS: Of the 3617 eligible subjects, 2554 (71%) participants completed a clinical examination. The prevalence was 2.5% for AMD, 1.4% for neovascular (NV) AMD, and 1.3% for geographic atrophy (GA). Bilateral AMD was present in 40% of AMD cases. The prevalence of AMD, NV, GA, and bilateral AMD increased with increasing age (P< .0001). No gender-specific statistically significant differences were noted. Of all participants with AMD, 67% were unaware of the diagnosis. CONCLUSIONS: The prevalence of AMD in Greece is comparable to that in other Caucasian populations. A dramatic increase in prevalence in people older than 80 years of age was observed.

Age Distribution↗
PubMed2006

Age-related macular degeneration is associated with an increased risk of hip fractures in the Medicare database.

PURPOSE: To explore the relationship between age-related macular degeneration (AMD) and incident hip fractures in the Medicare population. DESIGN: Prospective cohort study. METHODS: With a 5% random sample of Medicare beneficiaries in 1995, 8596 cases were coded with exudative AMD; 26,942 cases were coded with atrophic AMD, and 1,013,748 cases were coded without AMD. The Medicare claims from 1996 to 1999 were evaluated for hip fracture codes. The relationship between AMD and incident hip fractures was analyzed with multiple logistic regression models, with adjustment for baseline, ocular, and systemic covariates. RESULTS: In adjusted analyses, the risk of hip fractures was similar in cases that were coded with exudative AMD (odds ratio, 1.03; 95% confidence interval (CI), 0.95, 1.12) compared with cases with no AMD but was significantly higher in cases that were coded with atrophic AMD (odds ratio, 1.11; 95% CI, 1.06, 1.16). CONCLUSION: Medicare patients with a code for atrophic AMD had an 11% greater risk of hip fractures than did patients without a code for AMD over a four-year follow-up period.

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PubMed2006

A multicenter, retrospective pilot study of resource use and costs associated with severity of disease in glaucoma.

OBJECTIVE: To examine resource consumption and the direct costs of treating glaucoma at different disease severity levels. DESIGN: Observational, retrospective cohort study based on medical record review. PARTICIPANTS: One hundred fifty-one records of patients with primary open-angle or normal-tension glaucoma, glaucoma suspect, or ocular hypertension (age > or =18 years) were randomly selected from 12 sites in the United States and stratified according to severity based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Patients had to have been followed up for a minimum of 5 years. Patients with concomitant ocular disease likely to affect glaucoma treatment-related resource consumption were excluded. METHODS: Glaucoma severity was assessed and assigned using a 6-stage glaucoma staging system, modified from the Bascom Palmer (Hodapp-Anderson-Parrish) system. Clinical and resource use data were collected from the medical record review. Resource consumption for low-vision care and vision rehabilitation was estimated for patients with end-stage disease based on specialist surveys. For each stage of disease, publicly available economic data were then applied to assign resource valuation and estimate patient-level direct costs from the payer perspective. MAIN OUTCOME MEASURES: Average annual resource use and estimated total annual direct cost of treatment were calculated at the patient level and stratified by stage of disease. Direct costs by specific resource types, including ophthalmology visits, glaucoma surgeries, medications, visual field examinations, and other glaucoma services, were also assessed. RESULTS: Direct ophthalmology-related resource use, including ophthalmology visits, glaucoma surgeries, and medication use, increased as disease severity worsened. Average direct cost of treatment ranged from $623 per patient per year for glaucoma suspects or patients with early-stage disease to $2511 per patient per year for patients with end-stage disease. Medication costs composed the largest proportion of total direct cost for all stages of disease (range, 24%-61%). CONCLUSIONS: The study results suggest that resource use and direct cost of glaucoma management increase with worsening disease severity. Based on these findings, a glaucoma treatment that delays the progression of disease could have the potential to significantly reduce the health economic burden of this chronic disease over many years.

Adult↗
PubMed2006

Association of blood pressure status with the optic disk structure in non-glaucoma subjects: the Thessaloniki eye study.

PURPOSE: To study the association of blood pressure (BP) status on the optic disk structure as measured with the Heidelberg Retina Tomograph (HRT) in people without glaucoma. DESIGN: Cross-sectional population-based setting study. METHODS: Consecutive participants in the Thessaloniki Eye Study were included in this study. HRT images of the optic disk and BP measurements were taken. Hypertension was defined as a systolic BP (SBP) > or =140 mm Hg, diastolic BP (DBP) >/=90 mm Hg, or both. Subjects were classified in three groups by SBP and DBP. The Kruskal-Wallis test was used to compare the three groups with respect to the HRT parameters. Regression models adjusted for age, gender, height, disk size, intraocular pressure, cardiovascular disease, diabetes, and duration of antihypertensive treatment were used for each HRT parameter to compare values among the different groups. The P value was considered significant at <.05. RESULTS: A total of 232 subjects were included in the analysis. Rim area was significantly different among groups when DBP was considered as the criterion to classify subjects (P = .005). In regression models, cup area, and cup-to-disk (c/d) ratio were increased in subjects with normal DBP that was the result of treatment, as compared with both the high DBP and untreated normal DBP groups. CONCLUSIONS: In patients without glaucoma, the DBP <90 mm Hg that results from antihypertensive treatment is associated with increased cupping and decreased rim area of the optic disk. This information should be considered in research aiming to define the role of the BP status as an independent factor initiating optic disk changes and/or as a contributing factor to glaucoma damage.

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PubMed2006

Coding of glaucoma for patients with uveitis in the medicare database.

PURPOSE: To investigate possible causes for, and implications of, variations in coding of glaucoma for patients with uveitis in the Medicare database. PATIENTS AND METHODS: We identified 6,391 patients coded with one of several ICD-9 codes designating a form of uveitis from a 5% sample of the 1999 Medicare database. The proportion of patients with uveitis codes who also had codes for uveitic glaucoma, primary open-angle glaucoma (POAG), or unspecified open-angle glaucoma (OAG) were determined. The proportion with codes for argon laser trabeculoplasty (ALT), trabeculectomy, visual field examinations, fundus photographs, and gonioscopy were calculated in three groups: patients with both uveitis and uveitic glaucoma; those with both uveitis and POAG; and those with both uveitis and unspecified open-angle glaucoma. Summaries of the total allowed reimbursement related to eye visits and to eye codes were determined. RESULTS: Of the 6,391 patients with uveitis who were studied, 1,260 (19.7%) also had the code for POAG; 412 (6.4%) had the code for OAG; and 117 (1.8%) had the code for uveitic glaucoma. Visual field testing was less common among patients with uveitic glaucoma (37%) than among those with POAG/uveitis (46%) or OAG/uveitis (44%) (P < 0.001). There were no statistically significant differences among the three groups in the amount of total reimbursement related to eye services or eye codes. CONCLUSIONS: The code for POAG appears to be used in lieu of uveitic glaucoma in many cases. Discrepancies are probably not influenced by expected reimbursements, as much as by a lack of understanding about the available ICD-9 codes.

Databases, Factual↗
PubMed2006

Use of gonioscopy in medicare beneficiaries before glaucoma surgery.

PURPOSE: The American Academy of Ophthalmology Preferred Practice Patterns for angle closure and open-angle glaucoma (OAG) patients recommends performing bilateral gonioscopy upon initial presentation to evaluate the possibility of narrow angle or angle-closure glaucoma (ACG) and then repeating the examination at least every 5 years. This study aims to assess how commonly eye care providers perform gonioscopy before planned glaucoma surgery in OAG, anatomic narrow angle, and ACG in the Medicare population. METHODS: Data obtained from a 5% random sample of Medicare beneficiaries undergoing glaucoma surgery in the United States in 1999 were retrospectively reviewed. The proportion of patients with evidence of at least one gonioscopic examination before glaucoma surgery was determined for the period of 1995 to 1999. Demographic and clinical factors potentially influencing the decision to perform gonioscopy were also examined. RESULTS: Overall, gonioscopy is apparently performed in 49% of Medicare beneficiaries during the 4 to 5 years preceding glaucoma surgery. This rate was significantly lower (P < 0.001) in patients with OAG (46%), as compared with anatomic narrow angle (58%) and ACG (57%) patients. Hispanics, elderly (aged 70 to 84), patients undergoing laser iridotomy, and patients receiving care in the New York/New Jersey area all had significantly higher apparent preoperative gonioscopy rates (P < 0.05). CONCLUSIONS: Gonioscopy examination before glaucoma surgery in Medicare beneficiaries is underused, undercoded, and/or miscoded, given current recommendations. Underuse is of particular concern in patients undergoing laser iridotomy as it is the diagnostic test of choice in ACG.

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PubMed2006

Treatment of uncorrected refractive error improves vision-specific quality of life.

OBJECTIVES: To evaluate the benefit of eyeglasses and magnifiers in elderly patients with uncorrected refractive errors. DESIGN: A single-center, randomized, prospective, controlled trial (September 2001 to August 2003). SETTING: Los Angeles County, California. PARTICIPANTS: One hundred thirty-one community-dwelling persons aged 65 and older who had habitual distance visual acuity of 20/32 or worse and whose distant visual acuity, near visual acuity, or both could be improved with eyeglasses, a magnifier, or both by two lines of acuity or more. INTERVENTION: Sixty-six were randomized to receive a prescription and voucher for free eyeglasses, a magnifier, or both immediately, and 65 were randomized to receive a prescription and voucher after the 3-month follow-up visit (the control group). MEASUREMENTS: Primary outcome was vision-specific functioning as measured using the 25-item National Eye Institute-Visual Functioning Questionnaire (NEI-VFQ). Secondary outcomes were distance and near visual acuity and overall functioning as measured using the Rosow-Breslau function questionnaire. RESULTS: In the intention-to-treat analysis of 3-month follow-up data, participants who received the eyeglasses prescription and voucher immediately had greater improvement in NEI-VFQ composite scores than the control group (P<.01). They also had greater improvement in perceptions of their general vision (P<.01), distance visual acuity (P=.03), near visual acuity (P=.04), and mental health (P=.02). CONCLUSION: Correction of uncorrected refractive error, one of the leading causes of visual impairment in older people, improved the vision-specific quality of life of community-dwelling older persons.

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PubMed2006

Visual acuity, contrast sensitivity, and mortality in older women: Study of osteoporotic fractures.

OBJECTIVES: To determine whether poorer visual acuity and contrast sensitivity are independent risk factors for all-cause and traumatic mortality in older women. DESIGN: Twelve-year prospective cohort study (1986-2003). SETTING: Four U.S. clinical centers. PARTICIPANTS: Nine thousand seven hundred four postmenopausal white women aged 65 and older. MEASUREMENTS: Habitually corrected binocular visual acuity and low- and high-frequency contrast sensitivity were measured at baseline using a standard protocol. A study physician adjudicated the primary cause of death from death certificates and medical record review. RESULTS: During an average of 12.2 years of follow-up, 3,427 women died (35%), 72 (0.7%) from traumatic events. In multivariate models adjusted for age, chronic medical problems, and smoking, all-cause mortality risk was 19% greater for persons in the worst quartile of visual acuity than for those in the best (hazard ratio (HR) = 1.19, P = .008) and 39% greater for persons with the worst contrast sensitivity (HR = 1.39, P < .001) than for those with the best. Traumatic mortality risk was 2.4 times greater for women with the worst contrast sensitivity than for those with the best (HR = 2.44, P = .03). CONCLUSION: Poorer visual acuity and contrast sensitivity are associated with greater risk of traumatic and all-cause mortality in older women, even after controlling for demographic and clinical characteristics. Although further research is necessary to determine how treating reversible causes of visual impairment or improving current refraction affects mortality in older women, clinical detection and follow-up of these visual impairments holds promise for identifying those who are at risk of mortality from other systemic conditions.

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PubMed2005

Pointwise linear regression for evaluation of visual field outcomes and comparison with the advanced glaucoma intervention study methods.

OBJECTIVE: To investigate pointwise linear regression (PLR) for longitudinal evaluation of visual fields and to compare results with those of the Advanced Glaucoma Intervention Study (AGIS) criteria. METHODS: We selected 509 eyes (401 patients) from the AGIS with 3 or more years of follow-up, 7 or more visual field examinations, and an AGIS reference score of 16 or lower. Visual field change at test locations was defined as a change of threshold sensitivity of 1 dB/y or higher and P<or=.01. Several sets of criteria were investigated for defining change of visual field series with PLR. MAIN OUTCOME MEASURES: Progression or improvement of visual field series with PLR and AGIS criteria. RESULTS: Mean (SD) follow-up time and baseline AGIS score were 7.4 (1.7) years and 7.7 (4.4), respectively. Pairwise agreement between AGIS and various PLR criteria ranged from 52% to 64% with the kappa statistic varying between 0.22 (95% confidence interval, 0.15-0.29) and 0.30 (95% confidence interval, 0.22-0.38). One hundred thirty-eight (27%) and 151 (30%) eyes progressed (85 eyes or 17% detected by both methods) while 72 (14%) and 11 (2%) eyes improved (5 eyes or 1% detected by both methods) based on AGIS and the most rigorous PLR criteria, respectively. CONCLUSIONS: Based on rigorous, clinically relevant criteria, PLR detects progression in a similar proportion of eyes compared with AGIS criteria. Pointwise linear regression may be superior to AGIS methods since it identifies fewer visual field series as improving.

Adult↗
PubMed2005

Need for eye care among older adults with diabetes mellitus in fee-for-service and managed Medicare.

OBJECTIVE: To compare rates of need for eye care among Medicare beneficiaries with network-model Medicare+Choice (MC) and fee-for-service (FFS) health insurance. METHODS: Cross-sectional study of a random sample of MC and FFS community-dwelling Medicare beneficiaries with diabetes who are older than 65 years of age in Los Angeles County. Study ophthalmologists masked to the participants' type of health insurance performed standardized dilated eye examinations and indicated the need for ophthalmic care during the next 6 months. To evaluate the association between type of insurance and need for treatment, we constructed logistic regression models adjusted for participant sociodemographic and clinical characteristics. RESULTS: The 311 MC and 107 FFS respondents reported comparable rates of eye care provider visits and preexisting eye diseases. However, on masked clinical examination, MC respondents were more likely to have diabetic retinopathy, visually significant cataract, glaucoma, or suspected glaucoma than FFS participants (68% vs 46%, P<.001). In multivariate analyses, persons enrolled in MC were significantly more likely than FFS participants to require further treatment during the next 6 months (42% vs 24%, P = .01). CONCLUSIONS: Data from standardized study ophthalmic examinations suggest high rates of unrecognized and untreated eye diseases among Medicare beneficiaries enrolled in both FFS and MC and significantly higher rates of need for care among MC participants.

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PubMed2005

Baseline topographic optic disc measurements are associated with the development of primary open-angle glaucoma: the Confocal Scanning Laser Ophthalmoscopy Ancillary Study to the Ocular Hypertension Treatment Study.

OBJECTIVE: To determine whether baseline confocal scanning laser ophthalmoscopy (CSLO) optic disc topographic measurements are associated with the development of primary open-angle glaucoma (POAG) in individuals with ocular hypertension. METHODS: Eight hundred sixty-five eyes from 438 participants in the CSLO Ancillary Study to the Ocular Hypertension Treatment Study with good-quality baseline CSLO images were included in this study. Each baseline CSLO parameter was assessed in univariate and multivariate proportional hazards models to determine its association with the development of POAG. RESULTS: Forty-one eyes from 36 CSLO Ancillary Study participants developed POAG. Several baseline topographic optic disc measurements were significantly associated with the development of POAG in both univariate and multivariate analyses, including larger cup-disc area ratio, mean cup depth, mean height contour, cup volume, reference plane height, and smaller rim area, rim area to disc area, and rim volume. In addition, classification as "outside normal limits" by the Heidelberg Retina Tomograph classification and the Moorfields Regression Analysis classifications (overall, global, temporal inferior, nasal inferior, and superior temporal regions) was significantly associated with the development of POAG. Within the follow-up period of this analysis, the positive predictive value of CSLO indexes ranged from 14% (Heidelberg Retina Tomograph classification and Moorfields Regression Analysis overall classification) to 40% for Moorfields Regression Analysis temporal superior classification. CONCLUSIONS: Several baseline topographic optic disc measurements alone or when combined with baseline clinical and demographic factors were significantly associated with the development of POAG among Ocular Hypertension Treatment Study participants. Longer follow-up is required to evaluate the true predictive accuracy of CSLO measures.

False Positive Reactions↗
PubMed2005

Visual field testing in glaucoma Medicare beneficiaries before surgery.

OBJECTIVE: The standard of care for progressive glaucoma that requires medical or surgical intervention includes visual field (VF) testing at least annually. This study aims to assess how commonly ophthalmologists perform VF testing before planned glaucoma surgery in the Medicare population, and whether variations in conformance occur across demographic and clinical subgroups. DESIGN: Retrospective, observational, population-based analysis. PARTICIPANTS: Thirteen thousand seven hundred fifty-three Medicare beneficiaries. METHODS: Data were obtained from a 5% random sample of Medicare beneficiaries undergoing glaucoma surgery in the United States from 1995 to 1999. The proportion of patients with evidence of at least 1 VF examination in the year before glaucoma surgery was determined. MAIN OUTCOME MEASURE: Rate of VF testing in the year before glaucoma surgery. RESULTS: Overall, 70% of patients had at least 1 VF test in the year preceding glaucoma surgery. This rate was significantly lower (P<0.001) in patients > or =85 years (56%), blacks (64%), patients with race other than white or black (66%), patients with diabetic retinopathy (60%), and patients with bilateral blindness (47%). CONCLUSIONS: The use of VF testing before surgery in glaucoma Medicare beneficiaries is suboptimal relative to the recommended standard of care. Underutilization is of particular concern in blacks, who are at increased risk of glaucomatous damage. Quality-of-care initiatives are needed to facilitate appropriate preoperative evaluations of glaucoma Medicare beneficiaries for glaucoma surgery.

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PubMed2005

Comparison of safety and efficacy between silicone and polypropylene Ahmed glaucoma valves in refractory glaucoma.

OBJECTIVE: To compare the safety and efficacy of polypropylene and silicone Ahmed glaucoma valves (AGVs) over 1 year of follow-up. DESIGN: Retrospective comparative study. PARTICIPANTS: Fifty consecutive patients with polypropylene and 49 consecutive patients with silicone AGV implantation. METHODS: Our hospital instituted a formulary conversion of the glaucoma aqueous drainage device from polypropylene to silicone AGVs in January 2003. We reviewed the polypropylene AGVs within 7 months before and the silicone AGVs within 7 months after the date of conversion performed on patients with glaucoma refractory to medical treatment and filtering procedures, without previous drainage devices or cyclodestructive procedures, and with a minimum of 12 months' follow-up. Surgical success was defined as an intraocular pressure (IOP) reduction of > or =20% and a final IOP of >5 and <22 mmHg, without additional surgical intervention for IOP control, loss of light perception, or serious complications. MAIN OUTCOME MEASURES: The 2 groups were compared for IOP control, visual outcome, complication rate, and surgical success rate. RESULTS: Significant IOP reductions occurred after polypropylene AGV implantation (from 32.4+/-11.3 mmHg to 16.5+/-6.9 mmHg, P<0.0001) and silicone AGV implantation (from 32.6+/-12.6 mmHg to 14.7+/-6.9 mmHg, P<0.0001). The silicone group had a lower mean IOP than the polypropylene group at all postoperative visits, but the differences were significant only at 3 months postoperatively (P = 0.014). In addition, the silicone group was associated with a rate of insufficient IOP control as the reason of failure (IOP of > or =22 mmHg or IOP reduction of <20%) lower (4.1%) than that of the polypropylene group (20.0%, P = 0.015), but a rate of non-tube related serious complications (16.3%) higher than that of the polypropylene AGV (4.0%, P = 0.042). CONCLUSION: After 1 year of follow-up, the silicone AGV is at least as effective as the polypropylene AGV in IOP reduction but may be associated with a higher rate of complications. These differences are important for surgeons converting to use of the silicone AGV in patients with glaucoma refractory to other forms of treatment.

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PubMed2004

Racial differences in optic disc topography: baseline results from the confocal scanning laser ophthalmoscopy ancillary study to the ocular hypertension treatment study.

OBJECTIVE: To examine racial differences in optic disc topography among ocular hypertensive participants in the Ocular Hypertension Treatment Study. METHODS: Four hundred thirty-nine participants from 7 Ocular Hypertension Treatment Study centers who had good-quality baseline images obtained using a quantitative 3-dimensional confocal scanning laser ophthalmoscope, the Heidelberg Retina Tomograph (Heidelberg Engineering, Dossenheim, Germany), were included in this study. The first 10 degrees- or 15 degrees-field of view mean topographic image acquired was included in all analyses. Differences in Heidelberg Retina Tomograph topographic optic disc parameter measurements by self-identified race were assessed using a mixed-effects linear model to control for confounders and for the use of both eyes in the model. RESULTS: By self-attribution, 74 (17%) of the 439 participants were of African origin, 329 (75%) were white, 24 (5%) were Hispanic, and 12 (3%) were Native American, Native Alaskan, Asian, Pacific Islander, or unknown. The African American participants had statistically significantly (P<.001) larger mean (SD) optic disc areas than the other participants, 2.17 (0.41) mm(2) vs 1.87 (0.38) mm(2), respectively. African American participants had a larger cup area, cup volume, cup depth, neuroretinal rim area, rim volume, and smaller rim-optic disc area ratios than the other participants. No difference between African American and the other participants was found for cup shape and retinal nerve fiber layer thickness. After controlling for optic disc area, none of the differences between African American and the other participants found in the univariate analysis remained statistically significant (P>.10). CONCLUSIONS: This study demonstrated in a large cohort of subjects with ocular hypertension, that African Americans have significantly larger optic discs, optic cups, neuroretinal rims, and cup-disc ratios than other racial groups. Furthermore, this study found that differences in topographic optic disc parameters between African Americans with ocular hypertension and other racial groups are largely explained by the larger optic disc area in the African Americans. These results highlight the need to consider race and optic disc size when evaluating the appearance of the optic disc in glaucoma.

Antihypertensive Agents↗
PubMed2004

The confocal scanning laser ophthalmoscopy ancillary study to the ocular hypertension treatment study: study design and baseline factors.

PURPOSE: To describe the study design of the Confocal Scanning Laser Ophthalmoscopy (CSLO) Ancillary Study to the Ocular Hypertension Treatment Study (OHTS) and to examine the associations between optic disk topography, and baseline demographic, clinical, and ocular factors at study entry. DESIGN: A randomized clinical trial. METHODS: Participants in this ancillary study were recruited from seven of the 22 OHTS clinical centers. Each participant completed imaging annually using a CSLO, the Heidelberg Retina Tomograph (HRT). Associations between HRT topographic optic disk measurements and intraocular pressure (IOP), baseline photographic estimates of horizontal and vertical cup-to-disk diameter ratios by the OHTS Optic Disk Reading Center, baseline visual field indices, and demographic and clinical factors were assessed using linear mixed effects models. RESULTS: Four hundred thirty-nine participants had good quality images and were included in this baseline analysis. No associations between HRT topographic optic disk measurements and diabetes, systemic hypertension, cardiovascular disease, IOP, or visual function were found. The HRT topographic optic disk measurements were associated with baseline stereophotographic estimates of horizontal and vertical cup-to-disk diameter ratios. The strongest associations were found between stereophotographic assessment of horizontal and vertical cup-to-disk diameter ratios, and HRT cup-to-disk area ratio (r =.85 and.84, respectively), rim-to-disk area ratio (r = -.85 and -.84, respectively), mean cup depth (r =.84 and.83, respectively), and cup area (r =.83 and.80, respectively). After adjusting for optic disk area, all HRT topographic optic disk measurements remained associated with stereophotographic assessment of horizontal and vertical cup-to-disk diameter ratios. CONCLUSIONS: The CSLO ancillary study to the OHTS is the first multicenter clinical trial to use CSLO imaging to monitor changes in the optic disk. At study entry, HRT topographic measurements corresponded well with both horizontal and vertical stereophotographic-based estimates of cup-to-disk diameter ratio in ocular hypertensive participants.

Female↗
PubMed2004

Sensitivity and specificity of the 76-suprathreshold visual field test to detect eyes with visual field defect by Humphrey threshold testing in a population-based setting: the Thessaloniki eye study.

PURPOSE: To evaluate the screening performance of the 76-Suprathreshold (76-STHR) visual field test to detect eyes with visual field defect (VFD) as measured by Humphrey threshold testing in a population-based setting. DESIGN: Cross-sectional study. METHODS: All 88 subjects who agreed to participate in the pilot phase of the Thessaloniki Eye Study were included. Participants underwent a 76-STHR visual field test followed by a 30-full threshold (30-2 FTHR) test (Humphrey field analyzer). One eye/subject was randomly selected and included in the analysis. Sensitivity and specificity rates of the 76-STHR to detect eyes with VFD by the 30 to 2 FTHR test were calculated. RESULTS: When eyes with borderline results in the 30 to 2 FTHR test were classified as having a VFD, sensitivity rates of the 76-STHR to detect eyes with VFD by the 30 to 2 FTHR were 85.2%, 77.8%, and 74.1%, whereas specificity rates were 70%, 78%, and 86%, depending on the cutoff used for the 76-STHR. CONCLUSIONS: The 76-STHR test showed high sensitivity and low false-negative results at the "at least one point missed" cutoff level criterion to detect eyes with visual field defect by Humphrey threshold testing in a population-based setting. This criterion should be used when screening in a population-based study setting. By contrast, the 76-STHR would not be the appropriate screening test in a primary care setting with limited resources.

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PubMed2004

Optic disk appearance in advanced age-related macular degeneration.

PURPOSE: To describe and quantify the appearance of the optic disk in patients with advanced age-related macular degeneration (ARMD). DESIGN: Retrospective comparative study. METHODS: A total of 316 charts were reviewed. From these, 45 subjects with advanced ARMD (defined as geographic atrophy or disciform scar) in at least one eye were enrolled. Patients with glaucoma or glaucoma visual field defects were excluded. The probability of glaucomatous optic nerve damage was scored by evaluation of stereoscopic optic disk photographs in a masked fashion, according to a predefined evaluation scale and measured with confocal ophthalmoscopy (Heidelberg Retinal Tomograph; HRT). The area of macular involvement was measured in units of disk area. The optic disk evaluation scores and HRT measurements of a group of eyes with a large area of ARMD were compared with their fellow eyes with smaller areas of ARMD. The correlations between the area of macular involvement with the optic disk evaluation scores and HRT measurements were analyzed. MAIN OUTCOME MEASURES: The optic disk evaluation scores and the HRT measurements between study groups. RESULTS: Eyes with larger areas of ARMD had optic disks that were more likely to be classified as glaucomatous by clinical evaluation (3.45 +/- 0.23 vs 3.05 +/- 0.18, P =.015) and by HRT imaging analysis (-0.995 +/- 0.423 vs -0.376 +/- 0.249, P =.030) than the fellow eyes with smaller areas of ARMD. For eyes with six or more disk areas of ARMD, larger areas of ARMD correlated with a higher cup/disk ratio (P =.022), smaller neuroretinal rim area (P =.022), and glaucomatous classification (P =.040) with HRT discriminant function analysis. CONCLUSIONS: Eyes with large areas of geographic or diskiform ARMD have optic disk structural alterations that resemble glaucomatous optic neuropathy. This should be taken into consideration when evaluating patients with ARMD for glaucomatous damage.

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