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Anne L Coleman

Publications and source records attributed to Anne L Coleman.

32 records · Page 2Linked to original sources
PubMed2004

Risk assessment in the management of patients with ocular hypertension.

PURPOSE: To develop a model for estimating the global risk of disease progression in patients with ocular hypertension and to calculate the "number-needed-to-treat" (NNT) to prevent progression to blindness as an aid to practitioners in clinical decision making. DESIGN: Development of a mathematical model for estimating risk of glaucoma progression. METHODS: Population-based studies of patients with ocular hypertension and glaucoma were reviewed by a panel of glaucoma specialists. Measures of disease progression risks derived from three long-term studies and assumptions based on the available data were used to estimate the risk of progression from ocular hypertension to glaucoma and glaucoma to unilateral blindness for untreated and treated patients over a 15-year period. Using these estimates, the NNT (1/absolute risk reduction on treatment) to prevent unilateral blindness in one patient with ocular hypertension was calculated. RESULTS: In untreated patients, the estimated risk of progression from ocular hypertension to unilateral blindness was 1.5% to 10.5% and in treated patients, the estimated risk of progression was 0.3% to 2.4% over 15 years. From these estimates, between 12 and 83 patients with ocular hypertension will require treatment to prevent one patient from progressing to unilateral blindness over a 15-year period. CONCLUSION: Global risk assessment that incorporates all available data plays a vital role in managing patients with ocular hypertension. A more precise understanding of long-term vision loss should be factored into decisions pertaining to the initiation of glaucoma therapy. Undoubtedly, these estimates will evolve and change with the availability of new population-based epidemiologic information and improvements in multivariable model testing.

Blindness↗
PubMed2004

Applying an evidence-based approach to the management of patients with ocular hypertension: evaluating and synthesizing published evidence.

PURPOSE: The use of evidence-based medicine in managing patients with ocular hypertension has been constrained by the limited availability of high-quality data from controlled clinical trials and by limited formal training of clinicians in evaluating published evidence. This article will provide strategies and techniques to evaluate critically the quality of published research, synthesize the findings, and integrate published evidence in the care of patients with ocular hypertension. DESIGN: Review of the published literature and consensus of a panel of experts. METHODS: The published literature on evidence-based medicine was reviewed. Strategies and techniques in evaluating the quality of evidence and how to integrate evidence into the practice setting using the following three major questions were discussed by a panel of experts: Are the results of the study valid? What are the results? Do the study outcomes apply to individual patient care? RESULTS: Approaches to assessing study validity and the importance of considering the size of the treatment effect and precision of the effect size were detailed. The importance of using the "number-needed-to-treat" as a tool for translating results of clinical trials to individual patient care and the "number-needed-to-harm" as a method of comparing the potential benefit and harm of a given therapy was acknowledged. CONCLUSION: As the volume of high-quality data increases, the information provided herein may help ophthalmologists apply evidence-based medicine techniques as they seek to optimize the care of individual patients with ocular hypertension.

Evidence-Based Medicine↗
PubMed2004

Baseline risk factors for the development of primary open-angle glaucoma in the Ocular Hypertension Treatment Study.

PURPOSE: Higher baseline pattern standard deviation (PSD) and larger vertical cup-to-disk ratio (VC/D) were factors in the predictive model for the development of primary open-angle glaucoma (POAG) in the Ocular Hypertension Treatment Study. Because early changes in PSD and VC/D may be indicative of early POAG damage, we repeated the prediction model excluding PSD and VC/D. DESIGN: Reanalysis of baseline factors for the development of POAG. METHODS: We compared the hazard ratios for baseline factors predictive of POAG in the multivariate Cox proportional hazards model that included PSD and VC/D and in the model that excluded them. RESULTS: Hazard ratios for baseline factors predictive of POAG in Ocular Hypertension Treatment Study were not substantially affected by the inclusion or exclusion of PSD and VC/D in the proportional hazards model. CONCLUSION: Whether PSD or VC/D was included in the Cox proportional hazards model, the same baseline factors were statistically significant and their hazard ratios were essentially similar.

Glaucoma, Open-Angle↗
PubMed2004

Epithelial downgrowth following surgery for congenital glaucoma.

PURPOSE: To report epithelial downgrowth following goniotomy. DESIGN: Observational case report. METHODS: Surgical management of a child with congenital glaucoma and epithelial downgrowth. RESULTS: One year after nasal goniotomy and multiple Ahmed valve revisions an epithelial inclusion cyst was noted adjacent to the clear corneal goniotomy incision. Ab externo drainage and limbal cryotherapy were required twice for recurrent growth of the cyst. Six months after the second treatment the eye remains cyst-free. CONCLUSIONS: Epithelial downgrowth is a rare complication of surgery for glaucoma, but because of its potential to threaten sight it should always be considered as a possible complication.

Corneal Diseases↗
PubMed2004

Higher risk of multiple falls among elderly women who lose visual acuity.

OBJECTIVE: To determine the association between changes in visual acuity (VA) and frequent falls in older women. DESIGN: Prospective cohort study. PARTICIPANTS: Two thousand two elderly community-residing women participating in the Study of Osteoporotic Fractures with measurements of VA at baseline and a follow-up examination 4 to 6 years later (mean of 5.6 years). METHODS: Binocular VA with habitual correction was measured under standard illumination using Bailey-Lovie charts at baseline and fourth examinations. Change in VA was stratified into 5 categories: no change or VA gain, loss of 1 to 5 letters, loss of 6 to 10 letters, loss of 11 to 15 letters, and loss of >15 letters. A separate analysis considered decline in VA as the loss of >or=10 letters (>or=2 lines) on the Bailey-Lovie acuity measure between baseline and follow-up examinations. MAIN OUTCOME MEASURES: Data on falls were obtained from postcards sent every 4 months after the follow-up examination. Frequent falling was defined as >or=2 falls during a 1-year period after the follow-up examination. RESULTS: Compared with women with stable or improved VA, women with declining acuity had significantly greater odds of experiencing frequent falling during the subsequent year. Odds ratios after adjustment for baseline acuity and other confounders were 2.08 (95% confidence interval [CI]: 1.39-3.12) for loss of 1 to 5 letters, 1.85 (95% CI: 1.16-2.95) for loss of 6 to 10 letters, 2.51 (95% CI: 1.39-4.52) for loss of 11 to 15 letters, and 2.08 (95% CI: 1.01-4.30) for loss of >15 letters. In the analysis of visual decline defined as a loss of >or=10 letters, heightened risk of frequent falling was evident in each of 2 subgroups defined by splitting the sample on baseline VA, with borderline significant evidence of a more pronounced effect in those women with baseline VA of 20/40 or worse (P value for interaction, 0.083). CONCLUSIONS: Loss of vision among elderly women increases the risk of frequent falls. Prevention or correction of visual loss may help reduce the number of future falls.

Accidental Falls↗
PubMed2004

Predictive factors for glaucomatous visual field progression in the Advanced Glaucoma Intervention Study.

PURPOSE: To investigate the risk factors associated with visual field (VF) progression in the Advanced Glaucoma Intervention Study (AGIS) with pointwise linear regression (PLR) analysis of serial VFs. DESIGN: Prospective, multicenter, randomized clinical trial. PARTICIPANTS: Five hundred nine eyes of 401 patients from the AGIS with a baseline VF score of or=7 VF examinations, and >or=3 years of follow-up were selected. MAIN OUTCOME MEASURE: Visual field progression. METHODS: This is a cohort study of patients enrolled in a prospective randomized clinical trial (AGIS). Worsening of a test location on PLR analysis was defined as a change of threshold sensitivity of >or=1.00 decibels a year, with P<or=0.01. Visual field progression was defined as worsening of at least 2 test locations within a Glaucoma Hemifield Test cluster with PLR analysis. Multivariate logistic regression was used to determine risk factors associated with VF worsening. Intraocular pressure (IOP) fluctuation was defined as standard deviation of the IOP at all visits after the initial surgery. RESULTS: The mean (+/- standard deviation) follow-up time and baseline AGIS score were 7.4 (+/-1.7) years and 7.7 (+/-4.4), respectively. Visual field progression was detected with PLR analysis in 151 eyes (30%). Older age at the initial intervention (P = 0.0012; odds ratio [OR], 1.30; 95% confidence interval [CI], 1.11-1.50), larger IOP fluctuation (P = 0.0013; OR, 1.31; 95% CI, 1.12-1.54), increasing number of glaucoma interventions (P = 0.01; OR, 1.74; 95% CI, 1.14-2.64), and longer follow-up (P = 0.02; OR, 1.19; 95% CI, 1.03-1.38) were associated with increased odds of VF progression. When regression analyses were repeated in eyes with and without a history of cataract extraction, IOP fluctuation was the only variable to be consistently associated with VF progression. CONCLUSION: Both increasing age and greater IOP fluctuation increase the odds of VF progression by 30% (for each 5-year increment in age and 1-mmHg increase in IOP fluctuation). The higher risk conferred by IOP fluctuation was consistently observed in eyes with and without a history of cataract extraction.

Adult↗
PubMed2004

Recent trends in upper eyelid blepharoplasties in medicare patients in the United States from 1995 to 1999.

PURPOSE: To present data regarding the rate of upper eyelid blepharoplasty in the Medicare population at both the national and the regional levels from 1995 to 1999 and to analyze these data for any correlation with reimbursement, surgical criteria differences, or the number of ophthalmologists per capita. METHODS: This was a retrospective cohort study. The subjects consisted of a 5% random sample of the Medicare population who had blepharoplasty from 1995 to 1999. Number, rate, and reimbursements of blepharoplasty of the 10 Health Care Financing Administration (HCFA) regions were compared for the 5-year period. Number of ophthalmologists per capita and differences in the regional criteria for Medicare-approved upper eyelid blepharoplasty were compared among the 10 HCFA regions. RESULTS: Across the nation, there was a 13% annual increase in the rate of blepharoplasty from 1995 to 1999 in the Medicare-population after adjusting for age, race, sex, and HCFA regions. During the same period, the average reimbursement per surgery decreased by $26.50 annually. There was a statistically significant inverse correlation between reimbursement and rate of blepharoplasty at the national level (r= - 0.74, P< 0.001). On the regional level, this relation was less profound (r= -0.29, P= 0.039). There was no correlation between the rate of blepharoplasty and the number of ophthalmologists per capita or the differences in surgical criteria. CONCLUSIONS: The inverse relation between rate of Medicare-approved blepharoplasty and reimbursement between 1995 and 1999 was evident at both the national and regional levels. No relation between regional differences in the rates of blepharoplasty and regional differences in surgical criteria or the number of ophthalmologists per capita were identified. Though our study suggests no causal link between annual rate of blepharoplasty and Medicare reimbursement, such inverse correlation is interesting and may have been affected by other factors such as changing clinical indications for this procedure.

Aged↗
PubMed2004

Research agenda-setting program for geriatric ophthalmology.

The healthcare needs of an aging population of "baby boomers" (persons born between 1946 and 1964) will disproportionately affect ophthalmology. To meet this emerging need, the American Geriatrics Society and the John A. Hartford Foundation developed a research agenda-setting process for geriatric ophthalmology. A systematic literature search was performed using Medline from the years 1990 to 2000. The literature review (168 papers) was performed to determine the current state of information regarding selected issues in geriatric ophthalmology. A needs assessment for each of the identified topics was performed, gaps in the existing knowledge base were identified, and key questions for future research were proposed. A research agenda-setting process for geriatric ophthalmology might provide a structural framework for future research efforts in the field.

Accidental Falls↗
PubMed2004

Vision impairment and combined vision and hearing impairment predict cognitive and functional decline in older women.

OBJECTIVES: To determine the association between vision and hearing impairment and subsequent cognitive and functional decline in community-residing older women. DESIGN: Prospective cohort study. SETTING: Four metropolitan areas of the United States. PARTICIPANTS: A total of 6,112 women aged 69 and older participating in the Study of Osteoporotic Fractures (SOF) between 1992 and 1994. MEASUREMENTS: Five thousand three hundred forty-five participants had hearing measured, 1,668 had visual acuity measured, and 1,636 had both measured. Visual impairment was defined as corrected vision worse than 20/40. Hearing impairment was defined as the inability to hear a tone of 40 dB or greater at 2,000 hertz. Participants completed the modified Mini-Mental State Examination and/or a functional status assessment at baseline and follow-up. Cognitive and functional decline were defined as the amount of decline from baseline to follow-up that exceeded the observed average change in scores by at least 1 standard deviation. RESULTS: About one-sixth (15.7%) of the sample had cognitive decline; 10.1% had functional decline. In multivariate models adjusted for sociodemographic characteristics and chronic conditions, vision impairment at baseline was associated with cognitive (odds ratio (OR)=1.78, 95% confidence interval (CI)=1.21-2.61) and functional (OR=1.79, 95% CI=1.15-2.79) decline. Hearing impairment was not associated with cognitive or functional decline. Combined impairment was associated with the greatest odds for cognitive (OR=2.19, 95% CI=1.26-3.81) and functional (OR=1.87, 95% CI=1.01-3.47) decline. CONCLUSION: Sensory impairment is associated with cognitive and functional decline in older women. Studies are needed to determine whether treatment of vision and hearing impairment can decrease the risk for cognitive and functional decline.

Activities of Daily Living↗
PubMed2003

A 3-month randomized controlled trial of bimatoprost (LUMIGAN) versus combined timolol and dorzolamide (Cosopt) in patients with glaucoma or ocular hypertension.

PURPOSE: To compare the efficacy and safety of topical bimatoprost (LUMIGAN; Allergan, Inc., Irvine, CA) once daily with that of topical combined timolol and dorzolamide (Cosopt; Merck and Co, Inc., Whitehouse Station, NJ) twice daily. DESIGN: Prospective, randomized, double-masked, multicenter clinical trial. PARTICIPANTS: One hundred seventy-seven patients with a diagnosis of glaucoma or ocular hypertension and inadequate control of intraocular pressure (IOP) after at least 2 weeks of topical timolol maleate 0.5% monotherapy. METHODS: Patients were randomized to receive bimatoprost 0.03% once daily (n = 90) or combined timolol 0.5% and dorzolamide 2% twice daily (n = 87) over a 3-month period. MAIN OUTCOME MEASURES: Intraocular pressure, the primary end point, was measured at 8 AM and 10 AM at baseline, week 1, and months 1, 2, and 3, and also at 4 PM and 8 PM at baseline and month 3. RESULTS: Bimatoprost provided significantly greater IOP lowering compared with combined timolol and dorzolamide. At the 8 AM measurements, bimatoprost lowered mean IOP 6.8 mmHg to 7.6 mmHg from baseline, whereas combined timolol and dorzolamide lowered mean IOP 4.4 to 5.0 mmHg from baseline (P<0.001). At the last follow-up, patients had better diurnal IOP control with bimatoprost than combined timolol and dorzolamide. At 8 AM at the 3-month visit, the percentages of patients achieving IOPs of <or =13 mmHg, < or =14 mmHg, < or =15 mmHg, or < or =16 mmHg were more than twice as high for bimatoprost than for combined timolol and dorzolamide (all P< or =0.008). Taste perversion, ocular burning, and stinging with instillation were more common with combined timolol and dorzolamide, whereas conjunctival hyperemia was more common with bimatoprost. CONCLUSIONS: In individuals with glaucoma or ocular hypertension, uncontrolled on a topical beta-blocker alone, bimatoprost lowered IOP more consistently than did combined timolol and dorzolamide.

Administration, Topical↗
PubMed2002

Depression in patients with glaucoma as measured by self-report surveys.

PURPOSE: This study aimed to determine whether patients with glaucoma have more depressive symptoms than patients without glaucoma. DESIGN: Prospective case-control study. PARTICIPANTS: The study population was recruited from two university-based glaucoma clinical practices and a university-based general ophthalmology clinic and consisted of 121 patients with open-angle glaucoma, 42 with diagnoses of suspected glaucoma, and 135 with no chronic ocular conditions except cataract. INTERVENTION: The Center for Epidemiologic Studies Depression Scale (CES-D) and Composite International Diagnostic Interview, Short Form (CIDI-SF) questionnaires were administered to all subjects. Demographic information, medical history, and responses to the questionnaires were elicited by an interviewer. Medical record review was performed to obtain clinical examination data and to substantiate the medical and demographic data obtained by the interviewer. MAIN OUTCOME MEASURES: The questionnaire scores by diagnostic group, demographic characteristics, and medical history were examined. Secondary outcome measures were questionnaire scores in patients with glaucoma by visual impairment and glaucoma medication use. RESULTS: Depression scores for patients with glaucoma did not differ significantly from scores of control patients. Having past or present mental illness was the only consistent predictor for depression in both questionnaires. Among glaucoma patients, visual acuity level, visual field severity, and use of topical beta-blockers were not predictors for depression. CONCLUSIONS: Patients with glaucoma do not report being more depressed than patients without glaucoma as measured by the CES-D and the CIDI-SF questionnaires.

Adult↗
PubMed2002

Trends in glaucoma surgery incidence and reimbursement for physician services in the Medicare population from 1995 to 1998.

OBJECTIVE: To better understand the relationship between glaucoma management and economic incentives, we examined the volume and the reimbursement of argon laser trabeculoplasty (ALT) and trabeculectomy in a 5% random sample of the Medicare population from 1995 to 1998. DESIGN: Retrospective cohort study. PARTICIPANTS: Subjects in a 5% random sample of the Medicare population who had ALT and trabeculectomy from 1995 to 1998. METHODS: Using the Health Care Financing Administration (HCFA) Physician/Supplier Part-B files for a 5% random sample of the Medicare population, we identified all subjects who had ALT and trabeculectomy from 1995 to 1998. Descriptive summaries (the number of surgeries and the mean and the standard deviation of reimbursement per surgery) were calculated for each year. Analysis of variance was used to test for differences in reimbursement per surgery across years. Chi-square tests were used to assess any associations between the changing numbers of ALTs and trabeculectomies over the study period and both age and race. MAIN OUTCOME MEASURES: We assessed the number of ALTs and trabeculectomies and the allowed charges for each surgery in the 5% random sample of the Medicare population from 1995 to 1998. RESULTS: The volume of both ALTs and trabeculectomies declined during the study period. Reimbursement per surgery for both ALT and trabeculectomy varied significantly across years (P < 0.001). Significant associations were found between the changing number of ALTs and both age and race. CONCLUSIONS: Changing numbers of ALT and trabeculectomy seem unrelated to reimbursement rates. Rather, these changes are more likely driven by new developments in the clinical management of glaucoma, among other factors.

Aged↗
PubMed2002

Comparison of optic nerve imaging methods to distinguish normal eyes from those with glaucoma.

PURPOSE: To compare the ability of qualitative assessment of optic nerve head stereophotographs (ONHPs), confocal scanning laser ophthalmoscopy (CSLO), scanning laser polarimetry (SLP), and optical coherence tomography (OCT) to distinguish normal eyes from those with early to moderate glaucomatous visual field defects. METHODS: Eighty-nine eyes (63 normal, 63 age-matched with glaucoma) of 89 subjects more than 40 years of age were studied. Receiver operating characteristic (ROC) curves were generated from discriminant analysis of CSLO, SLP, and OCT measurements and from ONHP scores. Sensitivity at 80% and specificity at 90% were calculated. Differences between individual methods and combinations of methods were assessed for statistical significance. Agreement on categorization between methods (kappa) was assessed. RESULTS: The average visual field mean deviation (MD +/- SD) in patients with glaucoma was -3.9 +/- 2.2 dB, and the average pattern standard deviation (PSD) was 4.7 +/- 3.4 dB. In normal subjects the average MD was 0.1 +/- 0.9 dB and the average PSD was 1.5 +/- 0.3 dB. Optimal sensitivities, specificities, and areas under ROC curves were, respectively: ONHP (0.94, 0.87, 0.93), CSLO (0.84, 0.90, 0.92), SLP (0.89, 0.87, 0.94), and OCT (0.82, 0.84, 0.88). Best agreement on categorization (kappa) was between ONHPs and CSLO (0.70). The ROC area for the combination of methods was 0.99, higher than for any method alone. The ROC area for the combination of methods was significantly better than the CLSO rim area (P = 0.012) and the OCT retinal nerve fiber layer (RNFL) thickness (P = 0.002). CONCLUSIONS: The quantitative methods CSLO, SLP, and OCT were no better than qualitative assessment of disc ONHPs by experienced observers at distinguishing normal eyes from those with early to moderate glaucoma. A combination of the imaging methods significantly improves this capability.

Diagnostic Techniques, Ophthalmological↗