Biomedical subjects

Bo Bengtsson

Publications and source records attributed to Bo Bengtsson.

9 recordsLinked to original sources

PubMed2005

Risk of glaucoma in ocular hypertension with and without pseudoexfoliation.

PURPOSE: To compare glaucoma conversion rates in patients with ocular hypertension (OH) with and without pseudoexfoliation. DESIGN: Cohort study, based on 32,918 screening participants. PARTICIPANTS AND CONTROLS: Ninety-eight patients with OH and pseudoexfoliation and 98 matched controls. MAIN OUTCOME MEASURE: Perimetric glaucoma conversion. METHODS: A population-based glaucoma screening of elderly citizens of Malmö, Sweden, was conducted between 1992 and 1997 to recruit participants for the Early Manifest Glaucoma Trial. Screening participants with intraocular pressure (IOP) between 24 and 32 mmHg and pseudoexfoliation were compared to controls among other screening participants without pseudoexfoliation but matched for baseline IOP, age, and gender, and the 2 groups were invited to a reexamination. Computerized visual field tests were performed to identify persons with manifest glaucoma. Visual acuity, refraction, IOP, and central corneal thickness were also measured. RESULTS: After a mean of 8.7 years (range: 6.3-11.4), 54 of 98 patients (55.1%) with pseudoexfoliation at the baseline examination and 27 of 98 patients (27.6%) without pseudoexfoliation had developed glaucoma. The risk ratio was 2.0 (P<0.0001). CONCLUSION: The glaucoma conversion rate was twice as high in patients with OH and pseudoexfoliation as in control patients matched for IOP, age, and gender. Thus, pseudoexfoliation was a strong independent risk factor for glaucoma in patients with OH.

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PubMed2005

Treatment and vision-related quality of life in the early manifest glaucoma trial.

PURPOSE: To evaluate the effect of treatment, visual function, and other factors on vision-targeted health-related quality of life (HRQOL) of patients with early glaucoma. DESIGN: Randomized clinical trial. PARTICIPANTS: Two hundred fifty-five patients with newly detected open-angle glaucoma and repeatable early visual field (VF) defects, 50 to 80 years old (66% female). METHODS: Patients were randomized to receive either betaxolol plus laser trabeculoplasty in eligible eye(s) or no initial treatment and had ophthalmologic examinations every 3 months. A Swedish translation of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was self-administered at 2 follow-up visits (3 and 6 years after randomization). MAIN OUTCOME: Multiple linear regression analyses determined the effect of treatment and other factors on (1) VFQ-25 composite scores at the first administration and (2) change in scores between administrations. RESULTS: Two hundred thirty-three patients had 1 NEI VFQ-25 administration and 167 patients had 2 administrations. Internal consistency reliability was high for the composite VFQ-25 score (Cronbach alpha = 0.88) and satisfactory (alpha> or =0.76) for most subscale scores. At the first administration, the composite score was high (88.8+/-11.7). Mean subscale scores were also generally high (98.0-58.3) and were similar for each study group when analyzed separately. Most lower subscale scores were modestly but significantly related to worse visual acuity (VA) or mean deviation (MD) (better eye, r = 0.15-0.35). Composite scores were similar for treated and untreated patients. Lower composite scores were associated with low VA in the better eye (worse than 0.70) and worse perimetric MD (<4.16 decibels) and nuclear lens opacities (Lens Opacities Classification System II grade > or = 2), but not with age, gender, VF progression, intraocular pressure, cardiovascular disease, or hypertension. Between VFQ-25 administrations, larger decreases in the composite score were associated with larger decreases in VA (P<0.05), female gender (P = 0.001), and older age at first administration (P = 0.006). Treatment (assigned at randomization or later in the study) was not associated with change in HRQOL. CONCLUSIONS: Results suggest that absence or delay of treatment did not influence vision-targeted HRQOL in these newly diagnosed glaucoma patients. However, visual function affected vision-targeted quality of life up to 6 years after Early Manifest Glaucoma Trial enrollment.

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PubMed2004

Glaucoma and mortality.

PURPOSE: To compare mortality rates in glaucoma patients and matched controls from a large population screening as well as glaucoma patients diagnosed through routine clinical examination (self-selected patients). METHODS: A population-based screening of 32,918 elderly citizens of Malmö was conducted between 1992 and 1997. Individuals with newly detected, previously untreated open-angle glaucoma were identified. Two controls of the same age and gender were chosen among the screening negative participants for each patient. From the same birth cohorts, glaucoma patients seen in routine clinical practice (self-selected patients) were identified through retrospective examination of patient records from the Eye Department at Malmö University Hospital. The number and time of deaths for each group were determined based on centrally administered registers. RESULTS: Mean follow-up time was 7.75 years. Five-year mortality did not differ significantly between the groups, and was 9.2% among glaucoma patients from the screening (n=402), and 11.9% among the controls (n=804; p=0.7406). Self-selected glaucoma patients had a 5-year mortality of 8.5% (n=354), not significantly different from the screening-detected glaucoma patients (p=0.1361). Among glaucoma patients, neither IOP (p=0.1781) nor pseudoexfoliation (p=0.8882) was related to significantly increased mortality. CONCLUSIONS: The results of this study strongly suggest that the life expectancy of glaucoma patients does not differ from the population at large.

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PubMed2004

Factors for progression and glaucoma treatment: the Early Manifest Glaucoma Trial.

PURPOSE OF REVIEW: This review summarizes factors for progression in the Early Manifest Glaucoma Trial (EMGT), including the effect of treatment. EMGT randomized patients with early glaucoma either to argon laser trabeculoplasty plus betaxolol (n = 129) or to no immediate treatment (n = 126) and followed them every 3 months. RECENT FINDINGS: Treated patients had delayed progression, as compared with controls. In Cox regression, EMGT treatment halved the risk of progression (hazard ratio = 0.50; 95% confidence interval: 0.35, 0.71). Risk decreased about 10% with each millimeter mercury of intraocular pressure (IOP) reduction from baseline; the higher (or lower) the IOP at follow-up, the higher (or lower) the risk. Baseline factors increasing progression were higher IOP, exfoliation, bilateral disease, worse perimetric mean deviation and older age; frequent disc hemorrhages at follow-up also increased risk. SUMMARY: EMGT treatment reduced progression risk in half, demonstrating the value of IOP lowering in early glaucoma. Age and indicators of disease severity also predicted progression.

Antihypertensive Agents↗

PubMed2003

Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial.

OBJECTIVE: To assess factors for progression in the Early Manifest Glaucoma Trial (EMGT), including the effect of EMGT treatment. SETTING/PARTICIPANTS: Two hundred fifty-five open-angle glaucoma patients randomized to argon laser trabeculoplasty plus topical betaxolol or no immediate treatment (129 treated; 126 controls) and followed up every 3 months. METHODS: Progression was determined by perimetric and photographic optic disc criteria. Patient-based risk of progression was evaluated using Cox proportional hazard regression models and was expressed as hazard ratios (HR) with 95% confidence intervals (95% CI). RESULTS: After 6 years, 53% of patients progressed. In multivariate analyses, progression risk was halved by treatment (HR = 0.50; 95% CI, 0.35-0.71). Predictive baseline factors were higher intraocular pressure (IOP) (ie, the higher the baseline IOP, the higher the risk), exfoliation, and having both eyes eligible (each of the latter 2 factors doubled the risk), as well as worse mean deviation and older age. Progression risk decreased by about 10% with each millimeter of mercury of IOP reduction from baseline to the first follow-up visit (HR = 0.90 per millimeter of mercury decrease; 95% CI, 0.86-0.94). The first IOP at that visit (3 months' follow-up) was also related to progression (HR = 1.11 per millimeter of mercury higher; 95% CI, 1.06-1.17), as was the mean IOP at follow-up (HR = 1.13 per millimeter of mercury higher; 95% CI, 1.07-1.19). The percent of patient follow-up visits with disc hemorrhages was also related to progression (HR = 1.02 per percent higher; 95% CI, 1.01-1.03). No other factors were identified. CONCLUSIONS: Patients treated in the EMGT had half of the progression risk of control patients. The magnitude of initial IOP reduction was a major factor influencing outcome. Progression was also increased with higher baseline IOP, exfoliation, bilateral disease, worse mean deviation, and older age, as well as frequent disc hemorrhages during follow-up. Each higher (or lower) millimeter of mercury of IOP on follow-up was associated with an approximate 10% increased (or decreased) risk of progression.

Adrenergic beta-Antagonists↗

PubMed2003

Measuring visual field progression in the Early Manifest Glaucoma Trial.

AIMS: The Early Manifest Glaucoma Trial (EMGT) (316 eligible eyes) has used a new set of criteria to define visual field progression in glaucoma. This paper provides estimates of the amount of visual field worsening required to reach the EMGT definition of definite perimetric progression. METHODS: In the 148 eyes that reached definite progression, we first determined changes between baseline and the time of definite EMGT progression, both for mean deviation (MD) and for number of highly (p < 0.5%) significantly depressed test points in pattern deviation probability maps. Second, we studied whether such changes depended on baseline MD, intraocular pressure (IOP), age and time to progression, all of which are factors that affect the rate of field progression. RESULTS: In eyes reaching progression, the mean change in MD from baseline was -1.93 dB (SE +/- 0.20) and the mean change in number of significant points was +4.85 (SE +/- 0.35). These changes did not show linear dependency on baseline MD, IOP or time to progression. CONCLUSIONS: The average amount of field deterioration needed to reach EMGT visual field progression has been measured and expressed in more conventional units (i.e. a loss of about - 2dB in MD and an increase in about five highly significant points). These estimates will facilitate the clinical interpretation of the results of EMGT.

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PubMed2002

Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial.

OBJECTIVE: To provide the results of the Early Manifest Glaucoma Trial, which compared the effect of immediately lowering the intraocular pressure (IOP), vs no treatment or later treatment, on the progression of newly detected open-angle glaucoma. DESIGN: Randomized clinical trial. PARTICIPANTS: Two hundred fifty-five patients aged 50 to 80 years (median, 68 years) with early glaucoma, visual field defects (median mean deviation, -4 dB), and a median IOP of 20 mm Hg, mainly identified through a population screening. Patients with an IOP greater than 30 mm Hg or advanced visual field loss were ineligible. INTERVENTIONS: Patients were randomized to either laser trabeculoplasty plus topical betaxolol hydrochloride (n = 129) or no initial treatment (n = 126). Study visits included Humphrey Full Threshold 30-2 visual field tests and tonometry every 3 months, and optic disc photography every 6 months. Decisions regarding treatment were made jointly with the patient when progression occurred and thereafter. MAIN OUTCOME MEASURES: Glaucoma progression was defined by specific visual field and optic disc outcomes. Criteria for perimetric progression were computer based and defined as the same 3 or more test point locations showing significant deterioration from baseline in glaucoma change probability maps from 3 consecutive tests. Optic disc progression was determined by masked graders using flicker chronoscopy plus side-by-side photogradings. RESULTS: After a median follow-up period of 6 years (range, 51-102 months), retention was excellent, with only 6 patients lost to follow-up for reasons other than death. On average, treatment reduced the IOP by 5.1 mm Hg or 25%, a reduction maintained throughout follow-up. Progression was less frequent in the treatment group (58/129; 45%) than in controls (78/126; 62%) (P =.007) and occurred significantly later in treated patients. Treatment effects were also evident when stratifying patients by median IOP, mean deviation, and age as well as exfoliation status. Although patients reported few systemic or ocular conditions, increases in clinical nuclear lens opacity gradings were associated with treatment (P =.002). CONCLUSIONS: The Early Manifest Glaucoma Trial is the first adequately powered randomized trial with an untreated control arm to evaluate the effects of IOP reduction in patients with open-angle glaucoma who have elevated and normal IOP. Its intent-to-treat analysis showed considerable beneficial effects of treatment that significantly delayed progression. Whereas progression varied across patient categories, treatment effects were present in both older and younger patients, high- and normal-tension glaucoma, and eyes with less and greater visual field loss.

Adrenergic beta-Antagonists↗

PubMed2002

A comparison of glaucoma patients identified through mass screening and in routine clinical practice.

PURPOSE: To study differences between glaucoma patients identified through a population screening and glaucoma patients diagnosed in routine clinical practice (self-selected patients). METHODS: A total of 402 individuals with newly detected open-angle glaucoma were identified through a large population screening programme that ran from October 1992 to January 1997. The screening programme was attended by a total of 32918 citizens of Malmö, Sweden, aged between 57 and 79 years. Citizens who had visited the Eye Department of Malmö University Hospital in the year before the screening of their birth cohort were not invited to participate (n = 4117). Among the latter, we identified 354 patients with open-angle glaucoma through a retrospective examination of patient records. RESULTS: At detection, 52.9% of the glaucoma patients identified through screening had normal tension glaucoma (NTG), defined as intraocular pressure (IOP) < 21 mmHg in both eyes, compared to 13.5% of the self-selected patients (p < 0.0001). Mean IOP at the time of diagnosis was 22.9 mmHg in the screened group and 32.5 mmHg in the self-selected group. Pseudoexfoliation was present in 16.4% of the screened group and 44.0% of the self-selected group (p < 0.01). Bilateral disease was present in 40.1% of the screened group and 34.6% of the self-selected group (p = 0.1160). Median MD (mean deviation from the age-corrected normal visual field) in the worse eye was -8.0 dB in the screened group and -16.2 dB in the self-selected group (p < 0.0001). Visual acuity was lower in the self-selected group, which was also on average slightly more myopic. Of the patients detected through screening, 62% had seen an ophthalmologist previously, 17% within the preceding 2-year period. CONCLUSIONS: Normal tension glaucoma was four times as common in patients identified through population screening as in self-selected patients, suggesting that patients with NTG are easily overlooked in clinical practice. Even though the patients detected through population screening had lower mean IOP, lower prevalence of pseudoexfoliation, better visual fields and a lower incidence of bilateral disease than self-selected patients, many still had considerable damage. Special efforts, such as glaucoma screening, are needed if manifest glaucoma, and especially NTG, is to be detected at an earlier stage than it currently is.

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PubMed2002

Optic disc hemorrhages and generalized vascular disease.

PURPOSE: To study the relationship between optic disc hemorrhages and four different groups of medications used in general vascular disease and diabetes. METHODS: The authors screened citizens of the city of Malmö, Sweden who were between 57 and 79 years old (32,918 subjects), in order to find individuals with undetected glaucoma. One set of optic disc photographs was taken of each participant and examined for optic disc hemorrhages. Logistic regression was used, with platelet aggregation inhibitors, antihypertensive agents, cholesterol-lowering medication, and antidiabetic agents as independent variables that were tested in isolation as well as in various combinations and adjusted for age and gender. RESULTS: Optic disc hemorrhages were significantly more common in individuals taking platelet aggregation inhibitors (OR 3.16, P < 0.0001). There was no significant association between ODH and the other three groups of medications. CONCLUSIONS: The significant relationship between platelet aggregation inhibitors and optic disc hemorrhages is a new and interesting finding that could indicate an association between optic disc hemorrhages and generalized vascular disease. Alternatively, it could mean that platelet aggregation inhibitors prolong resorption of or predispose to optic disc hemorrhages.

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