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Biomedical subjects

George L Spaeth

Publications and source records attributed to George L Spaeth.

13 recordsLinked to original sources
PubMed2003

Reliability of the disk damage likelihood scale.

PURPOSE: To report the reliability of the glaucoma disk damage likelihood scale (DDLS) in comparison to the Armaly cup/disk ratio by determining the interobserver and intraobserver agreement for optic disk stereo photographs and the interobserver agreement for in vivo patient measurements of the optic disk. DESIGN: Observational case series. METHODS: Optic disk photographs: 48 stereo pairs of optic nerve photographs were selected from patients with a spectrum of glaucomatous visual field loss. Two masked observers graded the optic disk photographs three times according to the DDLS and Armaly cup/disk ratio. Interobserver and intraobserver agreements were calculated using the test-retest method. Patient measurements: three observers performed in vivo patient measurements on 34 eyes of glaucoma clinic patients and made a single determination of the DDLS stage and Armaly cup/disk ratio, based on the indirect biomicroscopic examination. Level of interobserver agreement was tabulated. RESULTS: Optic disk photographs: interobserver and intraobserver agreement for the vertical DDLS measurement was greater than for two determinations (clinical impression and measured) of the vertical Armaly cup/disk ratio (interobserver: 85% vs 68% and 74%, respectively; intraobserver grader 1: 97% vs 89% and 80%, grader 2: 99% vs 95% and 89%, respectively). In vivo patient measurements: the interobserver agreement for the DDLS and Armaly cup/disk ratio was similar (70.1% vs 67.6%, respectively). CONCLUSIONS: For the stereo optic disk photographs, the inter- and intra-observer agreement for the DDLS is greater than the Armaly cup/disk ratio. For the in vivo patient measurements, the level of agreement for the DDLS and the Armaly cup/disk ratio is similar.

Diagnostic Techniques, Ophthalmological↗
PubMed2003

Clinical agreement among glaucoma experts in the detection of glaucomatous changes of the optic disk using simultaneous stereoscopic photographs.

PURPOSE: To evaluate the clinical agreement in the detection of optic disk changes in patients with glaucoma using simultaneous stereophotographs. DESIGN: Masked-observer variability study. METHODS: Ten glaucoma specialists examined pairs of simultaneous stereophotographs of glaucomatous and control optic disks to determine whether there were changes compatible with progression of glaucomatous damage. RESULTS: Intraobserver agreement had a kappa value ranging from 0.55 to 0.78. Interobserver agreement among the glaucoma specialists had a kappa value ranging from 0.34 to 0.68. CONCLUSIONS: Clinical examination of stereophotographs to detect optic disk changes in glaucoma patients has limitations associated with suboptimal reproducibility.

Diagnostic Techniques, Ophthalmological↗
PubMed2003

Rate and amount of visual loss in 102 patients with open-angle glaucoma followed up for at least 15 years.

PURPOSE: To determine the probability of worsening of glaucoma and the rate of change in patients having open-angle glaucoma for approximately 20 years. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: One hundred and two patients diagnosed and treated for open-angle glaucoma before 1982. TESTING/INTERVENTION: The optic disc and visual field of one eye of each patient were graded independently at diagnosis and periodically throughout the follow-up period for a minimum of 15 years (mean, 19 +/- 3 years), using a scale ranging from 0 = no damage to 5 = far-advanced damage. Therapy was contemperaneous and stepped through medical laser, and surgery. MAIN OUTCOME MEASURES: The probability of worsening by one or more stages was plotted against the length of follow-up (Kaplan-Meier survival curves). RESULTS: Nineteen eyes did not worsen, 43 deteriorated one stage, 31 two stages, and 9 three stages. The median time to first worsening was 7.5 years, to second worsening 18.5 years, and to third worsening 24.5 years. Patients with more advanced stages of damage were not more likely to deteriorate than those with less-marked damage. The intraocular pressure was not significantly lower in the patients who remained stable. Seventeen eyes deteriorated to a visual acuity of 20/200 or worse. Of these, causes other than glaucoma were responsible in at least 60% of the cases. CONCLUSIONS: Approximately 20% of eyes with open-angle glaucoma remained stable for about 20 years, 43% deteriorated one of five stages, and 9% three of five stages. Seventeen of the eyes lost acuity to a level of 20/200, usually from causes other than glaucoma. Deterioration of field was, on average, first noted at 7.5 years, after which the rate of deterioration slowed.

Antihypertensive Agents↗
PubMed2003

Visual function, disability, and psychological impact of glaucoma.

PURPOSE OF REVIEW: This report briefly reviews recent instruments designed to test the visual function and quality of life of patients with glaucoma. RECENT FINDINGS: Several investigators have examined the functional status and vision-related quality of life among patients with glaucoma. These studies have shown that patients with glaucoma experience diminished visual function and poorer quality of life. SUMMARY: Because glaucoma and its treatment, either medical or surgical, can affect global quality of life as well as vision-related functioning, the assessment of both general and visual system health status is relevant.

Disability Evaluation↗
PubMed2002

The Heidelberg Retina Tomograph vs clinical impression in the diagnosis of glaucoma.

PURPOSE: To compare the sensitivity and the specificity of the Heidelberg Retina Tomograph (HRT) classification of "Glaucoma" or "Normal" with that derived from clinical impression (CI) based on several parameters. DESIGN: Consecutive observational case series. METHODS: In a retrospective chart review of 200 left eyes of 200 consecutive patients referred to the Glaucoma Service Diagnostic Laboratory of the Wills Eye Hospital, we compared the HRT-based classification of "Glaucoma" or "Normal" with a CI classification of "Definite glaucoma," "Probably glaucoma," "Probably no glaucoma," and "No glaucoma." RESULTS: The HRT-based diagnosis of "Glaucoma" or "Normal" had an 86% sensitivity and 68% specificity when compared with a clinical impression (CI) of "Definite glaucoma," used as a strict gold standard definition of glaucoma; an 83% sensitivity and 57% specificity when the CI "Definite glaucoma" and "Probably glaucoma" were combined as a more liberal definition of glaucoma; a 76% sensitivity and 69% specificity when the CI "Definite glaucoma," "Probably glaucoma," and "Probably no glaucoma" were combined as the most liberal definition of glaucoma. The HRT diagnosis had an 86% sensitivity and 51% specificity when compared with the groups "Probably glaucoma," "Probably no glaucoma," and "No glaucoma" combined and considered as no glaucoma. CONCLUSIONS: In this study, HRT-based classification of "Glaucoma" or "Normal" was moderately sensitive, but not very specific when compared with the clinical impression as the gold standard. Clinicians should not rely on the HRT diagnosis alone, but should use it to supplement the impression based on an eye examination and other ancillary tests.

False Negative Reactions↗
PubMed2002

Validity of a new disk grading scale for estimating glaucomatous damage: correlation with visual field damage.

PURPOSE: To determine the correlation of a new disk grading system, the disk damage likelihood scale (DDLS), with the visual field damage in patients with glaucoma. DESIGN: Observational case series. METHODS: Charts of 75 patients (150 eyes) with primary open-angle glaucoma (POAG), 41 patients (82 eyes) with low-tension glaucoma (LTG), and 25 patients (50 eyes) with pseudoexfoliative glaucoma (PXFG) were reviewed retrospectively. DDLS stages and vertical disk sizes were recorded. A masked observer staged the Humphrey field analyzer (program 24-2) visual fields using the Hodapp-Parrish-Anderson (HPA) visual field staging system. Mean deviation (MD) and pattern standard deviation (PSD) values were obtained. The correlation of DDLS with the visual field parameters and HPA staging system were evaluated. Findings were assessed by the Pearson and Spearman correlation coefficients. RESULTS: In the 282 eyes studied, the DDLS was strongly correlated with both MD (Pearson r = - 0.695, P <.001) and PSD (Pearson r =.703, P <.001). The HPA visual field staging system was also strongly correlated with the DDLS (Spearman r =.711, P <.001). These relationships continued to be significant when the three diagnostic groups (POAG, LTG, PXFG) were evaluated separately (P <.001) and also for small (< 1.5 mm) and average size (1.5-2.0 mm) disks. Large disks (> 2.0 mm) were not evaluated, because there was an insufficient number of cases. CONCLUSION: DDLS, a new system for estimating glaucomatous disk damage, strongly correlates with the degree of glaucomatous visual field damage.

Adult↗
PubMed2002

Prevalence of the use of complementary and alternative medicine for glaucoma.

OBJECTIVES: To estimate the prevalence of complementary and alternative medicine (CAM) for glaucoma, explore possible demographic and disease-related associations, and inquire about the perceived benefit of these treatments. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: One thousand twenty-seven consecutive patients from two urban, referral glaucoma practices. MAIN OUTCOME MEASURE: Use of CAM specifically for glaucoma. RESULTS: The response rate was 97.4%. The percentage of people reporting use of CAM for glaucoma was 5.4% (54 of 1000 subjects) with 32 of these 54 (59%) having used more than one type. The percentages of those using the various types of nontraditional medicine were: megavitamin therapy (62.9%), herbal therapy (57.4%), exercise (24.0%), diet modification (22.2%), meditation, (1.8%), acupuncture (1.8%), faith healing (1.8%), and homeopathic remedies (1.8%). Patients who used CAM were more likely to be educated beyond high school (P = 0.0014) and less likely to be retired (P = 0.0053). Use of nontraditional therapy was not strongly associated with race (P = 0.044), age (P = 0.062), gender (P = 0.24), length of diagnosis (P = 0.91), or number of glaucoma medications (P = 0.58). Of those using nontraditional therapy, 52% believed that it was helpful, 39% were unsure, and 9% considered it not helpful; 72% discussed their use with an ophthalmologist. Seventy percent discovered it from sources other than providers of either traditional or nontraditional care. CONCLUSIONS: The prevalence of CAM use for glaucoma was 5.4% (95% confidence interval, 4.0%--6.4%). Most glaucoma patients currently cared for by ophthalmologists do not use nontraditional medicine.

Aged↗
PubMed2002

The disc damage likelihood scale: reproducibility of a new method of estimating the amount of optic nerve damage caused by glaucoma.

PURPOSE: The major objective of this study was to test the reproducibility of a new method of estimating the amount of optic disc damage in patients with glaucoma. METHODS: The Disc Damage Likelihood Scale (DDLS) is based on the appearance of the neuroretinal rim of the optic disc corrected for disc diameter. The eight stages, extending from no damage to far advanced damage, are based on the width of the neuroretinal rim or the circumferential extent of absence of neuroretinal rim. Reproducibility was measured by two masked observers staging 48 optic nerve stereoscopic photographs by two different methods, the cup/disc ratio (c/d) and the DDLS. Also, reproducibility was assessed by three observers examining 34 eyes of 24 patients. RESULTS: With regard to the photographs, the intraobserver and interobserver reproducibility was better using the DDLS than the c/d ratio (98% versus 85% for intraobserver of reproducibility, and 85% versus 74% for interobserver reproducibility). The DDLS correlated better with the Humphrey Visual Field than did any Heidelberg Retina Tomograph parameter. CONCLUSION: In a clinical setting, the DDLS is as reproducible as, or more reproducible than, the c/d ratio system of estimating the amount of disc damage in patients with glaucoma.

Diagnostic Techniques, Ophthalmological↗
PubMedDate not supplied

An "exploding cataract" following Nd:YAG laser iridectomy.

A case of an "exploding" cataract (an iatrogenic posterior capsular rupture) following Nd:YAG laser iridectomy is described. Rapid cataract development was observed in the right eye of a 76-year-old woman following an iridectomy. B-scan ultrasonography documented cortical debris in the vitreous cavity. The patient underwent an extracapsular cataract extraction and intraocular lens implantation. During the cataract extraction, a posterior capsular tear extending from the 10-o'clock to the 4-o'clock position was noted, through which fluffy cortical material was floating in the vitreous.

Aged↗