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Biomedical subjects

Ivan Goldberg

Publications and source records attributed to Ivan Goldberg.

11 recordsLinked to original sources
PubMed2003

Relationship between intraocular pressure and preservation of visual field in glaucoma.

Intraocular pressure (IOP) correlates with progressive loss of visual field in patients with glaucoma. Decreasing IOP has been proven to reduce progressive loss of the visual field. This is true both for glaucoma patients with IOPs above or within the normal range. For individuals with ocular hypertension (high IOP but no evidence of glaucomatous neuropathy), lowering IOP may reduce the risk of developing glaucoma. This article reviews scientific evidence that supports the importance of lowering IOP in patients with glaucoma or ocular hypertension.

Glaucoma↗
PubMed2003

Does a family history of glaucoma affect disease severity at the time of diagnosis?

PURPOSE: Progressive glaucomatous optic neuropathy is an asymptomatic process with an insidious onset. Patients who are aware of glaucomatous signs and who suspect that they may have the disease may present earlier. If a person has glaucoma, this may alert his or her other family members to seek assessment and thereby permit earlier diagnosis. The authors sought to determine whether glaucoma patients with a family history of the disease were younger and showed less evidence of glaucomatous optic neuropathy at diagnosis than glaucoma patients without a family history of the disease. PATIENTS AND METHODS: Family history of glaucoma, age at diagnosis, and visual field mean defect within 2 years after diagnosis were recorded in 292 patients with primary open-angle glaucoma. Results were analyzed to compare visual field loss with age and family history. RESULTS: At diagnosis, patients with a family history of glaucoma were younger than those without such a history (mean +/- SD, 58 +/- 12.7 years versus 63 +/- 10.8 years; = 3.68, P<0.001). Patients who were younger than 50 years at the time of diagnosis and had a positive family history were significantly less likely to have a worse visual field than those with a negative family history (OR = 0.3; 95% CI, 0.1-0.6; P<0.001), whereas those aged 50 years or older showed no such correlation (OR = 0.9; 95% CI, 0.7-1.3; P = 0.6). CONCLUSION: A family history of glaucoma was associated with a better visual field at diagnosis in patients younger than 50 years, but not in patients 50 years or older.

Adult↗
PubMed2002

One-year, randomized study comparing bimatoprost and timolol in glaucoma and ocular hypertension.

OBJECTIVE: To compare bimatoprost with timolol maleate in patients with glaucoma or ocular hypertension. METHODS: In 2 identical, multicenter, randomized, double-masked, 1-year clinical trials, patients were treated with 0.03% bimatoprost once daily (QD) (n = 474), 0.03% bimatoprost twice daily (BID) (n = 483), or 0.5% timolol maleate BID (n = 241). MAIN OUTCOME MEASURES: Diurnal intraocular pressure (IOP) at 8 AM, 10 AM, and 4 PM and safety variables (IOP was also measured at 8 PM at selected sites). RESULTS: Bimatoprost QD provided significantly lower mean IOP than timolol at every time of the day at each study visit (P<.001). This was also true for bimatoprost BID at most time points, but the efficacy was not as good as that of the QD regimen. At 10 AM (peak timolol effect) at month 12, the mean reduction in IOP from baseline was 7.6 mm Hg (30%) with bimatoprost and 5.3 mm Hg (21%) with timolol (P<.001). A significantly higher percentage of patients receiving bimatoprost QD (58%) than timolol (37%) achieved IOPs at or below 17 mm Hg (10 AM, month 12; P<.001). The most common adverse effect with bimatoprost was hyperemia (significantly higher with bimatoprost QD than timolol; P<.001). CONCLUSIONS: Bimatoprost QD provides sustained IOP lowering superior to timolol or bimatoprost BID and achieves low target IOPs in significantly more patients.

Adrenergic beta-Antagonists↗
PubMed2002

Multifocal objective perimetry in the detection of glaucomatous field loss.

PURPOSE: To test the ability of a new type of multifocal objective perimetry to identify glaucomatous visual field defects. METHODS: A multichannel visual evoked potential was recorded using the ObjectiVision Accumap perimeter. One hundred patients (age, 62.2 +/- 9.8 years, mean MD -6.5 +/- 4.17 dB) with open-angle glaucoma and confirmed glaucomatous visual field defects were tested and compared with the normal database of 100 normal subjects (age, 58.9 +/- 10.7 years). Both eyes were tested, but for determining sensitivity the eye with the lesser field defect was chosen if both qualified. The amplitude and intereye asymmetry coefficient for each zone of the field were calculated. A mean amplitude and multifocal objective perimetry severity index was calculated for each subject. RESULTS: In 95 of 100 (95%) patients with glaucoma Humphrey field defects were correlated with visual evoked potential amplitude reductions identifying a cluster of three or more abnormal zones. In two of five remaining patients with glaucoma the defect was detected on the intereye asymmetry analysis. Topographic location was well correlated with Humphrey fields. Mean amplitude was significantly reduced in 86 of the glaucoma cases (86%). The glaucoma severity index was abnormal in 93 glaucoma cases and showed a correlation with Humphrey MD (r = 0.67 right eyes, 0.69 left eyes). In 37 glaucoma cases with no scotoma by definition in the fellow eye, 22 (59.4%) had an abnormal multifocal objective perimetry, whereas only eight had some other aspect of their Humphrey visual field flagged as abnormal. CONCLUSIONS: Multifocal objective perimetry can assess the visual field and identify glaucomatous visual field defects. It may have the potential for identifying defects earlier than conventional perimetry.

Adult↗
PubMed2002

Factors affecting awareness and knowledge of glaucoma among patients presenting to an urban emergency department.

BACKGROUND: Until advanced, glaucoma is asymptomatic. For early diagnosis to occur, patients may need to be aware of it and seek assessment regularly. People who have risk factors for glaucoma may have a greater awareness of the disease. METHODS: Patients presenting to an urban hospital emergency department were surveyed with a brief questionnaire to assess their knowledge of glaucoma. Data was collected about their gender, age, family history of glaucoma and presence of systemic hypertension, diabetes, Raynaud's phenomenon, migraines and myopia. RESULTS: Women (Odds ratio 2.3; 95% CI 1.4-3.7; P < 0.01), people who were 40 years or older (Odds ratio 2.2; 95% CI 1.1-4.4; P < 0.05) and those who were aware of a family history of glaucoma (Odds ratio 15.7; CI 5.5-45.3; P < 0.01) knew significantly more about the disease than others. People with other risk factors did not demonstrate significantly greater knowledge despite 89% of all participants having had a previous eye examination. CONCLUSION: This information may be useful to predict which patients may know about glaucoma when they present for an eye examination and who should be targeted in public health campaigns.

Adult↗
PubMed2002

Analysis of risk factors that may be associated with progression from ocular hypertension to primary open angle glaucoma.

BACKGROUND: As a multifactorial disease, glaucoma may be associated with pressure-dependent and pressure-independent factors. Ocular hypertension (OHT) may develop into primary open angle glaucoma (POAG) for many patients. Groups with OHT and POAG were compared for pressure-dependent and independent risk factors. A high prevalence of any factor(s) could indicate a contribution to progression from OHT to POAG. METHODS: A sample of patients with POAG (n = 438) and with OHT (n = 301) were selected from those attending a tertiary referral private glaucoma practice, and data were collected regarding age and intraocular pressure at the time of diagnosis, sex, family history of glaucoma, systemic hypertension, diabetes, Raynaud's phenomenon, migraine and myopia. RESULTS: After multivariate analysis, older age at time of diagnosis (chi(2)(5) = 73.89, P < 0.001), myopia (odds ratio [OR] = 1.5, 95% confidence interval [CI] 1.0-2.2; P < 0.05), a family history of glaucoma (OR = 1.6, 95% CI 1.1-2.3; P < 0.01) and a high intraocular pressure (chi(2)(4) = 16.96; P = 0.002) were found to be more prevalent among those with POAG. No other significant differences could be found between the two groups. CONCLUSION: Patients who have OHT may be at higher risk of developing POAG if they also have myopia, a family history of glaucoma or are of older age.

Adult↗
PubMed2002

Comparison of clinical optic disc assessment with tests of early visual field loss.

PURPOSE: Clinical optic disc assessment may identify glaucomatous optic neuropathy prior to a patient developing visual field abnormalities on achromatic automated peri-metry (AAP). Tests targeting axons that are selectively damaged or whose redundancy is low, such as short wavelength automated perimetry (SWAP) and frequency doubling perimetry (FDP), may detect visual field loss before it is seen on AAP. This study investigated whether patients in whom characteristic glaucomatous optic disc damage was present without AAP abnormalities had visual field abnormalities with SWAP and FDP. METHODS: A sample of patients (n = 50) with ocular hypertension (normal AAP) were selected, who had SWAP, FDP and stereofundus photography performed. The photographs were then analysed by two glaucoma subspecialists who were masked to the assessments of the other and to the patients' SWAP and FDP results. A categorization of the optic discs was made as either normal or abnormal and this was compared with their SWAP and FDP findings. RESULTS: On comparing SWAP and FDP with clinical optic disc assessment as the 'gold standard', the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 33%, 92%, 57% and 81%, respectively, for SWAP and 25%, 89%, 49% and 79%, respectively, for FDP. CONCLUSION: In glaucoma suspects, the study suggests that SWAP and FDP identify subjects with early glaucomatous optic neuropathy missed by AAP.

False Positive Reactions↗