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Biomedical subjects

M Roy Wilson

Publications and source records attributed to M Roy Wilson.

11 recordsLinked to original sources
PubMed2003

Long-term follow-up of primary glaucoma surgery with Ahmed glaucoma valve implant versus trabeculectomy.

PURPOSE: To compare the long-term results of trabeculectomy and Ahmed glaucoma valve implant in the initial surgical management of primary open- and closed-angle glaucoma. DESIGN: Randomized controlled clinical trial. METHODS: One eye each of consecutive patients with primary glaucoma and without prior intraocular surgery was randomized to receive either trabeculectomy or the Ahmed implant. Large university-affiliated eye hospital in Columbo, Sri Lanka. RESULTS: Of 123 patients, 64 were randomized to trabeculectomy and 59 to the Ahmed implant. With a mean follow-up of 31 months, the trabeculectomy group had statistically lower intraocular pressures (IOP) during the first postoperative year. After the first year, the IOPs were comparable. No statistically significant differences between groups were noted for postoperative visual acuity, visual field, anterior chamber depth, and short-term or long-term complications. Adjunctive medication requirement was comparable for both groups. The cumulative probabilities of success (IOP <21 mm Hg and at least 15% reduction in IOP from preoperative levels) at the final follow-up period (months, 41-52) were 68.1% for trabeculectomy and 69.8% for Ahmed implant (P =.86). CONCLUSIONS: Lower IOPs were noted for the trabeculectomy group during the first year. With longer follow-up, the IOPs and the cumulative probabilities of success were comparable between the two groups.

Adolescent↗
PubMed2003

Ocular Hypertension Treatment Study (OHTS) commentary.

PURPOSE OF REVIEW: To summarize the major findings of the Ocular Hypertension Treatment Study (OHTS). RECENT FINDINGS: Ocular hypertensive subjects who received topical glaucoma medication experienced conversion to glaucoma at less than half the rate of subjects who were monitored without treatment. Risk factors for converting to glaucoma included older age, higher intraocular pressure, larger cup-disc ratio, higher pattern SD, and thinner central corneal thickness. SUMMARY: The OHTS clearly established that medically treating ocular hypertension is efficacious in delaying or preventing the onset of glaucoma. Further, the results may assist in providing useful guidelines for determining who with ocular hypertension should be offered medical treatment.

Administration, Topical↗
PubMed2002

The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma.

BACKGROUND: Primary open-angle glaucoma (POAG) is one of the leading causes of blindness in the United States and worldwide. Three to 6 million people in the United States are at increased risk for developing POAG because of elevated intraocular pressure (IOP), or ocular hypertension. There is no consensus on the efficacy of medical treatment in delaying or preventing the onset of POAG in individuals with elevated IOP. Therefore, we designed a randomized clinical trial, the Ocular Hypertension Treatment Study. OBJECTIVE: To determine the safety and efficacy of topical ocular hypotensive medication in delaying or preventing the onset of POAG. METHODS: A total of 1636 participants with no evidence of glaucomatous damage, aged 40 to 80 years, and with an IOP between 24 mm Hg and 32 mm Hg in one eye and between 21 mm Hg and 32 mm Hg in the other eye were randomized to either observation or treatment with commercially available topical ocular hypotensive medication. The goal in the medication group was to reduce the IOP by 20% or more and to reach an IOP of 24 mm Hg or less. MAIN OUTCOME MEASURES: The primary outcome was the development of reproducible visual field abnormality or reproducible optic disc deterioration attributed to POAG. Abnormalities were determined by masked certified readers at the reading centers, and attribution to POAG was decided by the masked Endpoint Committee. RESULTS: During the course of the study, the mean +/- SD reduction in IOP in the medication group was 22.5% +/- 9.9%. The IOP declined by 4.0% +/- 11.6% in the observation group. At 60 months, the cumulative probability of developing POAG was 4.4% in the medication group and 9.5% in the observation group (hazard ratio, 0.40; 95% confidence interval, 0.27-0.59; P<.0001). There was little evidence of increased systemic or ocular risk associated with ocular hypotensive medication. CONCLUSIONS: Topical ocular hypotensive medication was effective in delaying or preventing the onset of POAG in individuals with elevated IOP. Although this does not imply that all patients with borderline or elevated IOP should receive medication, clinicians should consider initiating treatment for individuals with ocular hypertension who are at moderate or high risk for developing POAG.

Administration, Topical↗
PubMed2002

The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma.

BACKGROUND: The Ocular Hypertension Treatment Study (OHTS) has shown that topical ocular hypotensive medication is effective in delaying or preventing the onset of primary open-angle glaucoma (POAG) in individuals with elevated intraocular pressure (ocular hypertension) and no evidence of glaucomatous damage. OBJECTIVE: To describe baseline demographic and clinical factors that predict which participants in the OHTS developed POAG. METHODS: Baseline demographic and clinical data were collected prior to randomization except for corneal thickness measurements, which were performed during follow-up. Proportional hazards models were used to identify factors that predicted which participants in the OHTS developed POAG. RESULTS: In univariate analyses, baseline factors that predicted the development of POAG included older age, race (African American), sex (male), larger vertical cup-disc ratio, larger horizontal cup-disc ratio, higher intraocular pressure, greater Humphrey visual field pattern standard deviation, heart disease, and thinner central corneal measurement. In multivariate analyses, baseline factors that predicted the development of POAG included older age, larger vertical or horizontal cup-disc ratio, higher intraocular pressure, greater pattern standard deviation, and thinner central corneal measurement. CONCLUSIONS: Baseline age, vertical and horizontal cup-disc ratio, pattern standard deviation, and intraocular pressure were good predictors for the onset of POAG in the OHTS. Central corneal thickness was found to be a powerful predictor for the development of POAG.

Administration, Topical↗
PubMed2002

Progression of visual field loss in untreated glaucoma patients and glaucoma suspects in St. Lucia, West Indies.

PURPOSE: A 1986-1987 survey found 8.8% prevalence of open-angle glaucoma in the black population of St. Lucia, West Indies. This follow-up study assessed visual field loss progression in untreated glaucoma patients and glaucoma suspects 10 years later. DESIGN: Cohort study. METHODS: Subjects were 205 glaucoma patients and suspects; 1987 data included age, sex, visual acuity, and visual fields measured by automated threshold perimetry (Humphrey C 30-2 test), and 1997 data included intraocular pressure, visual acuity, and visual fields measured by the same test. Exclusion criteria included field unreliability, field improvement due to vision improvement, nonglaucomatous vision deterioration, glaucoma treatment since 1988, and scoring of a visual field as end stage in 1987. Visual fields were scored by algorithms for the Advanced Glaucoma Intervention Study (AGIS) and Collaborative Initial Glaucoma Treatment Study (CIGTS). RESULTS: By AGIS criteria, 55% of 146 right eyes and 52% of 141 left eyes showed progression of visual field loss. In linear regressions, progression severity was unassociated with sex, intraocular pressure, or baseline visual field score, but was positively associated with age (P <.001, right; P =.002, left). The cumulative probability of reaching end stage in 10 years in at least one eye was approximately 16% by AGIS criteria. By CIGTS criteria, 73% of 146 right eyes and 72% of 141 left eyes progressed. CONCLUSIONS: These data provide a unique opportunity to study progression of untreated glaucoma. The percentage of eyes showing visual field loss progression and the percentage reaching end stage were considerably higher than in studies of visual field progression in treated eyes.

Adult↗
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

Progression of visual field loss in untreated glaucoma patients and suspects in St Lucia, West Indies.

PURPOSE: A 1986-1987 survey found an 8.8% prevalence of open-angle glaucoma in the black population of St Lucia, West Indies. This follow-up study assessed progression of visual field loss in untreated glaucoma patients and persons with suspected glaucoma 10 years later. METHODS: Subjects were 205 patients with or suspected of having glaucoma. The 1987 data included age, sex, visual acuity, and visual fields measured by automated threshold perimetry (Humphrey C-30-2 test). The 1997 data included intraocular pressure, visual acuity, and visual fields measured by the same test. Exclusion criteria included field unreliability, field improvement due to vision improvement, nonglaucomatous vision deterioration, glaucoma treatment since 1988, and scoring of a field as end-stage in 1987. Visual fields were scored by algorithms for the Advanced Glaucoma Intervention Study (AGIS) and Collaborative Initial Glaucoma Treatment Study (CIGTS). RESULTS: By AGIS criteria, 55% of 146 right eyes and 52% of 141 left eyes progressed. In linear regressions, progression severity was unassociated with male or female sex, intraocular pressure, or baseline visual field score, but was positively associated with age (P < .001, right; P = .002, left). By CIGTS criteria, more eyes progressed. The cumulative probability of reaching end-stage disease in 10 years in at least on eye was about 16% by AGIS criteria and was 35% by CIGTS criteria. CONCLUSIONS: These data provide a unique opportunity to study progression of untreated glaucoma. A considerably larger percentage of eyes showed progression of visual field loss, and the rate of progression was greater than in studies of visual field loss in treated eyes.

Adult↗
PubMedDate not supplied

Primary open-angle glaucoma in blacks: a review.

Glaucoma is one of the leading causes of blindness worldwide. Primary open-angle glaucoma (POAG) is the most prevalent form of glaucoma and has a particularly devastating impact in blacks. In the black American population, POAG prevalence is estimated to be six times as high in certain age groups compared to whites. POAG is more likely to result in irreversible blindness, appears approximately 10 years earlier and progresses more rapidly in blacks than in whites. Racial differences in optic disk parameters have been reported and show that blacks have larger optic disks than whites. This finding is robust and may account for the reported differences in other optic disk parameters. The existence of racial differences in intraocular pressure remains to be demonstrated, as conflicting findings are reported in the literature. Intraocular pressure may actually be underestimated in blacks, perhaps because they have thinner corneas. The prevalence of diabetes and hypertension is higher in blacks than in whites, and although no causal relationship has been established between POAG and each of these systemic diseases, some reports suggest that they often occur together, perhaps through an indirect relationship with intraocular pressure. Compounding the problem, there is evidence that blacks are less responsive to both drug and surgical treatment for POAG. Finally, they often have reduced accessibility to treatment and are less aware of the risks of having POAG. This article provides a comprehensive review of the current knowledge pertaining to POAG in blacks.

Black People↗