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Journal of Glaucoma May 2024In this meta-analysis of 6 studies and 5,269 patients, deep learning algorithms applied to AS-OCT demonstrated excellent diagnostic performance for closed-angle compared...
PRCIS
In this meta-analysis of 6 studies and 5,269 patients, deep learning algorithms applied to AS-OCT demonstrated excellent diagnostic performance for closed-angle compared to gonioscopy, with a pooled sensitivity and specificity of 94% and 93.6%, respectively.
PURPOSE
This study aimed to review the literature and compare the accuracy of deep learning algorithms (DLA) applied to anterior segment optical coherence tomography images (AS-OCT) against gonioscopy in detecting angle-closure in patients with glaucoma.
METHODS
We performed a systematic review and meta-analysis evaluating DLA in AS-OCT images for the diagnosis of angle closure compared with gonioscopic evaluation. PubMed, Scopus, Embase, Lilacs, Scielo, and Cochrane Central Register of Controlled Trials were searched. The bivariate model was used to calculate pooled sensitivity and specificity.
RESULTS
The initial search identified 214 studies, of which 6 were included for final analysis. The total study population included 5,269 patients. The combined sensitivity of the DLA compared with gonioscopy was 94.0% (95% CI 83.8%-97.9%), whereas the pooled specificity was 93.6% (95% CI 85.7%-97.3%). Sensitivity analyses removing each individual study showed a pooled sensitivity in the range of 90.1% to 95.1%. Similarly, specificity results ranged from 90.3 to 94.5% with the removal of each individual study and recalculation of pooled specificity.
CONCLUSION
DLA applied to AS-OCT has excellent sensitivity and specificity in the identification of angle closure. This technology may be a valuable resource in the screening of populations without access to experienced ophthalmologists who perform gonioscopy.
PubMed: 38747721
DOI: 10.1097/IJG.0000000000002428 -
Frontiers in Medicine 2024SCUBA diving exposes participants to a unique hyperbaric environment, but few studies have examined the effects of such an environment on intraocular pressure (IOP) and...
PURPOSE
SCUBA diving exposes participants to a unique hyperbaric environment, but few studies have examined the effects of such an environment on intraocular pressure (IOP) and glaucoma. This systematic review aims to consolidate recent literature findings regarding the impact of increased atmospheric pressure on IOP and glaucoma.
METHODS
Three online databases were searched to identify publications encompassing the subjects of diving or increased atmospheric pressure in conjunction with IOP or glaucoma. Three reviewers independently screened the publications and identified eligible articles. Relevant data was extracted from each article. The heterogeneity of the data precluded the conduct of a meta-analysis.
RESULTS
Nine studies met the inclusion criteria. Six experimental studies employed hyperbaric chambers to measure IOP under simulated diving conditions. Among these, IOP exhibited a reduction with increased atmospheric pressures in four studies, while the findings of two studies were inconclusive. One study measured IOP pre- and post-dive and another measured IOP with and without a diving mask. Post-dive, a decrease in IOP was observed, and a statistically significant reduction was noted when subjects wore a diving mask. A retrospective study examining the incidence of acute angle closure glaucoma attack found no association with weather or atmospheric pressure.
CONCLUSION
The majority of studies found IOP to decrease with increased atmospheric pressure and after diving. The mechanisms underlying this reduction remain incompletely understood, with potential contributors including changes in ocular blood flow, sympathetic responses, and increased oxygenation. Hyperbaric chambers may have potential in future glaucoma treatments, but more studies are required to draw reliable conclusions regarding the safety of diving for glaucoma patients.
PubMed: 38633303
DOI: 10.3389/fmed.2024.1365259 -
Clinical Ophthalmology (Auckland, N.Z.) 2024Primary Angle Closure Glaucoma (PACG), is caused by narrowing the iridocorneal angle and increases the risk of blockage in the trabecular meshwork. Phacoemulsification... (Review)
Review
BACKGROUND
Primary Angle Closure Glaucoma (PACG), is caused by narrowing the iridocorneal angle and increases the risk of blockage in the trabecular meshwork. Phacoemulsification and laser peripheral iridotomy (LPI) effectively control IOP elevation and widen the angle. This systematic review and meta-analysis compared Phacoemulsification and LPI Effectiveness for PACG.
METHODS
We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared Phacoemulsification and LPI for individuals with PACG. We sought to evaluate the following outcomes: mean IOP, number of glaucoma medications, visual acuity (VA), visual field (VF) progression, peripheral anterior synechiae (PAS), Shaffer gonioscopy grading, central corneal thickness (CCT), central endothelial cell density (CECD), and poor response to surgery. The standardized mean difference (SMD) was used to represent continuous outcomes, while the risk ratio (RR) was used to represent dichotomous outcomes.
RESULTS
5 RCTs that enrolled 917 participants were deemed eligible. The phacoemulsification group showed statistically significance lower mean CCT and CECD and lower risk of poor response to surgery compared to LPI (SMD = -1.10; 95% -1.50, -0.70; P<0.001, SMD -366.12; 95% -652.59, -79.65; P=0.01, and RR 0.35; 95% 0.23, 0.54; P<0.001 respectively). There were no significant improvement in IOP and number of medications between both groups (SMD = -0.74; 95% CI = -2.26, 0.78; P=0.34, and SMD -17.58; 95% CI = -50.28, 15.12; P=0.29 respectively). Finally, there were also no significant differences in VA, VF progression, PAS, and mean Shaffer gonioscopy grading between both groups.
CONCLUSION
Phacoemulsification showed statistically significant lower mean corneal thickness, central endothelial cell density, and lower risk of poor response to surgery compared to LPI. However, there were no significant differences in mean IOP, number of medications, VA, VF progression, PAS, and mean Shaffer gonioscopy grading between Phacoemulsification and LPI.
PubMed: 38596663
DOI: 10.2147/OPTH.S446285 -
Journal of Clinical Medicine Feb 2024To investigate the relationship between glaucoma, pseudoexfoliation and hearing loss (HL). : A systematic literature search following PRISMA guidelines was conducted... (Review)
Review
To investigate the relationship between glaucoma, pseudoexfoliation and hearing loss (HL). : A systematic literature search following PRISMA guidelines was conducted using the PubMed, Embase, Scopus and Cochrane databases from 1995 up to 28 August 2023. : Thirty studies out of the 520 records screened met the inclusion criteria and were included. Most articles (n = 20) analysed the association between pseudoexfoliation syndrome (XFS) and HL, showing XFS patients to have higher prevalence of sensorineural hearing loss (SNHL) at both speech frequencies (0.25, 0.5, 1 and 2 kHz), and higher frequencies (4 and 8 kHz) compared to controls in most cases. No significant differences in prevalence or level of HL between XFS and pseudoexfoliative glaucoma (XFG) were detected in most studies. Eight articles analysed the relationship between primary open-angle glaucoma (POAG) and HL. Overall, a positive association between the two conditions was highlighted across all studies except for two cases. Similarly, articles focusing on NTG and HL (n = 4) showed a positive association in most cases. The role of autoimmunity and, in particular, the presence of antiphosphatidylserine antibodies (APSA) in patients with NTG and HL suggested an underlying autoimmune or vascular mechanism contributing to their pathogenesis. Only one study analysed the relationship between angle-closure glaucoma (ACG) and HL, showing higher incidence of ACG in patients with SNHL compared to normal hearing controls. : Most studies detected an association between XFS and HL as well as POAG/NTG/ACG and HL, suggesting the presence of a similar pathophysiology of neurodegeneration. However, given the strength of the association of XFS with HL, it remains unclear whether the presence of XFG is further associated with SNHL. Further research specifically targeted to assess the correlation between glaucoma, XFS and HL is warranted to provide a more comprehensive understanding of this association.
PubMed: 38592217
DOI: 10.3390/jcm13051379 -
JAMA Ophthalmology May 2024Effects of genetic variants on primary angle-closure disease remained uncertain. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Effects of genetic variants on primary angle-closure disease remained uncertain.
OBJECTIVE
To systematically review the associations of common single-nucleotide variants (SNVs) and rare coding variants with primary angle-closure disease, its subtypes (including primary angle-closure glaucoma, primary angle-closure suspect, and primary angle-closure) and progression.
DATA SOURCES
Eligible studies from PubMed, Embase, and Web of Science were retrieved up to April 3, 2023. SNV information was extracted from eligible reports and 2 genome-wide association studies summary statistics, UK BioBank and FinnGen.
STUDY SELECTION
Studies providing analyzable genotype or allele data in a case-control design for primary angle-closure disease association and longitudinal case-only design for primary angle-closure disease progression.
DATA EXTRACTION AND SYNTHESIS
PRISMA guidelines were used for literature screening and the Newcastle Ottawa Scale for data quality assessment. Pooled effect size with 95% CIs of SNV associations were calculated using fixed- or random-effect models according to I2 statistics.
MAIN OUTCOMES AND MEASURES
SNVs reported in 2 or more studies were meta-analyzed to generate pooled odds ratios and P values. Common and rare coding variants from single reports were summarized.
RESULTS
Sixty-nine citations were eligible for meta-analysis on overall primary angle-closure disease, involving 206 SNVs in 64 genes or loci. Seventeen SNVs in 15 genes or loci showed associations with primary angle-closure disease, and 15 SNVs in 13 genes or loci showed associations with primary angle-closure glaucoma. Two SNVs, ABCA1 rs2422493 and ZNRF3 rs3178915, were associated only with primary angle-closure disease. Two SNVs, PCMTD1-ST18 rs1015213 and COL11A1 rs3753841, were associated with primary angle-closure suspect, and 1 SNV, MMP9 rs3918249, was associated with primary angle-closure. This systematic review and meta-analysis newly confirmed 7 genes or loci associated with primary angle-closure glaucoma: ATOH7, CALCRL, FBN1, IL6, LOXL1, MMP19, and VAV3. Common and rare coding variants in 16 genes or loci that have been associated with primary angle-closure disease were cataloged. Stratification analysis revealed different primary angle-closure disease-associated genes in different ethnic populations. Only 1 study regarding the genetic association of primary angle-closure glaucoma progression was identified.
CONCLUSIONS AND RELEVANCE
This study revealed the genetic complexity of primary angle-closure disease, involving common SNVs and rare coding variants in more than 30 genes or loci, with ethnic and phenotypic diversities. Further replication, genotype-phenotype correlation, and pathway analyses are warranted.
Topics: Glaucoma, Angle-Closure; Humans; Polymorphism, Single Nucleotide; Genome-Wide Association Study; Genetic Predisposition to Disease; Intraocular Pressure
PubMed: 38546604
DOI: 10.1001/jamaophthalmol.2024.0363 -
Eye (London, England) May 2024This systematic review aimed to clarify the relationship between the location of laser peripheral iridotomy (LPI), a common procedure to prevent or treat angle-closure... (Review)
Review
This systematic review aimed to clarify the relationship between the location of laser peripheral iridotomy (LPI), a common procedure to prevent or treat angle-closure glaucoma, and the incidence of post-procedure visual disturbances known as dysphotopsias. Understanding this relationship is crucial due to the high frequency of LPIs performed and the significant impact dysphotopsia can have on vision and quality of life. Articles investigating the relationship between LPI location and dysphotopsia in at least five patients were identified via a literature search of OVID MEDLINE (1946-November 19, 2022) and EMBASE (1946-November 19, 2022). Non-comparative and non-English studies were excluded. Studies did not require a control group to be included. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system and Cochrane Risk of Bias 2 (RoB2) tool were used to appraise included studies. Our review included three studies encompassing 1756 eyes from 878 patients. The location of LPI was grouped into superior (604 patients, 889 eyes), inferior (150 patients, 150 eyes), and nasal/temporal (443 patients, 717 eyes). The analysis showed no significant difference in the incidence of any new dysphotopsia types among the location groups post-LPI. Overall, the incidence of lines, ghost images, and blurring significantly increased after LPI, while halos and glare significantly decreased. In conclusion, the current literature suggests that the location of LPI has no significant relationship to the types and rates of dysphotopsia experienced thereafter. While there is a 2-3% risk of linear dysphotopsia after LPI regardless of location, LPI may also resolve pre-existing halos and glare.
Topics: Humans; Glaucoma, Angle-Closure; Laser Therapy; Iridectomy; Iris; Vision Disorders; Visual Acuity; Postoperative Complications; Quality of Life; Intraocular Pressure
PubMed: 38195925
DOI: 10.1038/s41433-023-02913-1 -
Clinical & Experimental Ophthalmology 2024To appraise the quality of clinical practice guidelines for glaucoma suspects, and to assess their consistency for how a 'glaucoma suspect' is defined and their...
BACKGROUND
To appraise the quality of clinical practice guidelines for glaucoma suspects, and to assess their consistency for how a 'glaucoma suspect' is defined and their recommendations for treatment initiation for such individuals.
METHODS
This study included all documents that self-identified as a 'guideline' and provided recommendation(s) for the clinical care of glaucoma suspects. The quality of eligible guidelines was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument.
RESULTS
From 1196 records retrieved from comprehensive searches and two records manually included, 20 clinical practice guidelines were deemed eligible. Based on an appraisal using the AGREE II instrument, 16 (80%) guidelines had ≤2 domains with scores >66%. Overall, the lowest scoring domains were for applicability, editorial independence and stakeholder involvement. There was relatively poor agreement across the guidelines for what defines a 'glaucoma suspect' or 'primary open angle glaucoma [POAG] suspect', as well as the recommendations and criteria for treatment initiation in these populations. There was better agreement for the definition and recommendations for treatment initiation for 'primary angle closure suspects'.
CONCLUSIONS
There is substantial room to improve the methodological quality of most current international clinical guidelines for glaucoma suspects. Clinicians should consider this finding when using such guidelines to inform their care of glaucoma suspects. Substantial variation in the definition of a POAG suspect and recommendations for treatment initiation underscores important gaps in the current evidence for the accurate prediction of glaucoma development and treatment effectiveness in these individuals.
Topics: Humans; Practice Guidelines as Topic; Intraocular Pressure; Ocular Hypertension; Glaucoma, Open-Angle; Antihypertensive Agents
PubMed: 38093486
DOI: 10.1111/ceo.14339 -
Optometry and Vision Science : Official... Sep 2023This study summarized primary angle-closure glaucoma (PACG)-related factors across different dimensions. (Meta-Analysis)
Meta-Analysis
SIGNIFICANCE
This study summarized primary angle-closure glaucoma (PACG)-related factors across different dimensions.
OBJECTIVES
This review aimed at systematically summarizing the associated factors of PACG in published literatures.
METHODS
A systematic review and meta-analysis were conducted by searching the electronic databases including PubMed, EMBASE, and Web of Science from their inception to November 2021. The pooled risk estimates of continuous and categorical variables were calculated using weighted mean difference (WMD) and odds ratio (OR; 95% confidence intervals [CIs]), respectively.
RESULTS
We included 45 studies in this review. In the meta-analysis, intraocular pressure (WMD, 3.13; 95% CI, 2.37 to 3.89), anterior chamber depth (WMD, -0.52; 95% CI, -0.70 to -0.34), axial length (WMD, -0.77; 95% CI, -1.26 to -0.28), retinal nerve fiber layer (WMD, -21.23; 95% CI, -30.21 to -12.25), and spherical equivalent (WMD, 1.02; 95% CI, 0.66 to 1.38) were the most common ophthalmic anatomic factors, and lower body weight (WMD, -3.65; 95% CI, -6.48 to -0.82) was the most significant general morphological indicators. The presence of cataract (OR, 3.77; 95% CI, 3.46 to 4.11) and hyperlipidemia (OR, 1.10; 95% CI, 1.02 to 1.20) were significantly associated with PACG. Increased level of triglyceride (WMD, 0.17; 95% CI, 0.06 to 0.27) was associated with PACG. In addition, an association between short-term antidepressant exposure (OR, 1.36; 95% CI, 1.08 to 1.70) and acute angle-closure glaucoma was observed.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS
This review identified a few consistent factors related to PACG, providing important information for primary care physicians, general ophthalmologists, and public health professionals to counsel their patients on PACG risks.
Topics: Humans; Glaucoma, Angle-Closure; Intraocular Pressure; Tonometry, Ocular; Acute Disease; Risk Factors
PubMed: 37747945
DOI: 10.1097/OPX.0000000000002050 -
Journal of Glaucoma Oct 2023This systematic review has revealed that variable definitions of glaucoma continue to be used in prevalence studies, despite the introduction of the International...
PRCIS
This systematic review has revealed that variable definitions of glaucoma continue to be used in prevalence studies, despite the introduction of the International Society of Geographic and Epidemiologic Ophthalmology (ISGEO) criteria.
PURPOSE
To systematically review diagnostic criteria and examinations performed in glaucoma prevalence studies over time and determine the quality of reporting. Accurate estimates of glaucoma prevalence are crucial to inform resource allocation. However, diagnosis of glaucoma comprises inherently subjective examinations and the cross-sectional nature of prevalence studies precludes monitoring for progression.
METHODS
A systematic review of PubMed, Embase, Web of Science, and Scopus was performed to examine diagnostic protocols used by glaucoma prevalence studies and evaluate uptake of the ISGEO criteria, introduced in 2002 to standardize glaucoma diagnosis in prevalence studies. Detection bias and compliance with the Strengthening Reporting of Observational Studies in Epidemiology (STROBE) guidelines were evaluated.
RESULTS
Ten thousand five hundred forty-four articles were identified. After deduplication, 5589 articles were screened, yielding 136 articles pertaining to 123 studies. An absence of data in many countries was identified. Ninety-two percent of studies stated diagnostic criteria, and 62% used the ISGEO criteria since their publication. Weaknesses of the ISGEO criteria were identified. Temporal variations in the performance of various examinations were observed, including heterogeneity in angle assessment. Mean STROBE compliance was 82% (range 59-100%); 72 articles had a low risk of detection bias, 4 had a high risk, and 60 had some concerns.
CONCLUSION
Heterogeneous diagnostic definitions persist in glaucoma prevalence studies, despite introduction of the ISGEO criteria. Standardization of criteria remains imperative and the development of new criteria represent a valuable opportunity to achieve this goal. In addition, methods of determining diagnoses are poorly reported, suggesting a need for improvement in study conduct and reporting. Accordingly, we propose the Reporting of quality Of GlaUcoma Epidemiological Studies (ROGUES) Checklist. We have also identified a need for further prevalence studies in regions with limited data and to update Australian angle closure glaucoma prevalence. Design and reporting of future studies can be informed by this review's insights into diagnostic protocols previously used.
Topics: Humans; Cross-Sectional Studies; Intraocular Pressure; Australia; Glaucoma; Glaucoma, Angle-Closure; Prevalence
PubMed: 37406297
DOI: 10.1097/IJG.0000000000002248 -
Seminars in Ophthalmology Jan 2024To compare the intraocular pressure (IOP)-lowering effect of different types of surgery available in the literature using a network meta-analysis (NMA) based on a... (Meta-Analysis)
Meta-Analysis Review
Efficacy and Safety of Different Types of Intraocular Pressure-Lowering Surgeries in Patients with Primary Angle Closure (PAC) or PAC Glaucoma: Systematic Review and Network Meta-Analysis of Randomized Clinical Trials.
OBJECTIVE
To compare the intraocular pressure (IOP)-lowering effect of different types of surgery available in the literature using a network meta-analysis (NMA) based on a systematic review.
METHODS
PubMed and the Cochrane database were searched. Randomized clinical trials involving surgical interventions for high IOP for PAC (primary angle closure) or PACG (primary angle closure glaucoma) were included. Descriptive statistics and outcomes were extracted. Bayesian NMA was performed to compare the IOP-lowering effect and the change in the number of antiglaucoma drugs required between baseline and endpoint, as well as success rates.
RESULTS
This NMA included 21 articles with 1237 eyes with PAC or PACG. Interventions were characterised as phacoemulsification (phaco), trabeculectomy, goniosynechialysis (GSL) with viscoelastic or blunt device, goniosurgery (GS) (trabeculotomy or goniotomy), micro-bypass stent (Istent®), endocyclophotocoagulation (ECPL) or various combinations of these procedures. Phaco+GSL [-1.73 (95%CrI: -3.53 to -0.13)] and phaco+GSL+GS [-3.92 (95%CrI: -6.91 to -1.31)] provided better IOP lowering effects than phaco alone. Phaco+trabeculectomy [-3.11 (95%CrI: -5.82 to -0.44)] was inferior to phaco+GSL+GS. Phaco+trabeculectomy [-0.45 (95%CrI: -0.81 to -0.13)] provided a better outcome in terms of reducing the need for antiglaucoma drug compared to phaco alone. There were no differences between the other surgeries in terms of reduction of antiglaucoma drug number and IOP lowering effect. Success rates were similar for all surgical procedures.
CONCLUSIONS
Phaco+GSL+GS showed the most promising results for lowering IOP. Phaco+trabeculectomy resulted in a significant reduction in the number of antiglaucoma drugs compared to phaco alone.
Topics: Humans; Intraocular Pressure; Antiglaucoma Agents; Bayes Theorem; Network Meta-Analysis; Glaucoma, Angle-Closure; Randomized Controlled Trials as Topic; Trabeculectomy; Glaucoma; Phacoemulsification; Treatment Outcome; Retrospective Studies
PubMed: 37296113
DOI: 10.1080/08820538.2023.2223292