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- Bengtsson, Boel, et al.
(författare)
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Diagnostic sensitivity of fast blue-yellow and standard automated perimetry in early glaucoma: a comparison between different test programs.
- 2006
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Ingår i: Ophthalmology. - : Elsevier BV. - 1549-4713 .- 0161-6420. ; 113:7, s. 1092-1097
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To compare the ability of Fast Swedish interactive threshold algorithm (SITA) short-wavelength automated perimetry (SWAP), lengthier full-threshold SWAP, and standard automated perimetry (SAP) using the SITA Fast program to detect early glaucomatous visual field loss. Design: Cross-sectional prospective study of perimetric diagnostic sensitivity as defined by reference limits determined in the same healthy participants for all 3 test programs. Participants: One hundred one patients with ocular hypertension, or suspect or early manifest glaucoma. Methods: One eye of each patient was tested with 2 blue-yellow perimetric programs: the SITA and full-threshold SWAP and the SAP SITA Fast program. Main Outcome Measures: Glaucomatous visual field loss, defined as number of significantly depressed test point locations or the number of clusters of such test points. Results: No significant difference in number of significantly depressed test point locations between the 3 programs could be detected, neither at the P < 5% limit nor at the P < 2% limit. The difference in number of points depressed below the fifth percentile was 0.5 between full-threshold SWAP and SITA SWAP, 1.09 between full-threshold SWAP and SAP, and 1.04 between SITA SWAP and SAP. The number of eyes showing clusters of significantly depressed points also was similar with the 3 test programs: full-threshold SWAP identified clusters in 66 eyes, SITA SWAP identified clusters in 67 eyes, and SITA Fast SAP identified clusters in 65 eyes. Average test time was 12.0 minutes using full-threshold SWAP, 4.1 minutes with SITA SWAP, and 3.5 with SITA Fast. Conclusions: The SITA SWAP identified at least as much glaucomatous visual field loss as the older full-threshold SWAP, although test time was considerably reduced. Conventional SAP using SITA Fast was not significantly less sensitive than either of the 2 SWAP programs.
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- Bengtsson, Boel, et al.
(författare)
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Disc Hemorrhages and Treatment in the Early Manifest Glaucoma Trial.
- 2008
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Ingår i: Ophthalmology. - : Elsevier BV. - 1549-4713 .- 0161-6420. ; Aug 7, s. 2044-2048
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To evaluate the effect of intraocular pressure (IOP)-reducing treatment on the development of disc hemorrhages in patients with glaucoma. DESIGN: Prospective cohort study of patients in the Early Manifest Glaucoma Trial, followed up to 11 years (median = 8 years). PARTICIPANTS: Patients with newly detected glaucoma randomized to argon laser trabeculoplasty plus betaxolol (n = 129) or no initial treatment (n = 126), followed with tonometry, perimetry, and ophthalmoscopy every 3 months, and fundus photography every 6 months. METHODS: Logistic regression expressed as odds ratios (OR) and 95% confidence intervals (CIs), analysis of variance, and Cox time-dependent models, expressed as hazard ratios (HRs) and CIs. MAIN OUTCOME MEASURES: Presence (yes/no) and frequency of disc hemorrhages. RESULTS: Disc hemorrhages were identified in approximately 55% of all patients, whether by ophthalmoscopy or review of photographs. In analyses including data up to the time of progression, disc hemorrhages were equally common among treated and control patients: 51.2% versus 45.2%, respectively (P = 0.34), based on ophthalmoscopy, and 50.4% versus 44.4%, respectively (P = 0.34), based on photographs. Gender was the only factor related to the presence of disc hemorrhages detected by both ophthalmoscopy (OR = 0.48; CI, 0.26-0.88; P = 0.022) and photographs (OR = 0.64; CI, 0.38-1.09; P = 0.099) for male patients. The frequency of disc hemorrhages over time did not differ between treated and control patients: 8.4% versus 8.5%, respectively (P = 0.93), based on ophthalmoscopy, and 12.4% versus 11.2%, respectively (P = 0.36), based on photographs. Disc hemorrhages were significantly associated with time to progression (HR = 1.02; CI, 1.01-1.04), and there was no evidence of interaction between treatment group and disc hemorrhages. CONCLUSIONS: IOP-reducing treatment was unrelated to the presence or frequency of disc hemorrhages. The results may suggest that disc hemorrhages cannot be considered an indication of insufficient IOP-lowering treatment, and that glaucoma progression in eyes with disc hemorrhages cannot be totally halted by IOP reduction. The results also suggest that disc hemorrhages do not occur in all patients with glaucoma. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
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- Bengtsson, B, et al.
(författare)
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Fluctuation of intraocular pressure and glaucoma progression in the early manifest glaucoma trial.
- 2007
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Ingår i: Ophthalmology. - : Elsevier BV. - 1549-4713 .- 0161-6420. ; 114:2, s. 205-209
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To investigate whether increased fluctuation of intraocular pressure (IOP) is an independent factor for glaucoma progression. Design: A cohort of patients was followed up in a randomized clinical trial. Participants: Two hundred fifty-five glaucoma patients from the Early Manifest Glaucoma Trial (EMGT; 129 treated and 126 control patients). Methods: Study visits, conducted every 3 months, included ophthalmologic examinations, IOP measurements, and standard automated perimetry, with fundus photography every 6 months. Intraocular pressure values were included only until the time of progression in those eyes that showed such progression. Individual mean follow-up IOP and IOP fluctuation, calculated as the standard deviation of IOP at applicable visits, were the variables of main interest. Cox regression with time-dependent variables was used to evaluate the association between IOP fluctuation and time to progression, both with and without IOP mean in the models. These analyses also controlled for other significant variables. Main Outcome Measures: Glaucoma progression, as defined by a predetermined visual field criterion, worsening of the disk, assessed by an independent disc reading center, or both. Results: Median follow-up time was 8 years (range, 0.1-11.1 years). Sixty-eight percent of the patients progressed. When considering mean follow-up IOP and IOP fluctuation in the same time-dependent model, mean IOP was a significant risk factor for progression. The hazard ratio (HR) was 1.11 (95% confidence interval [CI], 1.06-1.17; P < 0.0001). Intraocular pressure fluctuation was not related to progression, with an HR of 1.00 (95% Cl, 0.81-1.24; P = 0.999). Conclusions: These results confirm our earlier finding that elevated IOP is a strong factor for glaucoma progression, with the HR increasing by 11% for every 1 mmHg of higher IOP. Intraocular pressure fluctuation was not an independent factor in our analyses, a finding that conflicts with some earlier reports. One explanation for the discrepancy is that our analyses did not include postprogression IOP values, which would be biased toward larger fluctuations because of more intensive treatment. In contrast, in this EMGT report, no changes in patient management occurred during the period analyzed.
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