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- Agardh, Elisabet, et al.
(author)
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Stable refraction and visual acuity in diabetic patients with variable glucose levels under routine care
- 2011
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In: Acta Ophthalmologica. - : Wiley-Blackwell. - 1755-375X .- 1755-3768. ; 89:2, s. 107-110
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Journal article (peer-reviewed)abstract
- PURPOSE: To investigate how refraction and visual acuity may vary in patients with diabetes under routine care.METHODS: Fifty-three eyes of 53 patients with various degrees of diabetic retinopathy were examined prospectively on four different occasions within a month. Refraction, best-corrected visual acuity (expressed as logMAR score) and blood glucose were measured on each occasion. Intraindividual variability was calculated as the range between the highest and lowest measurements. Associations between blood glucose levels and each of the other variables were tested by linear regression analysis for each patient.RESULTS: Refraction was completely stable in 43 patients and changed only slightly in 10, in whom the mean intraindividual variability of the spherical equivalent was 0.4 dioptres. Visual acuity test results were also highly reproducible. Mean intraindividual variability in visual acuity was 0.08 logMAR. Mean haemoglobin A1c (HbA1c) was 7.3 ± 1.5% but individual blood glucose levels ranged from 2.8 to > 22.2 mmol/l. Intraindividual variability ranged from 0.5 to 18.1 mmol/l, with a median of 6.0 mmol/l for the entire group. There were no associations between refraction or visual acuity and blood glucose levels or inter- or intraindividual glucose variations.CONCLUSION: Refraction and visual acuity test results were highly reproducible and stable in patients with reasonably well controlled diabetes but variable blood glucose levels under routine care.
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- Agardh, Elisabet, et al.
(author)
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Visual acuity and perimetry as measures of visual function in diabetic macular oedema
- 2006
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In: Diabetologia. - : Springer Science and Business Media LLC. - 1432-0428 .- 0012-186X. ; 49:1, s. 200-206
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Journal article (peer-reviewed)abstract
- AIMS/HYPOTHESIS: We examined to what extent visual acuity and perimetric sensitivity as measures of central and paracentral visual function would be useful for evaluating the presence and severity of diabetic macular oedema.MATERIALS AND METHODS: We evaluated 59 eyes of 59 diabetic patients by identifying the presence (n=20) or absence (n=39) of macular oedema on stereo fundus photographs. The area of oedema and its distance to the centre of the macula were measured. Ischaemic macular damage was quantified by measuring the foveal avascular zone and adjacent perifoveolar intercapillary areas on fluorescein angiograms. Visual function was assessed by visual acuity charts and by short-wavelength perimetry and standard white-on-white perimetry of the central 10 degrees field.RESULTS: Visual acuity did not differ between eyes with and without macular oedema. In eyes with oedema, visual acuity was correlated to the distance of the oedema from the centre of the macula (log of minimum angle of resolution {LogMar} score decreased by 0.15/mm; p=0.006) and to the thickness of the retina when the centre was affected (LogMar score decreased by 0.003/mum of thickness; p=0.0002). Multivariate analyses confirmed the results (R (2)=0.46 and 0.77, respectively). Short-wavelength perimetry sensitivity was more depressed in eyes with oedema (p=0.033) but was not significantly associated with the presence of oedema after correction for macular ischaemic damage. There was no correlation between these field defects and the severity of oedema.CONCLUSIONS/INTERPRETATION: Visual acuity was a useful measure of visual function in diabetic macular oedema involving the centre. Visual field defects were more common in eyes with macular oedema but reflected ischaemic damage of the macula rather than macular oedema itself.
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- Andersson, Sabina, et al.
(author)
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Comparison of clinicians and an artificial neural network regarding accuracy and certainty in performance of visual field assessment for the diagnosis of glaucoma.
- 2013
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In: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 91:5, s. 413-417
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Journal article (peer-reviewed)abstract
- Purpose: To compare clinicians and a trained artificial neural network (ANN) regarding accuracy and certainty of assessment of visual fields for the diagnosis of glaucoma. Methods: Thirty physicians with different levels of knowledge and experience in glaucoma management assessed 30-2 SITA Standard visual field printouts that included full Statpac information from 99 patients with glaucomatous optic neuropathy and 66 healthy subjects. Glaucomatous eyes with perimetric mean deviation values worsethan -10 dB were not eligible. The fields were graded on a scale of 1-10, where 1 indicated healthy with absolute certaintyand 10 signified glaucoma; 5.5 was the cut-off between healthy and glaucoma. The same fields were classified by a previously trained ANN. The ANN output was transformed into a linear scale that matched the scale used in the subjective assessments. Classification certainty was assessed using a classification error score. Results: Among the physicians, sensitivity ranged from 61% to 96% (mean 83%) and specificity from 59% to 100% (mean 90%). Our ANN achieved 93% sensitivity and 91% specificity, and it was significantly more sensitive than the physicians (p < 0.001) at a similar level of specificity. The ANN classification error score was equivalent to the top third scores of all physicians, and the ANN never indicated a high degree of certainty for any of its misclassified visual field tests. Conclusion: Our results indicate that a trained ANN performs at least as well as physicians in assessments of visual fields for the diagnosis of glaucoma.
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- Andersson, Sabina, et al.
(author)
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Optic disc classification by the Heidelberg Retina Tomograph and by physicians with varying experience of glaucoma.
- 2011
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In: Eye (London, England). - : Springer Science and Business Media LLC. - 1476-5454 .- 0950-222X. ; 25, s. 1401-1407
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Journal article (peer-reviewed)abstract
- PurposeTo compare the diagnostic accuracy of the Heidelberg Retina Tomograph's (HRT) Moorfields regression analysis (MRA) and glaucoma probability score (GPS) with that of subjective grading of optic disc photographs performed by ophthalmologists with varying experience of glaucoma and by ophthalmology residents.MethodsDigitized disc photographs and HRT images from 97 glaucoma patients with visual field defects and 138 healthy individuals were classified as either within normal limits (WNL), borderline (BL), or outside normal limits (ONL). Sensitivity and specificity were compared for MRA, GPS, and the physicians. Analyses were also made according to disc size and for advanced visual field loss.ResultsForty-five physicians participated. When BL results were regarded as normal, sensitivity was significantly higher (P<5%) for both MRA and GPS compared with the average physician, 87%, 79%, and 62%, respectively. Specificity ranged from 86% for MRA to 97% for general ophthalmologists, but the differences were not significant. In eyes with small discs, sensitivity was 75% for MRA, 60% for the average doctor, and 25% for GPS; in eyes with large discs, sensitivity was 100% for both GPS and MRA, but only 68% for physicians.ConclusionOur results suggest that sensitivity of MRA is superior to that of the average physician, but not that of glaucoma experts. MRA correctly classified all eyes with advanced glaucoma and showed the best sensitivity in eyes with small optic discs.
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- Andersson, Sabina, et al.
(author)
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The Effect of Education on the Assessment of Optic Nerve Head Photographs for the Glaucoma Diagnosis
- 2011
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In: BMC Ophthalmology. - : Springer Science and Business Media LLC. - 1471-2415. ; 11
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Journal article (peer-reviewed)abstract
- Background: To evaluate the effect of one lesson of continuing medical education (CME) of subjective assessment of optic nerve head appearance on sensitivity and specificity for the diagnosis of glaucoma. Methods: Ophthalmologists and residents in ophthalmology attending an international glaucoma meeting arranged at Malmo University Hospital, Malmo, Sweden, were asked to grade optic nerve head (ONH) photographs of healthy and glaucomatous subjects at two sessions separated by a lecture on glaucoma diagnosis by ONH assessment. Each grader had access to an individual portfolio of 50 ONH photographs randomly selected from a web-based data bank including ONH photographs of 73 glaucoma patients and 123 healthy subjects. The individual portfolio of photographs was graded before and after the lecture, but in different randomized order. Results: Ninety-six doctors, 91% of all attending the meeting, completed both assessment sessions. The number of correct classifications increased from 69 to 72% on the average. Diagnostic sensitivity increased significantly (p < 0.0001) from 70% to 80%, and the number of photographs classified as uncertain decreased significantly (p < 0.0001) from 22% to 13%. Specificity remained at 68%, and intra-grader agreement decreased. Conclusion: CME had only a small effect on the assessment of ONH for the glaucoma diagnosis. Sensitivity increased and the amount of uncertain classifications decreased, while specificity was unchanged.
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- Aspberg, Johan, et al.
(author)
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Estimating the Length of the Preclinical Detectable Phase for Open-Angle Glaucoma
- 2023
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In: JAMA Ophthalmology. - : American Medical Association (AMA). - 0003-9950 .- 2168-6165. ; 141:1, s. 48-54
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Journal article (peer-reviewed)abstract
- IMPORTANCE: A 50% reduction of glaucoma-related blindness has previously been demonstrated in a population that was screened for open-angle glaucoma. Ongoing screening trials of high-risk populations and forthcoming low-cost screening methods suggest that such screening may become more common in the future. One would then need to estimate a key component of the natural history of chronic disease, the mean preclinical detectable phase (PCDP). Knowledge of the PCDP is essential for the planning and early evaluation of screening programs and has been estimated for several types of cancer that are screened for.OBJECTIVE: To estimate the mean PCDP for open-angle glaucoma.DESIGN, SETTING, AND PARTICIPANTS: A large population-based screening for open-angle glaucoma was conducted from October 1992 to January 1997 in Malmö, Sweden, including 32 918 participants aged 57 to 77 years. A retrospective medical record review was conducted to assess the prevalence of newly detected cases at the screening, incidence of new cases after the screening, and the expected clinical incidence, ie, the number of new glaucoma cases expected to be detected without a screening. The latter was derived from incident cases in the screened age cohorts before the screening started and from older cohorts not invited to the screening. A total of 2029 patients were included in the current study. Data were analyzed from March 2020 to October 2021.MAIN OUTCOMES AND MEASURES: The length of the mean PCDP was calculated by 2 different methods: first, by dividing the prevalence of screen-detected glaucoma with the clinical incidence, assuming that the screening sensitivity was 100% and second, by using a Markov chain Monte Carlo (MCMC) model simulation that simultaneously derived both the length of the mean PCDP and the sensitivity of the screening.RESULTS: Of 2029 included patients, 1352 (66.6%) were female. Of 1420 screened patients, the mean age at screening was 67.4 years (95% CI, 67.2-67.7). The mean length of the PCDP of the whole study population was 10.7 years (95% CI, 8.7-13.0) by the prevalence/incidence method and 10.1 years (95% credible interval, 8.9-11.2) by the MCMC method.CONCLUSIONS AND RELEVANCE: The mean PCDP was similar for both methods of analysis, approximately 10 years. A mean PCDP of 10 years found in the current study allows for screening with reasonably long intervals, eg, 5 years.
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| 10. |
- Aspberg, Johan, et al.
(author)
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Intraocular Pressure Lowering Effect of Latanoprost as First-line Treatment for Glaucoma
- 2018
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In: Journal of glaucoma. - : Lippincott Williams & Wilkins. - 1057-0829 .- 1536-481X. ; 27:11, s. 976-980
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Journal article (peer-reviewed)abstract
- PURPOSE: The purpose of this study was to assess the intraocular pressure (IOP) - reducing effect of latanoprost in treatment-naïve patients with newly detected open-angle glaucoma with no restriction of the level of untreated IOP.METHODS: Eighty-six patients (105 eyes) with a diagnosis of open-angle glaucoma received IOP-lowering therapy with latanoprost. The IOP reduction 1 and 3 months after initiation of treatment was recorded.RESULTS: Mean untreated IOP for all eyes was 26.2 mm Hg (ranging from 10 to 51 mm Hg). The mean pressure reduction was 7.9 mm Hg (28%), with equivalent average levels at 1 and 3 months. The reduction in IOP ranged from -2.3 to 25.3 mm Hg after 1 month, and from -1.3 to 33.3 mm Hg after 3 months. The pressure-lowering effect was considerably more pronounced in eyes with higher untreated IOP; the reduction increased by 0.55 mm Hg per mm Hg higher untreated IOP. Four eyes, with untreated IOP within statistically normal limits, had no or negative IOP-reduction. A regression model predicted that IOP reduction ended at untreated IOP≤16 mm Hg. Multiple regression analysis showed that an additional IOP-lowering effect of 1.28 mm Hg was achieved in eyes with pseudoexfoliation glaucoma.CONCLUSIONS: To the best of our knowledge, this paper is the first to report the IOP-reducing effect of latanoprost treatment at all untreated IOP levels in newly detected glaucoma patients. The effect was proportional to the untreated IOP at all levels above 16 mm Hg and better at higher untreated IOP levels, also in relative terms. Our results further confirm the indication of latanoprost as a first-line therapy for glaucoma.
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