scholarly journals Effectiveness of simple interventions to remind eye doctors to educate glaucoma patients about the dangers of driving

2021 ◽  
Vol 16 (2) ◽  
pp. 45-49
Author(s):  
Adeline Low ◽  
Sujaya Singh ◽  
Ee Ling Ang ◽  
Azida Juana Kadir ◽  
Amir Samsudin
Keyword(s):  
Visual Field ◽  
Clinical Audit ◽  
Humphrey Visual Field

Purpose: A clinical audit to establish whether eye doctors achieve the benchmark in reminding glaucoma patients about the dangers of driving. After introducing two simple interventions, a follow-up audit was performed. Methodology: Initially, we interviewed 85 patients with established glaucoma who underwent Humphrey visual field (HVF) testing and also reviewed their medical notes. We looked for documentation of their driving status, specifically whether those with bilateral visual field (VF) defects recalled being given advice about the dangers of driving and whether this was documented in the notes. After this initial audit, doctors were educated on the availability of guidelines on visual requirements for driving, and reminder adhesive labels were put on the front of medical notes of driving glaucoma patients. A follow-up audit was then performed on 95 different patients. Results: In the initial audit, none of the patients had their driving status recorded. Only 36% of drivers with bilateral VF defects recalled being advised of the dangers of driving, with no documentation of whether the advice was given to them. Following the interventions, documentation of driving status became 86%. All drivers with bilateral VF defects recalled being advised regarding the dangers of driving, with documentation of the advice being given recorded in 73% of the medical notes. Conclusion: Eye doctors are inadequately identifying, advising, and documenting the dangers of driving in the medical notes of glaucoma patients with bilateral VF defects. This can be improved with simple interventions, such as the education of doctors and creating reminder labels, for the benefit of our glaucoma patients.

Relationship between mean follow-up intraocular pressure, rates of visual field progression and current target intraocular pressure guidelines

2020 ◽  
pp. bjophthalmol-2020-317406
Author(s):  
Bruna Melchior ◽  
Carlos Gustavo De Moraes ◽  
Jayter S Paula ◽  
George A Cioffi ◽  
Christopher A Girkin ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Visual Field ◽  
Treatment Guidelines ◽  
Evaluation Study ◽  
Mean Deviation ◽  
Racial Groups ◽  
Current Guideline ◽  
Registration Number ◽  
The Mean

AimsTo investigate if eyes presenting intraocular pressure (IOP) within the limits of current guideline-driven target IOP indeed experience slow rates of glaucomatous visual field (VF) progression.MethodsA total of 8598 24-2 VF tests from 603 eyes from the African Descent and Glaucoma Evaluation Study with manifest glaucoma were included. The sample was split into three groups based on baseline VF mean deviation (MD): G1 (better than −5.0 dB), G2 (−5.0 to −10 dB) and G3 (worse than −10 dB). We investigated the relationship between existing target IOP guidelines and rates of MD progression in these groups.ResultsFor stable eyes, the medians and IQR of the mean follow-up IOP were G1=15.0 mmHg (IQR: 13.1 to 17.7), G2=13.2 mmHg (IQR: 11.6 to 14.3) and G3=11.9 mmHg (IQR: 10.1 to 13.8) (p<0.01). When considering the mean follow-up IOP within the limits proposed by current guidelines, the median MD slopes were: −0.20 dB/y (IQR: −0.43 to −0.02) for G1<21 mmHg, −0.19 dB/y (IQR: −0.51 to −0.01) for G2<18 mmHg and −0.15 dB/y (IQR: −0.47 to 0.05) for G3<15 mmHg (p=0.63). There were no significant differences between racial groups.ConclusionIn a sample of patients with manifest glaucoma, despite substantial variability between eyes, adherence to treatment guidelines helped slow the rates of global VF progression at various stages of disease.Trial registration numberclinicaltrials.gov Identifier: NCT00221923.

Long-term visual outcome after microsurgical removal of occipital lobe cavernomas

2012 ◽  
Vol 117 (2) ◽  
pp. 295-301 ◽  
Author(s):  
Juri Kivelev ◽  
Elina Koskela ◽  
Kirsi Setälä ◽  
Mika Niemelä ◽  
Juha Hernesniemi
Keyword(s):  
Visual Field ◽  
Visual Fields ◽  
Visual Field Loss ◽  
Occipital Lobe ◽  
Visual Outcome ◽  
Surgical Removal ◽  
Long Term Outcome ◽  
Visual Field Deficit

Object Cavernomas in the occipital lobe are relatively rare. Because of the proximity to the visual cortex and incoming subcortical tracts, microsurgical removal of occipital cavernomas may be associated with a risk of visual field defects. The goal of the study was to analyze long-term outcome after operative treatment of occipital cavernomas with special emphasis on visual outcome. Methods Of the 390 consecutive patients with cavernomas who were treated at Helsinki University Central Hospital between 1980 and 2011, 19 (5%) had occipital cavernomas. Sixteen patients (4%) were surgically treated and are included in this study. The median age was 39 years (range 3–59 years). Seven patients (56%) suffered from hemorrhage preoperatively, 5 (31%) presented with visual field deficits, 11 (69%) suffered from seizures, and 4 (25%) had multiple cavernomas. Surgery was indicated for progressive neurological deterioration. The median follow-up after surgery was 5.25 years (range 0.5–14 years). Results All patients underwent thorough neuroophthalmological assessment to determine visual outcome after surgery. Visual fields were classified as normal, mild homonymous visual field loss (not disturbing the patient, driving allowed), moderate homonymous visual field loss (disturbing the patient, driving prohibited), and severe visual field loss (total homonymous hemianopia or total homonymous quadrantanopia). At the last follow-up, 4 patients (25%) had normal visual fields, 6 (38%) had a mild visual field deficit, 1 (6%) complained of moderate visual field impairment, and 5 (31%) had severe homonymous visual field loss. Cavernomas seated deeper than 2 cm from the pial surface carried a 4.4-fold risk of postoperative visual field deficit relative to superficial ones (p = 0.034). Six (55%) of the 11 patients presenting with seizures were seizure-free postoperatively. Eleven (69%) of 16 patients had no disability during the long-term follow-up. Conclusions Surgical removal of occipital cavernomas may carry a significant risk of postoperative visual field deficit, and the risk is even higher for deeper lesions. Seizure outcome after removal of these cavernomas appeared to be worse than that after removal in other supratentorial locations. This should be taken into account during preoperative planning.

scholarly journals Arteriovenous Passage Times and Visual Field Progression in Normal Tension Glaucoma

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Eva Charlotte Koch ◽  
Kay Oliver Arend ◽  
Marion Bienert ◽  
Andreas Remky ◽  
Niklas Plange
Keyword(s):  
Visual Field ◽  
Field Tests ◽  
Normal Tension Glaucoma ◽  
Retinal Blood Flow ◽  
Visual Field Progression ◽  
Confocal Scanning Laser Ophthalmoscope ◽  
Confocal Scanning ◽  
Confocal Scanning Laser ◽  
Passage Times

Purpose. Fluorescein angiographic studies revealed prolonged arteriovenous passage (AVP) times and increased fluorescein filling defects in normal tension glaucoma (NTG) compared to healthy controls. The purpose of this study was to correlate baseline AVP and fluorescein filling defects with visual field progression in patients with NTG.Patients and Methods. Patients with a follow-up period of at least 3 years and at least 4 visual field examinations were included in this retrospective study. Fluorescein angiography was performed at baseline using a confocal scanning laser ophthalmoscope (SLO, Rodenstock Instr.); fluorescein filling defects and AVP were measured by digital image analysis and dye dilution curves (25 Hz). Visual field progression was evaluated using regression analysis of the MD (Humphrey-Zeiss, SITA-24-2, MD progression per year (dB/year)). 72 patients with NTG were included, 44 patients in study 1 (fluorescein filling defects) and 28 patients in study 2 (AVP).Results. In study 1 (mean follow-up years, visual field tests), MD progression per year ( dB/year) was significantly correlated to the age (, ) but not to fluorescein filling defects, IOP, or MD at baseline. In study 2 (mean follow-up years, visual field tests), MD progression per year ( dB/year) was significantly correlated to AVP (, ) but not to age, IOP, or MD at baseline.Conclusion. Longer AVP times at baseline are correlated to visual field progression in NTG. Impaired retinal blood flow seems to be an important factor for glaucoma progression.

scholarly journals Radiofrequency Denervation of the Lumbar Zygapophysial Joints: 10-Year Prospective Clinical Audit

2007 ◽  
Vol 2;10 (3;2) ◽  
pp. 291-299
Author(s):  
Michael Gofeld
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Patient Selection ◽  
Clinical Audit ◽  
Low Back ◽  
Zygapophysial Joint ◽  
Radiofrequency Neurotomy ◽  
Radiofrequency Denervation

Background: Evidence for the efficacy of zygapophysial joint nerve radiofrequency neurotomy has remained controversial. Two randomized controlled trials showed positive results, but two others demonstrated no benefit. One carefully performed prospective trial confirmed high efficacy and lasting pain relief after the procedure; however, selection criteria for this study were superfluous, which resulted in a small number of patients available for follow up. Objectives: A large clinical audit with routine patient selection and use of appropriate technique was undertaken to determine the effect of radiofrequency neurotomy of the lumbar facet joints for relief of chronic low back pain. Design: Prospective clinical audit for quality was conducted in the pain clinic affiliated with a tertiary care teaching hospital. Setting: An interventional pain management setting in Canada. Methods: All patients with low back pain of more than 6 months’ duration, with or without non-radicular radiation to the buttock, hip, and leg were included. From January 1991 to December 2000, eligible patients underwent standardized diagnostic work-up, which included a self-reported pain questionnaire, physical examination, review of imaging studies, and diagnostic blockades. Those with an appropriate response to comparative double diagnostic blocks underwent standardized radiofrequency denervation of the lumbar zygapophysial joints. Patients were asked to estimate total perceived pain reduction (on a scale from 0% to 100%) at 6 weeks and at 6, 12, and 24 months after the procedure. Results: Of the 209 patients, 174 completed the study, and 35 were lost to follow-up or did not provide complete data for assessment. Of the 174 patients with complete data, 55 (31.6%) experienced no benefit from the procedure. One hundred and nineteen patients (68.4%) had good (> 50%) to excellent (> 80%) pain relief lasting from 6 to 24 months. Conclusion: This large, prospective clinical audit indicates that proper patient selection and anatomically correct radiofrequency denervation of the lumbar zygapophysial joints provide long-term pain relief in a routine clinical setting. Key words: low back pain, lumbar zygapophysial joint, radiofrequency denervation, clinical audit

scholarly journals Outcome in surgically treated Rathke's cleft cysts: long-term monitoring needed

2011 ◽  
Vol 165 (1) ◽  
pp. 33-37 ◽  
Author(s):  
R Trifanescu ◽  
V Stavrinides ◽  
P Plaha ◽  
S Cudlip ◽  
J V Byrne ◽  
...  
Keyword(s):  
Visual Field ◽  
Visual Field Defects ◽  
Rathke's Cleft Cysts ◽  
Long Term Monitoring ◽  
Rathke's Cleft ◽  
Term Monitoring ◽  
Field Defects ◽  
Tsh Deficiency

ObjectiveTo clarify the outcome of all cases of Rathke's cleft cysts (RCC) treated surgically and followed up in Oxford during a long-term period.Subjects and methodsThe records of all patients with RCC seen in the Department of Endocrinology between January 1978 and June 2009 were reviewed.ResultsA total of 33 patients (20 females, median age 43 years) were identified. At presentation, major visual field defects were detected in 58% of patients and gonadotrophin, ACTH and TSH deficiency in 60, 36 and 36% of patients respectively. Desmopressin treatment was required in 18% of patients. Treatment consisted of cyst evacuation combined with or without biopsy/removal of the wall. Post-operatively, visual fields improved in 83% of patients with impairment, whereas there was no reversal of ACTH or TSH deficiency or of diabetes insipidus. All but one subject had imaging follow-up during a mean period of 48 months (range 2–267). Cyst relapse was detected in 22% of patients at a mean interval of 29 months (range 3–48 months); in 57% of them, the recurrence was symptomatic. Relapse-free rates were 88% at 24-months and 52% at 48-months follow-up. At last assessment, at least quadrantanopia was reported in 19% of patients, gonadotrophin, ACTH and TSH deficiency in 50, 42 and 47% of patients respectively. Desmopressin treatment was required in 39% of patients.ConclusionsIn this study of patients with RCC and long-term follow-up, we showed a considerable relapse rate necessitating long-term monitoring. Surgical intervention is of major importance for the restoration of visual field defects, but it does not improve endocrine morbidity, which in the long-term affects a substantial number of patients.

Twenty-year outcomes in patients with newly diagnosed glaucoma: mortality and visual function

2018 ◽  
Vol 102 (12) ◽  
pp. 1663-1666
Author(s):  
Christopher King ◽  
Justin C Sherwin ◽  
Gokulan Ratnarajan ◽  
John F Salmon
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Open Angle Glaucoma ◽  
Survival Curve ◽  
Visual Outcome ◽  
Field Analysis ◽  
Time To Death ◽  
Kaplan Meier ◽  
Two Stages

Background/aimsTo determine the mortality within 20 years of diagnosis of chronic open-angle glaucoma (COAG) and visual acuity and visual field progression of a cohort followed for 20 years.MethodsTwenty years following the diagnosis of COAG in 68 of 436 (16%) patients seen in a glaucoma case-finding clinic, visual and mortality outcomes were audited from medical records. Causes of death were obtained from general practitioner records and death certificates. Probability of death was calculated using a Kaplan-Meier survival curve. The visual field of each eye of survivors was graded using a nine-stage severity scale. Visual outcome was analysed at the 20-year follow-up visit.ResultsFrom 68, 14 (21%) were lost to follow-up. In the remaining 54, 20 (37%) were alive 20 years after diagnosis. Of 63% who died, mean age of death was 84 years, most commonly due to vascular disease. Mean age at presentation of those who died was 73.7 years versus 63.2 years for survivors (P=0.001). The median time to death was 16 years. On visual field analysis, nearly half (48.9%) of eyes did not deteriorate, but 28.3% eyes deteriorated by more than two stages. Those who died had worse final visual acuity than survivors (P<0.001). Three who died were registered severely visually impaired mainly from macular disease, but no survivors were registered (P<0.001).ConclusionIn this cohort, approximately two-thirds of patients with glaucoma died within 20 years of diagnosis. In most older patients with glaucoma, the overall goal of preventing visual handicap and blindness is achievable 20 years after diagnosis.

Validating the usefulness of sectorwise regression of visual field in the central 10°

2021 ◽  
pp. bjophthalmol-2020-317391
Author(s):  
Takashi Omoto ◽  
Hiroshi Murata ◽  
Yuri Fujino ◽  
Masato Matsuura ◽  
Takehiro Yamashita ◽  
...  
Keyword(s):  
Visual Field ◽  
Mean Absolute Error ◽  
Open Angle Glaucoma ◽  
Absolute Error ◽  
Open Angle ◽  
Clustering Method ◽  
Significant Difference ◽  
The Mean ◽  
Test Points

AimTo evaluate the usefulness of the application of the clustering method to the trend analysis (sectorwise regression) in comparison with the pointwise linear regression (PLR).MethodsThis study included 153 eyes of 101 patients with open-angle glaucoma. With PLR, the total deviation (TD) values of the 10th visual field (VF) were predicted using the shorter VF sequences (from first 3 to 9) by extrapolating TD values against time in a pointwise manner. Then, 68 test points were stratified into 29 sectors. In each sector, the mean of TD values was calculated and allocated to all test points belonging to the sector. Subsequently, the TD values of the 10th VF were predicted by extrapolating the allocated TD value against time in a pointwise manner. Similar analyses were conducted to predict the 11th–16th VFs using the first 10 VFs.ResultsWhen predicting the 10th VF using the shorter sequences, the mean absolute error (MAE) values were significantly smaller in the sectorwise regression than in PLR. When predicting from the 11th and 16th VFs using the first 10 VFs, the MAE values were significantly larger in the sectorwise regression than in PLR when predicting the 11th VF; however, no significant difference was observed with other VF predictions.ConclusionAccurate prediction was achieved using the sectorwise regression, in particular when a small number of VFs were used in the prediction. The accuracy of the sectorwise regression was not hampered in longer follow-up compared with PLR.

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