Human ; Male ; Female ; INTRAOCULAR PRESSURE ; GLAUCOMA ; OCULAR HYPERTENSION ;

OBJECTIVE: Glaucomatous optic neuropathy (GON), defined as definitive damage to the optic-nerve head (ONH) and retinal-nerve-fiber layer (RNFL), involves structural changes in the ONH and RNFL and functional losses in the central visual field. Due to the unique anatomic distribution of the nerve fibers as they enter the ONH, there are specific changes in the ONH correlated with specific findings in the visual-field characteristic of GON. The evaluation of these changes is discussed. METHODS: There are qualitative and quantitative methods in the structural examination of the ONH and RNFL, and quantitative techniques in the functional assessment of the central visual field. They are correlated to one another their strengths and limitations are discussed. RESULTS: Clinical evaluation of the ONH and RNFL consists of five basic rules: (1) identify the limits of the optic disc and determine its size, (2) identify the s of the neuroretinal rim, (3) examine the RNFL, (4) examine the region for parapapillary atrophy, and (5) look for retinal and optic-disc hemorrhages. These steps are simple to use and comprise a portion of the comprehensive eye evaluation. Without proper documentation of the changes in glaucoma progression may be missed. Computer-based digital-imaging technology exemplified by the HRT II, GDx, OCT, provides fast, reproducible, objective measurements of the ONH and RNFL, allowing for more precise diagnosis and monitoring of glaucoma. These changes have good correlation to functional assessments exemplified by the standard automated perimetry (SAP) and the selective perimetry (FDT, SWAP). Typical glaucomatous visu field defects include nasal step, paracentral scotoma, and arcuate defects which follow the RNFL pattern. Progression of these defects is monitored over time and needs to be differentiated from long-term fluctuation. CONCLUSION: The clinician should perform both structural and functional assessments to diagnose and monitor glaucoma. Both examinations provide complimentary information and each has its own place in the clinical care of glaucoma patients. The newer imaging devices and selective perimetry augment the diagnostic armamentarium of the clinician and should, therefore, be used appropriately.
GLAUCOMA ; OPTIC NERVE ; VISUAL FIELDS ; VISUAL FIELD TESTS ; OPTIC DISK

OBJECTIVE: To determine the demographic and clinical profile of glaucoma patients seen in a Philippine tertiary hospital from 2011 to 2014.

METHOD: Medical records of glaucoma patients managed at the outpatient ophthalmology clinic from October 2010 to August 2014 were reviewed. Diagnosis of glaucoma was based on the International Society of Geographic and Epidemiological Ophthalmology (ISGEO) guidelines. The demographics, clinical profile, functional severity scoring, and initial management of patients were described.

RESULT: Majority of the 570 patients were females (60.17%), with a mean age of 56.23 years. Eighty-five percent claimed to have no family history of glaucoma. The mean best-corrected visual acuity (BCVA) was 0.40, the mean intraocular pressure (IOP) was 23.56 mmHg, and the mean cup-to-disc (CD) ratio was 0.69. There were more primary type of glaucoma (55.48%) than secondary glaucoma. Mixed pattern was the most common type of visual field pattern at initial presentation. Majority of the defects were under GSS 2 stage 2 of mean deviation (MD) and loss variance (LV). Medical treatment was the most common initial management given to glaucoma patients.

CONCLUSION: The primary glaucomas were more common than the secondary glaucomas seen in a private tertiary hospital. Most had moderate visual field damage (mixed type pattern) and the most common initial management given was medical treatment.

KEYWORD: Glaucoma, Epidemiology, Primary open angle glaucoma, Primary angle closure glaucoma, Secondary glaucoma, Normal tension glaucoma, ISGEO guidelines

Human ; Male ; Female ; Middle Aged ; Intraocular Pressure ; Low Tension Glaucoma ; Ophthalmology ; Glaucoma, Angle-closure ; Glaucoma, Primary Open Angle ; Glaucoma, Open-angle ; Tetrahymenina

Objective: This study adapted and translated the Trust in Oncologist Scale (TiOS) into the Tagalog Trust in Ophthalmologist Scale (TTOS) and validated the latter. Methods: The 18-item TiOS questionnaire was translated into Tagalog and validated in a cohort of 200 Filipino ophthalmology patients of a single institution. Internal consistency, construct validity, and test-retest reliabilities were determined. Exploratory factor analyses were also performed. Results: The TTOS showed high internal consistency with Cronbach alpha of 0.92, high reliability with Pearson's coefficient of 0.85, and high validity with Spearman’s coefficient of 0.67. Conclusion The TTOS is a valid and reliable tool to measure the level of trust of Filipino patients in their ophthalmologists.
patient-physician relationship

Objective: This study compared the effectiveness of prophylactic administration of topical ketorolac tromethamine 0.5% and nepafenac 0.1% on maintaining mydriasis during phacomulsification. Methods: This is a prospective, randomized, double-masked comparative study involving adult cataract patients given topical NSAIDs (ketorolac or nepafenac) or balanced salt solution (control) prior to phacoemulsification and capsular bag intraocular-lens (IOL) implantation at a tertiary hospital. Horizontal and vertical diameters of pupil were measured at different stages of cataract surgery and the mean values were compared across the three groups. Results: A total of 47 eyes of 44 cataract surgery patients, 13 males and 34 females, with a mean age of 66.04 ± 8.87 years, were included in the study. The mean horizontal and vertical diameters of the three groups were similar at the start of surgery. Significant differences were seen after IOL implantation, with the nepafenac group having the largest mean diameters in both horizontal (p = 0.012) and vertical (p = 0.012) pupil measurements. Conclusion Topical nepafenac has been shown to be a more effective inhibitor of miosis during phacoemulsification and provides a more stable mydriatic effect throughout the surgical procedure compared to topical ketorolac and placebo.
Cataract ; Phacoemulsification ; Mydriasis ; Ketorolac

Objective: To determine the correlation between average peripapillary retinal nerve fiber layer (RNFL) thickness measured with time domain optical coherence tomography (TD-OCT) in normal and glaucoma eyes. Methods: This was a cross-sectional study of 281 eyes randomly selected from a previous study. Assessment of glaucomatous damage was done by glaucoma specialists who based their diagnosis on the visual field tests and optic disc photos, independent of OCT results. Eyes were classified into the following groups: normal, mild, moderate, or severe glaucoma. Severity of glaucoma was based on visual field abnormalities following a modified HodappAnderson-Parish criteria for staging. Average RNFL thickness of normal and glaucoma subgroups, as measured with STRATUS–OCT, were analyzed using single ANOVA test. Association between average RNFL thickness and severity of glaucomatous visual field loss was evaluated using the Pearson’s correlation coefficient analysis. Results: 183 eyes had no glaucoma; 27 had mild, 32 had moderate, and 39 had severe glaucoma. Mean average peripapillary RNFL thickness (μm) in the normal, mild, moderate, and severe glaucoma groups were 98.05(±13.46), 76.27(±11.79), 76.42(±16.01), and 56.17(±14.92) respectively. Significant differences were seen in the average RNFL thickness among the groups (P<0.05), except in eyes with mild to moderate glaucoma. A moderately strong correlation of -0.57 (P<0.05) was observed between average RNFL thickness and the stage of glaucoma. Conclusion TD-OCT showed moderately strong correlation between the average RNFL thickness and perimetric stages of glaucoma. Average RNFL thickness is a good parameter to discriminate normal from glaucoma eyes.
Tomography, Optical Coherence ; Glaucoma ; Visual Field Tests

Background: and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.