Introduction: To determine the structure-function correlations of glaucoma in Filipinos using the average peripapillary retinal nerve fiber layer (RNFL) thickness and rim area (RA) of the spectral-domain optical coherence tomography (SD-OCT) and mean defect (MD), pattern standard deviation (PSD), and visual field (VF) clusters of standard automated perimetry (SAP) Methods: Consecutive tests consisting of SD-OCT, SAP, and disc photos were reviewed and selected based on abnormalities in VFs or OCTs or both. Each set of tests was classified as to VF defect type and severity. Mean threshold of VF clusters, MD, and PSD were correlated with average and sectoral RNFL thicknesses and RA. Results: One hundred eighty-six (168) eyes of 121 patients with mean age of 60.2 ± 14.7 years had an average MD, PSD, RNFL thickness, RA of -9.5 ± 8.5 dB, 5.4 ± 3.3 dB, 75.9 ± 15.9 μm, and 0.9 ± 0.4 mm2, respectively. Among VF tests, 23.1% were normal, 16.5% had early, 9.1% moderate, 12.4% advanced, and 8.3% severe glaucoma damage. Most common VF defect types were central islands, combined, and paracentral (16.5%, 14.4%, and 12.2%, respectively). The most commonly affected RNFL segments were inferior, followed by superior, and combined superior and inferior (51.2%, 47.1, and 34%, respectively). Among the OCT parameters, RNFL thickness and RA were strongly correlated (p<0.0001). Between the VF and OCT parameters, the strongest correlation was between the clusters of superior VF defects and the 6-8 o’clock RNFL thinning, followed by the inferior VF defects and the 12-1 o’clock RNFL thinning. Inferior RNFL thinning was strongly correlated with MD and PSD. Conclusion Among Filipino glaucomatous eyes monitored with SD-OCT and SAP, correlation was strongest between the superior VF defects and the infero-temporal RNFL thinning.
Visual Fields ; Tomography, Optical Coherence ; Glaucoma

Background: Andragogy, the theory of adult learning is relevant to medical education especially in the clinical internship learning context. It focuses on the students, faculty, and patients interacting together while developing competencies as future practitioners. Medical interns are active adult learners, enhancing their development of knowledge, skills, and positive attitudes, and pursuing professionalism as they participate in case-based discussions (CBD). Objectives: The study sought to identify the basic principles of andragogy while medical interns participate in case-based discussions including the end-of-course satisfaction. It also determined the selected demographic factors associated with the andragogic principles. Methodology: Respondents included 80 interns by convenience sampling who rotated at the Department of Ophthalmology and Visual Sciences in a tertiary referral hospital. The study used a combination of descriptive quantitative and qualitative research design. A valid instrument using the Adult Learning Principles Design Elements Questionnaire (ALPDEQ) was used to measure the medical intern's andragogic orientation as well as end-of-course satisfaction. A direct, non-participant observation of case-based discussions conducted at the department was done by the researcher and research associate. Results and Conclusion The occurrence of andragogic principles specifically motivation, experience, need to know, readiness, and self-directedness was observed during the conduct of case-based discussion. There was no association between principles of andragogy and demographic factors such as age, gender, civil status, medical school, preparatory medical course, and place of origin. CBD is an effective learning strategy, which provides medical interns adequate venues to be self-directed and apply the principles of andragogy in a workplace-based setting.
Internship and Residency

Confidence Intervals ; Probability ; Population

Instilling glaucoma eye drops has been the mainstay in glaucoma management for many years, be it as initial treatment or as adjunct to laser or filtering surgeries. There are different classes of glaucoma eye drops, with different mechanisms of action to lower the intraocular pressure (IOP), either by improving the outflow facility or by suppressing the aqueous production, singly or as combination therapy. Many of these eye drops can lower the IOP by as much as 35% when given either once or twice a day. Successful treatment outcomes for chronic diseases such as glaucoma, however, require daily use of glaucoma eye drops to minimize disease progression.

Objective: This study compared the rates of aqueous-humor flow and trabecular outflow in eyes that had undergone YAG laser iridotomy (LI) for primary-acute-angleclosure (PAC) attack and primary-angle-closure suspect (PACS). Methods: Patients who had PAC attack in one eye and narrow occludable angles (PACS) in the other eye that had undergone YAG LI were recruited. All underwent complete ophthalmologic examination including gonioscopy, ultrasonic pachymetry, A scan, and fluorophotometry to determine the rate of aqueous-humor flow. The Goldmann equation was used to compute the outflow facility using the values of aqueous flow and intraocular pressure (IOP). Results: Fifty eyes of 25 patients were included, 25 of which had PAC attack and 25 were PACS. The central corneal thickness (CCT), anterior-chamber depth, and anterior-chamber volume of the 2 groups were comparable. PAC-attack eyes had significantly higher IOP (18.4 mm Hg) than the PACS (14.12 mm Hg) (p = 0.001). The mean rate of aqueous flow was 2.50 ± 0.94 µL/min and 2.89 ± 1.17 µL/min in the PAC and PACS respectively (p = 0.20). The mean aqueous-outflow facility was 0.29 ± 0.18 µL/min and 0.59 ± 0.37 µL/min respectively (p = 0.0008). Conclusion A significantly lower aqueous-outflow facility was demonstrated by fluorophotometry among eyes with PAC. Despite the anatomically open angles, they continued to have higher IOPs.
Fluorophotometry ; Intraocular Pressure

Objective: This study assessed the relationship of two structural tests, optic-disc photography and optical coherence tomography (OCT), and a functional test, standard achromatic perimetry (SAP), in the diagnosis of glaucoma. Methods: A retrospective review of charts from the database of a private glaucoma specialist and the glaucoma clinic of a tertiary hospital was done. The participants were longitudinally evaluated and had comprehensive eye examination, imaging, and functional testing. Optic-disc photographs, OCTs, and SAPs were interpreted and evaluated separately, and then correlated with each other by two glaucoma experts working individually. Sensitivities, specificities, and predictive values were obtained for each diagnostic test and in combination. Kappa statistics were used for interobserver agreement. Results: Three hundred sixty-seven eyes of 188 patients were included in the study. Fifty-eight patients were diagnosed as normal, 130 had glaucoma. OCT had the highest sensitivity and specificity at 70.7% and 76.6%, followed by SAP at 72.4% and 53.5% respectively. Optic-disc photos had the lowest sensitivity and specificity at 55.8% and 54.4% respectively, and the lowest interobserver agreement (kappa = 0.50-0.61). The predictive values of the 3 tests increased to 82% with good interobserver agreement (kappa = 0.68-0.78) when correlated with each other. Conclusion The correlation of structural and functional tests increased the accuracy of diagnosing glaucoma. These examinations offered complementary information and, when used in conjunction with comprehensive clinical evaluation, guided the clinician in the proper management of patients with glaucoma.
Glaucoma Optic Disk Tomography ; Optical Coherence Visual Fields

Objective: This study determined the success and failure rates of primary trabeculectomy in a university hospital and identified the factors predictive of failure. A retrospective, nested case-control study was conducted involving primary trabeculectomies done in a university hospital from January 2005 to December 2007 with at least one year of follow-up. Depending on the outcomes, patients were classified as cases or controls. Cases were those with failed trabeculectomies defined as intraocular pressure (IOP) >21 mm Hg in all patients and >15 mm Hg in advanced glaucoma at 1 year follow-up. Eyes requiring further glaucoma surgery were also considered failure. Controls were those with successful trabeculectomies defined as IOP <21 mm Hg in all patients and <16 mm Hg in advanced glaucoma, and at least 20% reduction from the presenting IOP and on no more than 2 antiglaucoma medications at one-year follow-up. Preoperative, intraoperative, and postoperative variables were collected and analyzed by bivariate analyses and multiple logistic regression. Results: At one-year follow-up, the success rate was 79.8%. Age at the time of surgery, gender, eye laterality, presence of diabetes, history of intraocular surgery, previous laser treatment, maximum IOP, glaucoma diagnosis, and total number and duration of preoperative antiglaucoma medications were not shown to affect outcome of surgery. Variations in the intraoperative technique, including conjunctival flap approach, location and shape of the scleral flap, suturing technique, and surgeon’s competency were not associated with outcome. Postoperative IOP at 1 month, 3 months, and 6 months were predictors of successful outcome at 1 year. Postoperative subconjunctival 5FU injection, bleb manipulation, and laser suture lysis did not alter outcome. Conclusion Early postoperative IOP at 1 month is already predictive of the outcome of primary trabeculectomy at 1 year.
Trabeculectomy Risk Factors Glaucoma General Surgery Postoperative Care Intraocular Pressure

OBJECTIVE: This study determined the risk of postoperative visual loss and the factors affecting the decrease in visual acuity in patients with advanced glaucoma who underwent trabeculectomy or combined cataract surgery. METHODS: Charts of patients with advanced glaucoma who underwent trabeculectomy or combined cataract surgery were reviewed for the following parameters: visual acuity (VA), intraocular pressure (IOP), and visual-field indices of the Humphrey perimetry. Eyes that lost 2 or more Snellen lines or worsened one category two months after surgery were identified. Central vision was lost (wipeout) when best corrected VA was less than 20/200, characterized as a sudden, permanent, and unexplained visual loss within 2 months post-operatively. Analysis of variance (ANOVA) determined the differences between groups and logistic regression analyzed the factors affecting the decrease in visual acuity postoperatively. RESULTS: Ninety-eight eyes of 92 patients aged 18 years and older were included in the study. The incidence of postoperative visual loss 2 months after surgery was 20 percent (20/98), of which 3 percent (3/98) was considered "wipeout." Factors affecting the decrease in VA postoperatively include the presence of surgical complications (p = 0.04) and increase in postoperative IOP at two months (p = 0.05). CONCLUSION: The incidence of wipeout among patients with advanced glaucoma who underwent trabeculectomy or combined cataract surgery is low and generally occurs in patients with central-splitting fixation. Surgical complications play a major role in causing postoperative decrease in VA.
Human ; Young Adult ; Adolescent ; GLAUCOMA ; TRABECULECTOMY ; CATARACT ; SURGERY ; RISK FACTORS ; VISUAL ACUITY ; EYE DISEASES ; CATARACT EXTRACTION

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

Methods: Patients with and without glaucoma underwent a complete eye evaluation, automated perimetry, scanning laser polarimetry with the GDx 400, and opticdisc photography. Two glaucoma experts graded each study eye. Two-by-two tables were constructed for 5 GDx parameters (average thickness, superior average, inferior average, ellipse average, and ellipse modulation) and the CDx number. Receiver operating characteristic (ROC) curves were generated. Results: The study included 355 patients (171 normal, 184 glaucoma). The mean values of the 5 GDx parameters were lower for the glaucoma than for the normal group. The sensitivity and specificity of the GDx 400 were 45.4 percent and 91.9 percent if the cut off level of the GDx number was 71. Ellipse modulation (EM) measures have the best ROC curve with area under the curve of 0.725. Conclusion: The GDx 400 nerve-fiber analyzer is primarily used as a screening tool to detect the presence or absence of glaucoma. Its accuracy can be improved with use of continuous corneal compensator.
Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; GLAUCOMA ; RETINA ; NERVE FIBERS ; SCANNING LASER POLARIMETRY ;