Original articleShort-Term Enhancement of Visual Field Sensitivity in Glaucomatous Eyes Following Surgical Intraocular Pressure Reduction
Section snippets
Patients and Methods
This prospective cohort study was approved by the Institutional Review Board for Human Research at the University of Miami and followed the tenets of the Declaration of Helsinki. Case subjects made up of glaucoma patients who met eligibility criteria with uncontrolled IOP on maximal medical therapy requiring trabeculectomy or aqueous drainage device implantation, who gave informed consent to participate, were enrolled. Control subjects were medically treated glaucoma patients with stable IOP
Results
The study population consisted of 30 eyes of 30 surgically treated glaucoma patients (age 68.3 ± 18.4 years) and 41 eyes of 28 controls (age 67.4 ± 7.3 years). The baseline MD values in the surgical group (−7.6 ± 4.9 dB) and the control group (−5.6 ± 4.2 dB) were similar (P > .05). The mean time interval between the baseline and follow-up 3 examination was greater (P < .001) in control eyes (18.3 ± 2.91 months) compared to surgical eyes (4.9 ± 1.96 months). The population demographics and
Discussion
The total RGC population in a glaucomatous eye consists of RGCs that are physiologically normal, dysfunctional, nonviable, and atrophic undergoing variable stages of degeneration. Commercially available posterior segment imaging technologies provide structural measures of RGCs and axons no longer viable that have subsequently become atrophic. Quantification of RGC function is of considerable interest to clinicians and scientists who seek biomarkers for early diagnosis, prediction and
Tracy M. Wright, MD, received his Bachelor of Arts degree in biology from Harvard University in 2002 and his medical degree from Yale University in 2009. He completed his residency in ophthalmology at New York University in 2013 and his fellowship in glaucoma at Bascom Palmer Eye Institute in 2014. He is currently an Assistant Professor of Ophthalmology at Bascom Palmer Eye Institute.
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2021, Survey of OphthalmologyCitation Excerpt :It should be noted that while the examples presented below represent potential possibilities for measuring the extent of reversibility, work still needs to be done to stratify which individuals could benefit from the reversal of structure and function and to what extent. Since the 1985 study documenting the improvement of vision in patients treated for glaucoma, there have been numerous investigations indicating that robust IOP reduction in humans with glaucoma can improve visual sensitivities8,49,50,57,86,90; however, there is considerable variation in these results. Migdal and coworkers showed, in a study of 168 patients, that mean VF sensitivity improved in the first year after trabeculectomy—an effect not seen in patients treated with pharmacotherapy or laser.49
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2018, Progress in Retinal and Eye ResearchCitation Excerpt :This improvement was correlated to rate of IOP reduction, and was significant compared to a comparison group of patients with un-operated glaucoma. Although it appears likely that visual field recovery is possible following glaucoma treatment, evidence from the CIGTS and from a number of case series (Katz et al., 1989; Lesk et al., 1999; Leydhecker and Gramer, 1989; Salim et al., 2001; Schultz et al., 1987; Spaeth, 1985, Spaeth and Ichhpujani, 2009; Wright et al., 2015) has highlighted that this does not occur for all patients. In each of the case series, 12–35% of the included patients demonstrated improvement in visual fields 3–12 months post IOP lowering.
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2018, OphthalmologyCitation Excerpt :Although clinicians naturally rely on other clinical data to make glaucoma management decisions, especially information about optic nerve integrity, our model based purely on VF features may augment the clinical decision-making process. Studies have shown that eye surgeries, including intraocular pressure-lowering surgeries,26–29 cataract extraction,30,31 and ranibizumab treatment,32,33 can lead to enhanced VF sensitivity, which may trigger GHT results reversals. For our 97 eyes, we did not find any significant effects of eye surgeries on GHT results reversals (Table S2, available at www.aaojournal.org).
Trabeculectomy Can Improve Long-Term Visual Function in Glaucoma
2016, OphthalmologyCitation Excerpt :In their study, regression to the mean was acknowledged to influence the results because a majority of the improved clusters had returned to the lower baseline level in the second postoperative VF test.27 In a recent analysis of VF data from the Collaborative Initial Glaucoma Treatment Study, substantial VF improvement was observed in open-angle glaucoma eyes after medical or surgical glaucoma treatment.35,36 The authors reported that the rates of VF loss and improvement were similar after 5 years of treatment initiation, and they believed approximately half of the observed change reflected “real” loss or “real” improvement.
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Tracy M. Wright, MD, received his Bachelor of Arts degree in biology from Harvard University in 2002 and his medical degree from Yale University in 2009. He completed his residency in ophthalmology at New York University in 2013 and his fellowship in glaucoma at Bascom Palmer Eye Institute in 2014. He is currently an Assistant Professor of Ophthalmology at Bascom Palmer Eye Institute.