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David C Musch - One of the best experts on this subject based on the ideXlab platform.

  • the association between medication adherence and visual field progression in the collaborative initial Glaucoma Treatment study
    Ophthalmology, 2020
    Co-Authors: Paula Anne Newmancasey, Leslie M Niziol, Paul R Lichter, Nancy K Janz, Brenda W Gillespie, David C Musch
    Abstract:

    Purpose To evaluate the relationship between medication adherence and visual field progression in participants randomized to the medication arm of the Collaborative Initial Glaucoma Treatment Study (CIGTS). Design The CIGTS was a randomized, multicenter clinical trial comparing initial Treatment with topical medications to trabeculectomy for 607 participants with newly diagnosed Glaucoma. Participants Three hundred seven participants randomized to the medication arm of the CIGTS. Methods Participants were followed up at 6-month intervals for up to 10 years. Self-reported medication adherence and visual fields were measured. Medication adherence was assessed by telephone from responses to the question, “Did you happen to miss any dose of your medication yesterday?” The impact of medication adherence on mean deviation (MD) over time was assessed with a linear mixed regression model adjusting for the effects of baseline MD and age, cataract extraction, interactions, and time (through year 8, excluding time after crossover to surgery). Medication adherence was modeled as a cumulative sum of the number of prior visits where a missed dose of medication was reported. Main Outcome Measure Mean deviation over time. Results Three hundred seven subjects (306 with adherence data) were randomized to Treatment with topical medications and followed up for an average of 7.3 years (standard deviation, 2.3 years). One hundred forty-two subjects (46%) reported never missing a dose of medication over all available follow-up, 112 patients (37%) reported missing medication at up to one third of visits, 31 patients (10%) reported missing medication at one third to two thirds of visits, and 21 patients (7%) reported missing medication at more than two thirds of visits. Worse medication adherence was associated with loss of MD over time (P = 0.005). For subjects who reported never missing a dose of medication, the average predicted MD loss over 8 years was 0.62 dB, consistent with age-related loss (95% confidence interval [CI], 0.17–1.06; P = 0.007); subjects who reported missing medication doses at one third of visits had a loss of 1.42 dB (95% CI, 0.86–1.98; P Conclusions This longitudinal assessment demonstrated a statistically and clinically significant association between medication nonadherence and Glaucomatous vision loss.

  • trends in and predictors of depression among participants in the collaborative initial Glaucoma Treatment study cigts
    American Journal of Ophthalmology, 2019
    Co-Authors: David C Musch, Leslie M Niziol, Nancy K Janz, Brenda W Gillespie
    Abstract:

    Purpose To characterize longitudinal trends and factors predictive of depressive symptoms following Glaucoma diagnosis in Collaborative Initial Glaucoma Treatment Study (CIGTS) participants. Design Cohort study using follow-up data from a clinical trial. Methods A total of 607 participants with newly diagnosed open-angle Glaucoma were enrolled at 14 clinical centers in the United States from October 1993 through April 1997, randomized to Treatment with medication or surgery, and followed every 6 months through 2004. The 8-item Center for Epidemiologic Studies Depression Scale (CES-D) was administered at baseline and follow-up visits. Three outcome measures were investigated: overall CES-D depression score, presence of mild or worse depression (CES-D score ≥ 7), and number of depressive symptoms endorsed. Results The average baseline CES-D score was 2.4 (SD = 3.8), 12.5% of subjects reported symptoms associated with mild or worse depression, and 55.3% reported at least 1 depressive symptom. By 1 year postTreatment, depression measures decreased (1.5, 6.7%, and 38.4%, respectively), with modest decreases thereafter. Baseline factors predictive of mild or worse depression included worse vision-related quality of life (VRQOL) (odds ratio [OR] = 2.41), female sex (OR = 1.42), younger age (OR per 10 years younger = 1.24), and less than high school education (OR = 2.93); other outcomes showed similar results. Conclusions Depressive symptoms decreased considerably during the first year after Treatment initiation, but were elevated in those with impaired VRQOL. Given the potential of depression to reduce Treatment adherence and thus increase the risk of Glaucoma progression, eye care providers should ask patients about depressive symptoms, provide reassurance when appropriate, and make referrals as necessary.

  • refusal of trabeculectomy for the fellow eye in collaborative initial Glaucoma Treatment study cigts participants
    American Journal of Ophthalmology, 2016
    Co-Authors: Divakar Gupta, David C Musch, Leslie M Niziol, Philip P Chen
    Abstract:

    Purpose To understand the reasons for refusal of fellow eye surgical Treatment for Glaucoma after first eye trabeculectomy. Design Post hoc analysis of data collected in a multicenter, randomized clinical trial. Methods Data from participants in the Collaborative Initial Glaucoma Treatment Study (CIGTS) who were randomized to and underwent initial trabeculectomy on their study eye, and whose fellow eye was eligible for surgical Treatment, were analyzed. Participant demographic data and characteristics, surgical data from the study eye, and quality-of-life survey results were compared between groups that received or refused trabeculectomy in their fellow eye. The main outcome measure was patient refusal of fellow eye surgery for Glaucoma. Results Of 159 participants who were randomized to and underwent trabeculectomy on their study eye and had a fellow eye that was eligible for surgery, 30 (19%) refused fellow eye surgery. Eligible patients who refused fellow eye trabeculectomy did not differ significantly in visual function or local eye symptoms from those that underwent fellow eye trabeculectomy (all P > .05). In a multivariable analysis of data, increased fellow eye preoperative intraocular pressure (IOP) was associated with decreased odds (OR = 0.89, P  = .0188), study eye hypotony at 3 months postoperatively was associated with increased odds (OR = 7.24, P  = .0125), and argon suture lysis procedure was associated with decreased odds (OR = 0.38, P  = .0385) of surgery refusal. Conclusions Refusal of fellow eye surgery was not uncommonly encountered in the CIGTS. Those who refused fellow eye surgery had lower fellow eye IOP and were more likely to have had hypotony after study eye trabeculectomy.

  • visual field improvement in the collaborative initial Glaucoma Treatment study
    American Journal of Ophthalmology, 2014
    Co-Authors: David C Musch, Leslie M Niziol, Brenda W Gillespie, Paul Palmberg, George L Spaeth, Paul R Lichter
    Abstract:

    Purpose To evaluate critically visual field (VF) improvement in participants in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Design Prospective, comparative case series from a randomized clinical trial comparing trabeculectomy and topical medications in treating open-angle Glaucoma (OAG). Methods A total of 607 subjects with newly diagnosed OAG were identified for study. Baseline and follow-up VF tests were obtained and mean deviation (MD) change from baseline over follow-up was analyzed. Clinically substantial change (loss or improvement) was defined as change from baseline of ≥3 decibels in MD. Baseline factors were inspected to determine their association with VF improvement in repeated measures regression models. Results The percentage of participants showing substantial VF improvement over time was similar to that showing VF loss through 5 years after initial Treatment, after which VF loss became more frequent. Measures of better intraocular pressure (IOP) control during Treatment were significantly predictive of VF improvement, including a lower mean IOP, a lower minimum IOP, and lower sustained levels of IOP over follow-up. Other predictive factors included female sex (odds ratio [OR] = 1.73), visits 1 year prior to cataract extraction (OR = 0.11), and an interaction between Treatment and baseline MD wherein surgically treated subjects with worse baseline VF loss were more likely to show VF improvement. Conclusions In the CIGTS, substantial VF loss and improvement were comparable through 5 years of follow-up, after which VF loss became more frequent. Predictive factors for VF improvement included several indicators of better IOP control, which supports the postulate that VF improvement was real.

  • risk of endophthalmitis and other long term complications of trabeculectomy in the collaborative initial Glaucoma Treatment study cigts
    American Journal of Ophthalmology, 2013
    Co-Authors: Sarwar Zahid, David C Musch, Leslie M Niziol, Paul R Lichter
    Abstract:

    Purpose To report the risk of endophthalmitis and other long-term complications in patients randomized to trabeculectomy in the Collaborative Initial Glaucoma Treatment Study. Design A longitudinal cohort study using data collected from a multicenter, randomized clinical trial. Methods Long-term postoperative complications in the 300 patients randomized to trabeculectomy in the Collaborative Initial Glaucoma Treatment Study were tabulated. Kaplan-Meier analyses were used to estimate the time-related probabilities of blebitis, hypotony, and endophthalmitis. Results Two hundred eighty-five patients were included in the final trabeculectomy cohort after accounting for declining Treatment assignment and other early events. Patients were followed up for an average of 7.2 years. One hundred sixty-three patients (57%) received 5-fluorouracil during surgery. Of the 247 patients with at least 5 years of follow-up, 50 required further Treatment for Glaucoma. Cataract extraction was performed in 57 patients (20%). Forty patients (14%) required bleb revision at least once. Bleb-related complications included bleb leak (n = 15), blebitis (n = 8), and hypotony (n = 4). Three patients were noted to have endophthalmitis, although the diagnosis in 2 patients was presumptive. The occurrences of blebitis, hypotony, or endophthalmitis were not significantly associated with 5-fluorouracil use. The Kaplan-Meier calculated risks of blebitis and hypotony at 5 years were both 1.5%, whereas the risk of endophthalmitis was 1.1%. Conclusions The potential efficacy of trabeculectomy must be weighed against the long-term risk of complications, especially endophthalmitis, when selecting Treatments for patients with open-angle Glaucoma. We report a low 5-year risk of endophthalmitis (1.1%) and other bleb-related complications in the trabeculectomy cohort of the Collaborative Initial Glaucoma Treatment Study.

Paul R Lichter - One of the best experts on this subject based on the ideXlab platform.

  • the association between medication adherence and visual field progression in the collaborative initial Glaucoma Treatment study
    Ophthalmology, 2020
    Co-Authors: Paula Anne Newmancasey, Leslie M Niziol, Paul R Lichter, Nancy K Janz, Brenda W Gillespie, David C Musch
    Abstract:

    Purpose To evaluate the relationship between medication adherence and visual field progression in participants randomized to the medication arm of the Collaborative Initial Glaucoma Treatment Study (CIGTS). Design The CIGTS was a randomized, multicenter clinical trial comparing initial Treatment with topical medications to trabeculectomy for 607 participants with newly diagnosed Glaucoma. Participants Three hundred seven participants randomized to the medication arm of the CIGTS. Methods Participants were followed up at 6-month intervals for up to 10 years. Self-reported medication adherence and visual fields were measured. Medication adherence was assessed by telephone from responses to the question, “Did you happen to miss any dose of your medication yesterday?” The impact of medication adherence on mean deviation (MD) over time was assessed with a linear mixed regression model adjusting for the effects of baseline MD and age, cataract extraction, interactions, and time (through year 8, excluding time after crossover to surgery). Medication adherence was modeled as a cumulative sum of the number of prior visits where a missed dose of medication was reported. Main Outcome Measure Mean deviation over time. Results Three hundred seven subjects (306 with adherence data) were randomized to Treatment with topical medications and followed up for an average of 7.3 years (standard deviation, 2.3 years). One hundred forty-two subjects (46%) reported never missing a dose of medication over all available follow-up, 112 patients (37%) reported missing medication at up to one third of visits, 31 patients (10%) reported missing medication at one third to two thirds of visits, and 21 patients (7%) reported missing medication at more than two thirds of visits. Worse medication adherence was associated with loss of MD over time (P = 0.005). For subjects who reported never missing a dose of medication, the average predicted MD loss over 8 years was 0.62 dB, consistent with age-related loss (95% confidence interval [CI], 0.17–1.06; P = 0.007); subjects who reported missing medication doses at one third of visits had a loss of 1.42 dB (95% CI, 0.86–1.98; P Conclusions This longitudinal assessment demonstrated a statistically and clinically significant association between medication nonadherence and Glaucomatous vision loss.

  • visual field improvement in the collaborative initial Glaucoma Treatment study
    American Journal of Ophthalmology, 2014
    Co-Authors: David C Musch, Leslie M Niziol, Brenda W Gillespie, Paul Palmberg, George L Spaeth, Paul R Lichter
    Abstract:

    Purpose To evaluate critically visual field (VF) improvement in participants in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Design Prospective, comparative case series from a randomized clinical trial comparing trabeculectomy and topical medications in treating open-angle Glaucoma (OAG). Methods A total of 607 subjects with newly diagnosed OAG were identified for study. Baseline and follow-up VF tests were obtained and mean deviation (MD) change from baseline over follow-up was analyzed. Clinically substantial change (loss or improvement) was defined as change from baseline of ≥3 decibels in MD. Baseline factors were inspected to determine their association with VF improvement in repeated measures regression models. Results The percentage of participants showing substantial VF improvement over time was similar to that showing VF loss through 5 years after initial Treatment, after which VF loss became more frequent. Measures of better intraocular pressure (IOP) control during Treatment were significantly predictive of VF improvement, including a lower mean IOP, a lower minimum IOP, and lower sustained levels of IOP over follow-up. Other predictive factors included female sex (odds ratio [OR] = 1.73), visits 1 year prior to cataract extraction (OR = 0.11), and an interaction between Treatment and baseline MD wherein surgically treated subjects with worse baseline VF loss were more likely to show VF improvement. Conclusions In the CIGTS, substantial VF loss and improvement were comparable through 5 years of follow-up, after which VF loss became more frequent. Predictive factors for VF improvement included several indicators of better IOP control, which supports the postulate that VF improvement was real.

  • risk of endophthalmitis and other long term complications of trabeculectomy in the collaborative initial Glaucoma Treatment study cigts
    American Journal of Ophthalmology, 2013
    Co-Authors: Sarwar Zahid, David C Musch, Leslie M Niziol, Paul R Lichter
    Abstract:

    Purpose To report the risk of endophthalmitis and other long-term complications in patients randomized to trabeculectomy in the Collaborative Initial Glaucoma Treatment Study. Design A longitudinal cohort study using data collected from a multicenter, randomized clinical trial. Methods Long-term postoperative complications in the 300 patients randomized to trabeculectomy in the Collaborative Initial Glaucoma Treatment Study were tabulated. Kaplan-Meier analyses were used to estimate the time-related probabilities of blebitis, hypotony, and endophthalmitis. Results Two hundred eighty-five patients were included in the final trabeculectomy cohort after accounting for declining Treatment assignment and other early events. Patients were followed up for an average of 7.2 years. One hundred sixty-three patients (57%) received 5-fluorouracil during surgery. Of the 247 patients with at least 5 years of follow-up, 50 required further Treatment for Glaucoma. Cataract extraction was performed in 57 patients (20%). Forty patients (14%) required bleb revision at least once. Bleb-related complications included bleb leak (n = 15), blebitis (n = 8), and hypotony (n = 4). Three patients were noted to have endophthalmitis, although the diagnosis in 2 patients was presumptive. The occurrences of blebitis, hypotony, or endophthalmitis were not significantly associated with 5-fluorouracil use. The Kaplan-Meier calculated risks of blebitis and hypotony at 5 years were both 1.5%, whereas the risk of endophthalmitis was 1.1%. Conclusions The potential efficacy of trabeculectomy must be weighed against the long-term risk of complications, especially endophthalmitis, when selecting Treatments for patients with open-angle Glaucoma. We report a low 5-year risk of endophthalmitis (1.1%) and other bleb-related complications in the trabeculectomy cohort of the Collaborative Initial Glaucoma Treatment Study.

  • intraocular pressure control and long term visual field loss in the collaborative initial Glaucoma Treatment study
    Ophthalmology, 2011
    Co-Authors: David C Musch, Leslie M Niziol, Paul R Lichter, Brenda W Gillespie, Rohit Varma
    Abstract:

    Objective To evaluate the impact of measures of intraocular pressure (IOP) control on progression of visual field (VF) loss during long-term Treatment for open-angle Glaucoma (OAG). Design Longitudinal, randomized clinical trial. Participants We included 607 participants with newly diagnosed OAG. Methods Study participants were randomly assigned to initial Treatment with medications or trabeculectomy, and underwent examination at 6-month intervals. Standardized testing included Goldmann applanation tonometry and Humphrey 24-2 full threshold VFs. Summary measures of IOP control during follow-up included the maximum, mean, standard deviation (SD), range, proportion less than 16, 18, 20, or 22 mmHg, and whether all IOP values were less than each of these 4 cutpoints. Predictive models for VF outcomes were based on the mean deviation (MD) from VF testing, and were adjusted for age, gender, race, baseline VF loss, Treatment, and time. Each summary IOP measure was included as a cumulative, time-dependent variable, and its association with subsequent VF loss was assessed from 3 to 9 years postrandomization. Both linear mixed models, to detect shifts in MD levels, and logistic models, to detect elevated odds of substantial worsening (≥3 dB), were used. Main Outcome Measures We measured the MD from Humphrey 24-2 full threshold VF tests. Results The effect of the summary IOP measures differed between the medicine and surgery groups in models that addressed the continuous MD outcome. After adjustment for baseline risk factors, in the medicine group larger values of 3 IOP control measures—maximum IOP ( P = 0.0003), SD of IOP ( P = 0.0056), and range of IOP ( P Conclusions These results support considering more aggressive Treatment when undue elevation or variation in IOP measures is observed. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.

  • five year follow up optic disc findings of the collaborative initial Glaucoma Treatment study
    American Journal of Ophthalmology, 2009
    Co-Authors: Richard K Parrish, Paul R Lichter, William J Feuer, Joyce C Schiffman, David C Musch
    Abstract:

    Purpose To determine the effect of intraocular pressure (IOP) lowering on the optic disc in patients of the Collaborative Initial Glaucoma Treatment Study (CIGTS) after 5 years. Design Randomized clinical trial. Methods The baseline and 5-year stereoscopic optic disc photographs of 348 eyes (patients) randomized to medical or surgical Treatment of open-angle Glaucoma (OAG) were assessed by 2 independent readers for change in a masked side-by-side comparison, and confirmed by an independent committee. Results Three hundred and three (87.1%) eyes showed no change, 22 (6.3%) showed enlargement of the cup along any meridian (progression), and 23 (6.6%) showed a reduction in the cup along any meridian (reversal of cupping). Incidence of optic disc progression was higher ( P = .007) in the medicine group, 18/185 (10%) than in the surgical group 4/163 (3%); and the incidence of reversal of cupping was higher ( P P P P Conclusions Surgery prevents or delays Glaucomatous progression as measured by optic disc criteria in patients with early OAG. Reversal of cupping occurs more frequently in the surgical group than in the medical Treatment group. Reversal is associated with lower IOP, but is not associated with improved visual function.

Brenda W Gillespie - One of the best experts on this subject based on the ideXlab platform.

  • the association between medication adherence and visual field progression in the collaborative initial Glaucoma Treatment study
    Ophthalmology, 2020
    Co-Authors: Paula Anne Newmancasey, Leslie M Niziol, Paul R Lichter, Nancy K Janz, Brenda W Gillespie, David C Musch
    Abstract:

    Purpose To evaluate the relationship between medication adherence and visual field progression in participants randomized to the medication arm of the Collaborative Initial Glaucoma Treatment Study (CIGTS). Design The CIGTS was a randomized, multicenter clinical trial comparing initial Treatment with topical medications to trabeculectomy for 607 participants with newly diagnosed Glaucoma. Participants Three hundred seven participants randomized to the medication arm of the CIGTS. Methods Participants were followed up at 6-month intervals for up to 10 years. Self-reported medication adherence and visual fields were measured. Medication adherence was assessed by telephone from responses to the question, “Did you happen to miss any dose of your medication yesterday?” The impact of medication adherence on mean deviation (MD) over time was assessed with a linear mixed regression model adjusting for the effects of baseline MD and age, cataract extraction, interactions, and time (through year 8, excluding time after crossover to surgery). Medication adherence was modeled as a cumulative sum of the number of prior visits where a missed dose of medication was reported. Main Outcome Measure Mean deviation over time. Results Three hundred seven subjects (306 with adherence data) were randomized to Treatment with topical medications and followed up for an average of 7.3 years (standard deviation, 2.3 years). One hundred forty-two subjects (46%) reported never missing a dose of medication over all available follow-up, 112 patients (37%) reported missing medication at up to one third of visits, 31 patients (10%) reported missing medication at one third to two thirds of visits, and 21 patients (7%) reported missing medication at more than two thirds of visits. Worse medication adherence was associated with loss of MD over time (P = 0.005). For subjects who reported never missing a dose of medication, the average predicted MD loss over 8 years was 0.62 dB, consistent with age-related loss (95% confidence interval [CI], 0.17–1.06; P = 0.007); subjects who reported missing medication doses at one third of visits had a loss of 1.42 dB (95% CI, 0.86–1.98; P Conclusions This longitudinal assessment demonstrated a statistically and clinically significant association between medication nonadherence and Glaucomatous vision loss.

  • trends in and predictors of depression among participants in the collaborative initial Glaucoma Treatment study cigts
    American Journal of Ophthalmology, 2019
    Co-Authors: David C Musch, Leslie M Niziol, Nancy K Janz, Brenda W Gillespie
    Abstract:

    Purpose To characterize longitudinal trends and factors predictive of depressive symptoms following Glaucoma diagnosis in Collaborative Initial Glaucoma Treatment Study (CIGTS) participants. Design Cohort study using follow-up data from a clinical trial. Methods A total of 607 participants with newly diagnosed open-angle Glaucoma were enrolled at 14 clinical centers in the United States from October 1993 through April 1997, randomized to Treatment with medication or surgery, and followed every 6 months through 2004. The 8-item Center for Epidemiologic Studies Depression Scale (CES-D) was administered at baseline and follow-up visits. Three outcome measures were investigated: overall CES-D depression score, presence of mild or worse depression (CES-D score ≥ 7), and number of depressive symptoms endorsed. Results The average baseline CES-D score was 2.4 (SD = 3.8), 12.5% of subjects reported symptoms associated with mild or worse depression, and 55.3% reported at least 1 depressive symptom. By 1 year postTreatment, depression measures decreased (1.5, 6.7%, and 38.4%, respectively), with modest decreases thereafter. Baseline factors predictive of mild or worse depression included worse vision-related quality of life (VRQOL) (odds ratio [OR] = 2.41), female sex (OR = 1.42), younger age (OR per 10 years younger = 1.24), and less than high school education (OR = 2.93); other outcomes showed similar results. Conclusions Depressive symptoms decreased considerably during the first year after Treatment initiation, but were elevated in those with impaired VRQOL. Given the potential of depression to reduce Treatment adherence and thus increase the risk of Glaucoma progression, eye care providers should ask patients about depressive symptoms, provide reassurance when appropriate, and make referrals as necessary.

  • visual field improvement in the collaborative initial Glaucoma Treatment study
    American Journal of Ophthalmology, 2014
    Co-Authors: David C Musch, Leslie M Niziol, Brenda W Gillespie, Paul Palmberg, George L Spaeth, Paul R Lichter
    Abstract:

    Purpose To evaluate critically visual field (VF) improvement in participants in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Design Prospective, comparative case series from a randomized clinical trial comparing trabeculectomy and topical medications in treating open-angle Glaucoma (OAG). Methods A total of 607 subjects with newly diagnosed OAG were identified for study. Baseline and follow-up VF tests were obtained and mean deviation (MD) change from baseline over follow-up was analyzed. Clinically substantial change (loss or improvement) was defined as change from baseline of ≥3 decibels in MD. Baseline factors were inspected to determine their association with VF improvement in repeated measures regression models. Results The percentage of participants showing substantial VF improvement over time was similar to that showing VF loss through 5 years after initial Treatment, after which VF loss became more frequent. Measures of better intraocular pressure (IOP) control during Treatment were significantly predictive of VF improvement, including a lower mean IOP, a lower minimum IOP, and lower sustained levels of IOP over follow-up. Other predictive factors included female sex (odds ratio [OR] = 1.73), visits 1 year prior to cataract extraction (OR = 0.11), and an interaction between Treatment and baseline MD wherein surgically treated subjects with worse baseline VF loss were more likely to show VF improvement. Conclusions In the CIGTS, substantial VF loss and improvement were comparable through 5 years of follow-up, after which VF loss became more frequent. Predictive factors for VF improvement included several indicators of better IOP control, which supports the postulate that VF improvement was real.

  • intraocular pressure control and long term visual field loss in the collaborative initial Glaucoma Treatment study
    Ophthalmology, 2011
    Co-Authors: David C Musch, Leslie M Niziol, Paul R Lichter, Brenda W Gillespie, Rohit Varma
    Abstract:

    Objective To evaluate the impact of measures of intraocular pressure (IOP) control on progression of visual field (VF) loss during long-term Treatment for open-angle Glaucoma (OAG). Design Longitudinal, randomized clinical trial. Participants We included 607 participants with newly diagnosed OAG. Methods Study participants were randomly assigned to initial Treatment with medications or trabeculectomy, and underwent examination at 6-month intervals. Standardized testing included Goldmann applanation tonometry and Humphrey 24-2 full threshold VFs. Summary measures of IOP control during follow-up included the maximum, mean, standard deviation (SD), range, proportion less than 16, 18, 20, or 22 mmHg, and whether all IOP values were less than each of these 4 cutpoints. Predictive models for VF outcomes were based on the mean deviation (MD) from VF testing, and were adjusted for age, gender, race, baseline VF loss, Treatment, and time. Each summary IOP measure was included as a cumulative, time-dependent variable, and its association with subsequent VF loss was assessed from 3 to 9 years postrandomization. Both linear mixed models, to detect shifts in MD levels, and logistic models, to detect elevated odds of substantial worsening (≥3 dB), were used. Main Outcome Measures We measured the MD from Humphrey 24-2 full threshold VF tests. Results The effect of the summary IOP measures differed between the medicine and surgery groups in models that addressed the continuous MD outcome. After adjustment for baseline risk factors, in the medicine group larger values of 3 IOP control measures—maximum IOP ( P = 0.0003), SD of IOP ( P = 0.0056), and range of IOP ( P Conclusions These results support considering more aggressive Treatment when undue elevation or variation in IOP measures is observed. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.

  • visual field progression in the collaborative initial Glaucoma Treatment study the impact of Treatment and other baseline factors
    Ophthalmology, 2009
    Co-Authors: David C Musch, Leslie M Niziol, Paul R Lichter, Brenda W Gillespie, Nancy K Janz
    Abstract:

    Purpose To evaluate factors associated with visual field (VF) progression, using all available follow-up through 9 years after Treatment initiation, in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Design Longitudinal follow-up of participants enrolled in a randomized clinical trial. Participants Six hundred seven newly diagnosed Glaucoma patients. Methods In a randomized clinical trial, 607 subjects with newly diagnosed open-angle Glaucoma initially were treated with either medication or trabeculectomy. After Treatment initiation and early follow-up, subjects were evaluated clinically at 6-month intervals. Study participants in both arms of the CIGTS were treated aggressively in an effort to reduce intraocular pressure (IOP) to a level at or below a predetermined, eye-specific target pressure. Visual field progression was analyzed using repeated measures models. Main Outcome Measures Visual field progression, measured by Humphrey 24-2 full-threshold testing and assessed by the change in the mean deviation (MD), and an indicator of substantial worsening of the VF (MD decrease of ≥3 dB from baseline), assessed at each follow-up visit. Results Follow-up indicated minimal change from baseline in each initial Treatment group's average MD. However, at the 8-year follow-up examination, substantial worsening (≥3 dB) of MD from baseline was found in 21.3% and 25.5% of the initial surgery and initial medicine groups, respectively. The effect of initial Treatment on subsequent VF loss was modified by time ( P P = 0.03), and diabetes ( P = 0.01). Initial surgery led to less VF progression than initial medicine in subjects with advanced VF loss at baseline, whereas subjects with diabetes had more VF loss over time if treated initially with surgery. Conclusions The CIGTS intervention protocol led to a lowering of IOP that persisted over time in both Treatment groups. Progression in VF loss was seen in a subset, increasing to more than 20% of the subjects. The findings regarding initial surgery being beneficial for subjects with more advanced VF loss at presentation, but detrimental for patients with diabetes, are noteworthy and warrant independent confirmation. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Jeffrey M. Liebmann - One of the best experts on this subject based on the ideXlab platform.

  • rates of local retinal nerve fiber layer thinning before and after disc hemorrhage in Glaucoma
    Ophthalmology, 2017
    Co-Authors: Tadamichi Akagi, Linda M Zangwill, Luke J Saunders, Adeleh Yarmohammadi, Patricia Isabel C Manalastas, Min Hee Suh, Christopher A Girkin, Jeffrey M. Liebmann
    Abstract:

    Purpose To investigate longitudinal temporal and spatial associations between disc hemorrhage (DH) and rates of local retinal nerve fiber layer (RNFL) thinning before and after DHs. Design Longitudinal, observational cohort study. Participants Forty eyes of 37 participants (23 with Glaucoma and 17 with suspect Glaucoma at baseline) with DH episodes during follow-up from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Methods All subjects underwent optic disc photography annually and spectral-domain optical coherence tomography (OCT) RNFL thickness measurements every 6 months. The rates of RNFL thinning were calculated using multivariate linear mixed-effects models before and after DH. Main Outcome Measures Rates of global and local RNFL thinning. Results Thirty-six eyes of 33 participants with inferior or superior DHs were analyzed. The rates of RNFL thinning were significantly faster in DH quadrants than in non-DH quadrants after DH (−2.25 and −0.69 μm/year; P P P  = 0.19). In 18 eyes with unchanged Treatment, the rate of RNFL thinning in the DH quadrant was faster after DH than before DH ( P  = 0.008). Moreover, compared with eyes without a Treatment change, intensification of Glaucoma Treatment after DH significantly reduced the global, non-DH quadrants, and DH quadrant rates of RNFL thinning after DH compared with before DH (global, P  = 0.004; non-DH quadrant, P P  = 0.005). In the multiple linear regression analysis, Treatment intensification (β, 1.007; P  = 0.005), visual field mean deviation (β, 0.066; P  = 0.049), and difference in intraocular pressure before and after DH (β, −0.176; P  = 0.034) were associated significantly with the difference of global RNFL slope values before and after DH. Conclusions Although the rate of RNFL thinning worsened in a DH quadrant after DH, Glaucoma Treatment intensification may have a beneficial effect in reducing this rate of thinning.

  • risk factors for optic disc hemorrhage in the low pressure Glaucoma Treatment study
    American Journal of Ophthalmology, 2014
    Co-Authors: Rafael Furlanetto, David S. Greenfield, Jeffrey M. Liebmann, Stuart K Gardiner, Carlos Gustavo De Moraes, Christopher C Teng, Robert Ritch
    Abstract:

    Purpose To investigate risk factors for disc hemorrhage detection in the Low-Pressure Glaucoma Treatment Study. Design Cohort of a randomized, double-masked, multicenter clinical trial. Methods Low-Pressure Glaucoma Treatment Study patients with at least 16 months of follow-up were included. Exclusion criteria included untreated intraocular pressure (IOP) of more than 21 mm Hg, visual field mean deviation worse than −16 dB, or contraindications to study medications. Patients were randomized to topical Treatment with timolol 0.5% or brimonidine 0.2%. Stereophotographs were reviewed independently by 2 masked graders searching for disc hemorrhages. The main outcomes investigated were the detection of disc hemorrhage at any time during follow-up and their recurrence. Ocular and systemic risk factors for disc hemorrhage detection were analyzed using the Cox proportional hazards model and were tested further for independence in a multivariate model. Results Two hundred fifty-three eyes of 127 subjects (mean age, 64.7 ± 10.9 years; women, 58%; European ancestry, 71%) followed up for an average ± standard deviation of 40.6 ± 12 months were included. In the multivariate analysis, history of migraine (hazard ratio [HR], 5.737; P  = .012), narrower neuroretinal rim width at baseline (HR, 2.91; P  = .048), use of systemic β-blockers (HR, 5.585; P  = .036), low mean systolic blood pressure (HR, 1.06; P  = .02), and low mean arterial ocular perfusion pressure during follow-up (HR, 1.172; P  = .007) were significant and independent risk factors for disc hemorrhage detection. Treatment randomization was not associated with either the occurrence or recurrence of disc hemorrhages. Conclusions In this cohort of Low-Pressure Glaucoma Treatment Study patients, migraine, baseline narrower neuroretinal rim width, low systolic blood pressure and mean arterial ocular perfusion pressure, and use of systemic β-blockers were risk factors for disc hemorrhage detection. Randomization assignment did not influence the frequency of disc hemorrhage detection.

  • risk factors for visual field progression in the low pressure Glaucoma Treatment study
    American Journal of Ophthalmology, 2012
    Co-Authors: David S. Greenfield, Jeffrey M. Liebmann, Robert Ritch, Stuart K Gardiner, Carlos Gustavo De Moraes, Theodore Krupin
    Abstract:

    Purpose To investigate risk factors associated with visual field progression in the Low-pressure Glaucoma Treatment Study, a prospective trial designed to compare the effects of the alpha2-adrenergic agonist brimonidine tartrate 0.2% to the beta-adrenergic antagonist timolol maleate 0.5% on visual function in low-pressure Glaucoma. Design Prospective cohort study. Methods Low-pressure Glaucoma Treatment Study patients with ≥5 visual field tests during follow-up were included. Progression was determined using pointwise linear regression analysis, defined as the same 3 or more visual field locations with a slope more negative than −1.0 dB/year at P Results A total of 253 eyes of 127 subjects (mean age, 64.7 ± 10.9 years; mean follow-up, 40.6 ± 12 months) were analyzed. Eyes randomized to timolol progressed faster than those randomized to brimonidine (mean rates of progression, −0.38 ± 0.9 vs 0.02 ± 0.7 dB/y, P P = .022), use of systemic antihypertensives (HR = 2.53, 95% CI=1.32 to 4.87, P = .005), and mean ocular perfusion pressure (HR = 1.21/mm Hg lower, 95% CI=1.12 to 1.31, P P Conclusions While randomization to brimonidine 0.2% was protective compared to timolol 0.5%, lower mean ocular perfusion pressure increased the risk for reaching a progression outcome in the Low-pressure Glaucoma Treatment Study. This suggests that the beneficial effect of randomization to the brimonidine arm was independent of possible differences in ocular perfusion pressures between the 2 Treatment arms. The current results and large number of drop-outs in the brimonidine 0.2% arm suggest that more research is necessary before altering clinical practice paradigms.

  • a randomized trial of brimonidine versus timolol in preserving visual function results from the low pressure Glaucoma Treatment study
    American Journal of Ophthalmology, 2011
    Co-Authors: Theodore Krupin, David S. Greenfield, Jeffrey M. Liebmann, Robert Ritch, Stuart K Gardiner
    Abstract:

    Purpose To compare the alpha2-adrenergic agonist brimonidine tartrate 0.2% to the beta-adrenergic antagonist timolol maleate 0.5% in preserving visual function in low-pressure Glaucoma. Design Randomized, double-masked, multicenter clinical trial. Methods Exclusion criteria included untreated intraocular pressure (IOP) >21 mm Hg, visual field mean deviation worse than -16 decibels, or contraindications to study medications. Both eyes received twice-daily monotherapy randomized in blocks of 7 (4 brimonidine to 3 timolol). Standard automated perimetry and tonometry were performed at 4-month intervals. Main outcome measure was field progression in either eye, defined as the same 3 or more points with a negative slope ≥-1 dB/year at P Results Ninety-nine patients were randomized to brimonidine and 79 to timolol. Mean (± SE) months of follow-up for all patients was 30.0 ± 2. Statistically fewer brimonidine-treated patients (9, 9.1%) had visual field progression by pointwise linear regression than timolol-treated patients (31, 39.2%, log-rank 12.4, P=.001). Mean treated IOP was similar for brimonidine- and timolol-treated patients at all time points. More brimonidine-treated (28, 28.3%) than timolol-treated (9, 11.4%) patients discontinued study participation because of drug-related adverse events (P=.008). Similar differences in progression were observed when analyzed by GCPM and the 3-omitting method. Conclusion Low-pressure Glaucoma patients treated with brimonidine 0.2% who do not develop ocular allergy are less likely to have field progression than patients treated with timolol 0.5%.

  • visual field and intraocular pressure asymmetry in the low pressure Glaucoma Treatment study
    Ophthalmology, 2007
    Co-Authors: David S. Greenfield, Jeffrey M. Liebmann, Robert Ritch, Theodore Krupin
    Abstract:

    Objective To explore the relationship between asymmetric baseline intraocular pressure (IOP) and asymmetric visual field (VF) loss in the Low-Pressure Glaucoma Treatment Study. Design Randomized, multicenter, controlled clinical trial. Participants Low-pressure Glaucoma (LPG) patients 30 years or older were identified. Exclusion criteria included an untreated pressure > 21 mmHg, advanced VF loss, and contraindications to study medications. Interventions A baseline VF was created using the average of 2 reliable Humphrey full-threshold examinations. A baseline diurnal IOP curve was performed without IOP-lowering medication. Main Outcome Measures Mean diurnal, peak, trough, IOP range (peak − trough), and standard deviation (SD) of IOP measurements, and mean deviation (MD) and corrected pattern SD (CPSD) of VF examinations. Results One hundred ninety patients were enrolled (mean age, 64.9±10.7 years). Mean deviation and CPSD were not correlated with mean, peak, trough, or peak minus trough (P − T) IOP ( P s = 0.2–0.9). Among patients with unilateral VF loss (n = 53 [27.9%]), there were no differences ( P s = 0.3–0.9) in any IOP parameter between the normal VF eye and fellow Glaucomatous eyes. Among patients with bilateral VF loss (n = 137 [72.1%]), mean, peak, trough, and P − T IOPs were similar in eyes with a better VF MD compared with eyes with a worse VF MD ( P s = 0.2–0.7). Cross-classified contingency tables demonstrated no relationship ( P s = 0.1–0.3) between IOP and VF MD or CPSD using chi-square analysis. Conclusions Intraocular pressure asymmetry is unrelated to VF asymmetry in the Low-Pressure Glaucoma Treatment Study, suggesting an unclear pathogenic relationship between IOP and Glaucomatous damage in eyes with LPG.

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  • the association between medication adherence and visual field progression in the collaborative initial Glaucoma Treatment study
    Ophthalmology, 2020
    Co-Authors: Paula Anne Newmancasey, Leslie M Niziol, Paul R Lichter, Nancy K Janz, Brenda W Gillespie, David C Musch
    Abstract:

    Purpose To evaluate the relationship between medication adherence and visual field progression in participants randomized to the medication arm of the Collaborative Initial Glaucoma Treatment Study (CIGTS). Design The CIGTS was a randomized, multicenter clinical trial comparing initial Treatment with topical medications to trabeculectomy for 607 participants with newly diagnosed Glaucoma. Participants Three hundred seven participants randomized to the medication arm of the CIGTS. Methods Participants were followed up at 6-month intervals for up to 10 years. Self-reported medication adherence and visual fields were measured. Medication adherence was assessed by telephone from responses to the question, “Did you happen to miss any dose of your medication yesterday?” The impact of medication adherence on mean deviation (MD) over time was assessed with a linear mixed regression model adjusting for the effects of baseline MD and age, cataract extraction, interactions, and time (through year 8, excluding time after crossover to surgery). Medication adherence was modeled as a cumulative sum of the number of prior visits where a missed dose of medication was reported. Main Outcome Measure Mean deviation over time. Results Three hundred seven subjects (306 with adherence data) were randomized to Treatment with topical medications and followed up for an average of 7.3 years (standard deviation, 2.3 years). One hundred forty-two subjects (46%) reported never missing a dose of medication over all available follow-up, 112 patients (37%) reported missing medication at up to one third of visits, 31 patients (10%) reported missing medication at one third to two thirds of visits, and 21 patients (7%) reported missing medication at more than two thirds of visits. Worse medication adherence was associated with loss of MD over time (P = 0.005). For subjects who reported never missing a dose of medication, the average predicted MD loss over 8 years was 0.62 dB, consistent with age-related loss (95% confidence interval [CI], 0.17–1.06; P = 0.007); subjects who reported missing medication doses at one third of visits had a loss of 1.42 dB (95% CI, 0.86–1.98; P Conclusions This longitudinal assessment demonstrated a statistically and clinically significant association between medication nonadherence and Glaucomatous vision loss.

  • trends in and predictors of depression among participants in the collaborative initial Glaucoma Treatment study cigts
    American Journal of Ophthalmology, 2019
    Co-Authors: David C Musch, Leslie M Niziol, Nancy K Janz, Brenda W Gillespie
    Abstract:

    Purpose To characterize longitudinal trends and factors predictive of depressive symptoms following Glaucoma diagnosis in Collaborative Initial Glaucoma Treatment Study (CIGTS) participants. Design Cohort study using follow-up data from a clinical trial. Methods A total of 607 participants with newly diagnosed open-angle Glaucoma were enrolled at 14 clinical centers in the United States from October 1993 through April 1997, randomized to Treatment with medication or surgery, and followed every 6 months through 2004. The 8-item Center for Epidemiologic Studies Depression Scale (CES-D) was administered at baseline and follow-up visits. Three outcome measures were investigated: overall CES-D depression score, presence of mild or worse depression (CES-D score ≥ 7), and number of depressive symptoms endorsed. Results The average baseline CES-D score was 2.4 (SD = 3.8), 12.5% of subjects reported symptoms associated with mild or worse depression, and 55.3% reported at least 1 depressive symptom. By 1 year postTreatment, depression measures decreased (1.5, 6.7%, and 38.4%, respectively), with modest decreases thereafter. Baseline factors predictive of mild or worse depression included worse vision-related quality of life (VRQOL) (odds ratio [OR] = 2.41), female sex (OR = 1.42), younger age (OR per 10 years younger = 1.24), and less than high school education (OR = 2.93); other outcomes showed similar results. Conclusions Depressive symptoms decreased considerably during the first year after Treatment initiation, but were elevated in those with impaired VRQOL. Given the potential of depression to reduce Treatment adherence and thus increase the risk of Glaucoma progression, eye care providers should ask patients about depressive symptoms, provide reassurance when appropriate, and make referrals as necessary.

  • visual field progression in the collaborative initial Glaucoma Treatment study the impact of Treatment and other baseline factors
    Ophthalmology, 2009
    Co-Authors: David C Musch, Leslie M Niziol, Paul R Lichter, Brenda W Gillespie, Nancy K Janz
    Abstract:

    Purpose To evaluate factors associated with visual field (VF) progression, using all available follow-up through 9 years after Treatment initiation, in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Design Longitudinal follow-up of participants enrolled in a randomized clinical trial. Participants Six hundred seven newly diagnosed Glaucoma patients. Methods In a randomized clinical trial, 607 subjects with newly diagnosed open-angle Glaucoma initially were treated with either medication or trabeculectomy. After Treatment initiation and early follow-up, subjects were evaluated clinically at 6-month intervals. Study participants in both arms of the CIGTS were treated aggressively in an effort to reduce intraocular pressure (IOP) to a level at or below a predetermined, eye-specific target pressure. Visual field progression was analyzed using repeated measures models. Main Outcome Measures Visual field progression, measured by Humphrey 24-2 full-threshold testing and assessed by the change in the mean deviation (MD), and an indicator of substantial worsening of the VF (MD decrease of ≥3 dB from baseline), assessed at each follow-up visit. Results Follow-up indicated minimal change from baseline in each initial Treatment group's average MD. However, at the 8-year follow-up examination, substantial worsening (≥3 dB) of MD from baseline was found in 21.3% and 25.5% of the initial surgery and initial medicine groups, respectively. The effect of initial Treatment on subsequent VF loss was modified by time ( P P = 0.03), and diabetes ( P = 0.01). Initial surgery led to less VF progression than initial medicine in subjects with advanced VF loss at baseline, whereas subjects with diabetes had more VF loss over time if treated initially with surgery. Conclusions The CIGTS intervention protocol led to a lowering of IOP that persisted over time in both Treatment groups. Progression in VF loss was seen in a subset, increasing to more than 20% of the subjects. The findings regarding initial surgery being beneficial for subjects with more advanced VF loss at presentation, but detrimental for patients with diabetes, are noteworthy and warrant independent confirmation. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

  • the collaborative initial Glaucoma Treatment study baseline visual field and test retest variability
    Investigative Ophthalmology & Visual Science, 2003
    Co-Authors: Brenda W Gillespie, David C Musch, Paul R Lichter, Richard P Mills, Nancy K Janz, Kenneth E Guire, Patricia A Wren
    Abstract:

    PURPOSE: To compare the baseline Collaborative Initial Glaucoma Treatment Study (CIGTS) visual field (VF) score and mean deviation (MD), investigate test-retest variability, and identify variables associated with VF loss and VF measurement variability. METHODS: Baseline data from a randomized clinical trial of 607 patients with newly diagnosed open-angle Glaucoma were collected at 14 clinical centers. The CIGTS VF score and MD were obtained from 24-2 VF tests (Zeiss-Humphrey Systems, Dublin, CA) at two visits approximately 2 weeks apart. RESULTS: Although most baseline CIGTS VF scores showed limited field loss, 15% (91/607) of patients showed a substantial deficit (VF score >10 on a 0-20 scale). A small but significant learning effect was seen over the two baseline measures for CIGTS VF score and MD. CIGTS VF score and MD correlate highly (r = -0.93); both have high test-retest correlation (0.83 and 0.91, respectively). Variables associated with greater baseline VF loss for both CIGTS VF score and MD include (probabilities for VF only): male sex (P = 0.018), black race (P visual acuity (P

  • interim clinical outcomes in the collaborative initial Glaucoma Treatment study comparing initial Treatment randomized to medications or surgery
    Ophthalmology, 2001
    Co-Authors: Paul R Lichter, David C Musch, Nancy K Janz, Patricia A Wren, Kenneth E Guire, Brenda W Gillespie, M Richard P H P Mills
    Abstract:

    Purpose To report interim outcome data, using all available follow-up through 5 years after Treatment initiation, in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Design Randomized clinical trial. Participants Six hundred seven newly diagnosed Glaucoma patients. Methods In a randomized clinical trial, 607 patients with newly diagnosed open-angle Glaucoma were initially treated with either medication or trabeculectomy (with or without 5-fluorouracil). After Treatment onset and early follow-up, patients were evaluated clinically at 6-month intervals. In addition, quality of life telephone interviews were conducted at similar frequency to the clinical visits. Patients in both arms of CIGTS were treated aggressively in an effort to reduce intraocular pressure (IOP) to a level at or below a predetermined target pressure specific for each individual eye. Visual field (VF) scores were analyzed by time-specific comparisons and by repeated measures models. Main outcome measures VF loss was the primary outcome variable in CIGTS. Secondary outcomes of visual acuity (VA), IOP, and cataract were also studied. Results On the basis of completed follow-up through 4 years and partially completed through 5 years, VF loss did not differ significantly by initial Treatment. Over the entire period of follow-up, surgical patients had a greater risk of substantial VA loss compared with medical patients. However, by 4 years after Treatment, the average VA in the two groups was about equal. Over the course of follow-up, IOP in the medicine group has averaged 17 to 18 mmHg, whereas that in the surgery group averaged 14 to 15 mmHg. The rate of cataract requiring removal was greater in the surgically treated group. Conclusions Both initial medical or initial surgical therapy result in about the same VF outcome after up to 5 years of follow-up. VA loss was greater in the surgery group, but the differences between groups seem to be converging as follow-up continues. When aggressive Treatment aimed at substantial reduction in IOP from baseline is used, loss of VF can be seen to be minimal in general. Because 4 to 5 years of follow-up in a chronic disease is not adequate to draw Treatment conclusions, these interim CIGTS outcomes do not support altering current Treatment approaches to open-angle Glaucoma.