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Mae O Gordon - One of the best experts on this subject based on the ideXlab platform.
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densitometric profiles of optic disc hemorrhages in the Ocular Hypertension treatment study
American Journal of Ophthalmology, 2020Co-Authors: Clara C Cousins, Michael A Kass, Mae O Gordon, Jonathan Chou, Lucy Q Shen, Robert Ritch, Louis R PasqualeAbstract:Purpose The origin of blood in glaucoma-related disc hemorrhages (DH) remains unknown. A prior clinic-based study of primary open-angle glaucoma (POAG)-related DH showed that they had grayscale pixel intensities more similar to blood from retinal macroaneurysms and adjacent retinal arterioles than to blood from retinal vein occlusions or adjacent retinal venules, suggesting an arterial source. Here we assessed the densitometric profile of DH from fundus photographs in the Ocular Hypertension Treatment Study (OHTS). Design Retrospective cross-sectional study of prospectively collected images. Methods Stereo disc photographs of 161 DH events from 83 OHTS participants (mean age [standard deviation (SD)]: 65.6 [9.2] years; 46.6% female; 13.0% black race) were imported into ImageJ to measure densitometry differences (adjacent arterioles minus DH [ΔA] or venules minus DH [ΔV]). Their size as percentage of disc area, ratio of length to midpoint width, and location relative to the disc margin were also analyzed. We performed t tests to compare ΔA and ΔV, analysis of variance to compare ΔA and ΔV across DH recurrent events, and multivariable linear regression to identify determinants of ΔA and ΔV. Results Mean (SD) ΔA and ΔV were −2.2 (8.7) and −11.4 (9.7) pixel intensity units, respectively (P Conclusions OHTS DH had densitometric measurements more similar in magnitude to adjacent arterioles than venules, supporting an arterial origin for DH. Vascular dysregulation may contribute to disc hemorrhage formation in Ocular Hypertension.
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thirteen year follow up of optic disc hemorrhages in the Ocular Hypertension treatment study
American Journal of Ophthalmology, 2017Co-Authors: Donald L Budenz, Mae O Gordon, Julia Huecker, Steven J Gedde, Michael A KassAbstract:Purpose To determine the cumulative incidence of optic disc hemorrhage (ODH) before and after development of primary open-angle glaucoma (POAG); determine the prognostic significance of ODH for the development of POAG; and identify predictive factors for ODH. Design Prospective cohort study. Methods ODHs were evaluated in 3236 eyes of 1618 Ocular Hypertension Treatment Study (OHTS) participants annually using stereoscopic optic disc photographs. The incidence of ODH before and after the development of POAG, the risk of ODH for POAG, and risk factors for ODH were determined using a multivariate proportional hazards regression model. Results After a median follow-up of 13 years, 1 or more ODHs were detected in 179 eyes of 169 participants. The incidence of ODH was 0.5% per year during an average of 13 years before the development of POAG and 1.2% per year during an average of 6 years after the development of POAG. The cumulative incidence of POAG in eyes with ODH was 25.6% compared with 12.9% in eyes without ODH. The occurrence of an ODH increased the risk of developing POAG 2.6-fold in the multivariate analysis (95% confidence interval, 1.7–4.0; P Conclusion ODH is an independent predictive factor for the development of POAG in patients with Ocular Hypertension (OHT) and the predictive factors for ODH are very similar to those for POAG in OHT patients.
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reduction in intraOcular pressure after cataract extraction the Ocular Hypertension treatment study
Ophthalmology, 2012Co-Authors: Steven L Mansberger, Mae O Gordon, Henry D Jampel, Anjali M Bhorade, James D Brandt, Brad Wilson, Michael A KassAbstract:Purpose To determine the change in intraOcular pressure (IOP) after cataract extraction in the observation group of the Ocular Hypertension Treatment Study. Design Comparative case series. Participants Forty-two participants (63 eyes) who underwent cataract surgery in at least 1 eye during the study and a control group of 743 participants (743 eyes) who did not undergo cataract surgery. Methods We defined the "split date" as the study visit date at which cataract surgery was reported in the cataract surgery group and a corresponding date in the control group. Preoperative IOP was defined as the mean IOP of up to 3 visits before the split date. Postoperative IOP was the mean IOP of up to 3 visits including the split date (0, 6, and 12 months' with "0 months" equaling the split date). In both groups, we censored data after initiation of Ocular hypotensive medication or glaucoma surgery of any kind. Main Outcome Measures Difference in preoperative and postoperative IOP. Results In the cataract group, postoperative IOP was significantly lower than the preoperative IOP (19.8±3.2 mmHg vs. 23.9±3.2 mmHg; P Conclusions Cataract surgery decreases IOP in patients with Ocular Hypertension over a long period of time. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.
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longitudinal and cross sectional analyses of visual field progression in participants of the Ocular Hypertension treatment study
Archives of Ophthalmology, 2010Co-Authors: Paul H Artes, Chris A Johnson, John L Keltner, Kimberly E Cello, Mae O Gordon, Douglas R Anderson, Balwantray C Chauhan, Michael A KassAbstract:Objective To assess agreement between longitudinal and cross-sectional analyses for determining visual field progression in data from the Ocular Hypertension Treatment Study. Methods Visual field data from 3088 eyes of 1570 participants (median follow-up, 7 years) were analyzed. Longitudinal analyses were performed using change probability with total and pattern deviation, and cross-sectional analyses were performed using the glaucoma hemifield test, corrected pattern standard deviation, and mean deviation. The rates of mean deviation and general height change were compared to estimate the degree of diffuse loss in emerging glaucoma. Results Agreement on progression in longitudinal and cross-sectional analyses ranged from 50% to 61% and remained nearly constant across a wide range of criteria. In contrast, agreement on absence of progression ranged from 97.0% to 99.7%, being highest for the stricter criteria. Analyses of pattern deviation were more conservative than analyses of total deviation, with a 3 to 5 times lesser incidence of progression. Most participants developing field loss had both diffuse and focal changes. Conclusions Despite considerable overall agreement, 40% to 50% of eyes identified as having progressed with either longitudinal or cross-sectional analyses were identified with only one of the analyses. Because diffuse change is part of early glaucomatous damage, pattern deviation analyses may underestimate progression in patients with Ocular Hypertension.
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effect of patient s life expectancy on the cost effectiveness of treatment for Ocular Hypertension
Archives of Ophthalmology, 2010Co-Authors: Steven M Kymes, Michael A Kass, Michael Plotzke, Michael V Boland, Mae O GordonAbstract:Objective To assess the influence of expected life span on the cost-effectiveness of treating Ocular Hypertension to prevent primary open-angle glaucoma. Methods We used a Markov simulation model to estimate the cost and benefit of Ocular Hypertension treatment over a person's remaining life. We examined the influence of age on the cost-effectiveness decision in 2 ways: (1) by evaluating specific age cohorts to assess the influence of age at the initiation of treatment; and (2) by evaluating the influence of a specific life span. Results At a willingness to pay $50 000/quality-adjusted life year to $100 000/quality-adjusted life year, treatment of people with a 2% or greater annual risk of developing glaucoma was cost-effective for people aged 45 years with a life expectancy of at least 18 remaining years. However, to be cost-effective, a person aged 55 years must have a life expectancy of 21 remaining years and someone aged 65 years must have a life expectancy of 23 remaining years. Conclusions A person with Ocular Hypertension must have a life expectancy of at least 18 remaining years to justify treatment at a threshold of a 2% or greater annual risk of developing glaucoma. Persons at higher levels of risk require a life expectancy of 7 to 10 additional years to justify treatment.
Michael A Kass - One of the best experts on this subject based on the ideXlab platform.
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assessment of cumulative incidence and severity of primary open angle glaucoma among participants in the Ocular Hypertension treatment study after 20 years of follow up
JAMA Ophthalmology, 2021Co-Authors: Michael A Kass, Chris A Johnson, John L Keltner, Eve J Higginbotham, James D Brandt, Dale K Heuer, Richard K Parrish, Cheryl L Khanna, Joern B Soltau, Julia HueckerAbstract:Importance Ocular Hypertension is an important risk factor for the development of primary open-angle glaucoma (POAG). Data from long-term follow-up can be used to inform the management of patients with Ocular Hypertension. Objective To determine the cumulative incidence and severity of POAG after 20 years of follow-up among participants in the Ocular Hypertension Treatment Study. Design, Setting, and Participants Participants in the Ocular Hypertension Treatment Study were followed up from February 1994 to December 2008 in 22 clinics. Data were collected after 20 years of follow-up (from January 2016 to April 2019) or within 2 years of death. Analyses were performed from July 2019 to December 2020. Interventions From February 28, 1994, to June 2, 2002 (phase 1), participants were randomized to receive either topical Ocular hypotensive medication (medication group) or close observation (observation group). From June 3, 2002, to December 30, 2008 (phase 2), both randomization groups received medication. Beginning in 2009, treatment was no longer determined by study protocol. From January 7, 2016, to April 15, 2019 (phase 3), participants received ophthalmic examinations and visual function assessments. Main Outcomes and Measures Twenty-year cumulative incidence and severity of POAG in 1 or both eyes after adjustment for exposure time. Results A total of 1636 individuals (mean [SD] age, 55.4 [9.6] years; 931 women [56.9%]; 1138 White participants [69.6%]; 407 Black/African American participants [24.9%]) were randomized in phase 1 of the clinical trial. Of those, 483 participants (29.5%) developed POAG in 1 or both eyes (unadjusted incidence). After adjusting for exposure time, the 20-year cumulative incidence of POAG in 1 or both eyes was 45.6% (95% CI, 42.3%-48.8%) among all participants, 49.3% (95% CI, 44.5%-53.8%) among participants in the observation group, and 41.9% (95% CI, 37.2%-46.3%) among participants in the medication group. The 20-year cumulative incidence of POAG was 55.2% (95% CI, 47.9%-61.5%) among Black/African American participants and 42.7% (95% CI, 38.9%-46.3%) among participants of other races. The 20-year cumulative incidence for visual field loss was 25.2% (95% CI, 22.5%-27.8%). Using a 5-factor baseline model, the cumulative incidence of POAG among participants in the low-, medium-, and high-risk tertiles was 31.7% (95% CI, 26.4%-36.6%), 47.6% (95% CI, 41.6%-53.0%), and 59.8% (95% CI, 53.1%-65.5%), respectively. Conclusions and Relevance In this study, only one-fourth of participants in the Ocular Hypertension Treatment Study developed visual field loss in either eye over long-term follow-up. This information, together with a prediction model, may help clinicians and patients make informed personalized decisions about the management of Ocular Hypertension. Trial Registration ClinicalTrials.gov Identifier:NCT00000125.
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densitometric profiles of optic disc hemorrhages in the Ocular Hypertension treatment study
American Journal of Ophthalmology, 2020Co-Authors: Clara C Cousins, Michael A Kass, Mae O Gordon, Jonathan Chou, Lucy Q Shen, Robert Ritch, Louis R PasqualeAbstract:Purpose The origin of blood in glaucoma-related disc hemorrhages (DH) remains unknown. A prior clinic-based study of primary open-angle glaucoma (POAG)-related DH showed that they had grayscale pixel intensities more similar to blood from retinal macroaneurysms and adjacent retinal arterioles than to blood from retinal vein occlusions or adjacent retinal venules, suggesting an arterial source. Here we assessed the densitometric profile of DH from fundus photographs in the Ocular Hypertension Treatment Study (OHTS). Design Retrospective cross-sectional study of prospectively collected images. Methods Stereo disc photographs of 161 DH events from 83 OHTS participants (mean age [standard deviation (SD)]: 65.6 [9.2] years; 46.6% female; 13.0% black race) were imported into ImageJ to measure densitometry differences (adjacent arterioles minus DH [ΔA] or venules minus DH [ΔV]). Their size as percentage of disc area, ratio of length to midpoint width, and location relative to the disc margin were also analyzed. We performed t tests to compare ΔA and ΔV, analysis of variance to compare ΔA and ΔV across DH recurrent events, and multivariable linear regression to identify determinants of ΔA and ΔV. Results Mean (SD) ΔA and ΔV were −2.2 (8.7) and −11.4 (9.7) pixel intensity units, respectively (P Conclusions OHTS DH had densitometric measurements more similar in magnitude to adjacent arterioles than venules, supporting an arterial origin for DH. Vascular dysregulation may contribute to disc hemorrhage formation in Ocular Hypertension.
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thirteen year follow up of optic disc hemorrhages in the Ocular Hypertension treatment study
American Journal of Ophthalmology, 2017Co-Authors: Donald L Budenz, Mae O Gordon, Julia Huecker, Steven J Gedde, Michael A KassAbstract:Purpose To determine the cumulative incidence of optic disc hemorrhage (ODH) before and after development of primary open-angle glaucoma (POAG); determine the prognostic significance of ODH for the development of POAG; and identify predictive factors for ODH. Design Prospective cohort study. Methods ODHs were evaluated in 3236 eyes of 1618 Ocular Hypertension Treatment Study (OHTS) participants annually using stereoscopic optic disc photographs. The incidence of ODH before and after the development of POAG, the risk of ODH for POAG, and risk factors for ODH were determined using a multivariate proportional hazards regression model. Results After a median follow-up of 13 years, 1 or more ODHs were detected in 179 eyes of 169 participants. The incidence of ODH was 0.5% per year during an average of 13 years before the development of POAG and 1.2% per year during an average of 6 years after the development of POAG. The cumulative incidence of POAG in eyes with ODH was 25.6% compared with 12.9% in eyes without ODH. The occurrence of an ODH increased the risk of developing POAG 2.6-fold in the multivariate analysis (95% confidence interval, 1.7–4.0; P Conclusion ODH is an independent predictive factor for the development of POAG in patients with Ocular Hypertension (OHT) and the predictive factors for ODH are very similar to those for POAG in OHT patients.
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reduction in intraOcular pressure after cataract extraction the Ocular Hypertension treatment study
Ophthalmology, 2012Co-Authors: Steven L Mansberger, Mae O Gordon, Henry D Jampel, Anjali M Bhorade, James D Brandt, Brad Wilson, Michael A KassAbstract:Purpose To determine the change in intraOcular pressure (IOP) after cataract extraction in the observation group of the Ocular Hypertension Treatment Study. Design Comparative case series. Participants Forty-two participants (63 eyes) who underwent cataract surgery in at least 1 eye during the study and a control group of 743 participants (743 eyes) who did not undergo cataract surgery. Methods We defined the "split date" as the study visit date at which cataract surgery was reported in the cataract surgery group and a corresponding date in the control group. Preoperative IOP was defined as the mean IOP of up to 3 visits before the split date. Postoperative IOP was the mean IOP of up to 3 visits including the split date (0, 6, and 12 months' with "0 months" equaling the split date). In both groups, we censored data after initiation of Ocular hypotensive medication or glaucoma surgery of any kind. Main Outcome Measures Difference in preoperative and postoperative IOP. Results In the cataract group, postoperative IOP was significantly lower than the preoperative IOP (19.8±3.2 mmHg vs. 23.9±3.2 mmHg; P Conclusions Cataract surgery decreases IOP in patients with Ocular Hypertension over a long period of time. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.
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longitudinal and cross sectional analyses of visual field progression in participants of the Ocular Hypertension treatment study
Archives of Ophthalmology, 2010Co-Authors: Paul H Artes, Chris A Johnson, John L Keltner, Kimberly E Cello, Mae O Gordon, Douglas R Anderson, Balwantray C Chauhan, Michael A KassAbstract:Objective To assess agreement between longitudinal and cross-sectional analyses for determining visual field progression in data from the Ocular Hypertension Treatment Study. Methods Visual field data from 3088 eyes of 1570 participants (median follow-up, 7 years) were analyzed. Longitudinal analyses were performed using change probability with total and pattern deviation, and cross-sectional analyses were performed using the glaucoma hemifield test, corrected pattern standard deviation, and mean deviation. The rates of mean deviation and general height change were compared to estimate the degree of diffuse loss in emerging glaucoma. Results Agreement on progression in longitudinal and cross-sectional analyses ranged from 50% to 61% and remained nearly constant across a wide range of criteria. In contrast, agreement on absence of progression ranged from 97.0% to 99.7%, being highest for the stricter criteria. Analyses of pattern deviation were more conservative than analyses of total deviation, with a 3 to 5 times lesser incidence of progression. Most participants developing field loss had both diffuse and focal changes. Conclusions Despite considerable overall agreement, 40% to 50% of eyes identified as having progressed with either longitudinal or cross-sectional analyses were identified with only one of the analyses. Because diffuse change is part of early glaucomatous damage, pattern deviation analyses may underestimate progression in patients with Ocular Hypertension.
John L Keltner - One of the best experts on this subject based on the ideXlab platform.
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assessment of cumulative incidence and severity of primary open angle glaucoma among participants in the Ocular Hypertension treatment study after 20 years of follow up
JAMA Ophthalmology, 2021Co-Authors: Michael A Kass, Chris A Johnson, John L Keltner, Eve J Higginbotham, James D Brandt, Dale K Heuer, Richard K Parrish, Cheryl L Khanna, Joern B Soltau, Julia HueckerAbstract:Importance Ocular Hypertension is an important risk factor for the development of primary open-angle glaucoma (POAG). Data from long-term follow-up can be used to inform the management of patients with Ocular Hypertension. Objective To determine the cumulative incidence and severity of POAG after 20 years of follow-up among participants in the Ocular Hypertension Treatment Study. Design, Setting, and Participants Participants in the Ocular Hypertension Treatment Study were followed up from February 1994 to December 2008 in 22 clinics. Data were collected after 20 years of follow-up (from January 2016 to April 2019) or within 2 years of death. Analyses were performed from July 2019 to December 2020. Interventions From February 28, 1994, to June 2, 2002 (phase 1), participants were randomized to receive either topical Ocular hypotensive medication (medication group) or close observation (observation group). From June 3, 2002, to December 30, 2008 (phase 2), both randomization groups received medication. Beginning in 2009, treatment was no longer determined by study protocol. From January 7, 2016, to April 15, 2019 (phase 3), participants received ophthalmic examinations and visual function assessments. Main Outcomes and Measures Twenty-year cumulative incidence and severity of POAG in 1 or both eyes after adjustment for exposure time. Results A total of 1636 individuals (mean [SD] age, 55.4 [9.6] years; 931 women [56.9%]; 1138 White participants [69.6%]; 407 Black/African American participants [24.9%]) were randomized in phase 1 of the clinical trial. Of those, 483 participants (29.5%) developed POAG in 1 or both eyes (unadjusted incidence). After adjusting for exposure time, the 20-year cumulative incidence of POAG in 1 or both eyes was 45.6% (95% CI, 42.3%-48.8%) among all participants, 49.3% (95% CI, 44.5%-53.8%) among participants in the observation group, and 41.9% (95% CI, 37.2%-46.3%) among participants in the medication group. The 20-year cumulative incidence of POAG was 55.2% (95% CI, 47.9%-61.5%) among Black/African American participants and 42.7% (95% CI, 38.9%-46.3%) among participants of other races. The 20-year cumulative incidence for visual field loss was 25.2% (95% CI, 22.5%-27.8%). Using a 5-factor baseline model, the cumulative incidence of POAG among participants in the low-, medium-, and high-risk tertiles was 31.7% (95% CI, 26.4%-36.6%), 47.6% (95% CI, 41.6%-53.0%), and 59.8% (95% CI, 53.1%-65.5%), respectively. Conclusions and Relevance In this study, only one-fourth of participants in the Ocular Hypertension Treatment Study developed visual field loss in either eye over long-term follow-up. This information, together with a prediction model, may help clinicians and patients make informed personalized decisions about the management of Ocular Hypertension. Trial Registration ClinicalTrials.gov Identifier:NCT00000125.
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longitudinal and cross sectional analyses of visual field progression in participants of the Ocular Hypertension treatment study
Archives of Ophthalmology, 2010Co-Authors: Paul H Artes, Chris A Johnson, John L Keltner, Kimberly E Cello, Mae O Gordon, Douglas R Anderson, Balwantray C Chauhan, Michael A KassAbstract:Objective To assess agreement between longitudinal and cross-sectional analyses for determining visual field progression in data from the Ocular Hypertension Treatment Study. Methods Visual field data from 3088 eyes of 1570 participants (median follow-up, 7 years) were analyzed. Longitudinal analyses were performed using change probability with total and pattern deviation, and cross-sectional analyses were performed using the glaucoma hemifield test, corrected pattern standard deviation, and mean deviation. The rates of mean deviation and general height change were compared to estimate the degree of diffuse loss in emerging glaucoma. Results Agreement on progression in longitudinal and cross-sectional analyses ranged from 50% to 61% and remained nearly constant across a wide range of criteria. In contrast, agreement on absence of progression ranged from 97.0% to 99.7%, being highest for the stricter criteria. Analyses of pattern deviation were more conservative than analyses of total deviation, with a 3 to 5 times lesser incidence of progression. Most participants developing field loss had both diffuse and focal changes. Conclusions Despite considerable overall agreement, 40% to 50% of eyes identified as having progressed with either longitudinal or cross-sectional analyses were identified with only one of the analyses. Because diffuse change is part of early glaucomatous damage, pattern deviation analyses may underestimate progression in patients with Ocular Hypertension.
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normal visual field test results following glaucomatous visual field end points in the Ocular Hypertension treatment study
Archives of Ophthalmology, 2005Co-Authors: John L Keltner, Chris A Johnson, Richard A Levine, Kimberly E Cello, Michael A Kass, Mae O GordonAbstract:Objective To compare the occurrence of normal visual field (VF) test results following 2 vs 3 consecutive, abnormal, reliable test results in the Ocular Hypertension Treatment Study. Methods The Ocular Hypertension Treatment Study is a prospective, multicenter follow-up study as part of a longitudinal randomized clinical trial. Sixty-four (68 eyes) of 1636 participants developed a VF primary open-angle glaucoma (POAG) end point. We compared the proportion of normal VF test results after a VF POAG end point among eyes whose VF abnormality was confirmed by 2 (n = . eyes) vs 3 (n = 59 eyes) consecutive, abnormal, reliable VF test results. Results The proportion of VF test results that were normal subsequent to a VF POAG end point in eyes whose abnormality was confirmed by 2 consecutive, abnormal, reliable test results was significantly higher (73 [66%] of 110) compared with eyes whose abnormality was confirmed by 3 consecutive, abnormal, reliable test results (46 [12%] of 381) ( P = .01). Conclusions A VF POAG end point confirmed by 3 consecutive, abnormal, reliable VF test results appears to have greater specificity and stability than either 1 or 2 consecutive, abnormal, reliable VF test results. However, some eyes whose VF POAG end point was confirmed by 3 consecutive, abnormal, reliable test results nonetheless had 1 or more normal test results on follow-up.
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the Ocular Hypertension treatment study baseline factors that predict the onset of primary open angle glaucoma
Archives of Ophthalmology, 2002Co-Authors: Mae O Gordon, Chris A Johnson, John L Keltner, Eve J Higginbotham, James D Brandt, Dale K Heuer, Richard K Parrish, Julia A Beiser, Philip J Miller, Roy M WilsonAbstract:Background The Ocular Hypertension Treatment Study (OHTS) has shown that topical Ocular hypotensive medication is effective in delaying or preventing the onset of primary open-angle glaucoma (POAG) in individuals with elevated intraOcular pressure (Ocular Hypertension) and no evidence of glaucomatous damage. Objective To describe baseline demographic and clinical factors that predict which participants in the OHTS developed POAG. Methods Baseline demographic and clinical data were collected prior to randomization except for corneal thickness measurements, which were performed during follow-up. Proportional hazards models were used to identify factors that predicted which participants in the OHTS developed POAG. Results In univariate analyses, baseline factors that predicted the development of POAG included older age, race (African American), sex (male), larger vertical cup-disc ratio, larger horizontal cup-disc ratio, higher intraOcular pressure, greater Humphrey visual field pattern standard deviation, heart disease, and thinner central corneal measurement. In multivariate analyses, baseline factors that predicted the development of POAG included older age, larger vertical or horizontal cup-disc ratio, higher intraOcular pressure, greater pattern standard deviation, and thinner central corneal measurement. Conclusions Baseline age, vertical and horizontal cup-disc ratio, pattern standard deviation, and intraOcular pressure were good predictors for the onset of POAG in the OHTS. Central corneal thickness was found to be a powerful predictor for the development of POAG.
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confirmation of visual field abnormalities in the Ocular Hypertension treatment study Ocular Hypertension treatment study group
Archives of Ophthalmology, 2000Co-Authors: John L Keltner, Chris A Johnson, Kimberly E Cello, Michael A Kass, Jacqueline M Quigg, Mae O GordonAbstract:OBJECTIVE: To determine the frequency with which visual field abnormalities observed on follow-up visual fields for patients in the Ocular Hypertension Treatment Study were confirmed on retest. METHODS: Between April 1, 1994, and March 1, 1999, 21,603 visual fields were obtained from 1637 patients in the Ocular Hypertension Treatment Study. When follow-up visual fields are outside the normal limits on the Glaucoma Hemifield Test, the Corrected Pattern Standard Deviation (P<.05), or both, subsequent follow-up visual fields are monitored to confirm the abnormality. Abnormalities are confirmed if they are again abnormal on the Glaucoma Hemifield Test, the Corrected Pattern Standard Deviation, or both; if the defect is not artifactual; and if the same index and location are involved. Reliability criteria used by the study consisted of a limit of 33% for false positives, false negatives, and fixation losses. RESULTS: Of the 21,603 regular follow-up visual fields, 1006 were follow-up retests performed because of an abnormality (n = 748) or unreliability (n = 258). We found that 703 (94%) of the 748 visual fields were abnormal and reliable, and 45 (6%) were abnormal and unreliable. On retesting, abnormalities were not confirmed for 604 (85.9%) of the 703 originally abnormal and reliable visual fields. CONCLUSIONS: Most visual field abnormalities in patients in the Ocular Hypertension Treatment Study were not verified on retest. Confirmation of visual field abnormalities is essential for distinguishing reproducible visual field loss from long-term variability. Arch Ophthalmol. 2000;118:1187-1194
Chris A Johnson - One of the best experts on this subject based on the ideXlab platform.
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assessment of cumulative incidence and severity of primary open angle glaucoma among participants in the Ocular Hypertension treatment study after 20 years of follow up
JAMA Ophthalmology, 2021Co-Authors: Michael A Kass, Chris A Johnson, John L Keltner, Eve J Higginbotham, James D Brandt, Dale K Heuer, Richard K Parrish, Cheryl L Khanna, Joern B Soltau, Julia HueckerAbstract:Importance Ocular Hypertension is an important risk factor for the development of primary open-angle glaucoma (POAG). Data from long-term follow-up can be used to inform the management of patients with Ocular Hypertension. Objective To determine the cumulative incidence and severity of POAG after 20 years of follow-up among participants in the Ocular Hypertension Treatment Study. Design, Setting, and Participants Participants in the Ocular Hypertension Treatment Study were followed up from February 1994 to December 2008 in 22 clinics. Data were collected after 20 years of follow-up (from January 2016 to April 2019) or within 2 years of death. Analyses were performed from July 2019 to December 2020. Interventions From February 28, 1994, to June 2, 2002 (phase 1), participants were randomized to receive either topical Ocular hypotensive medication (medication group) or close observation (observation group). From June 3, 2002, to December 30, 2008 (phase 2), both randomization groups received medication. Beginning in 2009, treatment was no longer determined by study protocol. From January 7, 2016, to April 15, 2019 (phase 3), participants received ophthalmic examinations and visual function assessments. Main Outcomes and Measures Twenty-year cumulative incidence and severity of POAG in 1 or both eyes after adjustment for exposure time. Results A total of 1636 individuals (mean [SD] age, 55.4 [9.6] years; 931 women [56.9%]; 1138 White participants [69.6%]; 407 Black/African American participants [24.9%]) were randomized in phase 1 of the clinical trial. Of those, 483 participants (29.5%) developed POAG in 1 or both eyes (unadjusted incidence). After adjusting for exposure time, the 20-year cumulative incidence of POAG in 1 or both eyes was 45.6% (95% CI, 42.3%-48.8%) among all participants, 49.3% (95% CI, 44.5%-53.8%) among participants in the observation group, and 41.9% (95% CI, 37.2%-46.3%) among participants in the medication group. The 20-year cumulative incidence of POAG was 55.2% (95% CI, 47.9%-61.5%) among Black/African American participants and 42.7% (95% CI, 38.9%-46.3%) among participants of other races. The 20-year cumulative incidence for visual field loss was 25.2% (95% CI, 22.5%-27.8%). Using a 5-factor baseline model, the cumulative incidence of POAG among participants in the low-, medium-, and high-risk tertiles was 31.7% (95% CI, 26.4%-36.6%), 47.6% (95% CI, 41.6%-53.0%), and 59.8% (95% CI, 53.1%-65.5%), respectively. Conclusions and Relevance In this study, only one-fourth of participants in the Ocular Hypertension Treatment Study developed visual field loss in either eye over long-term follow-up. This information, together with a prediction model, may help clinicians and patients make informed personalized decisions about the management of Ocular Hypertension. Trial Registration ClinicalTrials.gov Identifier:NCT00000125.
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longitudinal and cross sectional analyses of visual field progression in participants of the Ocular Hypertension treatment study
Archives of Ophthalmology, 2010Co-Authors: Paul H Artes, Chris A Johnson, John L Keltner, Kimberly E Cello, Mae O Gordon, Douglas R Anderson, Balwantray C Chauhan, Michael A KassAbstract:Objective To assess agreement between longitudinal and cross-sectional analyses for determining visual field progression in data from the Ocular Hypertension Treatment Study. Methods Visual field data from 3088 eyes of 1570 participants (median follow-up, 7 years) were analyzed. Longitudinal analyses were performed using change probability with total and pattern deviation, and cross-sectional analyses were performed using the glaucoma hemifield test, corrected pattern standard deviation, and mean deviation. The rates of mean deviation and general height change were compared to estimate the degree of diffuse loss in emerging glaucoma. Results Agreement on progression in longitudinal and cross-sectional analyses ranged from 50% to 61% and remained nearly constant across a wide range of criteria. In contrast, agreement on absence of progression ranged from 97.0% to 99.7%, being highest for the stricter criteria. Analyses of pattern deviation were more conservative than analyses of total deviation, with a 3 to 5 times lesser incidence of progression. Most participants developing field loss had both diffuse and focal changes. Conclusions Despite considerable overall agreement, 40% to 50% of eyes identified as having progressed with either longitudinal or cross-sectional analyses were identified with only one of the analyses. Because diffuse change is part of early glaucomatous damage, pattern deviation analyses may underestimate progression in patients with Ocular Hypertension.
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normal visual field test results following glaucomatous visual field end points in the Ocular Hypertension treatment study
Archives of Ophthalmology, 2005Co-Authors: John L Keltner, Chris A Johnson, Richard A Levine, Kimberly E Cello, Michael A Kass, Mae O GordonAbstract:Objective To compare the occurrence of normal visual field (VF) test results following 2 vs 3 consecutive, abnormal, reliable test results in the Ocular Hypertension Treatment Study. Methods The Ocular Hypertension Treatment Study is a prospective, multicenter follow-up study as part of a longitudinal randomized clinical trial. Sixty-four (68 eyes) of 1636 participants developed a VF primary open-angle glaucoma (POAG) end point. We compared the proportion of normal VF test results after a VF POAG end point among eyes whose VF abnormality was confirmed by 2 (n = . eyes) vs 3 (n = 59 eyes) consecutive, abnormal, reliable VF test results. Results The proportion of VF test results that were normal subsequent to a VF POAG end point in eyes whose abnormality was confirmed by 2 consecutive, abnormal, reliable test results was significantly higher (73 [66%] of 110) compared with eyes whose abnormality was confirmed by 3 consecutive, abnormal, reliable test results (46 [12%] of 381) ( P = .01). Conclusions A VF POAG end point confirmed by 3 consecutive, abnormal, reliable VF test results appears to have greater specificity and stability than either 1 or 2 consecutive, abnormal, reliable VF test results. However, some eyes whose VF POAG end point was confirmed by 3 consecutive, abnormal, reliable test results nonetheless had 1 or more normal test results on follow-up.
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the Ocular Hypertension treatment study baseline factors that predict the onset of primary open angle glaucoma
Archives of Ophthalmology, 2002Co-Authors: Mae O Gordon, Chris A Johnson, John L Keltner, Eve J Higginbotham, James D Brandt, Dale K Heuer, Richard K Parrish, Julia A Beiser, Philip J Miller, Roy M WilsonAbstract:Background The Ocular Hypertension Treatment Study (OHTS) has shown that topical Ocular hypotensive medication is effective in delaying or preventing the onset of primary open-angle glaucoma (POAG) in individuals with elevated intraOcular pressure (Ocular Hypertension) and no evidence of glaucomatous damage. Objective To describe baseline demographic and clinical factors that predict which participants in the OHTS developed POAG. Methods Baseline demographic and clinical data were collected prior to randomization except for corneal thickness measurements, which were performed during follow-up. Proportional hazards models were used to identify factors that predicted which participants in the OHTS developed POAG. Results In univariate analyses, baseline factors that predicted the development of POAG included older age, race (African American), sex (male), larger vertical cup-disc ratio, larger horizontal cup-disc ratio, higher intraOcular pressure, greater Humphrey visual field pattern standard deviation, heart disease, and thinner central corneal measurement. In multivariate analyses, baseline factors that predicted the development of POAG included older age, larger vertical or horizontal cup-disc ratio, higher intraOcular pressure, greater pattern standard deviation, and thinner central corneal measurement. Conclusions Baseline age, vertical and horizontal cup-disc ratio, pattern standard deviation, and intraOcular pressure were good predictors for the onset of POAG in the OHTS. Central corneal thickness was found to be a powerful predictor for the development of POAG.
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confirmation of visual field abnormalities in the Ocular Hypertension treatment study Ocular Hypertension treatment study group
Archives of Ophthalmology, 2000Co-Authors: John L Keltner, Chris A Johnson, Kimberly E Cello, Michael A Kass, Jacqueline M Quigg, Mae O GordonAbstract:OBJECTIVE: To determine the frequency with which visual field abnormalities observed on follow-up visual fields for patients in the Ocular Hypertension Treatment Study were confirmed on retest. METHODS: Between April 1, 1994, and March 1, 1999, 21,603 visual fields were obtained from 1637 patients in the Ocular Hypertension Treatment Study. When follow-up visual fields are outside the normal limits on the Glaucoma Hemifield Test, the Corrected Pattern Standard Deviation (P<.05), or both, subsequent follow-up visual fields are monitored to confirm the abnormality. Abnormalities are confirmed if they are again abnormal on the Glaucoma Hemifield Test, the Corrected Pattern Standard Deviation, or both; if the defect is not artifactual; and if the same index and location are involved. Reliability criteria used by the study consisted of a limit of 33% for false positives, false negatives, and fixation losses. RESULTS: Of the 21,603 regular follow-up visual fields, 1006 were follow-up retests performed because of an abnormality (n = 748) or unreliability (n = 258). We found that 703 (94%) of the 748 visual fields were abnormal and reliable, and 45 (6%) were abnormal and unreliable. On retesting, abnormalities were not confirmed for 604 (85.9%) of the 703 originally abnormal and reliable visual fields. CONCLUSIONS: Most visual field abnormalities in patients in the Ocular Hypertension Treatment Study were not verified on retest. Confirmation of visual field abnormalities is essential for distinguishing reproducible visual field loss from long-term variability. Arch Ophthalmol. 2000;118:1187-1194
Kimberly E Cello - One of the best experts on this subject based on the ideXlab platform.
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longitudinal and cross sectional analyses of visual field progression in participants of the Ocular Hypertension treatment study
Archives of Ophthalmology, 2010Co-Authors: Paul H Artes, Chris A Johnson, John L Keltner, Kimberly E Cello, Mae O Gordon, Douglas R Anderson, Balwantray C Chauhan, Michael A KassAbstract:Objective To assess agreement between longitudinal and cross-sectional analyses for determining visual field progression in data from the Ocular Hypertension Treatment Study. Methods Visual field data from 3088 eyes of 1570 participants (median follow-up, 7 years) were analyzed. Longitudinal analyses were performed using change probability with total and pattern deviation, and cross-sectional analyses were performed using the glaucoma hemifield test, corrected pattern standard deviation, and mean deviation. The rates of mean deviation and general height change were compared to estimate the degree of diffuse loss in emerging glaucoma. Results Agreement on progression in longitudinal and cross-sectional analyses ranged from 50% to 61% and remained nearly constant across a wide range of criteria. In contrast, agreement on absence of progression ranged from 97.0% to 99.7%, being highest for the stricter criteria. Analyses of pattern deviation were more conservative than analyses of total deviation, with a 3 to 5 times lesser incidence of progression. Most participants developing field loss had both diffuse and focal changes. Conclusions Despite considerable overall agreement, 40% to 50% of eyes identified as having progressed with either longitudinal or cross-sectional analyses were identified with only one of the analyses. Because diffuse change is part of early glaucomatous damage, pattern deviation analyses may underestimate progression in patients with Ocular Hypertension.
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normal visual field test results following glaucomatous visual field end points in the Ocular Hypertension treatment study
Archives of Ophthalmology, 2005Co-Authors: John L Keltner, Chris A Johnson, Richard A Levine, Kimberly E Cello, Michael A Kass, Mae O GordonAbstract:Objective To compare the occurrence of normal visual field (VF) test results following 2 vs 3 consecutive, abnormal, reliable test results in the Ocular Hypertension Treatment Study. Methods The Ocular Hypertension Treatment Study is a prospective, multicenter follow-up study as part of a longitudinal randomized clinical trial. Sixty-four (68 eyes) of 1636 participants developed a VF primary open-angle glaucoma (POAG) end point. We compared the proportion of normal VF test results after a VF POAG end point among eyes whose VF abnormality was confirmed by 2 (n = . eyes) vs 3 (n = 59 eyes) consecutive, abnormal, reliable VF test results. Results The proportion of VF test results that were normal subsequent to a VF POAG end point in eyes whose abnormality was confirmed by 2 consecutive, abnormal, reliable test results was significantly higher (73 [66%] of 110) compared with eyes whose abnormality was confirmed by 3 consecutive, abnormal, reliable test results (46 [12%] of 381) ( P = .01). Conclusions A VF POAG end point confirmed by 3 consecutive, abnormal, reliable VF test results appears to have greater specificity and stability than either 1 or 2 consecutive, abnormal, reliable VF test results. However, some eyes whose VF POAG end point was confirmed by 3 consecutive, abnormal, reliable test results nonetheless had 1 or more normal test results on follow-up.
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confirmation of visual field abnormalities in the Ocular Hypertension treatment study Ocular Hypertension treatment study group
Archives of Ophthalmology, 2000Co-Authors: John L Keltner, Chris A Johnson, Kimberly E Cello, Michael A Kass, Jacqueline M Quigg, Mae O GordonAbstract:OBJECTIVE: To determine the frequency with which visual field abnormalities observed on follow-up visual fields for patients in the Ocular Hypertension Treatment Study were confirmed on retest. METHODS: Between April 1, 1994, and March 1, 1999, 21,603 visual fields were obtained from 1637 patients in the Ocular Hypertension Treatment Study. When follow-up visual fields are outside the normal limits on the Glaucoma Hemifield Test, the Corrected Pattern Standard Deviation (P<.05), or both, subsequent follow-up visual fields are monitored to confirm the abnormality. Abnormalities are confirmed if they are again abnormal on the Glaucoma Hemifield Test, the Corrected Pattern Standard Deviation, or both; if the defect is not artifactual; and if the same index and location are involved. Reliability criteria used by the study consisted of a limit of 33% for false positives, false negatives, and fixation losses. RESULTS: Of the 21,603 regular follow-up visual fields, 1006 were follow-up retests performed because of an abnormality (n = 748) or unreliability (n = 258). We found that 703 (94%) of the 748 visual fields were abnormal and reliable, and 45 (6%) were abnormal and unreliable. On retesting, abnormalities were not confirmed for 604 (85.9%) of the 703 originally abnormal and reliable visual fields. CONCLUSIONS: Most visual field abnormalities in patients in the Ocular Hypertension Treatment Study were not verified on retest. Confirmation of visual field abnormalities is essential for distinguishing reproducible visual field loss from long-term variability. Arch Ophthalmol. 2000;118:1187-1194
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classification of visual field abnormalities in the Ocular Hypertension treatment study
Archives of Ophthalmology, 2000Co-Authors: John L Keltner, Chris A Johnson, Kimberly E Cello, Michael A Kass, Jacqueline M Quigg, Mae O GordonAbstract:Objectives (1) To develop a classification system for visual field (VF) abnormalities, (2) to determine interreader and test-retest agreement, and (3) to determine the frequency of various VF defects in the Ocular Hypertension Treatment Study. Methods Follow-up VFs are performed every 6 months and are monitored for abnormality, indicated by a glaucoma hemifield test result or a corrected pattern SDoutside the normal limits. As of January 1, 2002, 1636patients had 2509 abnormal VFs. Three readers independently classified each hemifield using a classification system developed at the VF reading center. Asubset (50%) of the abnormal VFs was reread to evaluate test-retest reader agreement. A mean deviation was calculated separately for the hemifields as an index to the severity of VF loss. Main Outcome Measures A 97% interreader hemifield agreement. Results The average hemifield classification agreement (between any 2 of 3 readers) for 5018 hemifields was 97% and 88% for the 1266 abnormal VFs that were reread(agreement between the first and second classifications). Glaucomatous patterns of loss (partial arcuate, paracentral, and nasal step defects) composed the majority of VF defects. Conclusion The Ocular Hypertension Treatment Study classification system has high reproducibility and provides a possible nomenclature for characterizing VF defects.
