Faculty Bibliography

OBJECTIVE:To investigate the association of psychosocial factors with health self-management behaviors and beliefs among patients with POAG. DESIGN/METHODS:Prospective cross-sectional cohort study. PARTICIPANTS/METHODS:Patients (n=202) with mild, moderate, or advanced bilateral POAG. METHODS:Patients (n=1,164) were identified from electronic medical records at a single academic medical center. Letters soliciting participation were mailed to 591 randomly selected potential participants. Psychometric measures and a determinants of health questionnaire were administered by phone to 202 study participants. MAIN OUTCOME MEASURES/METHODS:The NEI VFQ-8 (NEI-VFQ), the Multidimensional Health Locus of Control (MHLC), the Perceived Medical Condition Self-Management Scale-4 (PMCSMS), the Patient Health Questionnaire-9 (PHQ), the Patient Activation Measure-13 (PAM), health literacy and a determinants of health questionnaire. RESULTS:=2.6%, 95% CI= [-0.664,-0.051], p=0.023). On multivariate analysis adjusting for age, sex and race, for each unit increase in PHQ, mean PAM score decreased (95% CI = [0.061,1.35], p=0.032); for each unit increase in MHLC 'Doctors', mean PAM score increased (95% CI=[-1.448,3.453], p<0.001); for each unit increase in MHLC 'Internal', mean PAM score increased (95% CI=[0.639,1.137 ], p<0.001); for each unit increase in MHLC 'Chance' , mean PAM score decreased (95% CI=[-0.685,-0.098], p=0.009). CONCLUSION/CONCLUSIONS:We identified modifiable behavioral factors that could increase patients' self-perceived ability and confidence to manage their own eye care. Locus of control (MHLC), level of depression (PHQ), and self-rated functional vision (NEI-VFQ) were each associated with patient behaviors, attitudes and beliefs needed for health self-management (activation, assessed by the PAM) and may be important determinants of adherence behaviors. Targeting change in patients' care beliefs and behaviors may improve activation and treatment outcomes.

Purpose:To investigate the ocular surface microbiome of patients with unilateral or asymmetric glaucoma being treated with topical ophthalmic medications in one eye and to determine whether microbial community changes were related to measures of ocular surface disease. Methods:V3-V4 16S rRNA sequencing was conducted on ocular surface swabs collected from both eyes of 17 subjects: 10 patients with asymmetric/unilateral glaucoma using topical glaucoma therapy on only one eye and seven age-matched, healthy controls with no history of ocular disease or eyedrop use. Samples were categorized into three groups: patients' glaucomatous eye treated with eyedrops, patients' contralateral eye without eyedrops, and healthy control eyes. Comparisons were made for microbial diversity and composition, with differences in composition tested for association with ocular surface disease measures including tear meniscus height, tear break-up time, and Dry Eye Questionnaire. Results:Samples obtained from the patients' treated and untreated eyes both had significantly greater alpha-diversity and relative abundance of gram-negative organisms compared to healthy controls. The microbial composition of patient eyes was associated with decreased tear meniscus height and tear break-up time, whereas metagenomic predictions, based on 16S rRNA data, suggested increased synthesis of lipopolysaccharide. Conclusions:The ocular surface microbiome of patients taking unilateral preserved glaucoma drops is characterized by a highly diverse array of gram-negative bacteria that is significantly different from the predominantly gram-positive microbes detected on healthy control eyes. These compositional differences were associated with decreased tear film measures and distinct inferred protein synthesis pathways, suggesting a potential link between microbial alterations and ocular surface inflammation.

OBJECTIVE:To understand the problems involved in using global OCT measures for detecting progression in early glaucoma. SUBJECTS/METHODS/METHODS:, were calculated. Using quantile regression, the 95% CI intervals were determined. Eyes outside the CIs were classified as "progressors." For a reference standard (RS), four experts evaluated OCT and VF information. RESULTS:falsely identified (false positive, FP) 10 (22.2%) of 45 patient RS-NP eyes and 7 (25%) of the 28 HC eyes as progressing. Post-hoc analysis identified three reasons (segmentation, centring, and local damage) for these errors. CONCLUSIONS:for detecting progression.

PURPOSE/OBJECTIVE:To compare the variability and ability to detect visual field progression of 24-2, central 12 locations of the 24-2 and 10-2 visual field (VF) tests in eyes with abnormal VFs. DESIGN/METHODS:Retrospective, multisite cohort. PARTICIPANTS/METHODS:A total of 52,806 24-2 and 11,966 10-2 VF tests from 7,307 eyes from the Glaucoma Research Network database were analyzed. Only eyes with ≥ 5 visits and ≥ 2 years of follow-up were included. METHODS:Linear regression models were used to calculate the rates of MD (Mean Deviation) change (slopes) while their residuals were used to assess variability across the entire MD range. Computer simulations (n=10,000) based upon real MD residuals of our sample were performed to estimate power to detect significant progression (P < 5%) at various rates of MD change. MAIN OUTCOME MEASURES/METHODS:Time required to detect progression. RESULTS:For all 3 patterns, the MD variability was highest within the -5 to -20 dB range and consistently lower with the 10-2 compared to 24-2 or Central 24-2. Overall, time to detect confirmed significant progression at 80% power was the lowest with 10-2 VF, with a decrease of 14.6% to 18.5% when compared to 24-2 and a decrease of 22.9% to 26.5% when compared to Central 24-2. CONCLUSION/CONCLUSIONS:Time to detect central VF progression was reduced with 10-2 MD compared with 24-2 and C24-2 MD in glaucoma eyes in this large dataset, in part because 10-2 tests had lower variability. These findings contribute to current evidence of the potential value of 10-2 testing in the clinical management of glaucoma patients and in clinical trial design.

PURPOSE/OBJECTIVE:To develop deep learning (DL) systems estimating visual function from macula-centered spectral domain optical coherence tomography (SDOCT) images. DESIGN/METHODS:Evaluation of a diagnostic technology PARTICIPANTS: 2,408 10-2 visual field (VF)-SDOCT pairs and 2,999 24-2 VF-SDOCT pairs collected from 645 (1,222 eyes) healthy and glaucoma participants. METHODS:DL models were trained on macula thickness maps from Spectralis macula SDOCT to estimate 10-2 and 24-2 VF mean deviation (MD) and pattern standard deviation (PSD). DL models were trained on thickness maps of the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), GCIPL, ganglion cell complex (GCC), and retina (RET) layers. A combined DL model was trained using all layers. Linear regression models of mean layer thicknesses were used for comparison. MAIN OUTCOME MEASURES/METHODS:and mean absolute error (MAE) compared to 10-2 and 24-2 VF measurements. Evaluation used independent test sets. RESULTS:=0.72) had the highest individual performance. CONCLUSIONS:DL models improved estimates of functional loss from SDOCT imaging. Accurate functional estimates can help clinicians more effectively individualize VF testing to each patient.

PURPOSE/OBJECTIVE:To report two unusual cases of optic disc hemorrhage occurring following pharmacologic mydriasis. OBSERVATION/METHODS:A 78-year old woman and 60-year old man with primary open angle glaucoma developed optic disc hemorrhages shortly after pupillary dilation. CONCLUSION AND IMPORTANCE/UNASSIGNED:Cycloplegia may cause subtle shifts in vitreous and lamina cribrosa position that may result in the formation of optic disc hemorrhages in susceptible glaucomatous eyes.

PURPOSE/OBJECTIVE:The temporary cessation and profound changes in ophthalmic care delivery that occurred as a result of the COVID-19 pandemic have yet to be fully understood. Our objective is to assess patients' self-reported impact of healthcare lockdown measures on their fears and anxieties during the crisis period of the COVID-19 pandemic in New York City. METHODS:We conducted a digital, self-reported, patient care survey distributed by electronic mail (e-mail) at Columbia University's department of ophthalmology outpatient faculty practice. Inclusion criteria were age greater than or equal to 18 years, a diagnosis of either retinal disease or glaucoma and a cancelled or rescheduled ophthalmology established patient appointment during the acute phase of the COVID-19 pandemic in New York City. Patients without an e-mail address listed in their electronic medical record were excluded. The survey occurred between March 2, 2020 to May 30, 2o2o. Primary measures were survey responses to assess key areas of patient anxiety or concern during the pandemic including safety of care delivery in a COVID pandemic, difficulties contacting or being seen by their ophthalmologist, concern of vision loss or disease progression, and concern over missed or access to treatments. Secondary measures were correlating survey response to factors such as: visual acuity, intraocular pressure (IOP), diagnosis, disease severity, follow up urgency, recent treatments and diagnostic testing data. RESULTS:Of the 2,594 surveys sent out, 510 (19.66%) were completed. Over 95% of patients were at least as concerned as in normal circumstances about their ocular health during the peak of the pandemic. 76% of respondents were more concerned than normal that they could not be seen by their ophthalmologist soon enough. Increased concern over ocular health, disease progression and access to care all showed positive correlations (P<0.05) with worse disease severity as measured with testing such as visual fields and optical coherence tomography. Additionally, 55% of patients were afraid of contracting COVID-19 during an office visit. CONCLUSION AND RELEVANCE/UNASSIGNED:We found a majority of our patients were concerned about limitations in access to ophthalmic care and were fearful of disease progression. Additionally, we found a number of demographic and clinical factors that correlated with increased anxiety in our patients.

PURPOSE/OBJECTIVE:To evaluate the thinning of circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) in primary open angle glaucoma (POAG) eyes with and without history of disc hemorrhage (DH). DESIGN/METHODS:Observational cohort study SUBJECTS: 39 eyes (34 subjects) with DH and 117 eyes (104 subjects) without DH from the Diagnostic Innovations in Glaucoma Study (DIGS) and the African Decent and Glaucoma Evaluation Study (ADAGES). METHODS:All participants had at least 1.5-years of follow-up with a minimum of 3 visits with bi-annual spectral-domain optic coherence tomography (SD-OCT) cpRNFL and mGCIPL thickness measurements and visual fields (VF). The rates of cpRNFL and mGCIPL thinning were calculated using mixed effects models. The dynamic range-based normalized rates of cpRNFL and mGCIPL were calculated and compared between the DH and non-DH groups. MAIN OUTCOME MEASURES/METHODS:= 5.2%(P=0.073), respectively). The area under operating receiver curves for VF progression based on Guided Progression Analysis was 0.75 for mGCIPL and 0.56 for cpRNFL in the DH group. CONCLUSIONS:In our study, the rate of mGCIPL and cpRNFL thinning was faster in DH eyes than non-DH eyes. mGCIPL showed higher proportional rates of thinning and greater association with functional progression compared to cpRNFL. In addition to cpRNFL, clinicians should consider incorporating mGCIPL imaging to monitor glaucoma progression, especially in glaucoma eyes with DH.