Chinese Primary Open-angle Glaucoma Patients Research Articles

Profile of Lipoprotein Subclasses in Chinese Primary Open-Angle Glaucoma Patients.

To investigate the plasma lipoprotein subclasses in patients with primary open-angle glaucoma (POAG), a total of 20 Chinese POAG patients on intraocular pressure (IOP)-lowering treatment and 20 age-matched control subjects were recruited. Based on the levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), the study subjects were divided into elevated- and normal-level subgroups. The plasma lipoprotein, lipoprotein subclasses, and oxidized LDL (oxLDL) levels were quantitatively measured. The discrimination potential of the lipoproteins was evaluated using the area under the receiver operating characteristic curve (AUC), and their correlation with clinical parameters was also evaluated. Compared to the control subjects with elevated TC and/or LDL-C levels, the levels of TC, LDL-C, non-high-density lipoprotein cholesterol (non-HDL), LDL subclass LDL3 and small dense LDL (sdLDL), and oxLDL were significantly higher in POAG patients with elevated TC and/or LDL-C levels. No differences in any lipoproteins or the subclasses were found between the POAG patients and control subjects with normal TC and LDL-C levels. Moderate-to-good performance of TC, LDL-C, non-HDL, LDL3, sdLDL, and oxLDL was found in discriminating between the POAG patients and control subjects with elevated TC and/or LDL-C levels (AUC: 0.710-0.950). Significant negative correlations between LDL3 and sdLDL with retinal nerve fiber layer (RNFL) thickness in the superior quadrant and between LDL3 and average RNFL thickness were observed in POAG patients with elevated TC and/or LDL-C levels. This study revealed a significant elevation of plasma lipoproteins, especially the LDL subclasses, in POAG patients with elevated TC and/or LDL-C levels, providing insights on monitoring specific lipoproteins in POAG patients with elevated TC and/or LDL-C.

Randomized Control Trial of the Impact of Patient Decision Aid Developed for Chinese Primary Open-Angle Glaucoma Patients

Introduction: Patient decision aid (PDA) is a tool to prompt shared decision-making. The aim of this study was to evaluate the impact of a PDA on Chinese primary open-angle glaucoma patients. Methods: All subjects were randomized into control and PDA group. The questionnaires, including 1) glaucoma knowledge; 2) 8-item Morisky medication adherence scale (MMAS-8); 3) 10-item glaucoma medication adherence self-efficacy scale (GMASES-10); and 4) 16-item decision conflict scale (DCS), were evaluated at baseline, 3- and 6-month follow-up. Results: Totally, 156 subjects participated in this study, including 77 in the control group and 79 in the PDA group. Compared to the control group, PDA group showed around 1 point more improvement in disease knowledge at both 3 and 6 months (both p < 0.05), 2.5 (95% CI: [1.0, 4.1]) and 1.9 (95% CI: [0.2, 3.7]) points more improvement in GMASES-10 at 3 and 6 months, respectively, and reduction in DCS by 8.8 (95% CI: [4.6, 12.9]) points more at 3 months and 13.5 (95% CI: [8.9, 18.0]) points more at 6 months. No difference was detected in MMAS-8. Conclusion: PDA led to improvement in disease knowledge and self-confidence in medication adherence and reduced decision conflict compared to control group for at least 6 months.

Comparison of Long-Term Effects After Modified CO2 Laser-Assisted Deep Sclerectomy and Conventional Trabeculectomy in Chinese Primary Open-Angle Glaucoma.

IntroductionTo compare the long-term effect after modified CO2 laser-assisted sclerectomy surgery (MCLASS) and conventional trabeculectomy (TRAB) in medically uncontrolled Chinese primary open-angle glaucoma (POAG) patients.This was a retrospective comparative study.MethodsA total of 87 patients were reviewed, including 45 in the MCLASS group and 42 in the TRAB group. Intraocular pressure (IOP), best-corrected visual acuity (BCVA), and use of supplemental medical therapy were retrospectively compared at baseline, and until 36 months postoperatively.ResultsPatients in both groups achieved a significant IOP decrease from baseline (P < 0.001); postoperative IOP in the MCLASS group was significantly lower than that in the TRAB group at 24 and 36 months. The reduced use of medication was statistically significant in both groups, and the number of postoperative medications was significantly more in TRAB group at 24 and 36 months. At 24 and 36 months, the complete success rate was 60% and 53.3% for MCLASS versus 66.7% and 59.5% for TRAB, and the qualified success rate was 91.1% and 88.9% for MCLASS versus 83.3% and 80.9% for TRAB, respectively. BCVA deterioration post TRAB was clinically more serious than that post MCLASS at 24 and 36 months, although the difference was not statically significant at any time point postoperatively. Compared with MCLASS, more complications occurred postoperatively in the TRAB group.ConclusionsMCLASS is an effective surgical option for Chinese POAG patients. Compared to TRAB, eyes undergoing MCLASS experience a comparable success rate, a greater IOP reduction, fewer medications, and a lower risk of complications up to 36 months.

Association of 24-Hour Intraocular Pressure Fluctuation With Corneal Hysteresis and Axial Length in Untreated Chinese Primary Open-Angle Glaucoma Patients.

PurposeThe purpose of this study was to evaluate the association of 24-hour intraocular pressure (IOP) fluctuation with corneal biomechanics and ocular biometric parameters in Chinese patients with primary open angle glaucoma (POAG) before initial treatment.MethodsForty-nine Chinese patients with POAG (98 eyes) were recruited in this study before start of any POAG treatment. The 24-hour IOP was measured with a 2-hour interval by a noncontact tonometer. Corneal biomechanical properties and biometric parameters were measured once during 8 AM to 6 PM before 24-hour IOP measurement.ResultsThe 24-hour IOP fluctuation was defined as the differences between the peak and trough IOP measurement and was significantly associated with axial length (AL) in the multivariate analysis. The POAG subjects with AL ≤ 26 mm had significantly larger 24-hour IOP fluctuation but lower corneal hysteresis, compared to those with AL > 26 mm. In addition, subgroup analysis showed that high tension glaucoma subjects had larger 24-hour IOP fluctuation and higher corneal resistance factor than patients with normal tension glaucoma.ConclusionsThis study revealed the association of 24-hour IOP fluctuation with office hour corneal biomechanical properties and AL in patients with POAG. Their contributions to IOP fluctuation should be considered in the risk analysis of glaucoma development and progression.Translational RelevanceOcular biometric parameters are related with 24-hour IOP fluctuation in patients with POAG, which is potentially helpful in explaining different progression patterns in different types of patients.

Optical Quality Assessed by Optical Quality Analysis System in Chinese Primary Open-Angle Glaucoma Patients and Its Correlations with Psychological Disturbances and Vision-Related Quality of Life

Purpose: To investigate if optical quality assessed by Optical Quality Analysis System (OQAS) is a new factor for psychological disturbance and vision-related quality of life (QoL) in Chinese patients with primary open-angle glaucoma (POAG). Methods: This is a cross-sectional study. OQAS, automated static perimetry, the Hospital Anxiety and Depression Scale (HADS) Questionnaire, and the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) were used to assess optical quality, visual field, psychological health, and QoL in 64 POAG patients. Correlation between the OQAS parameters and QoL or psychological health was analyzed by linear regression model. Results: OQAS parameters, the modulation transfer function cutoff frequency (MTF cutoff) and the mean OQAS values (mean OV) were significantly related to mean deviation (MD). Statistically significant correlation was also found between MTF cutoff, the mean OV, and QoL in more than half of the NEI VFQ-25 subscale scores and the composite. The correlation coefficients between OQAS parameters and QoL were similar to those between MD and QoL in most of the subscale scores. HADS-Depression and HADS-Anxiety scores significantly correlated with MD in the worse eye, the composite and 3 subscales of NEI VFQ-25, general health, social function, and mental health, but were not correlated with optical quality parameters measured by OQAS. Conclusions: OQAS-assessed optical quality is negatively related to MD and is a valid indicator for vision-related QoL, but not for psychological health in our study group. OQAS might be an alternative or supplement to perimeter in POAG patients.

Two-year outcomes of ab interno trabeculectomy with the Trabectome for Chinese primary open angle glaucoma: a retrospective multicenter study.

To evaluate the 2-year efficacy and safety of ab interno trabeculectomy with the Trabectome in Chinese primary open angle glaucoma (POAG) patients. This was a multicenter, retrospective, observational study and included POAG patients with or without visually-significant cataracts. The Chinese patients were enrolled from three glaucoma centers and a group of comparable Japanese POAG patients was analyzed from our international Trabectome database. The patients received Trabectome or a combined surgery with phacoemulsification and intraocular lens implantation. The primary outcome was intraocular pressure (IOP) reduction. Secondary outcomes included reduction of glaucoma medications, surgical complications, and success at 2y. Success was defined as: 1) IOP≤21 mm Hg and at least 20% IOP reduction from baseline after 3mo at any two consecutive visits; 2) no additional glaucoma surgery required. A total of 42 Chinese POAG patients from three glaucoma centers were enrolled. Twelve patients underwent Trabectome surgery combined with phacoemulsification and intraocular lens implantation while the remainder underwent Trabectome surgery alone. Thirteen patients had a history of failed glaucoma surgery and were considered as complicated cases. In China data, the mean preoperative IOP was 21.4±1.23 mm Hg. The Trabectome lowered IOP to 17.9±1.8 mm Hg at 2y (P=0.05). The number of glaucoma medications also decreased significantly from a baseline of 2.0±0.9 to 1.1±0.8 at 2y post-surgery (P=0.04). The overall 2-year success rate was 78%, with patients undergoing combined surgery having a higher success rate compared with those undergoing Trabectome surgery alone (100% vs 76%). In Japan data, the mean preoperative IOP was 20.8±7.7 mm Hg. The Trabectome lowered IOP to 12.20±2.0 mm Hg at 2y. The number of glaucoma medications also decreased significantly from a baseline of 2.1±0.9 to 3.4±0.6 at 2y post-surgery. In all patients, no major complications were seen. Surgery with the Trabectome appears to be an efficient and safe procedure in Chinese POAG patients in the long-term.

Macular Pigment Optical Density in Chinese Primary Open Angle Glaucoma Using the One-Wavelength Reflectometry Method.

Purpose. To investigate macular pigment optical density (MPOD) and its relationship with retinal thickness in primary open angle glaucoma (POAG) patients using the one-wavelength reflectometry method. Methods. A total of 30 eyes from 30 POAG patients (18 males and 12 females, mean age 47.27 ± 16.93) and 52 eyes from 52 controls (27 males and 25 females, mean age 49.54 ± 19.15) were included in this prospective, observational, case-control study. MPOD was measured in a 7-degree area using one-wavelength reflectometry method. Two parameters, max and mean optical density (OD), were used for analyses. Spectral-domain-optical coherence tomography was used to measure retinal thickness, including central retinal thickness (CRT), the macular ganglion cell complex (GCC), and the circumpapillary retinal nerve fiber layer (RNFL). Results. Both maxOD and meanOD were significantly reduced in POAG patients compared with normal subjects (P < 0.001). GCC, CRT, and RNFL thicknesses were also significantly reduced in POAG patients (P < 0.001). GCC thickness had a positive relationship with MPOD. Conclusions. MPOD within the 7-degree area was significantly lower in Chinese POAG patients than in control subjects, and GCC thickness was significantly and positively associated with MPOD. Whether the observed lower MPOD in POAG contributes to the disease process or is secondary to pathological changes caused by the disease (such as loss of ganglion cells) warrants further and longitudinal study.

The association between clinical parameters and glaucoma-specific quality of life in Chinese primary open-angle glaucoma patients

OBJECTIVE. To investigate the association between clinical measurements and glaucoma-specific quality of life in Chinese glaucoma patients. DESIGN. Cross-sectional study. SETTING. An academic hospital in Hong Kong. PATIENTS. A Chinese translation of the Glaucoma Quality of Life-15 questionnaire was completed by 51 consecutive patients with bilateral primary open-angle glaucoma. The binocular means of several clinical measurements were correlated with Glaucoma Quality of Life-15 findings using Pearson's correlation coefficient and linear regression. The measurements were the visual field index and pattern standard deviation from the Humphrey Field Analyzer, Snellen best-corrected visual acuity, presenting intra-ocular pressure, current intra-ocular pressure, average retinal nerve fibre layer thickness via optical coherence tomography, and the number of topical anti-glaucoma medications being used. RESULTS. In these patients, there was a significant correlation and linear relationship between a poorer Glaucoma Quality of Life-15 score and a lower visual field index (r=0.3, r(2)=0.1, P=0.01) and visual acuity (r=0.3, r(2)=0.1, P=0.03). A thinner retinal nerve fibre layer also correlated with a poorer Glaucoma Quality of Life-15 score, but did not attain statistical significance (r=0.3, P=0.07). There were no statistically significant correlations for the other clinical parameters with the Glaucoma Quality of Life-15 scores (all P values being >0.7). The three most problematic activities affecting quality of life were "adjusting to bright lights", "going from a light to a dark room or vice versa", and "seeing at night". CONCLUSION. For Chinese primary open-angle glaucoma patients, binocular visual field index and visual acuity correlated linearly with glaucoma-specific quality of life, and activities involving dark adaptation were the most problematic.

Association of Apolipoprotein E Polymorphisms With Normal Tension Glaucoma in a Chinese Population

To evaluate the role of apolipoprotein E (APOE) polymorphisms in primary open angle glaucoma (POAG). A cohort of 400 unrelated Chinese POAG patients was examined, including 294 cases of high tension glaucoma (HTG) and 106 with normal tension glaucoma (NTG). Also studied were 300 unrelated Chinese control subjects. The genotypes of the APOE polymorphisms in exon 4 and in the promoter at positions -491, -427, and -219 were determined by polymerase chain reaction and restriction endonuclease analysis. Frequencies of the genotypes were compared between patients and controls by chi test or Fisher exact test. The association of APOE polymorphisms with POAG phenotypes including age at diagnosis, intraocular pressure (IOP) at diagnosis, highest IOP, cup-disc ratio, and visual field score was investigated by the Kruskal-Wallis test. No significant difference was detected in the frequencies of APOE promoter polymorphisms between POAG patients and control subjects (P>0.0125). For the exon 4 polymorphism, when compared with control subjects, the frequency of epsilon 4 carriers was significantly lower in patients with NTG (P=0.008; odds ratio=0.36, 95% confidence interval=0.17, 0.79) but not in HTG (P=0.07). Compared with -219TT, the -219G carriers had a significant higher age at diagnosis (P=0.0046). No significant association was found between other APOE polymorphisms and POAG phenotypes (P>0.07). Our findings suggest that the APOE epsilon 4 allele confers a protective effect against NTG, whereas the APOE promoter polymorphisms do not contribute to POAG risk. However, the APOE -219G carriers tended to have later-onset POAG.

Association of Interleukin 1β and Receptor Antagonist Gene Polymorphisms with Primary Open-Angle Glaucoma

Purpose: Genetic factors are known to play a role in the etiology of glaucoma. More specifically, the role of the immune system is highly suspected. We evaluated the association between 2 polymorphisms in the interleukin (IL) 1β gene (IL-1 promoter 511, IL-1 exon 5) and 1 polymorphism in the IL-1 gene receptor antagonist (IL-1Ra) intron 2 with primary open-angle glaucoma (POAG). Patients and Methods: Fifty-eight POAG patients and 105 healthy volunteers were enrolled in this study. Analysis based on polymerase chain reaction was used to resolve the 2 IL-1β polymorphisms and the IL-1Ra intron 2 polymorphism. Results: There were significant differences in the distribution of the IL-1β exon 5 polymorphism between the POAG patients and the control subjects (p < 0.05). The E2 allele of IL-1β exon 5 was more frequently found in POAG patients than in healthy patients (odds ratio: 4.224, 95% confidence interval = 1.135–15.717). The distributions of the other 2 polymorphisms, IL-1β promoter 511 and IL-1Ra intron 2, were not significantly different between the POAG patients and the healthy control group. Conclusions: The frequency of the E2 allele of the IL-1β exon 5 polymorphism was high in POAG patients. Therefore the E2 allele can be used as a marker to predict or search for the genetic causes of glaucoma in Chinese POAG patients. Furthermore, we have concluded that the other 2 polymorphisms (IL-1 promoter 511 and IL-1Ra) are not helpful in predicting Chinese POAG.

Absence of trabecular meshwork-inducible stretch response (TISR)/oculomedin gene and proximal promoter mutation in primary open angle glaucoma patients.

We investigated the coding exon and promoter sequence in the trabecular meshwork-inducible stretch response (TISR)/oculomedin gene for mutations in Chinese primary open angle glaucoma (POAG) subjects. The entire TISR/oculomedin coding sequence, together with 138 bp of promoter sequence 5' to the start codon and 170 bp of the 3' untranslated region in 110 Chinese POAG patients and 108 unrelated control subjects without glaucoma, aged 50 years or above, were screened for alterations by DNA sequencing. One heterozygous sequence alteration, K28E, was identified in one control subject, and two homozygous sequence alterations, K28K and 135+36delC, were universally found in every sample. As a result, no common TISR/ oculomedin coding sequence nor any proximal promoter mutation that causes POAG was found. The effect of TISR/ oculomedin in glaucoma has yet to be established.