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Olujić M, Biuk D, Balog S, Kotromanović Šimić I, Kotromanović D, Dodig-Ćurković K. Presence of Anxiety and Depression in Patients with Open-Angle Glaucoma of Different Degrees of Damage. J Clin Med 2025; 14:3954. [PMID: 40507715 PMCID: PMC12155668 DOI: 10.3390/jcm14113954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2025] [Revised: 05/29/2025] [Accepted: 05/31/2025] [Indexed: 06/16/2025] Open
Abstract
Background: Glaucoma is a group of eye conditions that damage the optic nerve, and it can be interconnected with psychoneurotic disorders due to the psychological and emotional stress that comes with such a chronic condition. The aim of this study was to examine the characteristics of the occurrence of anxiety, depression and open-angle glaucoma (OAG) in glaucoma patients from December 2023 to December 2024. Methods: This cross-sectional study was conducted on 200 patients with three different stages of OAG. Multiple questionnaires were used to determine the influence of different OAG stages on the severity of anxiety and depression. Results: While predicting the anxiety expression, in a multivariate logistic regression (stepwise method), there was a significant model in predicting the expression of anxiety: female gender (Odds ratio (OR) = 3.03), age of 66 and over (OR = 3.4) and the feeling of being under stress (OR = 7.07). In the prediction of a higher severity of depression, predictors are age 66 and older (OR = 2.03) and feeling stressed (OR = 9.47). Conclusions: While glaucoma and psychoneurotic disorders affect different systems in the body, the psychological toll of living with glaucoma can lead to exacerbation of glaucoma.
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Affiliation(s)
- Marija Olujić
- Ophthalmology Polyclinic Dr. Balog, Ivana Gundulića 36 b, 31000 Osijek, Croatia; (M.O.); (S.B.)
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia; (I.K.Š.); (D.K.); (K.D.-Ć.)
| | - Dubravka Biuk
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia; (I.K.Š.); (D.K.); (K.D.-Ć.)
- Clinic for Eye Diseases, Clinical Hospital Centre Osijek, Europska Avenija 14, 31000 Osijek, Croatia
| | - Slaven Balog
- Ophthalmology Polyclinic Dr. Balog, Ivana Gundulića 36 b, 31000 Osijek, Croatia; (M.O.); (S.B.)
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia; (I.K.Š.); (D.K.); (K.D.-Ć.)
| | - Ivana Kotromanović Šimić
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia; (I.K.Š.); (D.K.); (K.D.-Ć.)
| | - Darko Kotromanović
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia; (I.K.Š.); (D.K.); (K.D.-Ć.)
- Oncology Clinic, Clinical Hospital Centre Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
| | - Katarina Dodig-Ćurković
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia; (I.K.Š.); (D.K.); (K.D.-Ć.)
- Institute for Child and Adolescent Psychiatry, Clinical Hospital Centre Osijek, Europska Avenija 14, 31000 Osijek, Croatia
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31000 Osijek, Croatia
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Choi S, Kim G, Pionke JJ. The Sleep Health of Individuals with Visual Impairments: A Scoping Review. Ophthalmic Epidemiol 2025; 32:259-277. [PMID: 38865606 DOI: 10.1080/09286586.2024.2361167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/07/2024] [Accepted: 05/21/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE Amidst the global aging population and an increasing prevalence of visual impairment across all age groups, this study aims to investigate the current state of research on sleep health in visually impaired populations. METHODS A scoping review was conducted to synthesize the existing literature on sleep health and visual impairment. We employed conceptual mapping to identify key research topics, analyzing data from four databases: PubMed (n = 290), CINAHL (n = 81), Scopus (n = 117), and PsycInfo (n = 96). A total of 83 peer-reviewed articles, published from 1977 to August 2023, were included in the review. RESULTS Our analysis identified 11 distinct eye health conditions including blindness, glaucoma, diabetic retinopathy, low vision, cataract, retinitis pigmentosa, macular degeneration, optic neuropathy, visual field defects, ocular hypertension, and retinal vein occlusion. Additionally, 8 major sleep problems were recognized: abnormal sleep duration, daytime sleepiness, insomnia, Non-24-Hour Sleep Wake Disorder, sleep apnea, sleep disorders, sleep disturbances, and sleep disordered breathing. The dominant research themes were (1) poor sleep quality in individuals with visual impairments and ophthalmic diseases, (2) high prevalence of sleep issues in patients with ophthalmic diseases, (3) sleep apnea in patients with ophthalmic conditions, and (4) circadian rhythm disruptions in blind individuals. CONCLUSION This review highlights research gaps that, when addressed, could greatly enhance our comprehension of the interplay between visual impairment and sleep health. Bridging these gaps promises to lead to more holistic care strategies, potentially improving vision functioning and rehabilitation outcomes for individuals with visual impairments.
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Affiliation(s)
- Soyoung Choi
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Grace Kim
- Department of Human Development and Family Studies, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - J J Pionke
- School of Information Studies, Syracuse University, Syracuse, NY, USA
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Ball DM, Abud-Henando S, Mann SS, Santhi N, Speekenbrink M, Walsh V. The structure of sleep and how it may be altered by visual impairments. PROGRESS IN BRAIN RESEARCH 2025; 292:89-111. [PMID: 40409925 DOI: 10.1016/bs.pbr.2025.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2025]
Abstract
Individuals with visual impairments often experience poor sleep health, which may impact brain physiology and function, as evidenced by altered brain activity during sleep. The sleeping brain can be categorized into stages: three non-rapid eye movement (NREM) stages and one rapid eye movement (REM) stage, with each stage defined by its structure, that is, the duration and frequency of specific brain oscillations. Research investigating alterations in sleep structure among visually impaired individuals has yielded mixed results: some studies indicate reduced or absent deep sleep (N3), others report longer REM latency (the time until the first REM epoch), while some suggest that circadian dysfunction may play a more significant role than visual impairment itself. Sleep is regulated by two processes: the homeostatic sleep drive, which accumulates during wakefulness and is relieved during sleep, and the circadian process, which describes the 24-hour sleep-wake cycle. The circadian process is particularly vulnerable to disruption by visual impairments, as damage to the retina can alter photic entrainment, the process by which light signals from the retina align the circadian sleep-wake cycle with the solar day. Visually impaired individuals often experience a drifting sleep-wake cycle that misaligns with the light-dark cycle, and during periods of misalignment, sleep quality may be particularly poor, especially REM sleep, which is largely under circadian control. Some causes of visual impairment, such as glaucoma, may be more susceptible to circadian dysfunction than others, as glaucoma affects cells in the retinal layer necessary for photic entrainment, which in turn may increase the risk of changes to sleep structure. Given that abnormal sleep structure is associated with long-term health consequences, including increased risks of depression, anxiety, and cognitive decline, it may contribute to the high prevalence of these issues found among the visually impaired population. Further research is needed to clarify the roles of the causes of visual impairments, circadian misalignment, and the impact on sleep structure. A better understanding of these relationships could help develop targeted interventions to improve sleep and enhance health outcomes for visually impaired individuals.
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Affiliation(s)
- Danny M Ball
- The Institute of Cognitive Neuroscience, University College London, London, United Kingdom.
| | - Sonia Abud-Henando
- Department of Psychology, Goldsmiths, University of London, London, United Kingdom
| | - Samantha S Mann
- Guys and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Nayantara Santhi
- Department of Psychology, Northumbria University, Newcastle, London, United Kingdom
| | | | - Vincent Walsh
- The Institute of Cognitive Neuroscience, University College London, London, United Kingdom
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Deng J, Qin Y. From meta-analysis to Mendelian randomization: Unidirectional perspectives on the association of glaucoma with depression and anxiety. PLoS One 2024; 19:e0310985. [PMID: 39561182 PMCID: PMC11575789 DOI: 10.1371/journal.pone.0310985] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 09/10/2024] [Indexed: 11/21/2024] Open
Abstract
BACKGROUND Glaucoma, a primary cause of blindness worldwide, has its association with depression and anxiety noted, yet the understanding of such association is still rudimentary. This study aims to provide the unidirectional perspectives on the association of glaucoma with depression and anxiety, informing public health strategies. METHODS The Meta-analysis screened observational studies from Medline, Embase, and Web of Science, using the modified Newcastle-Ottawa Scale for quality assessment. It employed R's 'meta' package to assess the association between glaucoma and depression or anxiety prevalence. The Mendelian Randomization (MR) analysis was conducted using R's 'TwoSampleMR' package, based on data from the IEU database data to explore the impact of glaucoma on depression and anxiety. RESULTS This Meta-analysis included 23 out of 379 studies involving 11,845 glaucoma patients. The combined prevalence of depression among glaucoma patients, derived from 18 cross-sectional studies, stood at 19.42%. Five case-control studies indicated that glaucoma patients had a 6.17-fold higher risk of depression compared to controls. Derived from 16 cross-sectional studies, the consolidated prevalence for anxiety was 19.07%. According to five case-control studies, glaucoma patients exhibited a 4.45-fold increased risk of anxiety compared to controls. MR analysis failed to uncover a causal effect of glaucoma on depression and anxiety. CONCLUSION This study suggests that glaucoma patients may experience higher prevalence of depression and anxiety than the general population, with no clear genetic links found. It suggests that environmental factors and non-genetic biological pathways, among others, may play significant roles in their association, though the role of genetic factors cannot be ruled out. These findings highlight the necessity of a comprehensive approach to study the complex factors influencing the association of glaucoma with depression or anxiety and underscore the importance of integrating mental health considerations into glaucoma management to improve medication adherence and disease progression.
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Affiliation(s)
- Jie Deng
- First Clinical College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, China
- Graduate School, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - YuHui Qin
- First Clinical College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, China
- Graduate School, Hunan University of Chinese Medicine, Changsha, Hunan, China
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Malewicz K, Pender A, Chabowski M, Jankowska-Polańska B. Impact of Sociodemographic and Psychological Factors on Adherence to Glaucoma Treatment - A Cross-Sectional Study. Clin Ophthalmol 2024; 18:2503-2520. [PMID: 39246554 PMCID: PMC11380480 DOI: 10.2147/opth.s475812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Accepted: 08/14/2024] [Indexed: 09/10/2024] Open
Abstract
Introduction Glaucoma is a group of eye diseases characterized by progressive and irreversible damage to the optic nerve. The aim of the study was to examine the impact of sociodemographic and psychological factors on adherence to glaucoma therapy. Methods The study was carried out among 190 adults treated for glaucoma at the Ophthalmology Outpatient Clinic of the University Teaching Hospital in Wroclaw between January 2019 and September 2019. Treatment adherence was measured using the Adherence to Refills and Medications Scale (ARMS). We used the Acceptance of Illness Scale (AIS), the Revised Life Orientation Test (LOT-R) and the Satisfaction with Life Scale (SWLS). Results 58.9% patients reported low treatment adherence. Educated females aged 68 or under living in cities had higher adherence. The regression analysis showed an association between dispositional optimism and glaucoma treatment adherence. The higher the level of dispositional optimism, the better the adherence. Higher dispositional optimism is directly associated with a sense of self-esteem and self-efficacy and a feeling of internal control. Patients reporting a high level of illness acceptance were found to have 2.5 times higher odds of adhering to glaucoma therapy. Illness acceptance is an indicator of the degree of adaptation to an illness and is positively correlated with a sense of self-esteem and self-efficacy and engagement in healthy behavior. Conclusion More than half of patients with glaucoma have low adherence. Sociodemographic characteristics (female gender, age 68 or under, tertiary education and living in an urban area) and psychological characteristics (high level of illness acceptance, dispositional optimism and satisfaction with life) are significant predictors of high adherence.
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Affiliation(s)
- Katarzyna Malewicz
- Division of Family and Pediatric Nursing, Department of Nursing and Obstetrics, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Aleksandra Pender
- Student Research Group No. 180, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Mariusz Chabowski
- Department of Surgery, 4th Military Clinical Hospital, Wroclaw, Poland
- Department of Clinical Surgical Sciences, Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Beata Jankowska-Polańska
- Department of Preclinical Sciences, Pharmacology and Medical Diagnostics, Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland
- Center for Research and Innovation, 4th Military Clinical Hospital, Wroclaw, 50-981, Poland
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Giacometti HHAR, Coelho LF, Iankilevich LG, Valentin LSS, Ferreira LA, Balbino M, Seixas RCS. Prevalence of anxiety and depression among patients with glaucoma. Front Psychol 2024; 15:1410890. [PMID: 39246310 PMCID: PMC11378733 DOI: 10.3389/fpsyg.2024.1410890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/26/2024] [Indexed: 09/10/2024] Open
Abstract
Purpose This study aimed to determine the prevalence of anxiety and depression among patients with glaucoma compared to the average Brazilian prevalence (9.8% of anxiety and 5.8% of depression, according to the World Health Organization) and its correlation with the severity of the disease. Methods This was a transversal, single-arm trial of patients from four glaucoma centers in São Paulo and Curitiba-Brazil. Patients comprised adults at least 18 years of age with glaucoma diagnosis under treatment for at least 6 months. All subjects of the study answered two questionnaires (PHQ-9 and GAD-7) to evaluate the presence of anxiety and depression, and the results were analyzed accordingly to clinical and demographic characteristics. Results The protocol included a total of 210 patients. The average age was 61.6 ± 15.3 years, and the female gender was more common (68.86%). Primary open-angle glaucoma was the most common diagnosis (59.90%). The average IOP was 18.5 mmHg, and 1.5 anti-glaucoma drops were the mean treatment. The prevalence of depression and anxiety was 26.90 and 25.71%, respectively. Most patients with anxiety were classified as early glaucoma, while those with depression had severe glaucoma. Conclusion This study found that the prevalence of anxiety and depression among patients with glaucoma is higher than in the general population in our country.
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Lin B, Xu M, Chen LL, Li DK. A study exploring the causal relationship between glaucoma and anxiety disorders. Front Med (Lausanne) 2024; 11:1410607. [PMID: 39170036 PMCID: PMC11335643 DOI: 10.3389/fmed.2024.1410607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/29/2024] [Indexed: 08/23/2024] Open
Abstract
Background Glaucoma, a leading cause of global blindness, is characterized by optic nerve damage and visual field loss. Previous studies have suggested a potential association between glaucoma and anxiety disorders. However, the causal relationship between these two conditions remains unclear. Methods In this study, we conducted a Mendelian Randomization analysis to investigate the causal relationship between glaucoma and anxiety disorders. We sourced Genome-Wide Association Study (GWAS) datasets for glaucoma and anxiety with the largest sample sizes from the Integrative Epidemiology Unit OpenGWAS (IEU OpenGWAS) project website. Instrumental variables were selected based on specific criteria, and statistical analyses were performed using the R programming language. Results After filtering and merging the datasets, a total of 60 Single Nucleotide Polymorphisms (SNPs) were obtained for analysis. Regression models were applied to assess the causal relationship between glaucoma and anxiety disorders. The results from all four methods indicated that glaucoma does not cause anxiety disorders (p > 0.05). Conclusion Through rigorous Mendelian Randomization analysis, our findings indicate that glaucoma is not a causative factor for anxiety, with minimal influence from confounding factors in this study. These findings enhance our understanding of the relationship between glaucoma and anxiety.
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Affiliation(s)
- Bin Lin
- Xiamen Eye Center and Eye Institute of Xiamen University, Xiamen, China
- Xiamen Clinical Research Center for Eye Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Ophthalmology, Xiamen, Fujian, China
- Fujian Key Laboratory of Corneal and Ocular Surface Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Corneal and Ocular Surface Diseases, Xiamen, Fujian, China
- Translational Medicine Institute of Xiamen Eye Center of Xiamen University, Xiamen, Fujian, China
| | - Meng Xu
- Xiamen Eye Center and Eye Institute of Xiamen University, Xiamen, China
- Xiamen Clinical Research Center for Eye Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Ophthalmology, Xiamen, Fujian, China
- Fujian Key Laboratory of Corneal and Ocular Surface Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Corneal and Ocular Surface Diseases, Xiamen, Fujian, China
- Translational Medicine Institute of Xiamen Eye Center of Xiamen University, Xiamen, Fujian, China
| | - Long-long Chen
- Xiamen Eye Center and Eye Institute of Xiamen University, Xiamen, China
- Xiamen Clinical Research Center for Eye Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Ophthalmology, Xiamen, Fujian, China
- Fujian Key Laboratory of Corneal and Ocular Surface Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Corneal and Ocular Surface Diseases, Xiamen, Fujian, China
- Translational Medicine Institute of Xiamen Eye Center of Xiamen University, Xiamen, Fujian, China
| | - Dong-kan Li
- Xiamen Eye Center and Eye Institute of Xiamen University, Xiamen, China
- Xiamen Clinical Research Center for Eye Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Ophthalmology, Xiamen, Fujian, China
- Fujian Key Laboratory of Corneal and Ocular Surface Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Corneal and Ocular Surface Diseases, Xiamen, Fujian, China
- Translational Medicine Institute of Xiamen Eye Center of Xiamen University, Xiamen, Fujian, China
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Tang WSW, Lau NXM, Krishnan MN, Chin YC, Ho CSH. Depression and Eye Disease-A Narrative Review of Common Underlying Pathophysiological Mechanisms and their Potential Applications. J Clin Med 2024; 13:3081. [PMID: 38892791 PMCID: PMC11172702 DOI: 10.3390/jcm13113081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Depression has been shown to be associated with eye diseases, including dry eye disease (DED), cataracts, glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR). This narrative review explores potential pathophysiological connections between depression and eye disease, as well as its potential correlations with ocular parameters. Methods: A literature search was conducted in August 2022 in PUBMED, EMBASE, and PsycINFO. Published articles related to the subject were consolidated and classified according to respective eye diseases and pathophysiological mechanisms. Results: The literature reviewed suggests that common pathophysiological states like inflammation and neurodegeneration may contribute to both depression and certain eye diseases, while somatic symptoms and altered physiology, such as disruptions in circadian rhythm due to eye diseases, can also influence patients' mood states. Grounded in the shared embryological, anatomical, and physiological features between the eye and the brain, depression is also correlated to changes observed in non-invasive ophthalmological imaging modalities, such as changes in the retinal nerve fibre layer and retinal microvasculature. Conclusions: There is substantial evidence of a close association between depression and eye diseases. Understanding the underlying concepts can inform further research on treatment options and monitoring of depression based on ocular parameters.
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Affiliation(s)
- Wymann Shao Wen Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Nicole Xer Min Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | | | - You Chuen Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Raffles Medical Group, Singapore 188770, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, National University of Singapore, Singapore 119077, Singapore
- Department of Psychological Medicine, National University Hospital, Singapore 119228, Singapore
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Ramesh PV, Morya AK, Azad A, Pannerselvam P, Devadas AK, Gopalakrishnan ST, Ramesh SV, Aradhya AK. Navigating the intersection of psychiatry and ophthalmology: A comprehensive review of depression and anxiety management in glaucoma patients. World J Psychiatry 2024; 14:362-369. [PMID: 38617979 PMCID: PMC11008383 DOI: 10.5498/wjp.v14.i3.362] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/28/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
Glaucoma, a prevalent and debilitating eye disease, has long been associated with vision impairment and blindness. However, recent research has shed light on the often-underestimated psychological dimensions of this condition. Anxiety and depression, two pervasive psychiatric comorbidities, have been increasingly recognized among glaucoma patients. This comprehensive review aims to explore the intricate relationship between psychiatry and ophthalmology, in the context of managing depression and anxiety in glaucoma patients. By meticulously examining peer-reviewed literature, we synthesize current knowledge on the prevalence, risk factors, and underlying mechanisms of anxiety and depression in glaucoma. The evidence reveals that glaucoma patients face an elevated risk of experiencing these mood disorders. Factors such as progressive vision loss, complex medication regimens, and the fear of further visual deterioration contribute to their vulnerability. Moreover, we delve into the bidirectional relationship between glaucoma and mood disorders, shedding light on the complex interplay between ocular and emotional health. Our review investigates the implications of anxiety and depression on glaucoma management, including their potential impact on treatment adherence, disease progression, and overall quality of life. We also explore the neurobiological pathways linking glaucoma and mood disorders, providing a foundation for future research and potential therapeutic interventions. In conclusion, recognizing the psychological burden carried by glaucoma patients is essential for holistic and patient-centered care. This review underscores the pressing need for integrated approaches that bring together ophthalmological and psychiatric expertise to optimize the well-being of individuals facing the challenges of glaucoma. By addressing anxiety and depression in glaucoma care, healthcare providers can enhance the overall quality of life for these patients, ultimately leading to improved outcomes and a brighter future for those affected by this condition. This review offers valuable insight for healthcare practitioners and researchers, providing a concise overview of key topics and research in the field of managing depression and anxiety in glaucoma patients.
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Affiliation(s)
- Prasanna Venkatesh Ramesh
- Department of Glaucoma and Research, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
| | - Arvind Kumar Morya
- Department of Ophthalmology, All India Institute of Medical Sciences, Hyderabad 508126, Telangana, India
| | - Ashik Azad
- Department of Optometry and Visual Science, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
| | - Pavithra Pannerselvam
- Junior Resident, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
| | - Aji Kunnath Devadas
- Department of Optometry and Visual Science, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
| | | | - Shruthy Vaishali Ramesh
- Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
| | - Ajanya K Aradhya
- Department of Optometry and Visual Science, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
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Fu J, Yang J, Li Q, Huang D, Yang H, Xie X, Xu H, Zhang M, Zheng C. What can we learn from a Chinese social media used by glaucoma patients? BMC Ophthalmol 2023; 23:470. [PMID: 37986061 PMCID: PMC10661764 DOI: 10.1186/s12886-023-03208-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 11/07/2023] [Indexed: 11/22/2023] Open
Abstract
PURPOSE Our study aims to discuss glaucoma patients' needs and Internet habits using big data analysis and Natural Language Processing (NLP) based on deep learning (DL). METHODS In this retrospective study, we used web crawler technology to crawl glaucoma-related topic posts from the glaucoma bar of Baidu Tieba, China. According to the contents of topic posts, we classified them into posts with seeking medical advice and without seeking medical advice (social support, expressing emotions, sharing knowledge, and others). Word Cloud and frequency statistics were used to analyze the contents and visualize the keywords of topic posts. Two DL models, Bidirectional Long Short-Term Memory (Bi-LSTM) and Bidirectional Encoder Representations from Transformers (BERT), were trained to identify the posts seeking medical advice. The evaluation matrices included: accuracy, F1 value, and the area under the ROC curve (AUC). RESULTS A total of 10,892 topic posts were included, among them, most were seeking medical advice (N = 7071, 64.91%), and seeking advice regarding symptoms or examination (N = 4913, 45.11%) dominated the majority. The following were searching for social support (N = 2362, 21.69%), expressing emotions (N = 497, 4.56%), and sharing knowledge (N = 527, 4.84%) in sequence. The word cloud analysis results showed that ocular pressure, visual field, examination, and operation were the most frequent words. The accuracy, F1 score, and AUC were 0.891, 0.891, and 0.931 for the BERT model, 0.82, 0.821, and 0.890 for the Bi-LSTM model. CONCLUSION Social media can help enhance the patient-doctor relationship by providing patients' concerns and cognition about glaucoma in China. NLP can be a powerful tool to reflect patients' focus on diseases. DL models performed well in classifying Chinese medical-related texts, which could play an important role in public health monitoring.
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Affiliation(s)
- Junxia Fu
- Department of Ophthalmology, School of Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, 200092, Shanghai, China
- Institute of Hospital Development Strategy, China Hospital Development Institute, Shanghai Jiao Tong University, 200092, Shanghai, China
| | - Junrui Yang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou University Medical College, Shantou, Guangdong, China
- Department of Ophthalmology, The 74th Army Group Hospital, Guangzhou, Guangdong, China
| | - Qiuman Li
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Danqing Huang
- Institute of Hospital Development Strategy, China Hospital Development Institute, Shanghai Jiao Tong University, 200092, Shanghai, China
| | - Hongyang Yang
- Institute of Hospital Development Strategy, China Hospital Development Institute, Shanghai Jiao Tong University, 200092, Shanghai, China
| | - Xiaoling Xie
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou University Medical College, Shantou, Guangdong, China
| | - Huaxin Xu
- The Faculty of Science, University of Technology Sydney, Sydney, Australia
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou University Medical College, Shantou, Guangdong, China.
| | - Ce Zheng
- Department of Ophthalmology, School of Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, 200092, Shanghai, China.
- Institute of Hospital Development Strategy, China Hospital Development Institute, Shanghai Jiao Tong University, 200092, Shanghai, China.
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Vergroesen JE, Schuster AK, Stuart KV, Asefa NG, Cougnard-Grégoire A, Delcourt C, Schweitzer C, Barreto P, Coimbra R, Foster PJ, Luben RN, Pfeiffer N, Stingl JV, Kirsten T, Rauscher FG, Wirkner K, Jansonius NM, Arnould L, Creuzot-Garcher CP, Stricker BH, Keskini C, Topouzis F, Bertelsen G, Eggen AE, Bikbov MM, Jonas JB, Klaver CCW, Ramdas WD, Khawaja AP. Association of Systemic Medication Use with Glaucoma and Intraocular Pressure: The European Eye Epidemiology Consortium. Ophthalmology 2023; 130:893-906. [PMID: 37150298 DOI: 10.1016/j.ophtha.2023.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/17/2023] [Accepted: 05/01/2023] [Indexed: 05/09/2023] Open
Abstract
PURPOSE To investigate the association of commonly used systemic medications with glaucoma and intraocular pressure (IOP) in the European population. DESIGN Meta-analysis of 11 population-based cohort studies of the European Eye Epidemiology Consortium. PARTICIPANTS The glaucoma analyses included 143 240 participants and the IOP analyses included 47 177 participants. METHODS We examined associations of 4 categories of systemic medications-antihypertensive medications (β-blockers, diuretics, calcium channel blockers [CCBs], α-agonists, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers), lipid-lowering medications, antidepressants, and antidiabetic medications-with glaucoma prevalence and IOP. Glaucoma ascertainment and IOP measurement method were according to individual study protocols. Results of multivariable regression analyses of each study were pooled using random effects meta-analyses. Associations with antidiabetic medications were examined in participants with diabetes only. MAIN OUTCOME MEASURES Glaucoma prevalence and IOP. RESULTS In the meta-analyses of our maximally adjusted multivariable models, use of CCBs was associated with a higher prevalence of glaucoma (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.08 to 1.39). This association was stronger for monotherapy of CCBs with direct cardiac effects (OR, 1.96; 95% CI, 1.23 to 3.12). No other antihypertensive medications, lipid-lowering medications, antidepressants, or antidiabetic medications were associated with glaucoma. Use of systemic β-blockers was associated with a lower IOP (β coefficient, -0.33 mmHg; 95% CI, -0.57 to -0.08 mmHg). Monotherapy of both selective systemic β-blockers (β coefficient, -0.45 mmHg; 95% CI -0.74 to -0.16 mmHg) and nonselective systemic β-blockers (β coefficient, -0.54 mmHg; 95% CI, -0.94 to -0.15 mmHg) was associated with lower IOP. A suggestive association was found between use of high-ceiling diuretics and lower IOP (β coefficient, -0.30 mmHg; 95% CI, -0.47 to -0.14 mmHg) but not when used as monotherapy. No other antihypertensive medications, lipid-lowering medications, antidepressants, or antidiabetic medications were associated with IOP. CONCLUSIONS We identified a potentially harmful association between use of CCBs and glaucoma prevalence. Additionally, we observed and quantified the association of lower IOP with systemic β-blocker use. Both findings potentially are important, given that patients with glaucoma frequently use systemic antihypertensive medications. Determining causality of the CCB association should be a research priority. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Joëlle E Vergroesen
- Department of Ophthalmology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Alexander K Schuster
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Kelsey V Stuart
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom
| | - Nigus G Asefa
- Department of Ophthalmology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Cécile Delcourt
- INSERM, BPH, U1219, Université de Bordeaux, Bordeaux, France
| | - Cédric Schweitzer
- INSERM, BPH, U1219, Université de Bordeaux, Bordeaux, France; Department of Ophthalmology, CHU de Bordeaux, Bordeaux, France
| | - Patrícia Barreto
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal; University of Coimbra, Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine (iCBR- FMUC), Coimbra, Portugal
| | - Rita Coimbra
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal; Department of Mathematics, University of Aveiro, Aveiro, Portugal
| | - Paul J Foster
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom
| | - Robert N Luben
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom; MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Julia V Stingl
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Toralf Kirsten
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany; Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany; Medical Informatics Center, Department of Medical Data Science, Leipzig University Medical Center, Leipzig, Germany
| | - Franziska G Rauscher
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany; Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
| | - Kerstin Wirkner
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany; Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
| | - Nomdo M Jansonius
- Department of Ophthalmology, University Medical Center Groningen, Groningen, The Netherlands
| | - Louis Arnould
- Department of Ophthalmology, University Hospital, Dijon, France
| | | | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Christina Keskini
- First Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotis Topouzis
- First Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Geir Bertelsen
- Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Anne E Eggen
- Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | | | - Jost B Jonas
- Ufa Eye Research Institute, Ufa, Russia; Institute of Molecular and Clinical Ophthalmology, University of Basel, Basel, Switzerland; Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Institute of Molecular and Clinical Ophthalmology, University of Basel, Basel, Switzerland; Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wishal D Ramdas
- Department of Ophthalmology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anthony P Khawaja
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom; MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
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12
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Groff ML, Choi B, Lin T, Mcllraith I, Hutnik C, Malvankar-Mehta MS. Anxiety, depression, and sleep-related outcomes of glaucoma patients: systematic review and meta-analysis. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:346-355. [PMID: 35305959 DOI: 10.1016/j.jcjo.2022.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aims to synthesize data quantifying the prevalence and severity of common psychological conditions in patients with glaucoma. DESIGN Systematic review and meta-analysis. METHODS Databases including Ovid MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Library, Web of Science, Open Grey, and ProQuest Theses and dissertations were searched. Two reviewers independently assessed and screened all studies, followed by quality assessment of included studies using the modified Downs and Black checklist. Data were pooled using fixed-effect and random-effects models. RESULTS Of 2067 studies identified by the search strategy, 57 passed full-text screening, and 45 studies (4 995 538 subjects) were eligible for analysis. Overall, the prevalence of depression (effect size [ES] = 0.19, 95% CI 0.16-0.23; n = 31), anxiety (ES = 0.25, 95% CI 0.21-0.30; n = 18), and sleep disorders (ES = 0.47, 95% CI 0.26-0.68; n = 7) were high in patients with glaucoma. Similarly, symptomatic measurements of depression (standardized mean difference [SMD] = 0.46, 95% CI 0.19-0.73), anxiety (SMD = 0.44, 95% CI 0.08-0.81), and sleep quality (SMD = 0.72, 95% CI 0.22-1.21) were significant in glaucoma patients. CONCLUSIONS A higher prevalence and severity of depression, anxiety, and sleep disorders was experienced in patients with glaucoma compared with patients without glaucoma. Caregivers as well as health care providers may need to be aware of unique psychological and social stressors placed on glaucoma patients.
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Affiliation(s)
- Michael Lee Groff
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Bohmyi Choi
- Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - Tony Lin
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Ian Mcllraith
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Cindy Hutnik
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Monali S Malvankar-Mehta
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON; Department of Ophthalmology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON.
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13
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Gubin D, Neroev V, Malishevskaya T, Kolomeichuk S, Cornelissen G, Yuzhakova N, Vlasova A, Weinert D. Depression scores are associated with retinal ganglion cells loss. J Affect Disord 2023; 333:290-296. [PMID: 37084971 DOI: 10.1016/j.jad.2023.04.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/27/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Light is a known factor affecting mood and the circadian system. Light deficit is linked to deteriorated transduction of photic information to the brain, and reduced amplitude of the perceived circadian light signaling. Retinal ganglion cells (RGCs) loss due to advanced glaucoma can be a factor compromising light perception, with consequences for circadian rhythms, sleep and mood. This study aimed to estimate associations of RGCs loss with a depression score by multiple regression, accounting for other features of glaucoma. METHODS One hundred and fifteen patients diagnosed with primary open-angle glaucoma completed the Beck Depression Inventory II questionnaire. The damage to their RGCs was assessed by high-definition optical coherence tomography (HD-OCT) and their function by pattern electroretinogram (PERG). On fifteen of these patients, 24-h salivary melatonin patterns were determined under light-controlled laboratory conditions, and analysis of eight clock related gene polymorphisms was performed. RESULTS Backward stepwise multiple regression revealed that the BDI score was the strongest factor that was most closely associated with the HD-OCT-based percentage of global RGCs loss (standardized coefficient, b* = 0.784, p < 0.001), surpassing other related factors, including age, intraocular pressure, visual field loss, and PERG amplitude. A high BDI score was associated with the GNβ3 825C > T polymorphism (dbSNP rs5443). LIMITATIONS This study did not specifically address damage to intrinsically photoreceptive RGCs. The gene study is based on a limited number of volunteers. CONCLUSIONS Depression scores are strongly associated with RGCs loss, increasing abruptly above a threshold of 15 %, supporting the hypothesis that RGCs loss in advanced glaucoma may affect non-visual photic transduction and lead to mood disturbances.
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Affiliation(s)
- Denis Gubin
- Laboratory for Chronobiology and Chronomedicine, Research Institute of Biomedicine and Biomedical Technologies, Medical University, 625023 Tyumen, Russia; Department of Biology, Medical University, 625023 Tyumen, Russia; Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia.
| | - Vladimir Neroev
- Helmholz National Medical Research Center of Eye Diseases, Moscow, Russia.
| | | | - Sergey Kolomeichuk
- Laboratory for Genomics, Metabolomics and Proteomics, Research Institute of Biomedicine and Biomedical Technologies, Medical University, 625023 Tyumen, Russia; Laboratory of Genetics, Institute of Biology, Karelian Scientific Center of RAS, Petrozavodsk, Russia; Tyumen State Medical University, Tyumen, Russia
| | - Germaine Cornelissen
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA.
| | - Natalia Yuzhakova
- Laboratory for Genomics, Metabolomics and Proteomics, Research Institute of Biomedicine and Biomedical Technologies, Medical University, 625023 Tyumen, Russia.
| | - Anastasia Vlasova
- State Autonomous Health Care Institution Tyumen Regional Ophthalmological Dispensary, 625048, Tyumen, Russia
| | - Dietmar Weinert
- Institute of Biology/Zoology, Martin Luther University, Halle-Wittenberg, Germany.
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14
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Stoner AM, Patnaik JL, Ertel MK, Capitena-Young CE, SooHoo JR, Pantcheva MB, Kahook MY, Seibold LK. Subjective and Objective Measurement of Sleep Quality and Activity in Glaucoma. J Glaucoma 2023; 32:265-271. [PMID: 36795515 DOI: 10.1097/ijg.0000000000002186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/22/2023] [Indexed: 02/17/2023]
Abstract
PRCIS Glaucoma patients exhibit worse indices of sleep function by both objective and subjective metrics compared with controls. PURPOSE The purpose of this study is to characterize the sleep parameters and physical activity levels of glaucoma patients compared with controls. PATIENTS AND METHODS A total of 102 patients with a diagnosis of glaucoma in at least 1 eye and 31 control subjects were enrolled in the study. Participants completed the Pittsburgh Sleep Quality Index (PSQI) during enrollment and then wore wrist actigraphs for 7 consecutive days to characterize circadian rhythm, sleep quality, and physical activity. The primary outcomes of the study were subjective and objective metrics of sleep quality using the PSQI and actigraphy devices, respectively. The secondary outcome was physical activity, measured by the actigraphy device. RESULTS From the PSQI survey, glaucoma patients had higher (worse) scores compared with controls for sleep latency, sleep duration, and subjective sleep quality, whereas scores for sleep efficiency were lower (better), suggesting more time spent in bed asleep. By actigraphy, time in bed was significantly higher in glaucoma patients as was time awake after sleep onset. Interdaily stability, quantifying the synchronization to the 24-hour light-dark cycle, was lower in glaucoma patients. There were no other significant differences between glaucoma and control patients with regard to rest-activity rhythms or physical activity metrics. In contrast to the survey data, findings from the actigraphy demonstrated that there were no significant associations between the study group and controls regarding sleep efficiency, onset latency, or total sleep time. CONCLUSIONS In this study, patients with glaucoma demonstrated several subjective and objective differences in sleep function when compared with controls, whereas physical activity metrics were similar.
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Affiliation(s)
- Ari M Stoner
- Indiana University School of Medicine, Indianapolis, IN
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| | - Monica K Ertel
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| | | | - Jeffrey R SooHoo
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| | - Mina B Pantcheva
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| | - Malik Y Kahook
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| | - Leonard K Seibold
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
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15
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Structural Basis for Agonistic Activity and Selectivity toward Melatonin Receptors hMT1 and hMT2. Int J Mol Sci 2023; 24:ijms24032863. [PMID: 36769183 PMCID: PMC9918025 DOI: 10.3390/ijms24032863] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Glaucoma, a major ocular neuropathy originating from a progressive degeneration of retinal ganglion cells, is often associated with increased intraocular pressure (IOP). Daily IOP fluctuations are physiologically influenced by the antioxidant and signaling activities of melatonin. This endogenous modulator has limited employment in treating altered IOP disorders due to its low stability and bioavailability. The search for low-toxic compounds as potential melatonin agonists with higher stability and bioavailability than melatonin itself could start only from knowing the molecular basis of melatonergic activity. Thus, using a computational approach, we studied the melatonin binding toward its natural macromolecular targets, namely melatonin receptors 1 (MT1) and 2 (MT2), both involved in IOP signaling regulation. Besides, agomelatine, a melatonin-derivative agonist and, at the same time, an atypical antidepressant, was also included in the study due to its powerful IOP-lowering effects. For both ligands, we evaluated both stability and ligand positioning inside the orthosteric site of MTs, mapping the main molecular interactions responsible for receptor activation. Affinity values in terms of free binding energy (ΔGbind) were calculated for the selected poses of the chosen compounds after stabilization through a dynamic molecular docking protocol. The results were compared with experimental in vivo effects, showing a higher potency and more durable effect for agomelatine with respect to melatonin, which could be ascribed both to its higher affinity for hMT2 and to its additional activity as an antagonist for the serotonin receptor 5-HT2c, in agreement with the in silico results.
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16
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Klauke S, Sondocie C, Fine I. The impact of low vision on social function: The potential importance of lost visual social cues. JOURNAL OF OPTOMETRY 2023; 16:3-11. [PMID: 35568628 PMCID: PMC9811370 DOI: 10.1016/j.optom.2022.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/09/2022] [Accepted: 03/06/2022] [Indexed: 05/06/2023]
Abstract
Visual cues usually play a vital role in social interaction. As well as being the primary cue for identifying other people, visual cues also provide crucial non-verbal social information via both facial expressions and body language. One consequence of vision loss is the need to rely on non-visual cues during social interaction. Although verbal cues can carry a significant amount of information, this information is often not available to an untrained listener. Here, we review the current literature examining potential ways that the loss of social information due to vision loss might impact social functioning. A large number of studies suggest that low vision and blindness is a risk factor for anxiety and depression. This relationship has been attributed to multiple factors, including anxiety about disease progression, and impairments to quality of life that include difficulties reading, and a lack of access to work and social activities. However, our review suggests a potential additional contributing factor to reduced quality of life that has been hitherto overlooked: blindness may make it more difficult to effectively engage in social interactions, due to a loss of visual information. The current literature suggests it might be worth considering training in voice discrimination and/or recognition when carrying out rehabilitative training in late blind individuals.
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Affiliation(s)
| | - Chloe Sondocie
- Department of Psychology, University of Washington, Seattle, USA
| | - Ione Fine
- Department of Psychology, University of Washington, Seattle, USA.
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17
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Fu J, Yang J, Li Q, Huang D, Yang H, Xie X, Xu H, Zhang M, Zheng C. Glaucoma-related posts from a Chinese social media: An exploratory study.. [DOI: 10.21203/rs.3.rs-2312218/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Abstract
Purpose: Our study aims to discuss glaucoma patients' needs and Internet habits using big data analysis and Natural Language Processing (NLP) based on deep learning (DL). We also developed and validated DL models to recognize social media data.
Methods: In this retrospective study, we used web crawler technology to crawl glaucoma-related topic posts from the glaucoma bar of Baidu Tieba. According to the contents of topic posts, we classified them into posts with or without seeking medical advice. Word Cloud and frequency statistics were used to analyze the contents and visualize the keywords. Two DL models, Bidirectional Long Short-Term Memory (Bi-LSTM) and Bidirectional Encoder Representations from Transformers (BERT), were trained to identify the posts seeking medical advice. The evaluation matrices included: accuracy, F1 value, and the area under the ROC curve (AUC).
Results: A total of 10,892 topic posts were included, among them, most were seeking medical advice (N=7071, 64.91%), and seeking advice regarding symptoms or examination (N=4913, 45.11%) dominated the majority, followed by searching for social support , expressing emotions, and sharing knowledge. The word cloud analysis showed that ocular pressure, visual field, examination, and operation were the most frequent words. The accuracy, F1 score, and AUC were 0.891, 0.891, and 0.931 for BERT model, 0.82, 0.821, and 0.890 for Bi-LSTM model.
Conclusion: Social media can help enhance the patient-doctor relationship by providing patients’ concerns and cognition about glaucoma. DL models performed well in classifying Chinese medical-related texts, which could play an important role in public health monitoring.
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Affiliation(s)
| | - Junrui Yang
- Joint Shantou International Eye Center of Shantou University, Chinese University of Hong Kong, Shantou University Medical College
| | - Qiuman Li
- Guangzhou Women and Children’s Medical Center
| | | | | | - Xiaoling Xie
- Joint Shantou International Eye Center of Shantou University, Chinese University of Hong Kong, Shantou University Medical College
| | | | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University, Chinese University of Hong Kong, Shantou University Medical College
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18
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Peng Q, Qu B, Sznajder KK, Chen Q, Fu J, He S, Yang X. Exploring the Association Between Resilience and Quality of Life Among Glaucoma Patients: Sleep Disturbance as a Mediating Factor. Front Med (Lausanne) 2022; 9:842864. [PMID: 36438057 PMCID: PMC9682153 DOI: 10.3389/fmed.2022.842864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/18/2022] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Patients with glaucoma may experience many symptoms such as blindness, which seriously affect their quality of life (QoL). Resilience is playing a vital role in enhancing the QoL and well-being of patients with chronic diseases. In addition, sleep disturbance is common in patients with glaucoma, leading to a decline in their QoL. However, there is a dearth of research on whether sleep disturbance plays a mediating role between resilience and QoL among glaucoma patients. OBJECTIVE The aim of this study is to explore the role of sleep disturbance in the relationship between resilience and QoL among glaucoma patients. METHODS From July to December 2019, a cross-sectional survey was conducted on 215 glaucoma patients in an ophthalmic hospital in Liaoning Province. Hierarchical multiple regression (HMR) analyses and structural equation modeling (SEM) were conducted to examine the factors related to QoL and to test the hypothesis that sleep disturbance mediates the relationship between resilience and QoL among glaucoma patients. RESULTS The average QoL score among glaucoma patients was 43.85 ± 14.97 as reported by the Glaucoma Quality of Life-15 (GQL-15) scale, where a higher scores indicating a poorer QoL. Resilience was found to be linked with a lower QoL score (P < 0.01), while sleep disturbance was associated with a higher QoL score (P < 0.01). When sleep disturbance was included in the model as partial mediator, the path coefficients for the association between resilience and QoL score was significantly decreased (a*b = -0.1, BCa95% CI: -0.154∼-0.045). CONCLUSION Findings of this study reflected that QoL among glaucoma patients in China was poor. Resilience was found to be an important positive factor, which could result in the improvement of QoL. Furthermore, sleep disturbance mediated the relationship between resilience and QoL among patients with glaucoma, thereby reducing the positive impact of resilience on QoL in glaucoma patients. Efforts to improve QoL among glaucoma patients may benefit from interventions that enhance the levels of resilience and promote healthy sleep.
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Affiliation(s)
- Qinqi Peng
- Department of Social Medicine, College of Health Management, China Medical University, Shenyang, China
| | - Bo Qu
- Department of Ophthalmology, Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Key Laboratory of Lens Research of Liaoning Province, Shenyang, China
| | - Kristin K. Sznajder
- Department of Public Health, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Qiongli Chen
- Department of Social Medicine, College of Health Management, China Medical University, Shenyang, China
| | - Jiahui Fu
- Department of Social Medicine, College of Health Management, China Medical University, Shenyang, China
| | - Shan He
- Department of Social Medicine, College of Health Management, China Medical University, Shenyang, China
| | - Xiaoshi Yang
- Department of Social Medicine, College of Health Management, China Medical University, Shenyang, China
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19
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Yuan Y, Hu W, Zhang X, Borchert G, Wang W, Zhu Z, He M. Daily Patterns of Accelerometer-Measured Movement Behaviors in Glaucoma Patients: Insights From UK Biobank Participants. Asia Pac J Ophthalmol (Phila) 2022; 11:521-528. [PMID: 36417676 DOI: 10.1097/apo.0000000000000578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/23/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The purpose of this study is to compare daily patterns of accelerometer-measured movement behaviors between glaucoma patients and those without glaucoma. METHODS From 2013 to 2015, 106,053 UK Biobank participants took part in a 7-day accelerometer test. Based on established algorithms, continuous accelerometer data were classified into 4 movement behaviors: moderate to vigorous physical activity (MVPA), light physical activity, sedentary behaviors, and sleep. Glaucoma and other covariates were defined according to baseline assessments and inpatient diagnosis records. Negative binomial regression models were used to compare daily patterns of movement behaviors between glaucoma patients and those without glaucoma. RESULTS Accelerometer data from 1262 glaucoma patients and 81,551 participants without glaucoma were included. Compared with participants without glaucoma, glaucoma patients spent 4.7% less time on MVPA in multivariable models [mean=28.3 vs 31.4 min/d; incidence-rate ratio (IRR) 0.953, 95% confidence interval (CI): 0.910-0.998; P=0.044], which was mainly attributed to the decreased MVPA time during 18:00-23:59 (IRR=0.863, Bonferroni-corrected 95% CI: 0.768-0.970; P=0.002). Subgroup analyses indicated that compared with those with normal body mass index, the decreased MVPA time was more pronounced in participants with overweight and obesity (IRR=0.912, Bonferroni-corrected 95% CI: 0.851-0.978; P for interaction=0.007). No significant association was found between glaucoma and time spent on other movement behaviors including light physical activity, sedentary behaviors, and sleep. CONCLUSIONS Daily patterns of movement behaviors were significantly changed in glaucoma patients. Compared with those without glaucoma, glaucoma patients spent less time on MVPA, especially in the evening.
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Affiliation(s)
- Yixiong Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wenyi Hu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Xiayin Zhang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Grace Borchert
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Zhuoting Zhu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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20
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Tegegne YB, Hussen MS, Ayele FA, Mersha GA. Association of Glaucoma with Poor Quality of Sleep in an Ethiopian Glaucoma Population – A Comparative Cross-Sectional Study. Clin Ophthalmol 2022; 16:3701-3710. [PMID: 36389639 PMCID: PMC9661991 DOI: 10.2147/opth.s387623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022] Open
Abstract
Background Glaucoma is a group of ocular disorders characterized by progressive optic nerve damage resulting in irreversible visual field defects. Poor quality of sleep in glaucoma patients could be explained by the reduction of the light input to the circadian system as a result of damage to photosensitive retinal ganglion cells in the retina. Information is limited on the association of poor quality of sleep with glaucoma in general and the Ethiopian glaucoma population in particular. Objective The study aimed to explore the association between poor quality of sleep and glaucoma at a Tertiary Eye Care Center in Ethiopia. Methods An institutional-based comparative cross-sectional study was conducted among 200 glaucoma and 201 non-glaucoma participants recruited by systematic random sampling. Each group was administered with a Pittsburgh Sleep Quality Index (PSQI) questionnaire. Stata-14 was employed for data analysis; an independent t-test was used to show the statistical difference in the global mean PSQI score for the two groups. A binary logistic regression model was applied to identify factors associated with poor quality of sleep. Statistical significance was declared at a 95% confidence interval and a p-value of <0.05. Results The prevalence of poor quality of sleep was 82.5% among the glaucoma population, which statistically differed (p<0.001) from the non-glaucomatous population (55.7%). Poor quality of sleep in glaucoma was associated with older age (adjusted odds ratio (AOR)=4.4, 95% confidence interval (CI): 1.5–5.4), depression (AOR=2.9, 95% CI: 1.1–7.3), visual impairment (AOR=3.9, 95% CI: 1.3–12.3) and severe glaucoma (AOR=2.5, 95% CI: 1.1–5.9). Conclusion and Recommendation Poor quality of sleep was significantly higher in the glaucoma population compared to their non-glaucoma control. It was associated with older age, depression, visual impairment and advanced glaucoma. Incorporating psychiatric counseling into the existing glaucoma follow-up was recommended.
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Affiliation(s)
- Yohannes Bizualem Tegegne
- Department of Optometry, School of Medicine, University of Gondar, Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Mohammed Seid Hussen
- Department of Optometry, School of Medicine, University of Gondar, Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Fisseha Admassu Ayele
- Department of Ophthalmology, School of Medicine, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Getasew Alemu Mersha
- Department of Optometry, School of Medicine, University of Gondar, Comprehensive Specialized Hospital, Gondar, Ethiopia
- Correspondence: Getasew Alemu Mersha, POB: 196, Tel +251932823935, Fax +251-058-114 1240, Email ;
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21
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Sun C, Yang H, Hu Y, Qu Y, Hu Y, Sun Y, Ying Z, Song H. Association of sleep behaviour and pattern with the risk of glaucoma: a prospective cohort study in the UK Biobank. BMJ Open 2022; 12:e063676. [PMID: 36319053 PMCID: PMC9644340 DOI: 10.1136/bmjopen-2022-063676] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Given the role of intraocular pressure in glaucoma, the patient's sleeping pattern might contribute to the development and progression of glaucoma. We performed a study to understand the association between sleep behaviours and glaucoma. DESIGN Our study was a prospective cohort study. SETTING This was a prospective cohort study in the UK Biobank. Self-reported data on five sleep behaviours were collected using a questionnaire at baseline. We identified four sleep patterns based on a cluster analysis of the sleep behaviours. PARTICIPANTS In the UK Biobank, 409 053 participants were recruited between 2006 and 2010 and followed for a diagnosis of glaucoma. We identified glaucoma as any hospital admission with a diagnosis of glaucoma, based on UK Biobank inpatient hospital data. Individuals who withdrew from the UK Biobank, or were diagnosed with glaucoma before recruitment, or had self-reported surgery or laser treatment for glaucoma, or had no information on sleep behaviors were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES We estimated hazard ratios (HRs) with 95% confidence intervals (CI) using Cox proportional hazards models to estimate the associations of different sleep behaviors, as well as identified sleep patterns, with the risk of glaucoma, adjusting for multiple confounders. RESULTS Compared with individuals who had a healthy sleep pattern, an excess risk of any glaucoma was observed among individuals with snoring and daytime sleepiness (HR 1.11, 95% CI 1.03 to 1.19) or insomnia and short/long sleep duration (HR 1.13, 95% CI 1.06 to 1.20), but not late chronotype sleep pattern (HR 0.98, 95% CI 0.93 to 1.03). CONCLUSION Snoring, daytime sleepiness, insomnia, and short/long duration, individually or jointly, were all associated with the risk of glaucoma. These findings underscore the need for sleep intervention for individuals at high risk of glaucoma as well as potential ophthalmologic screening among individuals with chronic sleep problems for glaucoma prevention.
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Affiliation(s)
- Cun Sun
- Beijing Huimin Hospital, Beijing, China
| | - Huazhen Yang
- West China Biomedical Big Data Center, West China Hospital,Sichuan University, Chengdu, Sichuan, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yihan Hu
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Yuanyuan Qu
- West China Biomedical Big Data Center, West China Hospital,Sichuan University, Chengdu, Sichuan, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yao Hu
- West China Biomedical Big Data Center, West China Hospital,Sichuan University, Chengdu, Sichuan, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yajing Sun
- West China Biomedical Big Data Center, West China Hospital,Sichuan University, Chengdu, Sichuan, China
| | - Zhiye Ying
- West China Biomedical Big Data Center, West China Hospital,Sichuan University, Chengdu, Sichuan, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Huan Song
- West China Biomedical Big Data Center, West China Hospital,Sichuan University, Chengdu, Sichuan, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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22
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Duong AT, Van Tassel SH. Depression and Glaucoma: A Review and Considerations for Researchers and Providers. Int Ophthalmol Clin 2022; 62:39-44. [PMID: 36170220 DOI: 10.1097/iio.0000000000000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Ali MS. Commentary: Visual field testing: A distressing or an unpleasant experience! Indian J Ophthalmol 2022; 70:2887-2888. [PMID: 35918937 DOI: 10.4103/ijo.ijo_1189_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- M Shiraz Ali
- Glaucoma Consultant, MatriPrerna Eye Hospital, Ranchi, Jharkhand, India
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24
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Meer EA, Lee YH, Repka MX, Borlik MF, Velez FG, Perez C, Yu F, Coleman AL, Pineles SL. Association of Mood Disorders, Substance Abuse, and Anxiety Disorders in Children and Teens With Serious Structural Eye Diseases. Am J Ophthalmol 2022; 240:135-142. [PMID: 35314189 DOI: 10.1016/j.ajo.2022.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/06/2022] [Accepted: 03/06/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE We sought to evaluate the association between 5 eye diseases (including glaucoma, cataract, congenital optic nerve disease, congenital retinal disease, and blindness/low vision) and mental illness in a pediatric population. DESIGN Cross-sectional study. METHODS A de-identified commercial insurance claims database, OptumLabs Data Warehouse, between January 1, 2007, and December 31, 2018, was used. Children and teens less than 19 years of age at the time of eye diagnosis were included. Demographics and mental illness claims were compared, looking at the association of mental illness and eye disease claims. RESULTS A total of 11,832,850 children and teens were included in this study with mean age of 8.04 ± 5.94 years at the first claim. Of the patients with at least 1 of the 5 eye diseases (n = 180,297), 30.5% had glaucoma (n = 54,954), 9.5% had cataract (n = 17,214), 21.4% had congenital optic nerve disease (n = 38,555), 26.9% had congenital retinal disease (n = 48,562), and 25.9% had blindness or low vision (n = 46,778). There was a statistically significant association, after adjusting for confounding variables, between at least 1 of the 5 eye diseases and schizophrenia disorder (OR = 1.54, 95% CI = 1.48-1.61, P < .001), anxiety disorder (OR = 1.45, 95% CI = 1.43-1.48, P < .001), depressive disorder (OR = 1.27, 95% CI = 1.25-1.29, P < .001), and bipolar disorder (OR = 1.27, 95% CI = 1.21-1.31, P < .001), but a reversed association with substance use disorder (OR = 0.88, 95% CI = 0.86-0.90, P < .001). CONCLUSIONS We found associations between eye disease in children and teens and mental illness. Understanding these relationships may improve mental illness screening and treatment in the pediatric population.
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Affiliation(s)
- Elana A Meer
- From the Perelman School of Medicine (E.A.M), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yoon H Lee
- Department of Ophthalmology (Y.H.L., F.Y., A.L.C., S.L.P.), Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA
| | - Michael X Repka
- Department of Ophthalmology (M.X.R.), Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Marcy F Borlik
- Department of Psychiatry and Biobehavioral Sciences (M.F.B.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Federico G Velez
- Department of Ophthalmology (F.G.V.), Doheny Eye Institute, University of California Los Angeles, Los Angeles, California; USA; Department of Ophthalmology (F.G.V.), Duke University School of Medicine, Durham, North Carolina, USA
| | - Claudia Perez
- Department of Medicine Statistics Core (C.P.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Fei Yu
- Department of Ophthalmology (Y.H.L., F.Y., A.L.C., S.L.P.), Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA; Department of Biostatistics (F.Y.), University of California Los Angeles Fielding School of Public Health, Los Angeles, California, USA
| | - Anne L Coleman
- Department of Ophthalmology (Y.H.L., F.Y., A.L.C., S.L.P.), Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA; Department of Epidemiology (A.L.C.), University of California Los Angeles Fielding School of Public Health, Los Angeles, California, USA
| | - Stacy L Pineles
- Department of Ophthalmology (Y.H.L., F.Y., A.L.C., S.L.P.), Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA
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25
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Halawa OA, Roldan AM, Meshkin RS, Zebardast N, Fenwick EK, Lamoureux EL, Friedman DS. Factors associated with glaucoma-specific quality of life in a US glaucoma clinic in a pilot implementation of an online computerised adaptive test (GlauCAT). Br J Ophthalmol 2022:bjophthalmol-2022-321145. [PMID: 35551060 DOI: 10.1136/bjophthalmol-2022-321145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/25/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Measure quality of life (QoL) outcomes using a novel computerised adaptive test in a clinical setting, and determine the social and demographic factors associated with specific QoL domains in patients with glaucoma. DESIGN Cross-sectional study between July 2020 and April 2021. PARTICIPANTS English-speaking adults presenting to glaucoma clinic. Patients with cognitive impairment on a six-item cognitive impairment screen or with intraocular surgery within 90 days prior to presentation were excluded. RESULTS Of 206 patients surveyed, mean age was 64.8 years (SD 15.2), 122 (56.7%) were female and 159 (74.7%) were white. On multivariable regression, visual acuity was associated with greater activity limitation (β=-2.8 points, 95% CI -3.8 to -1.8, p<0.001) and worse mobility (β=-2.1 points, 95% CI -3.2 to -0.9, p<0.001), while poorer visual field (VF) mean deviation was associated with lower scores on the emotional well-being domain (β=-2.4 points, 95% CI -4.6 to -0.3, p=0.03). Glaucoma suspects and those with early VF defects had higher QoL scores than those with severe glaucoma in the following domains: activity limitation (88.5±14.6 vs 74.3±21.9, respectively, p<0.001), mobility (91.0±12.5 vs 80.0±25.3, respectively, p=0.005) and concerns domains (82.2±13.9 vs 72.5 5±18.9, respectively, p=0.01). CONCLUSIONS In a busy glaucoma clinic where QoL was measured with online adaptive tests for glaucoma, we found that several demographic and clinical variables are associated with lower domain scores, suggesting that patients with predisposing demographic and clinical factors are at a higher risk of worse QoL.
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Affiliation(s)
- Omar A Halawa
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Ana M Roldan
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Ryan S Meshkin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nazlee Zebardast
- Harvard Medical School, Boston, Massachusetts, USA.,Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Eva K Fenwick
- Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Ecosse Luc Lamoureux
- HSSR, Duke-NUS Medical School, Singapore.,Population Health, Singapore Eye Research Institute, Singapore
| | - David S Friedman
- Glaucoma Center of Excellence, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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26
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Abed S, Reilly A, Arnold SJ, Feldheim DA. Adult Expression of Tbr2 Is Required for the Maintenance but Not Survival of Intrinsically Photosensitive Retinal Ganglion Cells. Front Cell Neurosci 2022; 16:826590. [PMID: 35401124 PMCID: PMC8983909 DOI: 10.3389/fncel.2022.826590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/18/2022] [Indexed: 12/14/2022] Open
Abstract
Retinal ganglion cells expressing the photopigment melanopsin are intrinsically photosensitive (ipRGCs). ipRGCs regulate subconscious non-image-forming behaviors such as circadian rhythms, pupil dilation, and light-mediated mood. Previously, we and others showed that the transcription factor Tbr2 (EOMES) is required during retinal development for the formation of ipRGCs. Tbr2 is also expressed in the adult retina leading to the hypothesis that it plays a role in adult ipRGC function. To test this, we removed Tbr2 in adult mice. We found that this results in the loss of melanopsin expression in ipRGCs but does not lead to cell death or morphological changes to their dendritic or axonal termination patterns. Additionally, we found ectopic expression of Tbr2 in conventional RGCs does not induce melanopsin expression but can increase melanopsin expression in existing ipRGCs. An interesting feature of ipRGCs is their superior survival relative to conventional RGCs after an optic nerve injury. We find that loss of Tbr2 decreases the survival rate of ipRGCs after optic nerve damage suggesting that Tbr2 plays a role in ipRGC survival after injury. Lastly, we show that the GABAergic amacrine cell marker Meis2, is expressed in the majority of Tbr2-expressing displaced amacrine cells as well as in a subset of Tbr2-expressing RGCs. These findings demonstrate that Tbr2 is necessary but not sufficient for melanopsin expression, that Tbr2 is involved in ipRGC survival after optic nerve injury, and identify a marker for Tbr2-expressing displaced amacrine cells.
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Affiliation(s)
- Sadaf Abed
- Department of Molecular, Cell, and Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA, United States
| | - Andreea Reilly
- Department of Molecular, Cell, and Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA, United States
| | - Sebastian J. Arnold
- Institute of Experimental and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David A. Feldheim
- Department of Molecular, Cell, and Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA, United States
- *Correspondence: David A. Feldheim,
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27
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Yuhas PT. Non-24-Hour Sleep–Wake Disorder and Tasimelteon: A Review for Practitioners Who Work with Blind People. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2022. [DOI: 10.1177/0145482x211072521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction This narrative review summarizes the biology of human circadian rhythms; details the epidemiology, clinical manifestation, and diagnosis of non-24-hour sleep–wake disorder (N24SWD); and reviews the efficacy of possible treatments. Methods Searches of targeted phrases, such as “non-24-hour sleep–wake disorder” and “tasimelteon,” were conducted on PubMed between December 2016 and March 2020. Results As the world’s population ages, health practitioners frequently work with people who are blind. Damage to the retinal ganglion cells that signal environmental irradiance levels to the suprachiasmatic nucleus prevents many of these individuals from synchronizing their internal clocks to the 24-hour day. As a result, they experience a condition called N24SWD, where the body’s circadian rhythms fall in and out of phase with the solar cycle. The ability to fall asleep and remain asleep is a complex process that depends on many variables, including the release of the neurohormone melatonin. Melatonin is produced at night and is a key regulator of regular sleep cycles. Periods of interrupted sleep, increased sleep latency, and reduced total sleep time occur when melatonin production peaks during daytime. Thus, many persons with N24SWD have difficulty maintaining normal schedules due in part to the mistimed release of melatonin. Randomized clinical trials have shown that melatonin receptor agonist tasimelteon is an effective therapy for individuals with N24SWD. Other treatments have varying efficacy profiles. Conclusions Although rare, N24SWD is a serious condition that can impair quality of life for blind persons. Tasimelteon appears to be a safe and efficacious treatment option. Implications for practitioners Practitioners can use this information to better understand why blind persons often report difficulties sleeping and to realize that therapeutic options are available to these individuals.
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Affiliation(s)
- Phillip T. Yuhas
- College of Optometry, the Ohio State University, Columbus, OH, USA
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28
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Ulhaq ZS, Soraya GV, Dewi NA, Wulandari LR. The prevalence of anxiety symptoms and disorders among ophthalmic disease patients. Ther Adv Ophthalmol 2022; 14:25158414221090100. [PMID: 35464342 PMCID: PMC9021519 DOI: 10.1177/25158414221090100] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/09/2022] [Indexed: 12/26/2022] Open
Abstract
Background: Progressive and irreversible vision loss has been shown to place a patient at risk of mental health problems such as anxiety. However, the reported prevalence of anxiety symptoms and disorders among eye disease patients vary across studies. Thus, this study aims to clarify the estimated prevalence of anxiety symptoms and disorders among ophthalmic disease patients. Methods: Relevant studies on the prevalence of anxiety symptoms and disorders among eye disease patients were collected through international databases, PubMed, Scopus, and Web of Science. A random-effects model was used to determine the pooled prevalence of anxiety symptoms and disorders among ophthalmic disease patients. Results: The 95 included studies yielded a pooled prevalence of 31.2% patients with anxiety symptoms and 19.0% with anxiety disorders among subjects with ophthalmic disease. Pediatric patients were more anxious (58.6%) than adults (29%). Anxiety symptoms were most prevalent in uveitis (53.5%), followed by dry eye disease (DED, 37.2%), retinitis pigmentosa (RP, 36.5%), diabetic retinopathy (DR, 31.3%), glaucoma (30.7%), myopia (24.7%), age-related macular degeneration (AMD, 21.6%), and cataract (21.2%) patients. Anxiety disorders were most prevalent in thyroid eye disease (TED, 28.9%), followed by glaucoma (22.2%) and DED (11.4%). When compared with healthy controls, there was a twofold increase on the prevalence of anxiety symptoms (OR = 1.912, 95% CI 1.463–2.5, p < 0.001) and anxiety disorders (OR = 2.281, 95% CI 1.168–4.454, p = 0.016). Conclusion: Anxiety symptoms and disorders are common problems associated with ophthalmic disease patients. Thus, comprehensive and appropriate treatments are necessary for treating anxiety symptoms and disorders among ophthalmic disease patients.
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Affiliation(s)
- Zulvikar Syambani Ulhaq
- Research Center for Pre-Clinical and Clinical Medicine, National Research and Innovation Agency Republic of Indonesia, Cibinong, Indonesia
| | - Gita Vita Soraya
- Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Nadia Artha Dewi
- Department of Ophthalmology, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Lely Retno Wulandari
- Department of Ophthalmology, Faculty of Medicine, Brawijaya University, Malang, Indonesia
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29
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Nuzzi R, Vitale A. Cerebral Modifications in Glaucoma and Macular Degeneration: Analysis of Current Evidence in Literature and Their Implications on Therapeutic Perspectives. Eye Brain 2021; 13:159-173. [PMID: 34168513 PMCID: PMC8216745 DOI: 10.2147/eb.s307551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/14/2021] [Indexed: 01/19/2023] Open
Abstract
Glaucoma and macular degeneration are leading causes of irreversible blindness, significantly compromising the quality of life and having a high economic and social impact. Promising therapeutic approaches aimed at regenerating or bypassing the damaged anatomical-functional components are currently under development: these approaches have generated great expectations, but to be effective require a visual network that, despite the pathology, maintains its integrity up to the higher brain areas. In the light of this, the existing findings concerning how the central nervous system modifies its connections following the pathological damage caused by glaucoma and macular degeneration acquire great interest. This review aims to examine the scientific literature concerning the morphological and functional changes affecting the central nervous system in these pathological conditions, summarizing the evidence in an analytical way, discussing their possible causes and highlighting the potential repercussions on the current therapeutic perspectives.
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Affiliation(s)
- Raffaele Nuzzi
- Eye Clinic, Department of Surgical Sciences, University of Turin, Turin, 10126, Italy
| | - Alessio Vitale
- Eye Clinic, Department of Surgical Sciences, University of Turin, Turin, 10126, Italy
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30
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Tan Z, Tung TH, Xu SQ, Chen PE, Chien CW, Jiang B. Personality types of patients with glaucoma: A systematic review of observational studies. Medicine (Baltimore) 2021; 100:e25914. [PMID: 34114987 PMCID: PMC8202580 DOI: 10.1097/md.0000000000025914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/16/2021] [Accepted: 04/21/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To synthesize recent empirical research on the association between personality and glaucoma among this sub-population. METHODS PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Scopus and ScienceDirect databases were searched to identify eligible studies published between January 1950 and March 2019 in any language. The quality of included observational studies was assessed using an 11-item checklist which was recommended by Agency for Healthcare Research and Quality (AHRQ). After using the checklist, 12 papers are included into the systematic review. RESULTS There are some differences on the studies about the negative personality of glaucoma patients. In spite of these differences, most included studies significantly showed that glaucoma patients tend to or do have some specific personality. CONCLUSION The extant research could demonstrate that glaucoma patients tend to have some negative personality in some extent. Future studies are needed to provide more convincing support to personality of glaucoma patients.
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Affiliation(s)
- Zhenyan Tan
- Institute for Hospital Management, Tsinghua University, Shenzhen Campus
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang
| | - Shi-Qing Xu
- Institute for Hospital Management, Tsinghua University, Shenzhen Campus
| | - Pei-En Chen
- Taiwan Association of Health Industry Management and Development
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsinghua University, Shenzhen Campus
| | - Bo Jiang
- Department of Ophthalmology, Maoming People's Hospital, Maoming, Guangdong Province, China
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31
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Østergaard Madsen H, Hageman I, Kolko M, Lund-Andersen H, Martiny K, Ba-Ali S. Seasonal variation in neurohormones, mood and sleep in patients with primary open angle glaucoma - implications of the ipRGC-system. Chronobiol Int 2021; 38:1421-1431. [PMID: 34112046 DOI: 10.1080/07420528.2021.1931275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Primary open angle glaucoma is associated with an increased risk of mood and sleep disorders. These adversities have been suggested to relate to a disrupted function of the intrinsically photosensitive retinal ganglion cells (ipRGCs). The ipRGCs are key components in the nonvisual photoreceptive system that mediates light effects on mood, sleep and circadian rhythm. We assessed the diurnal hormone levels, pupillary responses and mood and sleep under seasons with different photoperiods in 24 patients with glaucoma and 24 age- and sex-matched healthy controls to investigate responses to naturalistic seasonal changes in daylight. The patients had moderate-to-advanced glaucoma with substantial visual field defects and reductions in the ipRGC-mediated pupillary responses (p < .001). In winter, compared with summer, patients with glaucoma had higher daytime melatonin concentration (p < .001) and lower nighttime cortisol (p = .002). In winter, the daytime melatonin level was inversely correlated with the ipRGC-mediated pupillary responses in the control group (p = .04). In the control group, there were no significant changes in hormone levels between seasons or any correlations between neurohormone levels and the ipRGC-mediated responses. The two groups showed a similar response to season with lower depression scores in summer compared with winter. In between-group comparison, the nocturnal melatonin level (area under curve from 20:00 h to 08:00 h) in summer was lower in glaucoma compared with controls (p = .03). In winter, nocturnal cortisol (at 04:00 h) was lower (p = .004) and daytime cortisol (12:00 h and 16:00 h) was higher (p = .007) in glaucoma compared with controls. In conclusion, we found that patients with glaucoma displayed a seasonal variation in diurnal hormone levels that was not present in healthy controls. Such neurohormonal changes may contribute to the increased risk of mood and sleep disorders seen in patients with glaucoma.
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Affiliation(s)
| | - Ida Hageman
- Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Department of Ophthalmology, Rigshospitalet-Glostrup Hospital, Copenhagen, Denmark
| | - Henrik Lund-Andersen
- Department of Ophthalmology, Rigshospitalet-Glostrup Hospital, Copenhagen, Denmark
| | - Klaus Martiny
- Mental Health Center Copenhagen, Copenhagen, Denmark
| | - Shakoor Ba-Ali
- Department of Ophthalmology, Rigshospitalet-Glostrup Hospital, Copenhagen, Denmark
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Neuroprotection in Glaucoma: NAD +/NADH Redox State as a Potential Biomarker and Therapeutic Target. Cells 2021; 10:cells10061402. [PMID: 34198948 PMCID: PMC8226607 DOI: 10.3390/cells10061402] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 02/07/2023] Open
Abstract
Glaucoma is the leading cause of irreversible blindness worldwide. Its prevalence and incidence increase exponentially with age and the level of intraocular pressure (IOP). IOP reduction is currently the only therapeutic modality shown to slow glaucoma progression. However, patients still lose vision despite best treatment, suggesting that other factors confer susceptibility. Several studies indicate that mitochondrial function may underlie both susceptibility and resistance to developing glaucoma. Mitochondria meet high energy demand, in the form of ATP, that is required for the maintenance of optimum retinal ganglion cell (RGC) function. Reduced nicotinamide adenine dinucleotide (NAD+) levels have been closely correlated to mitochondrial dysfunction and have been implicated in several neurodegenerative diseases including glaucoma. NAD+ is at the centre of various metabolic reactions culminating in ATP production—essential for RGC function. In this review we present various pathways that influence the NAD+(H) redox state, affecting mitochondrial function and making RGCs susceptible to degeneration. Such disruptions of the NAD+(H) redox state are generalised and not solely induced in RGCs because of high IOP. This places the NAD+(H) redox state as a potential systemic biomarker for glaucoma susceptibility and progression; a hypothesis which may be tested in clinical trials and then translated to clinical practice.
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Tilahun MM, Yibekal BT, Kerebih H, Ayele FA. Prevalence of common mental disorders and associated factors among adults with Glaucoma attending University of Gondar comprehensive specialized hospital tertiary eye care and training center, Northwest, Ethiopia 2020. PLoS One 2021; 16:e0252064. [PMID: 34015012 PMCID: PMC8136648 DOI: 10.1371/journal.pone.0252064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/07/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study aimed to assess the prevalence of common mental disorders and associated factors among adults with glaucoma at Gondar university comprehensive specialized hospital tertiary eye care and training center. Glaucoma predisposes patients to common mental problems and leads to wasteful, costly and inefficient use of medical services and complications of the diagnoses. So, determining the level and factors associated with common mental disorders among glaucoma patient would help to improve and integrate comprehensive ophthalmic services which address common mental disorder in a follow-up visit. METHODS An institution-based cross-sectional study was conducted on 495 glaucoma patients selected by using systematic random sampling. Data were collected through face-to-face interview and chart review. Self-reported questionnaire (SRQ-20) was used to assess the presence of common mental disorders. Binary logistic regression analysis was done to identify factors associated with common mental disorders. Variables with P<0.05 were considered as factors significantly associated with common mental disorders. RESULT Four hundred sixty-eight patients were included in this study with a response rate of 94.54%. The mean age of the participant was 58 ± 14.11 years. The prevalence of common mental disorders was found to be 29.5% (95% CI 25.4-33.3). Female sex (AOR = 3.79, 95% CI: 1.66-8.62) (p-value = 0.001), average monthly income of less than 1200 birr (AOR = 6.05 95% CI: 2.26-16.22) (p-value = 0.001), poor level of social support (AOR = 17.39 95% CI: 7.79-38.82) (p-value = 0.001), moderate and high risk of alcohol use (AOR = 10.42 95%CI: 2.74-39.54) (p-value = 0.001), presence of chronic medical illness (AOR = 3.85 95% CI: 2.07-7.16) (p-value = 0.001), receiving both drug and surgical treatment (AOR = 2.50, 95%CI: 1.30-4.83) (p-value = 0.006) and presence of systemic carbonic anhydrase inhibitors use (AOR = 3.16, 95%CI: 1.65-6.06) (p-value = 0.001) were significantly associated with increased level of common mental disorders. CONCLUSION Significant numbers of glaucoma patients have CMD and found significantly associated with socio-economic, ocular and systemic clinical factors. Therefore, the integration of psychosocial care into the current treatment of patients with glaucoma would have a significant advantage to help these patients.
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Affiliation(s)
- Mikias Mered Tilahun
- Department of Optometry, School of Medicine, College of Medicine and Health Science, University of Gondar Comprehensive specialized hospital, Gondar Town, Ethiopia
| | - Betelhem Temesgen Yibekal
- Department of Optometry, School of Medicine, College of Medicine and Health Science, University of Gondar Comprehensive specialized hospital, Gondar Town, Ethiopia
| | - Habtamu Kerebih
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar Comprehensive Specialized Hospital, Gondar Town, Ethiopia
| | - Fisseha Ademassu Ayele
- Department of Ophthalmology, School of Medicine, College of Medicine and Health Science, University of Gondar Comprehensive Specialized Hospital, Gondar Town, Ethiopia
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Stamatiou ME, Kazantzis D, Theodossiadis P, Chatziralli I. Depression in glaucoma patients: A review of the literature. Semin Ophthalmol 2021; 37:29-35. [PMID: 33822676 DOI: 10.1080/08820538.2021.1903945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purpose: The purpose of this review was to evaluate the association between glaucoma and depression and to identify possible risk factors for depressive symptoms in glaucoma patients.Methods: A total of 587 abstracts were screened and 32 studies were deemed eligible for inclusion in this review.Results: An association of glaucoma and depression was found, while advanced disease stage, older age, female sex and faster visual loss progression were recognized as potential risk factors for depression in patients with glaucoma.Conclusions: Our findings may have important clinical significance, such as alerting ophthalmologists to implement a multidisciplinary approach in patients with glaucoma. Further research is needed to examine this association in different types of glaucoma and try to investigate the underlying pathophysiological mechanisms to establish a causal inference between glaucoma and depression.
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Influence of Circadian Rhythm in the Eye: Significance of Melatonin in Glaucoma. Biomolecules 2021; 11:biom11030340. [PMID: 33668357 PMCID: PMC7996162 DOI: 10.3390/biom11030340] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 02/07/2023] Open
Abstract
Circadian rhythm and the molecules involved in it, such as melanopsin and melatonin, play an important role in the eye to regulate the homeostasis and even to treat some ocular conditions. As a result, many ocular pathologies like dry eye, corneal wound healing, cataracts, myopia, retinal diseases, and glaucoma are affected by this cycle. This review will summarize the current scientific literature about the influence of circadian patterns on the eye, focusing on its relationship with increased intraocular pressure (IOP) fluctuations and glaucoma. Regarding treatments, two ways should be studied: the first one, to analyze if some treatments could improve their effect on the ocular disease when their posology is established in function of circadian patterns, and the second one, to evaluate new drugs to treat eye pathologies related to the circadian rhythm, as it has been stated with melatonin or its analogs, that not only could be used as the main treatment but as coadjutant, improving the circadian pattern or its antioxidant and antiangiogenic properties.
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Kawasaki A, Udry M, El Wardani M, Münch M. Can Extra Daytime Light Exposure Improve Well-Being and Sleep? A Pilot Study of Patients With Glaucoma. Front Neurol 2021; 11:584479. [PMID: 33519670 PMCID: PMC7843442 DOI: 10.3389/fneur.2020.584479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/09/2020] [Indexed: 12/03/2022] Open
Abstract
Glaucoma damages retinal ganglion cells, including intrinsically photosensitive retinal ganglion cells (ipRGCs). These cells modulate various non-visual physiological and psychological functions which are modulated by light. In patients with glaucoma, we assessed the effect of daily bright light exposure (LE) on several melanopsin-dependent functions, such as the pupil constriction, circadian rest-activity cycles, sleep and subjective well-being including relaxation, alertness and mood. Twenty patients participated in the study (9 women, 11 men, mean age = 67.6 ± 7.5 y). Pupillometry was performed before the LE weeks and repeated on the last day of LE. The post-illumination pupil response (PIPR) was calculated as a proxy for melanopsin-dependent activation. Participants continuously wore an activity monitor and self-assessed sleep quality, well-being and visual comfort for 7 days before and during 4 weeks of daily bright LE (30 min to 10,000 lux polychromatic bright white light). After the LE, there was a significantly greater PIPR and higher subjective sleep quality when compared to the pre-LE week (p < 0.05), but no significant changes in 24-h rhythms or sleep parameters. A greater PIPR was correlated with an increase in circadian amplitude and higher inter-daily stability (derived from rest-activity cycles; p < 0.05). In a small group of patients with glaucoma, scheduled daily bright light exposure could improve subjective sleep quality. These findings highlight the importance to evaluate and maintain non-visual functions at different levels in patients with progressive loss of ipRGCs.
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Affiliation(s)
- Aki Kawasaki
- Hôpital Ophtalmique Jules Gonin, Fondation Asile des Aveugles, Department of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Morgane Udry
- Hôpital Ophtalmique Jules Gonin, Fondation Asile des Aveugles, Department of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Mohamad El Wardani
- Hôpital Ophtalmique Jules Gonin, Fondation Asile des Aveugles, Department of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Ophthalmology Department, Calderdale and Huddersfield NHS Foundation, Huddersfield, United Kingdom
| | - Mirjam Münch
- Sleep/Wake Research Centre, Massey University, Wellington, New Zealand
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van Oterendorp C. Endocrine Dysfunction in Open Angle Glaucoma. Klin Monbl Augenheilkd 2021; 238:128-131. [PMID: 33434931 DOI: 10.1055/a-1306-1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The eye, like all organs, is exposed to the effects of the body's endocrine system. In addition, however, local branches of the endocrine system control important organ-specific functions, such as the production and drainage of aqueous humour. Similarly, the eye as a sensory organ acts back on endocrine controlled functions of the body, for example the day-night rhythm. This article aims to illustrate the physiological and pathological interactions of the eye and the endocrine functions of the body in the context of glaucoma. 1. The renin-angiotensin-aldosterone system, which as a local system is involved in the control of aqueous humour production and outflow. 2. The hormone endothelin, which as a strong vasoconstrictor plays a role in the dysregulated perfusion of the optic nerve and retina, and 3. the disruption of the day-night rhythm in advanced glaucoma, which is thought to be caused by damage to light-sensitive ganglion cells.
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Do Levels of Stress Markers Influence the Retinal Nerve Fiber Layer Thickness in Young Adults? J Glaucoma 2020; 29:587-592. [PMID: 32287148 DOI: 10.1097/ijg.0000000000001511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PRECIS Although mental or emotional stress may result raise in intraocular pressure (IOP) we found weak associations between endogenous stress markers concentrations and retinal nerve fiber layer (RNFL) thickness, thus limited evidence that stress affects retinal ganglion cells integrity. PURPOSE Increased exposure to glucocorticoids is linked to elevated IOP, which is a risk factor for glaucoma. We explored the RNFL thickness for changes that may mimic preclinical glaucomatous changes, in relation to the hormonal stress response. MATERIALS AND METHODS Young healthy adults (n=863) underwent a Trier Social Stress Test. Endogenous plasma adrenocorticotropic hormone (ACTH) and cortisol were measured for those who provided biological samples, and adrenal sensitivity was calculated. On the basis of cortisol levels before and after the Trier Social Stress Test, participants were categorized into one of 3 stress response types: anticipatory-responders, reactive-responders, and nonresponders. Participants underwent an eye examination that included spectral-domain optical coherence tomography to measure peripapillary RNFL thickness. RESULTS Higher levels of ACTH were associated with thinner RNFL globally (P=0.009), and at the inferotemporal (P=0.015), superotemporal (P=0.044), and temporal sectors (P=0.046). Lower adrenal sensitivity was associated with thinner RNFL inferotemporally (P<0.001) and temporally (P=0.037). However, these effect sizes were small; for example, a 10 pg/mL increase in baseline ACTH was associated with only a 3 µm thinner RNFL. RNFL thickness was not associated with plasma cortisol levels and or significantly different between groups of acute stress response patterns. CONCLUSIONS Although there was a link between ACTH or adrenal sensitivity and RNFL thickness, this association was weak and its clinical significance is unclear. Despite the close associations between levels of endogenous stress markers and IOP, we found limited evidence of a link to RNFL integrity.
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Liu CH, Kang EYC, Lin YH, Wu WC, Liu ZH, Kuo CF, Lai CC, Hwang YS. Association of ocular diseases with schizophrenia, bipolar disorder, and major depressive disorder: a retrospective case-control, population-based study. BMC Psychiatry 2020; 20:486. [PMID: 33008365 PMCID: PMC7532110 DOI: 10.1186/s12888-020-02881-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/19/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Psychiatric disorders and ocular neurovascular diseases may share a similar pathophysiological route of vascular structures or neurological changes. The aim of this study is to investigate the association between ocular neurovascular diseases and the risk of major psychiatric disorders. METHODS This was a retrospective case-control, population-based study including patients aged ≥20 and were diagnosed between 1997 and 2013. Ocular neurovascular diseases diagnosed between 1997 and 2006 and newly diagnosed psychiatric disorders including bipolar disorder (BD), major depressive disorder (MDD), and schizophrenia between 2007 and 2013 were registered. Patients were propensity-score matched with control groups without psychiatric disorders in each cohort based on selected covariates. RESULTS A total of one million sampled patients in the database were categorized based on their diagnoses; 2243 (37.4% men) were categorized into the BD group, 10,110 (35.2% men) into the MDD group, and 1623 (43.1% men) into the schizophrenia group. In the BD group, all glaucoma (OR 1.49, [1.18-1.89]), open-angle glaucoma (OR 2.08, [1.34-3.24]), and closed-angle glaucoma (OR 2.12, [1.36-3.33]) showed statistical significance of risk. In the MDD group, age-related macular degeneration (OR 1.33, [1.13-1.57]), all glaucoma (OR 1.24, [1.11-1.37]), open-angle glaucoma (OR 1.47, [1.21-1.80]), and dry eye syndrome (OR 1.22, [1.13-1.31]) were associated with a significantly higher risk. In the schizophrenia group, only all glaucoma (OR 1.47, [1.02-2.11]), glaucoma suspect (OR 1.88, [1.01-3.49]), and open-angle glaucoma (OR 2.19, [1.13-4.26]) showed statistical significance. CONCLUSIONS In this population-based study, ocular neurovascular diseases, especially glaucoma, were associated with increased risks of BD, MDD, and schizophrenia.
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Affiliation(s)
- Chun-Hao Liu
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan ,Department of Psychiatry, New Taipei Municipal Tu-Cheng Hospital, New Taipei, Taiwan ,grid.145695.aCollege of Medicine, Chang Gung University, Taoyuan, Taiwan ,grid.260567.00000 0000 8964 3950Department of Sinophone Literatures, National Dong Hwa University, Hualien, Taiwan
| | - Eugene Yu-Chuan Kang
- grid.145695.aCollege of Medicine, Chang Gung University, Taoyuan, Taiwan ,Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Yu-Hsiang Lin
- grid.145695.aCollege of Medicine, Chang Gung University, Taoyuan, Taiwan ,Department of Urology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan ,grid.145695.aGraduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chi Wu
- grid.145695.aCollege of Medicine, Chang Gung University, Taoyuan, Taiwan ,Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Zhuo-Hao Liu
- grid.145695.aCollege of Medicine, Chang Gung University, Taoyuan, Taiwan ,Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- grid.145695.aCollege of Medicine, Chang Gung University, Taoyuan, Taiwan ,Department of Rheumatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Chi-Chun Lai
- grid.145695.aCollege of Medicine, Chang Gung University, Taoyuan, Taiwan ,Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Yih-Shiou Hwang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
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Madsen HØ, Ba-Ali S, Lund-Andersen H, Martiny K, Hageman I. Mood and behavior seasonality in glaucoma; assessing correlations between seasonality and structure and function of the retinal ganglion cells. PLoS One 2020; 15:e0229991. [PMID: 32163458 PMCID: PMC7067444 DOI: 10.1371/journal.pone.0229991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/18/2020] [Indexed: 12/26/2022] Open
Abstract
Aim In glaucoma, depression and disturbed sleep has been associated with degeneration of the intrinsically photosensitive retinal ganglion cells, that mediate non-image forming effects of light such as regulation of circadian rhythm, alertness and mood. In this study we assessed associations between seasonal mood and behavior variation and retinal ganglion cell damage in outpatients with glaucoma. Methods The seasonal pattern assessment questionnaire was administered to outpatients with glaucoma. Data on visual field defects identified by autoperimetry and retinal nerve fiber layer thickness visualized by ocular coherence tomography were collected from patient charts. The correlations between seasonality and retinal damage were tested and the adjusted effects of retinal function on seasonality were evaluated in a linear regression model. Results In total, 113 persons completed the questionnaire. Of these, 4% fulfilled the criteria for seasonal affective disorder (SAD) and 8% for subsyndromal seasonal affective disorder (sSAD). Mean global seasonal score was 4.3. There were no significant correlations between seasonality and either visual field or retinal nerve fiber layer thickness. In the adjusted analysis there were trends toward differential effects of visual field on seasonality in subgroups with different sex and type of glaucoma. Conclusion There were no strong associations between seasonality and visual field or retinal nerve fiber layer thickness. Sex, age and glaucoma subtype may modify light effects on complex regulatory systems.
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Affiliation(s)
| | - Shakoor Ba-Ali
- Department of Ophthalmology, Rigshospitalet-Glostrup Hospital, Copenhagen, Denmark
| | - Henrik Lund-Andersen
- Department of Ophthalmology, Rigshospitalet-Glostrup Hospital, Copenhagen, Denmark
| | - Klaus Martiny
- Mental Health Center Copenhagen, Copenhagen, Denmark
| | - Ida Hageman
- Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
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Resting-state functional magnetic resonance study of primary open-angle glaucoma based on voxelwise brain network degree centrality. Neurosci Lett 2019; 712:134500. [PMID: 31557522 DOI: 10.1016/j.neulet.2019.134500] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/12/2019] [Accepted: 09/14/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate alterations in the functional brain networks of patients with primary open-angle glaucoma (POAG) by using the resting-state functional magnetic resonance imaging (fMRI) voxelwise degree centrality (DC) method. MATERIALS AND METHODS Thirteen patients with POAG and thirteen healthy subjects were recruited for this study, and each participant underwent a rs-fMRI scan. The voxelwise DC method was used to assess the features of spontaneous brain activity. The differences in the mean DC across brain regions between the POAG group and the healthy control group were analyzed, and the correlations between the DC values of altered brain regions and various clinical ophthalmic parameters were analyzed in the POAG group. RESULTS Compared with healthy controls, patients with POAG exhibited significantly decreased DC values of the left superior frontal gyrus and the left postcentral gyrus as well as significantly increased DC values of the left superior occipital gyrus. In POAG patients, the DC value of the left superior occipital gyrus was significantly positively correlated with age (r = 0.571, P = 0.042) and negatively correlated with the intraocular pressure of the right eye (r=-0.625, P = 0.022). The DC value of the left superior frontal gyrus was significantly positively correlated with the right eye average cup-to-disc ratio (r = 0.683, P = 0.010), vertical cup-to-disc ratio (r = 0.779, P = 0.002), and pattern standard deviation (r = 0.567, P = 0.043). CONCLUSION The results showed that altered DC values in three brain regions may reflect the underlying pathological mechanisms of POAG. Decreased DC values of the left superior occipital gyrus could be useful imaging markers for determining the extent of brain damage in POAG patients compared to healthy subjects.
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Abstract
This article focuses on irregular sleep-wake rhythm disorder (ISWRD) and its associations with several other comorbidities. Irregular sleep-wake rhythm disorder is a circadian disorder characterized by a lack of a clear sleep-wake pattern. The disorder has yet to be fully understood from pathophysiologic perspective. Treatments are available, but there is a need for development of novel interventions. The goal of this article is to focus on multiple aspects of ISWRD.
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Affiliation(s)
- Temitayo Oyegbile
- Georgetown University, MedStar St. Mary's Sleep Lab, Georgetown University Medical Center, 3800 Reservoir Road, Washington, DC 20007, USA.
| | - Aleksandar Videnovic
- MGH Neurological Clinical Research Institute, 165 Cambridge Street, Suite 600, Boston, MA 02114, USA
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Ayaki M, Tsubota K, Kawashima M, Kishimoto T, Mimura M, Negishi K. Sleep Disorders are a Prevalent and Serious Comorbidity in Dry Eye. Invest Ophthalmol Vis Sci 2019; 59:DES143-DES150. [PMID: 30481819 DOI: 10.1167/iovs.17-23467] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Sleep is an essential life habit and closely associated with lifespan, diabetes, hypertension, and mental health. Sleep disorders are a prominent, but overlooked problem in patients with dry eye disease (DED), characterized by a poor sleep index, short sleep duration, long sleep latency, and poor subjective sleep. DED and sleep disorders are more prevalent in women than men. Moreover, sleep quality in DED is worse than in other eye diseases, including glaucoma, retinal diseases, cataract, and allergic and chronic conjunctivitis. Methods We reviewed the literature for studies investigating sleep and health, eyes and sleep, and DED and sleep, in terms of systemic and eye health, especially in women. Results Two studies reported that approximately half of patients with DED suffer from poor sleep. The severity of mood disorders, including anxiety and depression, is correlated strongly with sleep disorders in DED, and the symptoms and signs of DED, especially pain, also are correlated with sleep quality. Sleep disorders are documented in primary Sjögren's syndrome and an association with sleep apnea and depression is suggested. Primary Sjögren's syndrome includes arthritis and other rheumatic disease causing pain and fatigue; however, how sicca contributes to sleep disorders is not known. Conclusions Possible explanations for sleep disorders in DED may be depression, pain, and eye exposure at night. Reciprocal effects may be expected and consultation-liaison psychiatry is recommended for the management of sleep disorders in DED. Topical medication and lid heating also may be advantageous for sleep quality in DED.
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Affiliation(s)
- Masahiko Ayaki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.,Otake Clinic Moon View Eye Center, Yamato, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Motoko Kawashima
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Taishiro Kishimoto
- Department of Psychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Psychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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Abstract
Pharmacy data reveal that 70% of patients were missing one or more days worth of drops out of five. Adopting approaches to behavior change and management skills used for people with diabetes may provide insight to improve self-management of glaucoma. Every person who is diagnosed with a chronic health condition such as glaucoma has unique life circumstances that may present barriers to behavior change. An accurate diagnosis and a treatment plan are useless if patients do not use their prescribed eye drops. Active listening and effective communication can result in persons who are more engaged in their self-care behaviors. Collaborative communication using person-centered and strengths-based messages could help eye care providers identify challenges and concerns for people with glaucoma who are experiencing inconsistencies with their eye drops. In an atmosphere where patients can discuss their challenges with treatment recommendations without judgment or fear, they are more likely to trust their provider and therefore share their situation openly and honestly. This is accomplished by choosing language that communicates mutually-agreed-upon self-management goals and addresses and strengthens individual and clinical outcomes. The eye care professional is then seen by the patient as a resource who can empathize when setbacks occur and reinforce the patient's self-management goals. Open-ended questions and tell-ask-tell approaches for identifying barriers to care are keys to more effective communication and trusting relationships. This includes recognizing that glaucoma is associated with increased rates of anxiety or depression that may be an overlooked barrier to self-management. By adopting language recommendations from diabetes care and education, eye care practitioners may be better equipped to help people with glaucoma improve their self-care.
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Altered whole-brain gray matter volume in primary angle closure glaucoma patients: a voxel-based morphometry study. Neuroreport 2019; 29:1405-1412. [PMID: 30199440 DOI: 10.1097/wnr.0000000000001126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The study aimed to compare the whole-brain gray matter volume (GMV) and white matter volume (WMV) difference between primary angle closure glaucoma (PACG) patients and health controls (HCs) using a voxel-based morphometry method. A total of 27 patients with PACG (17 males and 10 females) and 27 HCs (17 males and 10 females), closely matched for age and education, were enrolled in the study. All subjects underwent magnetic resonance imaging (MRI) scans. The MRI data were processed using SPM8 software in voxel-based morphometry 8 toolbox. The relationship between the mean GMV values of brain regions and the clinical features including psychological testing and mean retinal nerve fiber layer (RNFL) thickness in PACG groups were analyzed by using Pearson correlation. Compared with HCs, PACG patients showed significantly decreased GMV values in the left cerebellum posterior lobe (CPL), right extra-nuclear, and right superior temporal gyrus. In contrast, PACG patients showed significantly increased GMV values in the left CPL, right CPL, right superior temporal gyrus, right thalamus and right insula (P<0.01). Moreover, in the PACG group, the left mean RNFL showed a positive correlation with the mean GMV values of the left CPL (r=0.719; P<0.001) and the right mean RNFL showed a positive correlation with the mean GMV values of the left CPL (r=0.721; P<0.001). The Hamilton depression score showed a positive correlation with the mean GMV values of right insula (r=0.897; P<0.001). Our results demonstrated that PACG patients showed altered brain structure in various regions related to visuomotor function, thalamocortical pathway, and emotion function, which might provide a useful informations to understanding the anatomy neural mechanisms of deficit in vision loss and depression in PACG.
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Chen L, Li S, Cai F, Wu L, Gong H, Pei C, Zhou F, Zeng X. Altered functional connectivity density in primary angle-closure glaucoma patients at resting-state. Quant Imaging Med Surg 2019; 9:603-614. [PMID: 31143651 DOI: 10.21037/qims.2019.04.13] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Primary angle-closure glaucoma (PACG) is a neurodegenerative disease. Previous structural and functional studies of functional magnetic resonance imaging (fMRI) have demonstrated widespread dysfunction of spontaneous activity in the PACG brain. In this study, we applied a data-driven graph theory approach of functional connectivity density (FCD) mapping to investigate the altered local and global functional connectivity (FC) of the cortex in PACG. Methods Forty-five PACG patients (53.28±10.79 years, 17 males/28 females) and 46 well-matched healthy controls (HCs) (52.67±11.01 years,18 males/28 females) received resting-state fMRI scans. All PACG patients finished complete ophthalmologic examinations, including retinal nerve fiber layer thickness (RNFLT), intraocular pressure (IOP), average cup to disc ratio (A-C/D), and vertical cup to disc ratio (V-C/D). We calculated the between-group FCD difference for short-range and long-range in each voxel. Then, we generated the intrinsic FC of the seed region with the whole brain. Finally, correlations were investigated between FCD value of the altered regions and clinical variables. Results PACG patients showed increased short-range FCD in the left inferior frontal gyrus (IFG)/insula/parahippocampal gyrus and right IFG/insula (P<0.05, corrected), compared with the HCs. Simultaneously, the decreased regions in short-range FCD map were the occipital/cuneus/precuneus/superior parietal/postcentral lobe (P<0.05, corrected). In the PACG groups, decreased long-range FCD was observed in the left middle frontal gyrus compared to the HC (P<0.05, corrected). RNFLT was positively correlated with decreased short-range FCD value of the occipital/cuneus/precuneus/superior parietal/postcentral lobes, and the A-C/D was negatively correlated with the increased short-range FCD value of the left IFG/insula/parahippocampal gyrus, and the right IFG/insula. Conclusions Our findings suggest that PACG can induce extensive brain dysfunction, and showed different spatial distribution in short- and long-range FCD.
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Affiliation(s)
- Linglong Chen
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, China
| | - Shenghong Li
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, China
| | - Fengqin Cai
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, China
| | - Lin Wu
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, China
| | - Honghan Gong
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, China
| | - Chonggang Pei
- Department of Ophthalmology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, China
| | - Fuqing Zhou
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, China.,Jiangxi Medical Imaging Research Institute, Nanchang 330006, China
| | - Xianjun Zeng
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, China.,Jiangxi Medical Imaging Research Institute, Nanchang 330006, China
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Bierings RAJM, Gordijn MCM, Jansonius NM. Chronotyping glaucoma patients with the Munich ChronoType Questionnaire: A case-control study. PLoS One 2019; 14:e0214046. [PMID: 30921336 PMCID: PMC6438473 DOI: 10.1371/journal.pone.0214046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/19/2019] [Indexed: 01/12/2023] Open
Abstract
Purpose The circadian clock is entrained to light by the intrinsically photosensitive retinal ganglion cells. Loss of these cells in glaucoma, an eye disease with loss of retinal ganglion cells as its key feature, might thus result in a change in chronotype. We aimed to compare the chronotype between glaucoma patients and healthy subjects. Methods We sent the Munich ChronoType Questionnaire to 221 glaucoma patients (response rate 81%); controls (primary control group) were primarily their spouses. After exclusion of shift workers and participants who woke-up due to an alarm clock on days off, 159 glaucoma patients (88 early, 21 moderate, 23 severe) and 163 controls remained. We calculated chronotype as the mid-sleep on days off, corrected for workweek accumulated sleep debt (MSFsc). We compared means and variances between groups using Welch’s tests and F-tests, respectively. A secondary control group was recruited from participants in a citizen-science project (n = 17073) who completed an online questionnaire. A resampling method was applied to enable an age- and gender- matched comparison with the glaucoma patients. Results Compared to the primary control group, glaucoma did not affect the mean MSFsc (controls 3:47; early, moderate, and severe glaucoma 3:40, 3:45, and 3:33, respectively [P = 0.62]). Chronotype variability seemed to increase with increasing disease severity (severe glaucoma versus controls: P = 0.023). The mean MSFsc of the secondary control group was 3:50 (95% confidence interval 3:48 to 3:52); significantly later than that of the glaucoma patients (3:40; P = 0.024). Mean MSFsc did not differ significantly between the control groups (P = 0.42). Conclusions No clear changes were found in the chronotype as determined by sleep phase in patients with glaucoma, especially not in early and moderate glaucoma. In severe glaucoma, chronotype variability seems to increase, possibly alongside a small advancement.
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Affiliation(s)
- Ronald A J M Bierings
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marijke C M Gordijn
- Chronobiology Unit, Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, the Netherlands.,Chrono@Work B.V., Groningen, the Netherlands
| | - Nomdo M Jansonius
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Hark LA, Madhava M, Radakrishnan A, Anderson-Quiñones C, Robinson D, Adeghate J, Silva S, Zhan T, Adepoju T, Dave Y, Fudemberg SJ. Impact of a Social Worker in a Glaucoma Eye Care Service: A Prospective Study. HEALTH & SOCIAL WORK 2019; 44:48-56. [PMID: 30561635 DOI: 10.1093/hsw/hly038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 10/17/2018] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to evaluate the effects of a six-month social worker intervention for participants with a glaucoma-related diagnosis in an urban ophthalmic setting (N = 40). The social worker assessed common barriers to eye care, helping participants with transportation, access to low-vision resources, and supportive counseling. The Distress Thermometer, Patient Health Questionnaire-9, and a satisfaction survey were administered to determine the effect of the social worker intervention and participants' overall impressions of the social worker. The most common barrier to eye care was emotional distress (77.5 percent). There was a significant decrease in the number of participants with symptoms of major and moderate depression. Fourteen participants experienced a clinically relevant decrease in depression, 37 participants felt that the social worker's support addressed their issues, and 29 participants thought it helped them in managing their glaucoma. This study provides evidence that a social work intervention may improve care coordination and management of individuals afflicted with vision impairment due to glaucoma and other ocular diseases.
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Affiliation(s)
- Lisa A Hark
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Malika Madhava
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Anjithaa Radakrishnan
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Catherine Anderson-Quiñones
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Debra Robinson
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Jennifer Adeghate
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Stephen Silva
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Tingting Zhan
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Tomilade Adepoju
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Yatee Dave
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Scott J Fudemberg
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
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