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Article ; Online: Hypotony Keratopathy Following Trabeculectomy.

Camp, Andrew S / Weinreb, Robert N

2019 Volume 29, Issue 2, Page(s) 77–80

Abstract: Precis: Hypotony keratopathy is a potential complication of hypotony following trabeculectomy and successful treatment depends on increasing intraocular pressure (IOP).: Purpose: To evaluate corneal decompensation in patients following trabeculectomy ...

Abstract	Precis: Hypotony keratopathy is a potential complication of hypotony following trabeculectomy and successful treatment depends on increasing intraocular pressure (IOP). Purpose: To evaluate corneal decompensation in patients following trabeculectomy with adjuvant mitomycin C (MMC). We propose "hypotony keratopathy" as a descriptive term. Methods: Patients with trabeculectomy and follow-up performed by the authors were included in this retrospective single-center study. Patients were included if they had evidence of corneal decompensation (Descemet membrane folds or corneal edema) the following trabeculectomy with MMC with concurrent hypotony. Outcome measures included best-corrected visual acuity, average IOP at time of diagnosis, and changes in central corneal thickness. Clinical outcomes for the treatment of hypotony keratopathy were noted when performed. Results: A total of 14 eyes from 12 patients were included in the series. Hypotony developed an average of 5 years after trabeculectomy, and hypotony keratopathy was diagnosed 7.5 years after trabeculectomy. Hypotony keratopathy ranged from nonvisually significant Descemet membrane fold without increased corneal thickness to visually significant corneal edema. Best-corrected visual acuity decreased 0 to 6 Snellen lines after diagnosis of hypotony keratopathy. Lower IOP was associated with increased corneal thickness. Vision improved after trabeculectomy revision (6 eyes) and cataract extraction with an intraocular lens implant (1 eye) but did not improve after Descemet stripping automated endothelial keratoplasty (2 eyes). Conclusions: Hypotony keratopathy is a poorly described but potentially treatable complication of trabeculectomy with MMC. Hypotony keratopathy may be related to endothelial dysfunction secondary to hypotony.
MeSH term(s)	Aged ; Aged, 80 and over ; Alkylating Agents/administration & dosage ; Corneal Edema/diagnosis ; Corneal Edema/etiology ; Corneal Edema/surgery ; Female ; Glaucoma, Open-Angle/surgery ; Humans ; Intraocular Pressure/physiology ; Male ; Middle Aged ; Mitomycin/administration & dosage ; Ocular Hypotension/diagnosis ; Ocular Hypotension/etiology ; Ocular Hypotension/surgery ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Terminology as Topic ; Trabeculectomy/adverse effects
Chemical Substances	Alkylating Agents ; Mitomycin (50SG953SK6)
Language	English
Publishing date	2019-12-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	913494-3
ISSN	1536-481X ; 1057-0829
ISSN (online)	1536-481X
ISSN	1057-0829
DOI	10.1097/IJG.0000000000001425
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Article ; Online: Association of Visual Field Pattern Reversal with Paracentral Visual Field Loss.

Chang, Aimee C / Camp, Andrew S / Patella, Vincent M / Weinreb, Robert N

Ophthalmology. Glaucoma

2021 Volume 5, Issue 3, Page(s) 353–358

Abstract: Purpose: Visual field (VF) results that show more test points outside normal limits on the pattern deviation map than on the total deviation map have been assumed to be evidence of unreliable VF results. We propose the term pattern reversal to describe ... ...

Abstract	Purpose: Visual field (VF) results that show more test points outside normal limits on the pattern deviation map than on the total deviation map have been assumed to be evidence of unreliable VF results. We propose the term pattern reversal to describe this VF finding and explore its association with paracentral loss. Design: Retrospective cohort and case-control studies. Participants: Glaucoma and glaucoma suspect patients who completed VF testing in Veteran's Affairs ophthalmology or optometry clinics. Methods: In the cohort study, VF results were included that demonstrated pattern reversal. The area of pattern reversal was categorized as peripheral, paracentral, or mixed (both peripheral and paracentral). In the case-control study, a group of patients with paracentral loss confirmed on 10-2 VF tests were compared with a control group whose VF results were without paracentral loss. Main outcome measures: In the cohort study, the calculated false-positive (FP) error rates were compared among groups categorized by area of pattern reversal. In the case-control study, the rates of pattern reversal were compared between patients with and without paracentral loss. Results: Two hundred seventeen eyes of 145 patients were included in the cohort study. Visual field results with pattern reversal and mixed loss had significantly higher FP rates compared with those with paracentral or peripheral loss only (16.25% vs. 6.26% and 8.15%, respectively; P < 0.001). Fifty-five eyes of 41 patients were included in the case group and 55 eyes of 41 patients were included in the control group. Patients with paracentral loss were more likely to have history of pattern reversal compared with those without paracentral loss (58.2% vs. 29.1%; P = 0.004). Twelve eyes with paracentral loss had 24-2 VF results that showed defects on the pattern deviation map, but not on the total deviation map. Conclusions: Pattern reversal may be associated with paracentral VF loss and is not always associated with elevated FP rates.
MeSH term(s)	Case-Control Studies ; Cohort Studies ; Glaucoma/complications ; Glaucoma/diagnosis ; Humans ; Retrospective Studies ; Scotoma/diagnosis ; Scotoma/etiology ; Visual Fields
Language	English
Publishing date	2021-10-21
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ISSN	2589-4196
ISSN (online)	2589-4196
DOI	10.1016/j.ogla.2021.10.009
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Article ; Online: Detection of Nonglaucomatous Macula Findings With Ganglion Cell Analysis Printouts vs Full Macular Cube Scans.

Yamane, Maya / Ferreyra, Henry / Xu, Benjamin Y / Weinreb, Robert N / Camp, Andrew S

JAMA ophthalmology

2022 Volume 140, Issue 10, Page(s) 1002–1005

Abstract: Importance: Ganglion cell analysis (GCA) of ocular coherence tomography (OCT) imaging is routinely used to detect and monitor glaucomatous damage of the ganglion cell complex in the macula. The GCA printout provides qualitative and quantitative data ... ...

Abstract	Importance: Ganglion cell analysis (GCA) of ocular coherence tomography (OCT) imaging is routinely used to detect and monitor glaucomatous damage of the ganglion cell complex in the macula. The GCA printout provides qualitative and quantitative data about the macular ganglion cell-inner plexiform layer and a single B-scan of the retina through the fovea. However, the full macular cube scan, including all 128 B-scans, is available for review. The macular cube scan provides considerable information about nonglaucomatous ocular pathology that may be missed if clinicians review only the GCA printout. Objective: To determine the frequency and type of nonglaucomatous macular findings that are observable in the full macular cube scan but not the GCA printout. Design, setting, and participants: A retrospective cross-sectional analysis of GCA printouts and full macular cube scans to detect nonglaucomatous macular pathology at a tertiary care academic center. Consecutive patients undergoing ganglion cell complex imaging during routine glaucoma evaluations over a 1-week period in a multi-clinician glaucoma clinic. Main outcomes and measures: The prevalence and type of nonglaucomatous macular pathology visible on the GCA printout or macular cube scan. Results: Among 105 patients (mean (SD) age, 67 (15.46) years; 63 [60%] female and 42 [40%] male) 201 eyes were imaged (64 [31.7%] with suspected glaucoma, 126 [62.4%] with open-angle glaucoma, 6 [3.0%] with closed-angle glaucoma, and 6 [3.0%] with other glaucoma). GCA printouts and macular cube scans revealed nonglaucomatous macular pathology in 65 eyes (32.2%). Of these, 25 eyes (38.5%) included findings that were not visible on the GCA printout. Of the cases not visible on the printout, 16 eyes (64.0% ) included macular pathology that required further evaluation. Conclusions and relevance: The findings indicate that nonglaucomatous macular pathology may be missed based on GCA printouts alone. While it may be beneficial to review the full macular cube to detect potentially vision-threatening disease and ensure proper patient care, this study cannot determine if this missed pathology affects clinical outcomes.
MeSH term(s)	Humans ; Male ; Female ; Aged ; Glaucoma, Open-Angle/diagnosis ; Optic Disk/pathology ; Nerve Fibers/pathology ; Retinal Ganglion Cells/pathology ; Tomography, Optical Coherence/methods ; Retrospective Studies ; Cross-Sectional Studies ; Glaucoma/diagnosis ; Glaucoma/pathology ; Macula Lutea ; Vision Disorders
Language	English
Publishing date	2022-09-08
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	2701705-9
ISSN	2168-6173 ; 2168-6165
ISSN (online)	2168-6173
ISSN	2168-6165
DOI	10.1001/jamaophthalmol.2022.3450
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Article ; Online: Dry Eye Symptom Severity and Visual Field Reliability Metrics.

Camp, Andrew S / Long, Christopher P / Galor, Anat / Yamane, Maya / Proudfoot, James A / Weinreb, Robert N

Journal of glaucoma

2022 Volume 31, Issue 5, Page(s) 305–309

Abstract: Prcis: Tracking failure frequency (TFF) increases with dry eye symptom severity and in the left eye.: Purpose: Symptoms of dry eye disease are commonly encountered in glaucoma patients and can be exacerbated by topical glaucoma medications. Dry eye ... ...

Abstract	Prcis: Tracking failure frequency (TFF) increases with dry eye symptom severity and in the left eye. Purpose: Symptoms of dry eye disease are commonly encountered in glaucoma patients and can be exacerbated by topical glaucoma medications. Dry eye disease may influence the reliability of visual field (VF) tests and impact the accurate interpretation of the results. Patients and methods: Patients at the Veterans Administration Medical Center San Diego completed the 5-item Dry Eye Questionnaire before VF testing between December 2018 and February 2019. VF reliability metrics were recorded for each patient. Standard reliability metrics included fixation losses, false positive, and false negative rates. Gaze tracking (GT) metrics included percent of stimuli with gaze deviations between 1 and 2 degrees, 3 and 5 degrees, 6 degrees or greater, and percent of stimuli with tracking failure (TFF). The use of glaucoma medications and artificial tears was also recorded. Results: A total of 494 patients completed the 5-item Dry Eye Questionnaire and VF testing. There was no association between dry eye symptom severity and standard reliability metrics or most GT metrics. However, TFF increased as dry eye symptom severity increased (P=0.015). TFF was also greater in the left eye, which was tested second (P=0.012); no other reliability metrics were related to laterality. Patients were more likely to use artificial tears with increased dry eye symptom severity (P<0.001), but there was no relationship between symptom severity and glaucoma medication use. Discussion: Dry eye symptom severity may influence the acceptable range or threshold of TFF when using GT metrics to determine VF reliability. Likewise, the acceptable range or threshold for TFF may be different between eyes.
MeSH term(s)	Benchmarking ; Dry Eye Syndromes/diagnosis ; Glaucoma/complications ; Glaucoma/diagnosis ; Humans ; Intraocular Pressure ; Lubricant Eye Drops ; Reproducibility of Results ; Visual Fields
Chemical Substances	Lubricant Eye Drops
Language	English
Publishing date	2022-03-18
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	913494-3
ISSN	1536-481X ; 1057-0829
ISSN (online)	1536-481X
ISSN	1057-0829
DOI	10.1097/IJG.0000000000002017
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Article ; Online: Will Perimetry Be Performed to Monitor Glaucoma in 2025?

Camp, Andrew S / Weinreb, Robert N

Ophthalmology

2017 Volume 124, Issue 12S, Page(s) S71–S75

Abstract: Visual field testing has played an essential role in the diagnosis and management of glaucoma for more than a century. Methods to examine the visual field have been refined from early kinetic perimetry to current standard automated perimetry (SAP). ... ...

Abstract	Visual field testing has played an essential role in the diagnosis and management of glaucoma for more than a century. Methods to examine the visual field have been refined from early kinetic perimetry to current standard automated perimetry (SAP). Clinicians now use SAP for the diagnosis and management of glaucoma throughout the world. Various testing paradigms and analytic methods have been developed to simplify the diagnosis of glaucoma and the interpretation of progression. Moreover, strategies have been implemented to improve patient experience with visual field testing and to increase reliability. Objective functional tests, such as electroretinography, provide an alternative to subjective visual field testing but are not yet ready for widespread adoption. Standard automated perimetry is being adapted and improved constantly. New devices may allow patients to complete visual field tests at home, which could relieve patients and clinicians from in-office testing and allow for more frequent examinations. Glaucoma detection and progression analysis also are incorporating progressively more information and will be improved as deep learning strategies are applied. Finally, perimetric and structural testing likely will become more closely intertwined as testing platforms and progression analysis incorporate both of these measures. Visual field testing will continue to have an important role in the diagnosis and management of glaucoma.
MeSH term(s)	Glaucoma, Open-Angle/diagnosis ; Humans ; Vision Disorders/diagnosis ; Visual Field Tests/trends ; Visual Fields
Language	English
Publishing date	2017-08-31
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	392083-5
ISSN	1549-4713 ; 0161-6420
ISSN (online)	1549-4713
ISSN	0161-6420
DOI	10.1016/j.ophtha.2017.04.009
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Zs.MO 533: Show issues

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Article ; Online: Peripheral Vaso-Occlusive Events Following Trauma in Patients With Sickle Cell Trait.

Camp, Andrew S / Read, Sarah P / Lee, Richard K

Ophthalmic surgery, lasers & imaging retina

2019 Volume 50, Issue 3, Page(s) e84–e87

Abstract: Sickle cell trait (SCT) is a common hemoglobin variant, particularly in patients of African descent. Patients with SCT have an increased risk of adverse ocular events following trauma with subsequent elevated intraocular pressure (IOP). The authors ... ...

Abstract	Sickle cell trait (SCT) is a common hemoglobin variant, particularly in patients of African descent. Patients with SCT have an increased risk of adverse ocular events following trauma with subsequent elevated intraocular pressure (IOP). The authors describe three cases of young males with peripheral vaso-occlusive events following ocular trauma with subsequent elevated IOP. These cases demonstrate the importance of careful peripheral exams in young patients with SCT following trauma. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e84-e87.].
MeSH term(s)	Adolescent ; Anemia, Sickle Cell/complications ; Eye Injuries/complications ; Humans ; Male ; Peripheral Vascular Diseases/etiology ; Retinal Vessels/pathology ; Sclerosis/etiology ; Young Adult
Language	English
Publishing date	2019-03-20
Publishing country	United States
Document type	Case Reports ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2701167-7
ISSN	2325-8179 ; 2325-8160
ISSN (online)	2325-8179
ISSN	2325-8160
DOI	10.3928/23258160-20190301-18
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Article ; Online: Evaluation and Optimization of Diabetic Retinopathy Screenings for Uninsured Latinx Patients in a Resource-Limited Student-Run Free Clinic.

Bu, Jennifer J / Delavar, Arash / Dayao, John Kevin / Lieu, Alexander / Chuter, Benton G / Chen, Kevin / Nishihara, Taiki / Meller, Leo / Camp, Andrew S / Lee, Jeffrey E / Baxter, Sally L

Journal of student-run clinics

2023 Volume 10, Issue 1

Abstract: Background: Diabetic retinopathy (DR) is a sight-threatening condition that causes progressive retina damage. Student-run free clinics represent a valuable opportunity to provide DR screenings to high-risk populations. We characterized the patient ... ...

Abstract	Background: Diabetic retinopathy (DR) is a sight-threatening condition that causes progressive retina damage. Student-run free clinics represent a valuable opportunity to provide DR screenings to high-risk populations. We characterized the patient population, evaluated the performance, and conducted a needs assessment of DR screenings at the University of California, San Diego Student-Run Ophthalmology Free Clinic, which provides care to predominantly uninsured, Latino patients. Methods: Retrospective chart review was conducted of all patients seen at the free clinic since 2019 with a diagnosis of type II diabetes. Date and outcome of all DR-related screenings or visits from 2015 onward, demographics information, and DR risk factors such as A1c and insulin dependence were recorded. Predictors of diabetic retinopathy and frequency of DR screenings for each patient were analyzed using multiple logistic regression, t-test for equality of means, and Pearson's correlation. Results: Of 179 uninsured diabetic patients receiving care at the free clinic, 71% were female and average age was 59. 83% had hypertension, 93% had hyperlipidemia, and 79% had metabolic syndrome. Prevalence of non-proliferative DR was 34% and that of proliferative DR was 15% in diabetic patients. The free clinic capacity in recent years plateaued at just under 50% of patients seen for DR screening or visit per year, though average wait time was over 2 years between visits. Patients with higher no-show rates had less frequent DR screenings. Chronic kidney disease and poor glycemic control were the strongest predictors of DR. Conclusion: The student-run free ophthalmology clinic has been effective in providing screening and follow-up care for DR patients. Creation of a protocol to identify which patients are at highest risk of DR and should be seen more urgently, addressing no-shows, and implementation of a tele-retina program are potential avenues for improving clinic efficiency in a resource-limited setting for vulnerable populations.
Language	English
Publishing date	2023-11-01
Publishing country	United States
Document type	Journal Article
ISSN	2474-9354
ISSN (online)	2474-9354
DOI	10.59586/jsrc.v10i1.407
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Article ; Online: Review of the measurement and management of 24-hour intraocular pressure in patients with glaucoma.

Mansouri, Kaweh / Tanna, Angelo P / De Moraes, Carlos Gustavo / Camp, Andrew S / Weinreb, Robert N

Survey of ophthalmology

2019 Volume 65, Issue 2, Page(s) 171–186

Abstract: Elevated intraocular pressure (IOP) is a major, and currently the only, modifiable risk factor that has been shown to reduce the risk of glaucoma onset and progression. Diurnal measurements of IOP, usually during office hours, are commonly used for the ... ...

Abstract	Elevated intraocular pressure (IOP) is a major, and currently the only, modifiable risk factor that has been shown to reduce the risk of glaucoma onset and progression. Diurnal measurements of IOP, usually during office hours, are commonly used for the assessment of IOP variation and the relative success of medical, laser, or surgical IOP-lowering interventions. Such measurements, however, fail to capture variation in IOP over the day/night cycle, which may be influenced by factors such as body position. We examine current evidence in the field of IOP measurement and control-with a focus on 24-hour (circadian) study design and measurement techniques and the 24-hour efficacy of current treatments-in patients with glaucoma and ocular hypertension. We then provide our recommendations for the design of future studies of circadian IOP with the aim of improving the assessment, management, and treatment of patients with glaucoma and ocular hypertension.
MeSH term(s)	Antihypertensive Agents/therapeutic use ; Circadian Rhythm/physiology ; Disease Management ; Glaucoma/drug therapy ; Glaucoma/physiopathology ; Humans ; Intraocular Pressure/physiology ; Posture ; Tonometry, Ocular/methods
Chemical Substances	Antihypertensive Agents
Language	English
Publishing date	2019-10-16
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	391346-6
ISSN	1879-3304 ; 0039-6257
ISSN (online)	1879-3304
ISSN	0039-6257
DOI	10.1016/j.survophthal.2019.09.004
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Article ; Online: Usability and Clinician Acceptance of a Deep Learning-Based Clinical Decision Support Tool for Predicting Glaucomatous Visual Field Progression.

Chen, Jimmy S / Baxter, Sally L / van den Brandt, Astrid / Lieu, Alexander / Camp, Andrew S / Do, Jiun L / Welsbie, Derek S / Moghimi, Sasan / Christopher, Mark / Weinreb, Robert N / Zangwill, Linda M

Journal of glaucoma

2022 Volume 32, Issue 3, Page(s) 151–158

Abstract: Prcis: We updated a clinical decision support tool integrating predicted visual field (VF) metrics from an artificial intelligence model and assessed clinician perceptions of the predicted VF metric in this usability study.: Purpose: To evaluate ... ...

Abstract	Prcis: We updated a clinical decision support tool integrating predicted visual field (VF) metrics from an artificial intelligence model and assessed clinician perceptions of the predicted VF metric in this usability study. Purpose: To evaluate clinician perceptions of a prototyped clinical decision support (CDS) tool that integrates visual field (VF) metric predictions from artificial intelligence (AI) models. Methods: Ten ophthalmologists and optometrists from the University of California San Diego participated in 6 cases from 6 patients, consisting of 11 eyes, uploaded to a CDS tool ("GLANCE", designed to help clinicians "at a glance"). For each case, clinicians answered questions about management recommendations and attitudes towards GLANCE, particularly regarding the utility and trustworthiness of the AI-predicted VF metrics and willingness to decrease VF testing frequency. Main outcomes and measures: Mean counts of management recommendations and mean Likert scale scores were calculated to assess overall management trends and attitudes towards the CDS tool for each case. In addition, system usability scale scores were calculated. Results: The mean Likert scores for trust in and utility of the predicted VF metric and clinician willingness to decrease VF testing frequency were 3.27, 3.42, and 2.64, respectively (1=strongly disagree, 5=strongly agree). When stratified by glaucoma severity, all mean Likert scores decreased as severity increased. The system usability scale score across all responders was 66.1±16.0 (43rd percentile). Conclusions: A CDS tool can be designed to present AI model outputs in a useful, trustworthy manner that clinicians are generally willing to integrate into their clinical decision-making. Future work is needed to understand how to best develop explainable and trustworthy CDS tools integrating AI before clinical deployment.
MeSH term(s)	Humans ; Visual Fields ; Decision Support Systems, Clinical ; Artificial Intelligence ; Deep Learning ; Intraocular Pressure ; Glaucoma/diagnosis ; Glaucoma/therapy
Language	English
Publishing date	2022-12-21
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	913494-3
ISSN	1536-481X ; 1057-0829
ISSN (online)	1536-481X
ISSN	1057-0829
DOI	10.1097/IJG.0000000000002163
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Article ; Online: Evaluating Self-Refraction and Ready-Made Spectacles for Treatment of Uncorrected Refractive Error.

Camp, Andrew S / Shane, Thomas S / Kang, Julia / Thomas, Benjamin / Pole, Cameron / Lee, Richard K

Ophthalmic epidemiology

2018 Volume 25, Issue 5-6, Page(s) 392–398

Abstract: Purpose: Uncorrected refractive error is the leading cause of visual impairment worldwide and has significant quality of life and economic implications. Treatment with subjective refraction and custom-made spectacles requires expensive equipment and ... ...

Abstract	Purpose: Uncorrected refractive error is the leading cause of visual impairment worldwide and has significant quality of life and economic implications. Treatment with subjective refraction and custom-made spectacles requires expensive equipment and highly trained personnel. We examine several alternatives. Methods: Patients were taught to self-refract using two devices: AdSpecs and the I-test Vision Screener. Ready-made spectacles were fit to the self-refraction and visual acuity (VA) was measured. Donated-spectacles were fit to subjective refraction and VA was measured. Self-refraction and donated spectacles spherical equivalent (SE) and VA were compared to subjective refraction SE and VA. Results: About 57 patients (102 eyes) were enrolled in the study. Patients accurately determined refractive power with self-refraction by both AdSpecs and the I-test (compared to subjective refraction SE, r Conclusion: Patients accurately self-refract using both devices and ready-made spectacles fit to self-refraction have excellent visual outcomes. Donated spectacles have worse visual outcomes but might be useful in a subset of patients. Ready-made spectacles fit to self-refraction may provide a treatment alternative to uncorrected refractive error.
MeSH term(s)	Diagnostic Self Evaluation ; Equipment Design ; Eyeglasses ; Female ; Humans ; Male ; Middle Aged ; Refraction, Ocular/physiology ; Refractive Errors/diagnosis ; Refractive Errors/physiopathology ; Refractive Errors/therapy ; Retrospective Studies ; Vision Tests ; Visual Acuity
Language	English
Publishing date	2018-08-17
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1213070-9
ISSN	1744-5086 ; 0928-6586
ISSN (online)	1744-5086
ISSN	0928-6586
DOI	10.1080/09286586.2018.1500615
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