Acta Ophthalmologica 2015 control group (all p < 0.05). The detailed profile of CH, CRF, CCT, IOPcc, IOPg, and IOP GAT in both groups is depicted in Table 1. In the GD group, positive and significant correlations were observed between CRF and CCT (r = +0.438, p = 0.032) and between CH and CCT (r = +0.486, p = 0.016). The principal finding of this study is that patients with GD present significantly higher values of CH and CRF than healthy subjects. Recently, Ozkok et al. (2014) have showed that CH and CRF are higher in acromegalic patients than in healthy subjects. Our group has reported that treatment with thyroxine supplementation may improve corneal biomechanics in patients with GD (Gatzioufas et al. 2014). On the other hand, no significant differences in CCT values were observed between GD and control group. This finding is in agreement with a previous report (Konuk et al. 2008). Similarly, significant positive correlation between CH and CRF values and CCT was reported in acromegalic patients (Ozkok et al. 2014). GD-associated ophthalmopathy is an inflammatory disease of the orbital tissues. The effects of inflammation, mediated through cytokine release, include proliferation of fibroblasts, increased deposition of extracellular matrix, and adipocyte differentiation and proliferation in the orbital space (Hatton & Rubin 2002). We assume that oedema, enlargement of the extraocular muscles and increased volume of the orbital soft tissues may account for the modified biomechanical behaviour of the globe, as reflected by the corneal biomechanics. To our knowledge, this is the first study to evaluate the corneal biomechanics in patients with GD. We report higher CH and CRF values in cases with GD without CCT changes. These modifications may also have an impact on the measurement of IOP in patients with GD. Therefore, ophthalmologists should be aware of the corneal biomechanical variations in these patients.
References Gatzioufas Z, Panos GD, Brugnolli E & Hafezi F (2014): Corneal topographical and biomechanical variations associated with hypothyroidism. J Refract Surg 30: 78–79.
Hatton MP & Rubin PA (2002): The pathophysiology of thyroid-associated ophthalmopathy. Ophthalmol Clin North Am 15: 113–119. Konuk O, Aktas Z, Aksoy S, Onol M & Unal M (2008): Hyperthyroidism and severity of orbital disease do not change the central corneal thickness in Graves’ ophthalmopathy. Eur J Ophthalmol 18: 125–127. Menconi F, Marcocci C & Marino M (2014): Diagnosis and classification of Graves’ disease. Autoimmun Rev 13: 398–402. Ozkok A, Hatipoglu E, Tamcelik N, Balta B, Gundogdu AS, Ozdamar MA & Kadioglu P (2014): Corneal biomechanical properties of patients with acromegaly. Br J Ophthalmol 98: 651–657.
Correspondence: Dr. med. Georgios D. Panos Chef de Clinique (Attending) Dpt of Ophthalmology Geneva University Hospitals Rue Alcide – Jentzer 22 CH 1211, Geneva 14, Switzerland Tel: +41 79 55 34 739 Fax: +41 22 382 83 82 Emails: [email protected]; georgios. [email protected]
Reading performance in glaucoma Lucka Boltezar and Barbara Cvenkel Department of Ophthalmology, University Medical Centre, Ljubljana, Slovenia doi: 10.1111/aos.12613
Editor, isual fields (VFs) are important clinical measure of visual function, but may not reflect the effect of disease on the individual’s quality of life and on the performance of visionrelated tasks. Assessing performance of vision-dependent activities may represent a more objective measure of the impact of glaucoma on daily functioning (Haymes et al. 2008). Elderly people frequently suffer from comorbidities that affect their mobility. Therefore, reading represents an important activity and enjoyment. We aimed to investigate the association between self-reported visual disability, visual function and reading performance in patients with glaucoma.
V
We recruited 63 patients with openangle glaucoma (with better eye Snellen visual acuity (VA) ≥0.6 and absence of clinically significant cataract) and 20 controls. Subjects with systemic diseases affecting visual and cognitive functions were excluded. Following measurement of VA, Octopus perimetry was performed and the better eye mean defect (MD) was used as a measure of VF loss. The standardized International Reading Speed Texts (IReST) was used to assess reading performance (Trauzettel-Klosinski et al. 2012). Participants read aloud texts presented at a distance of 40 cm, and the number of mistakes and words read per minute were marked. The Glaucoma Quality of life (GQL)-15 questionnaire was used to identify selfreported visual disability. It inquires about four factors of visual disability: central/near vision, peripheral vision, dark adaptation/glare and outdoor mobility. Response to each item is scored from 1 indicating no difficulty to 5 representing severe difficulty (Nelson et al. 2003). The summary score and subfactor scores were calculated, with higher scores indicating greater difficulties in daily activities. Based on the better eye MD, patients were divided into three groups with mild (MD < 6 dB), moderate (6 ≥ MD ≤ 13 dB) and advanced (MD > 13 dB) glaucoma. Characteristics of patients with glaucoma (37 with mild, 14 with moderate and 12 with advanced glaucoma) and controls are summarized in Table 1. Summary GQL-15 score increased with severity of glaucoma and was significantly higher in the advanced versus early (p = 0.016) and control group (p = 0.007). In the four subfactor scores, the difference was significant only for the subfactor peripheral vision between controls versus advanced glaucoma (p = 0.006) and early versus advanced glaucoma group (p = 0.015; ANOVA). Patients with glaucoma read significantly more slowly than controls. Among patients, better eye MD correlated significantly with reading speed (r = 0.41, p = 0.001), GQL-15 summary score (r = 0.29, p = 0.02), peripheral vision score (r = 0.34, p = 0.006), age (r = 0.27, p = 0.03) and better eye VA (r = 0.25, p = 0.046). A multiple regression analysis was performed to predict the reading speed from better eye MD adjusting for age and better
e321
Acta Ophthalmologica 2015
Table 1. Characteristics of glaucoma patients and control groups. Controls (n = 20) Age (years) mean (SD) Sex (Male/Female) Better eye VA (Snellen) Better eye MD (dB) GQL-15 scores mean (SD) Summary score Factor 1: central and near vision Factor 2: peripheral vision Factor 3: glare and dark adaptation Factor 4: outdoor mobility IReST mean (SD) Words/min Number of mistakes
57.8 (14.3) 5/15 1.0 (0.1) 0.2 (1.5) 21.9 2.9 10.2 7.6 1.2
(6.8) (1.2) (3.3) (2.6) (0.4)
155.9 (24.5) 1.2 (1.4)
Glaucoma (n = 63)
p-Value
72.8 (11.1) 27/36 0.93 (0.1) 6.4 (6.7)
References Gatzioufas Z, Panos GD, Brugnolli E & Hafezi F (2014): Corneal topographical and biomechanical variations associated with hypothyroidism. J Refract Surg 30: 78–79.
Hatton MP & Rubin PA (2002): The pathophysiology of thyroid-associated ophthalmopathy. Ophthalmol Clin North Am 15: 113–119. Konuk O, Aktas Z, Aksoy S, Onol M & Unal M (2008): Hyperthyroidism and severity of orbital disease do not change the central corneal thickness in Graves’ ophthalmopathy. Eur J Ophthalmol 18: 125–127. Menconi F, Marcocci C & Marino M (2014): Diagnosis and classification of Graves’ disease. Autoimmun Rev 13: 398–402. Ozkok A, Hatipoglu E, Tamcelik N, Balta B, Gundogdu AS, Ozdamar MA & Kadioglu P (2014): Corneal biomechanical properties of patients with acromegaly. Br J Ophthalmol 98: 651–657.
Correspondence: Dr. med. Georgios D. Panos Chef de Clinique (Attending) Dpt of Ophthalmology Geneva University Hospitals Rue Alcide – Jentzer 22 CH 1211, Geneva 14, Switzerland Tel: +41 79 55 34 739 Fax: +41 22 382 83 82 Emails: [email protected]; georgios. [email protected]
Reading performance in glaucoma Lucka Boltezar and Barbara Cvenkel Department of Ophthalmology, University Medical Centre, Ljubljana, Slovenia doi: 10.1111/aos.12613
Editor, isual fields (VFs) are important clinical measure of visual function, but may not reflect the effect of disease on the individual’s quality of life and on the performance of visionrelated tasks. Assessing performance of vision-dependent activities may represent a more objective measure of the impact of glaucoma on daily functioning (Haymes et al. 2008). Elderly people frequently suffer from comorbidities that affect their mobility. Therefore, reading represents an important activity and enjoyment. We aimed to investigate the association between self-reported visual disability, visual function and reading performance in patients with glaucoma.
V
We recruited 63 patients with openangle glaucoma (with better eye Snellen visual acuity (VA) ≥0.6 and absence of clinically significant cataract) and 20 controls. Subjects with systemic diseases affecting visual and cognitive functions were excluded. Following measurement of VA, Octopus perimetry was performed and the better eye mean defect (MD) was used as a measure of VF loss. The standardized International Reading Speed Texts (IReST) was used to assess reading performance (Trauzettel-Klosinski et al. 2012). Participants read aloud texts presented at a distance of 40 cm, and the number of mistakes and words read per minute were marked. The Glaucoma Quality of life (GQL)-15 questionnaire was used to identify selfreported visual disability. It inquires about four factors of visual disability: central/near vision, peripheral vision, dark adaptation/glare and outdoor mobility. Response to each item is scored from 1 indicating no difficulty to 5 representing severe difficulty (Nelson et al. 2003). The summary score and subfactor scores were calculated, with higher scores indicating greater difficulties in daily activities. Based on the better eye MD, patients were divided into three groups with mild (MD < 6 dB), moderate (6 ≥ MD ≤ 13 dB) and advanced (MD > 13 dB) glaucoma. Characteristics of patients with glaucoma (37 with mild, 14 with moderate and 12 with advanced glaucoma) and controls are summarized in Table 1. Summary GQL-15 score increased with severity of glaucoma and was significantly higher in the advanced versus early (p = 0.016) and control group (p = 0.007). In the four subfactor scores, the difference was significant only for the subfactor peripheral vision between controls versus advanced glaucoma (p = 0.006) and early versus advanced glaucoma group (p = 0.015; ANOVA). Patients with glaucoma read significantly more slowly than controls. Among patients, better eye MD correlated significantly with reading speed (r = 0.41, p = 0.001), GQL-15 summary score (r = 0.29, p = 0.02), peripheral vision score (r = 0.34, p = 0.006), age (r = 0.27, p = 0.03) and better eye VA (r = 0.25, p = 0.046). A multiple regression analysis was performed to predict the reading speed from better eye MD adjusting for age and better
e321
Acta Ophthalmologica 2015
Table 1. Characteristics of glaucoma patients and control groups. Controls (n = 20) Age (years) mean (SD) Sex (Male/Female) Better eye VA (Snellen) Better eye MD (dB) GQL-15 scores mean (SD) Summary score Factor 1: central and near vision Factor 2: peripheral vision Factor 3: glare and dark adaptation Factor 4: outdoor mobility IReST mean (SD) Words/min Number of mistakes
57.8 (14.3) 5/15 1.0 (0.1) 0.2 (1.5) 21.9 2.9 10.2 7.6 1.2
(6.8) (1.2) (3.3) (2.6) (0.4)
155.9 (24.5) 1.2 (1.4)
Glaucoma (n = 63)
p-Value
72.8 (11.1) 27/36 0.93 (0.1) 6.4 (6.7)
