The pattern of blindness in urban Baltimore appears to be different among blacks and whites. Whites are far more likely to have age-related macular degeneration, and blacks to have primary open-angle glaucoma. The high rate of unoperated cataracts among younger blacks and among elderly subjects of both races suggests that health services are underused. Half of all blindness in this urban population is probably preventable or reversible.
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Purpose-To evaluate the efficacy of repeat 360° selective laser trabeculoplasty (SLT) in glaucoma patients with prior successful 360° SLT. Design-Retrospective chart reviewMethods-Forty-four eyes of 35 patients, ≥ 18 years of age, with open-angle glaucoma (primary open-angle, pseudoexfoliation or pigmentary glaucoma), uncontrolled on maximum tolerable medical therapy, underwent an initial 360° SLT (SLT1), which was successful for ≥ 6 months, but eventually lost efficacy and was followed by a repeat 360° SLT (SLT2). Patients with prior argon laser trabeculoplasty or other glaucoma surgery, before or during the study period, were excluded. Intraocular pressure (IOP) measurements were recorded before each procedure and 1-4 weeks, 1-3 months, and 5-8 months post-treatment, as well 15-21 weeks after the initial SLT.Results-Reduction in IOP after SLT1 and SLT2 was significantly less with repeat treatment at 1-3 months, with average decreases of −5.0 and −2.9mmHg, respectively (p=.01); but there were no statistically significant differences between treatments at the other equivalent time points. Using a definition of "success" as ≥ 20% peak IOP reduction, success rates for SLT1 and SLT2 were not significantly different. There was also no significant difference in eyes that received SLT2 6-12 months after SLT1 compared to those that received SLT2 12 months or more after SLT1.Conclusions-Our findings suggest that repeat 360° SLT may be safe and effective after an initially successful 360° SLT has failed. These results may be achieved as early as six months after the first treatment.
Background: The microvasculature, the smallest blood vessels in the body, has key roles in maintenance of organ health as well as tumorigenesis. The retinal fundus is a window for human in vivo non-invasive assessment of the microvasculature. Large-scale complementary machine learning-based assessment of the retinal vasculature with phenome-wide and genome-wide analyses may yield new insights into human health and disease. Methods: We utilized 97,895 retinal fundus images from 54,813 UK Biobank participants. Using convolutional neural networks to segment the retinal microvasculature, we calculated fractal dimension (FD) as a measure of vascular branching complexity, and vascular density. We associated these indices with 1,866 incident ICD-based conditions (median 10y follow-up) and 88 quantitative traits, adjusting for age, sex, smoking status, and ethnicity. Results: Low retinal vascular FD and density were significantly associated with higher risks for incident mortality, hypertension, congestive heart failure, renal failure, type 2 diabetes, sleep apnea, anemia, and multiple ocular conditions, as well as corresponding quantitative traits. Genome-wide association of vascular FD and density identified 7 and 13 novel loci respectively, which were enriched for pathways linked to angiogenesis (e.g., VEGF, PDGFR, angiopoietin, and WNT signaling pathways) and inflammation (e.g., interleukin, cytokine signaling). Conclusions: Our results indicate that the retinal vasculature may serve as a biomarker for future cardiometabolic and ocular disease and provide insights on genes and biological pathways influencing microvascular indices. Moreover, such a framework highlights how deep learning of images can quantify an interpretable phenotype for integration with electronic health records, biomarker, and genetic data to inform risk prediction and risk modification.
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