Bilateral Same-day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project

Waisbourd, Michael; Delvadia, Radha; Sembhi, Harjeet; Molineaux, Jeanne; Henderer, Jeffery D.; Pizzi, Laura T.; Myers, Jonathan S.; Hark, Lisa A; Katz, L. Jay

doi:10.1097/ijg.0000000000000409

Cited by 14 publications

(9 citation statements)

References 36 publications

(39 reference statements)

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“…Same-day bilateral treatments were encouraged. 19 Patients with OAG who declined laser therapy and patients with PACG or secondary angle-closure glaucoma received a prescription for appropriate IOP-lowering medications as determined by the treating ophthalmologist.…”

Section: Methodsmentioning

confidence: 99%

The Philadelphia Glaucoma Detection and Treatment Project

et al. 2016

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Purpose To evaluate the detection rates of glaucoma-related diagnoses and the initial treatments received in the Philadelphia Glaucoma Detection and Treatment Project, a community-based initiative aimed at improving the detection, treatment, and follow-up care of individuals at risk for glaucoma. Design Retrospective analysis. Participants A total of 1649 individuals at risk for glaucoma who were examined and treated in 43 community centers located in underserved communities of Philadelphia. Methods Individuals were enrolled if they were African American aged ≥50 years, were any other adult aged ≥60 years, or had a family history of glaucoma. After attending an informational glaucoma workshop, participants underwent a targeted glaucoma examination including an ocular, medical, and family history; visual acuity testing, intraocular pressure (IOP) measurement, and corneal pachymetry; slit-lamp and optic nerve examination; automated visual field testing; and fundus color photography. If indicated, treatments included selective laser trabeculoplasty (SLT), laser peripheral iridotomy (LPI), or IOP-lowering medications. Follow-up examinations were scheduled at the community sites after 4 to 6 weeks or 4 to 6 months, depending on the clinical scenario. Main Outcome Measures Detection rates of glaucoma-related diagnoses and types of treatments administered. Results Of the 1649 individuals enrolled, 645 (39.1%) received a glaucoma-related diagnosis; 20.0% (n = 330) were identified as open-angle glaucoma (OAG) suspects, 9.2% (n = 151) were identified as having narrow angles (or as a primary angle closure/suspect), and 10.0% (n = 164) were diagnosed with glaucoma, including 9.0% (n = 148) with OAG and 1.0% (n = 16) with angle-closure glaucoma. Overall, 39.0% (n = 64 of 164) of those diagnosed with glaucoma were unaware of their diagnosis. A total of 196 patients (11.9%) received glaucoma-related treatment, including 84 (5.1%) who underwent LPI, 13 (0.8%) who underwent SLT, and 103 (6.2%) who were prescribed IOP-lowering medication. Conclusions Targeting individuals at risk for glaucoma in underserved communities in Philadelphia yielded a high detection rate (39.1%) of glaucoma-related diagnoses. Providing examinations and offering treatment, including first-line laser procedures, at community-based sites providing services to older adults are effective to improve access to eye care by underserved populations.

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Section: Methodsmentioning

confidence: 99%

The Philadelphia Glaucoma Detection and Treatment Project

et al. 2016

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“…This is consistent with the results of a recent retrospective study, which showed higher rates of immediate IOP elevation in African-Americans following LPI for angle closure. 21 A greater degree of pigment dispersion in thicker, darkly pigmented irides has been suggested to impact IOP elevation and iritis following LPI. [26][27][28][29][30] Consistent with this, patients who racially selfidentified as "Other" also experienced higher rates of post-LPI IOP elevation compared with Whites, which could similarly be because of differences in postlaser pigment dispersion resulting from differences in iris characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…13,15,16 Despite the widespread use of LPI as a routine procedure for many eye care providers, the determinants of shortterm complications following prophylactic LPI for PACS are not well known. Existing studies that investigated post-LPI complications either did not directly compared Nd: YAG and sequential argon-Nd:YAG lasers, 13,[17][18][19][20][21] included mixed cohorts of PACG and primary angle closure (PAC) patients, 13,17,19,21 or were limited to only Asian populations. 13,[18][19][20]22 In addition, while 3 studies examining LPI complications did include Black patients, they were limited by small sample sizes and the inclusion of Nd:YAG laser procedures only.…”

mentioning

confidence: 99%

“…13,[18][19][20]22 In addition, while 3 studies examining LPI complications did include Black patients, they were limited by small sample sizes and the inclusion of Nd:YAG laser procedures only. 17,21,23 This study evaluated the determinants of short-term LPI complications in patients with anatomical narrow angles in cohorts inclusive of a large Black population.…”

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confidence: 99%

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Self-identified Black Race as a Risk Factor for Intraocular Pressure Elevation and Iritis Following Prophylactic Laser Peripheral Iridotomy

Adetunji

Meer

Whitehead

et al. 2022

Journal of Glaucoma

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Précis: In primary angle closure suspects (PACS), self-identified Black race was a risk factor for intraocular pressure (IOP) elevation and iritis following laser peripheral iridotomy (LPI). Laser type was not associated with either immediate post-LPI IOP elevation or iritis in multivariate analysis. Purpose: The aim was to determine the impact of laser type and patient characteristics on the incidence of IOP elevation and iritis after LPI in PACS. Materials and Methods: The electronic medical records of 1485 PACS (2407 eyes) who underwent either neodymium-doped yttrium-aluminum-garnet or sequential argon and neodymium-doped yttrium-aluminum-garnet LPI at the University of Pennsylvania between 2010 and 2018 were retrospectively reviewed. Average IOP within 30 days before LPI (baseline IOP), post-LPI IOP within 1 hour, laser type, laser energy, and the incidence of new iritis within 30 days following the procedure were collected. Multivariate logistic regression accounting for intereye correlation was used to assess factors associated with incidence of post-LPI IOP elevation and iritis, adjusted by age, sex, surgeon, and histories of autoimmune disease, diabetes, and hypertension. Results: The incidence of post-LPI IOP elevation and iritis were 9.3% (95% confidence interval: 8.1%-10.5%) and 2.6% (95% CI: 1.9%-3.2%), respectively. In multivariate analysis, self-identified Black race was a risk factor for both IOP elevation [odds ratio (OR): 2.08 compared with White; P=0.002] and iritis (OR: 5.07; P<0.001). Higher baseline IOP was associated with increased risk for post-LPI IOP elevation (OR: 1.19; P<0.001). Laser type and energy were not associated with either post-LPI IOP elevation or iritis (P>0.11 for all). Conclusions: The incidence of immediate IOP elevation and iritis following prophylactic LPI was higher in Black patients independent of laser type and energy. Heightened vigilance and increased medication management before and after the procedure are suggested to help mitigate these risks.

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“…However, community-based bilateral laser PI was found to be cost-effective approach. [10] It is minimally invasive in early cases as extensive peripheral anterior synechia are yet not developed. Although this could be an initial treatment modality for managing chronic angle-closure glaucoma, these patients would need long-term follow-up, and if the IOP is not controlled, other surgeries would be needed after few years.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Angle Closure Glaucoma in a Teenage Girl

Sharma

2022

PIJR

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Primary angle closure glaucoma (PACG) usually presents as unilateral and has acute onset. To the best of our knowledge, chronic PACG in very young age is rare. We share a case report of a teenage girl with advanced glaucomatous changes and, on gonioscopy, had synechia and closed angle of anterior chamber. She was treated by bilateral laser iridotomy and topical glaucoma medication. As patient had poor control of IOP on medications in right eye , she underwent filteration surgery in right eye. The author concludes that, even at very young age, in the absence of predisposing factors for secondary glaucoma, the patient should be investigated for PACG and managed accordingly.

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Bilateral Same-day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project

Abstract: Performing bilateral, same-day LPI was well tolerated in a large community-based, glaucoma detection and treatment project. Applying this treatment strategy may be considered in similar settings, where patients' access to eye care is limited and it may be a cost-effective strategy.

Cited by 14 publications

References 36 publications

The Philadelphia Glaucoma Detection and Treatment Project

The Philadelphia Glaucoma Detection and Treatment Project

Self-identified Black Race as a Risk Factor for Intraocular Pressure Elevation and Iritis Following Prophylactic Laser Peripheral Iridotomy

Bilateral Angle Closure Glaucoma in a Teenage Girl

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