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1. Adherence and Persistence to Medical Therapy in Glaucoma: An Overview

Author

Luciano Quaranta, Alessio Novella, Mauro Tettamanti, Luca Pasina, Robert N. Weinreb, and Alessandro Nobili

Subjects
Glaucoma, Therapy, Progression, Adherence, Persistence, Ophthalmology, RE1-994
Abstract

Abstract Glaucoma is a group of progressive optic neuropathies characterized by loss of retinal ganglion cells and visual field deterioration. Despite the fact that the underlying pathophysiology of glaucoma remains unknown, elevated intraocular pressure (IOP) is a well-established risk factor, and the only factor that can be modified. Robust evidence from epidemiological studies and clinical trials has clearly demonstrated the benefits of IOP control in reducing the risk of glaucoma progression. IOP-lowering therapy by the means of eye drops remains a first-line treatment option. However, like other chronic and asymptomatic conditions, many patients with glaucoma have difficulties in maintaining high rates of adherence persistence to prescribed medications. On average, patients with chronic medical conditions take 30–70% of the prescribed medication doses, and on average 50% discontinue medications in the first months of therapy. The ophthalmic literature shows similarly low rates of adherence to treatment. Indeed, poor adherence is associated with disease progression and increased complication rates, as well as healthcare costs. The present review analyzes and discusses the causes of variability of the adherence to the prescribed drugs. The education of patients about glaucoma and the potential consequences of insufficient adherence and persistence seems fundamental to maximize the probability of treatment success and therefore prevent visual disability to avoid unnecessary healthcare costs.

Published
2023
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2. Physiology-Enhanced Data Analytics to Evaluate the Effect of Altitude on Intraocular Pressure and Ocular Hemodynamics

Author

Alice Verticchio Vercellin, Alon Harris, Aditya Belamkar, Ryan Zukerman, Lucia Carichino, Marcela Szopos, Brent Siesky, Luciano Quaranta, Carlo Bruttini, Francesco Oddone, Ivano Riva, and Giovanna Guidoboni

Subjects
glaucoma, altitude, intraocular pressure, mathematical modeling, physiology-enhanced data analytics, Applied optics. Photonics, TA1501-1820
Abstract

Altitude affects intraocular pressure (IOP); however, the underlying mechanisms involved and its relationship with ocular hemodynamics remain unknown. Herein, a validated mathematical modeling approach was used for a physiology-enhanced (pe-) analysis of the Mont Blanc study (MBS), estimating the effects of altitude on IOP, blood pressure (BP), and retinal hemodynamics. In the MBS, IOP and BP were measured in 33 healthy volunteers at 77 and 3466 m above sea level. Pe-retinal hemodynamics analysis predicted a statistically significant increase (p < 0.001) in the model predicted blood flow and pressure within the retinal vasculature following increases in systemic BP with altitude measured in the MBS. Decreased IOP with altitude led to a non-monotonic behavior of the model predicted retinal vascular resistances, with significant decreases in the resistance of the central retinal artery (p < 0.001) and retinal venules (p = 0.003) and a non-significant increase in the resistance in the central retinal vein (p = 0.253). Pe-aqueous humor analysis showed that a decrease in osmotic pressure difference (OPD) may underlie the difference in IOP measured at different altitudes in the MBS. Our analysis suggests that venules bear the significant portion of the IOP pressure load within the ocular vasculature, and that OPD plays an important role in regulating IOP with changes in altitude.

Published
2022
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3. A Comparison of Hyper-Reflective Retinal Spot Counts in Optical Coherence Tomography Images from Glaucomatous and Healthy Eyes

Author

Luciano Quaranta, Carlo Bruttini, Giovanni De Angelis, Silvia Montescani, Alberto Ardizzone, Andreas Katsanos, Carmela Carnevale, Francesco Oddone, and Ivano Riva

Subjects
glaucoma, hyper-reflective retinal spots, optical coherence tomography, visual field, Medicine
Abstract

Purpose: To compare the number of hyper-reflective retinal spots (HRS) in optical coherence tomography (OCT) images of healthy controls and patients affected with primary open angle glaucoma (POAG). Methods: Thirty patients affected with POAG and 34 healthy controls were recruited and underwent raster OCT examination of the macular region. Among the acquired B-scans, the one with the lowest foveal thickness was selected, and a central area of 3000 μm was defined (region of interest, ROI), in order to identify HRS. HRS were defined as small point-like hyper-reflective elements, detectable at the visual inspection of the OCT image. HRS were independently counted by two investigators in the ROI of each OCT scan. Results: Inter-rater agreement for HRS counting was good to excellent (ICC = 0.96, 95% CI: 0.83–0.99). More HRS were found in the OCT images from glaucoma patients, in comparison with healthy controls (average value: 90.5 ± 13.02 and 74.72 ± 11.35, for glaucoma and healthy subjects, respectively; p < 0.01). Significant correlations between the average number of HRS and visual field mean deviation (MD, p = 0.01) and pattern standard deviation (PSD, p < 0.01) were found. Conclusions: OCT images from glaucoma patients showed a higher number of HRS when compared with healthy controls. As HRS have been hypothesized to be a sign of neuroinflammation, these results may support the role of neuroinflammation in glaucoma etiopathogenesis.

Published
2021
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6. A new look at the safety and tolerability of prostaglandin analogue eyedrops in glaucoma and ocular hypertension

Author

Banu Bozkurt, Gábor Holló, Luciano Quaranta, Gordon N. Dutton, Anastasios G. P. Konstas, Andreas Katsanos, Francesco Oddone, Murat Irkec, and Ivano Riva

Subjects
medicine.medical_specialty, medicine.drug_class, Glaucoma, chemistry.chemical_compound, Prostaglandins, Synthetic, medicine, Humans, Pharmacology (medical), Latanoprost, Intensive care medicine, Adverse effect, Antihypertensive Agents, Intraocular Pressure, Bimatoprost, business.industry, Tafluprost, General Medicine, medicine.disease, chemistry, Tolerability, Ocular Hypertension, Travoprost, Ophthalmic Solutions, Prostaglandin analogue, business, Glaucoma, Open-Angle, medicine.drug
Abstract

Introduction In the last 25 years, topical prostaglandin analogues (PGAs) have emerged to become first line and first choice therapeutic options in the management of glaucoma and ocular hypertension (OHT). Although the short-term efficacy and safety of PGAs has been extensively investigated, less is known about their long term safety and tolerability. This gap in current knowledge is clinically relevant, because treatment-related adverse events and long-term tolerability issues are key determinants of the overall success of long-term therapy and the final outcome of a lifelong, symptomless disease like glaucoma. Areas covered We include selected evidence pertaining to the safety and tolerability of available and emerging PGA formulations. We also outline PGA formulations with different concentrations of the active ingredient, different preservatives, and preservative-free (PF) options. Expert opinion Undoubtedly PGAs will continue to play a major role in the medical therapy of glaucoma and OHT. Despite extensive literature and prolonged clinical experience with these agents worldwide, a number of areas that warrant further research have been identified in the present review. Recently launched novel PGAs, or those still in development offer new opportunities and future challenges.

Published
2021

7. Glaucoma and neuroinflammation: An overview

Author

Manuele Michelessi, Diego Sbardella, Carlo Bruttini, Andreas Katsanos, Luciano Quaranta, Giovanni De Angelis, Ivano Riva, Francesco Oddone, Anastasios G. P. Konstas, and Eleonora Micheletti

Subjects
Retinal Ganglion Cells, genetic structures, Optic Disk, Glaucoma, Degeneration (medical), Retinal ganglion, Optic neuropathy, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Optic Nerve Diseases, medicine, Humans, Neuroinflammation, business.industry, Retinal, medicine.disease, eye diseases, Ophthalmology, medicine.anatomical_structure, chemistry, Retinal ganglion cell, Neuroinflammatory Diseases, 030221 ophthalmology & optometry, sense organs, business, Neuroscience, 030217 neurology & neurosurgery, Optic disc
Abstract

Glaucoma is an optic neuropathy characterized by well-defined optic disc morphological changes (i.e., cup enlargement, neuroretinal border thinning, and notching, papillary vessel modifications) consequent to retinal ganglion cell loss, axonal degeneration, and lamina cribrosa remodeling. These modifications tend to be progressive and are the main cause of functional damage in glaucoma. Despite the latest findings about the pathophysiology of the disease, the exact trigger mechanisms and the mechanism of degeneration of retinal ganglion cells and their axons have not been completely elucidated. Neuroinflammation may play a role in both the development and the progression of the disease as a result of its effects on retinal environment and retinal ganglion cells. We summarize the latest findings about neuroinflammation in glaucoma and examine the connection between risk factors, neuroinflammation, and retinal ganglion cell degeneration.

Published
2021

9. Effect of COVID-19-related lockdown on ophthalmic practice in Italy: A report from 39 institutional centers

Author

Roberto dell’Omo, Mariaelena Filippelli, Gianni Virgili, Francesco Bandello, Giuseppe Querques, Paolo Lanzetta, Teresio Avitabile, Francesco Viola, Michele Reibaldi, Francesco Semeraro, Luciano Quaranta, Stanislao Rizzo, Edoardo Midena, Giuseppe Campagna, Ciro Costagliola, Paola Marolo, Carlo Enrico Traverso, Michele Iester, Carlo Alberto Cutolo, Claudio Azzolini, Simone Donati, Elias Premi, Paolo Nucci, Stela Vujosevic, Giovanni Staurenghi, Ferdinando Bottoni, Francesco Romano, Domenico Grosso, Enrico Borrelli, Riccardo Sacconi, Paolo Milella, Simone Ganci, Mario R. Romano, Gabriella Ricciardelli, Davide Allegrini, Marco Casaluci, Davide Romano, Giorgio Marchini, Francesca Chemello, Camilla Amantea, Rino Frisina, Elisabetta Pilotto, Raffaele Parrozzani, Daniele Veritti, Valentina Sarao, Tognetto Daniele, Massimo Busin, Francesco Parmeggiani, Katia De Nadai, Luca Furiosi, Rodolfo Mastropasqua, Bruno Battaglia, Matteo Gironi, Stefano Gandolfi, Enrico Luciani, Paolo Mora, Costantino Schiavi, Patrizia Bertaccini, Alessandro Finzi, Matilde Roda, Carlo Cagini, Marco Lupidi, Fabrizio Giansanti, Daniela Bacherini, Gianmarco Tosi, Elena De Benedetto, Marco Nardi, Michele Figus, Chiara Posarelli, Cesare Mariotti, Vittorio Pirani, Michele Nicolai, Stefano Bonini, Marco Coassin, Antonio Di Zazzo, Mariacristina Savastano, Alfonso Savastano, Gloria Gambini, Umberto De Vico, Leopoldo Spadea, Andrea Iannaccone, Carlo Nucci, Federico Ricci, Francesco Aiello, Gabriele Gallo Afflitto, Leonardo Mastropasqua, Giada D’Onofio, Federica Evangelista, Lorenza Brescia, Pasquale Napolitano, Paolo Polisena, Nicolina Gianfrancesco, Domenico Trivisonno, Francesco Petti, Francesca Simonelli, Settimio Rossi, Antonio Tartaglione, Nicola Rosa, Maddalena De Bernardo, Cristiana Iaculli, Anna Valeria Bux, Giulia Maggiore, Francesco Boscia, Giancarlo Sborgia, Maria Oliva Grassi, Vincenzo Scorcia, Giuseppe Giannaccare, Guglielmo Parisi, Salvatore Cillino, Francesco Alaimo, Pasquale Aragona, Alessandro Meduri, Antonio Pinna, Andrea Sollazzo, Enrico Peiretti, Emanuele Siotto, dell’Omo, Roberto, Filippelli, Mariaelena, Virgili, Gianni, Bandello, Francesco, Querques, Giuseppe, Lanzetta, Paolo, Avitabile, Teresio, Viola, Francesco, Reibaldi, Michele, Semeraro, Francesco, Quaranta, Luciano, Rizzo, Stanislao, Midena, Edoardo, Campagna, Giuseppe, Costagliola, Ciro, Marolo, Paola, Traverso, Carlo Enrico, Iester, Michele, Cutolo, Carlo Alberto, Azzolini, Claudio, Donati, Simone, Premi, Elia, Nucci, Paolo, Vujosevic, Stela, Staurenghi, Giovanni, Bottoni, Ferdinando, Romano, Francesco, Grosso, Domenico, Borrelli, Enrico, Sacconi, Riccardo, Milella, Paolo, Ganci, Simone, Romano, Mario R., Ricciardelli, Gabriella, Allegrini, Davide, Casaluci, Marco, Romano, Davide, Marchini, Giorgio, Chemello, Francesca, Amantea, Camilla, Frisina, Rino, Pilotto, Elisabetta, Parrozzani, Raffaele, Veritti, Daniele, Sarao, Valentina, Daniele, Tognetto, Busin, Massimo, Parmeggiani, Francesco, De Nadai, Katia, Furiosi, Luca, Mastropasqua, Rodolfo, Battaglia, Bruno, Gironi, Matteo, Gandolfi, Stefano, Luciani, Enrico, Mora, Paolo, Schiavi, Costantino, Bertaccini, Patrizia, Finzi, Alessandro, Roda, Matilde, Cagini, Carlo, Lupidi, Marco, Giansanti, Fabrizio, Bacherini, Daniela, Tosi, Gianmarco, De Benedetto, Elena, Nardi, Marco, Figus, Michele, Posarelli, Chiara, Mariotti, Cesare, Pirani, Vittorio, Nicolai, Michele, Bonini, Stefano, Coassin, Marco, Di Zazzo, Antonio, Savastano, Mariacristina, Savastano, Alfonso, Gambini, Gloria, Vico, Umberto De, Spadea, Leopoldo, Iannaccone, Andrea, Nucci, Carlo, Ricci, Federico, Aiello, Francesco, Afflitto, Gabriele Gallo, Mastropasqua, Leonardo, D’Onofio, Giada, Evangelista, Federica, Brescia, Lorenza, Napolitano, Pasquale, Polisena, Paolo, Gianfrancesco, Nicolina, Trivisonno, Domenico, Petti, Francesco, Simonelli, Francesca, Rossi, Settimio, Tartaglione, Antonio, Rosa, Nicola, Bernardo, Maddalena De, Iaculli, Cristiana, Valeria Bux, Anna, Maggiore, Giulia, Boscia, Francesco, Sborgia, Giancarlo, Grassi, Maria Oliva, Scorcia, Vincenzo, Giannaccare, Giuseppe, Parisi, Guglielmo, Cillino, Salvatore, Alaimo, Francesco, Aragona, Pasquale, Meduri, Alessandro, Pinna, Antonio, Sollazzo, Andrea, Peiretti, Enrico, Siotto, Emanuele, Dell'Omo, R., Filippelli, M., Virgili, G., Bandello, F., Querques, G., Lanzetta, P., Avitabile, T., Viola, F., Reibaldi, M., Semeraro, F., Quaranta, L., Rizzo, S., Midena, E., Campagna, G., Costagliola, C., Marolo, P., Traverso, C. E., Iester, M., Cutolo, C. A., Azzolini, C., Donati, S., Premi, E., Nucci, P., Vujosevic, S., Staurenghi, G., Bottoni, F., Romano, F., Grosso, D., Borrelli, E., Sacconi, R., Milella, P., Ganci, S., Romano, M. R., Ricciardelli, G., Allegrini, D., Casaluci, M., Romano, D., Marchini, G., Chemello, F., Amantea, C., Frisina, R., Pilotto, E., Parrozzani, R., Veritti, D., Sarao, V., Daniele, T., Busin, M., Parmeggiani, F., De Nadai, K., Furiosi, L., Mastropasqua, R., Battaglia, B., Gironi, M., Gandolfi, S., Luciani, E., Mora, P., Schiavi, C., Bertaccini, P., Finzi, A., Roda, M., Cagini, C., Lupidi, M., Giansanti, F., Bacherini, D., Tosi, G., De Benedetto, E., Nardi, M., Figus, M., Posarelli, C., Mariotti, C., Pirani, V., Nicolai, M., Bonini, S., Coassin, M., Di Zazzo, A., Savastano, M., Savastano, A., Gambini, G., Vico, U. D., Spadea, L., Iannaccone, A., Nucci, C., Ricci, F., Aiello, F., Afflitto, G. G., Mastropasqua, L., D'Onofio, G., Evangelista, F., Brescia, L., Napolitano, P., Polisena, P., Gianfrancesco, N., Trivisonno, D., Petti, F., Simonelli, F., Rossi, S., Tartaglione, A., Rosa, N., Bernardo, M. D., Iaculli, C., Valeria Bux, A., Maggiore, G., Boscia, F., Sborgia, G., Grassi, M. O., Scorcia, V., Giannaccare, G., Parisi, G., Cillino, S., Alaimo, F., Aragona, P., Meduri, A., Pinna, A., Sollazzo, A., Peiretti, E., and Siotto, E.

Subjects
medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Trauma, phacoemulsification, glaucoma, retinal detachment, choroidal neovascular membranes, venous occlusive disease, corneal transplantation, Trauma, choroidal neovascular membranes, retinal detachment, Retrospective Studie, Settore MED/30, medicine, Retrospective analysis, choroidal neovascular membrane, Humans, venous occlusive disease, Retrospective Studies, corneal transplantation, glaucoma, phacoemulsification, Communicable Disease Control, SARS-CoV-2, COVID-19, Retinal Detachment, Settore MED/30 - Malattie Apparato Visivo, business.industry, Retinal detachment, General Medicine, Phacoemulsification, Surgical procedures, medicine.disease, Surgery, Ophthalmology, business, trauma, Human
Abstract

Background/objectives: To compare the number of eye surgical procedures performed in Italy in the 2 months following the beginning of lockdown (study period) because of COVID-19 epidemic with those performed in the two earlier months of the same year (intra-year control) and in the period of 2019 corresponding to the lockdown (inter-year control). Methods: Retrospective analysis of surgical procedures carried out at 39 Academic hospitals. A distinction was made between elective and urgent procedures. Intravitreal injections were also considered. Percentages for all surgical procedures and incidence rate ratios (IRR) for rhegmatogenous retinal detachment (RRD) events were calculated. A p value Results: A total of 20,886 versus 55,259 and 56,640 patients underwent surgery during the lockdown versus intra-and inter-year control periods, respectively. During the lockdown, only 70% of patients for whom an operation/intravitreal injection was recommended, finally underwent surgery; the remaining patients did not attend because afraid of getting infected at the hospital (23%), taking public transportation (6.5%), or unavailable swabs (0.5%). Elective surgeries were reduced by 96.2% and 96.4%, urgent surgeries by 49.7% and 50.2%, and intravitreal injections by 48.5% and 48.6% in the lockdown period in comparison to intra-year and inter-year control periods, respectively. IRRs for RRDs during lockdown dropped significantly in comparison with intra- and inter-year control periods (CI: 0.65–0.80 and 0.61–0.75, respectively, p Conclusion: This study provides a quantitative analysis of the reduction of eye surgical procedures performed in Italy because of the COVID-19 epidemic.

Published
2022

10. A Comparison of Hyper-Reflective Retinal Spot Counts in Optical Coherence Tomography Images from Glaucomatous and Healthy Eyes

Author

Francesco Oddone, Carmela Carnevale, Andreas Katsanos, Ivano Riva, Alberto Ardizzone, Luciano Quaranta, Silvia Montescani, Giovanni De Angelis, and Carlo Bruttini

Subjects
visual field, medicine.medical_specialty, Open angle glaucoma, genetic structures, Glaucoma, Article, chemistry.chemical_compound, Pattern standard deviation, Optical coherence tomography, Region of interest, Ophthalmology, medicine, optical coherence tomography, medicine.diagnostic_test, business.industry, Healthy subjects, Retinal, General Medicine, medicine.disease, hyper-reflective retinal spots, eye diseases, Visual field, glaucoma, chemistry, Medicine, sense organs, business
Abstract

Purpose: To compare the number of hyper-reflective retinal spots (HRS) in optical coherence tomography (OCT) images of healthy controls and patients affected with primary open angle glaucoma (POAG). Methods: Thirty patients affected with POAG and 34 healthy controls were recruited and underwent raster OCT examination of the macular region. Among the acquired B-scans, the one with the lowest foveal thickness was selected, and a central area of 3000 μm was defined (region of interest, ROI), in order to identify HRS. HRS were defined as small point-like hyper-reflective elements, detectable at the visual inspection of the OCT image. HRS were independently counted by two investigators in the ROI of each OCT scan. Results: Inter-rater agreement for HRS counting was good to excellent (ICC = 0.96, 95% CI: 0.83–0.99). More HRS were found in the OCT images from glaucoma patients, in comparison with healthy controls (average value: 90.5 ± 13.02 and 74.72 ± 11.35, for glaucoma and healthy subjects, respectively, p &lt, 0.01). Significant correlations between the average number of HRS and visual field mean deviation (MD, p = 0.01) and pattern standard deviation (PSD, p &lt, 0.01) were found. Conclusions: OCT images from glaucoma patients showed a higher number of HRS when compared with healthy controls. As HRS have been hypothesized to be a sign of neuroinflammation, these results may support the role of neuroinflammation in glaucoma etiopathogenesis.

Published
2021

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