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Purpose The Moorfields Motion Displacement Test (MMDT; Enhanced Standard Threshold Algorithm [ESTA] version 1, London, UK) is a new 31-point suprathreshold test for visual field assessment using moving line stimuli displayed on a standard laptop computer. This study evaluated the diagnostic performance of the MMDT for discriminating between healthy eyes and eyes with glaucoma. Design Evaluation of diagnostic technology. Participants Seventy-eight subjects with glaucoma and 348 healthy subjects. Methods All participants underwent a standardized ophthalmologic examination, including the MMDT and Heidelberg Retina Tomography (HRT; Heidelberg Engineering, Heidelberg, Germany) scanning of the optic disc. The diagnosis of glaucoma was based on clinical examination with glaucomatous optic neuropathy defined by the presence of neuroretinal rim thinning, notching or excavation of the cup, cup-to-disc asymmetry between eyes of 0.25 or more, nerve fiber layer thinning (focal or diffuse), or a combination thereof; and HRT-based Moorfields Regression Analysis (MRA) results of outside normal limits in any sector. Normal eyes were defined as clinically having healthy neuroretinal rims and an MRA analysis of within normal limits in all sectors. The MMDT used a Pandora response version of the ESTA without optical correction. Subjects with a false-positive response of 15% or more in MMDT were excluded. Main Outcome Measures The performance of the global probability of true damage (global PTD) for diagnosing glaucoma was assessed by sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). The global PTD was calculated as a sum of individual PTD values, ranging from 0% to 100% for all 31 visual locations, and was expressed as a quotient of 100. Results Seventy-eight subjects with glaucoma (mean age, 66.6±13.1 years; male gender, 55.1%) and 348 healthy subjects (mean age, 55.2±9.2 years; male gender, 35.3%) were analyzed. The AUC for the global PTD was 0.930 (95% confidence interval, 0.893–0.967) for diagnosing glaucoma. At 85% specificity, the MMDT demonstrated a sensitivity of 88.5%. This decreased to 83.3% at 95% specificity. At the global PTD cutoff point value of 2.0, the sensitivity was 85.9% and the specificity was 94.5%. Conclusions The suprathreshold MMDT showed good diagnostic performance for diagnosing glaucoma when glaucoma was defined by a structural criterion.

PURPOSE: To identify factors associated prospectively with increased cataract surgical rate (CSR) in rural Chinese hospitals. METHODS: Annual cataract surgical output was obtained at baseline and 24 months later from operating room records at 42 rural, county-level hospitals. Total local CSR (cases/million population/y), and proportion of CSR from hospital and local competitors were calculated from government records. Hospital administrators completed questionnaires providing demographic and professional information, and annual clinic and outreach screening volume. Independent cataract surgeons provided clinical information and videotapes of cases for grading by two masked experts using the Ophthalmology Surgical Competency Assessment Rubric (OSCAR). Uncorrected vision was recorded for 10 consecutive cataract cases at each facility, and 10 randomly-identified patients completed hospital satisfaction questionnaires. Total value of international nongovernmental development organization (INGDO) investment in the previous three years and demographic information on hospital catchment areas were obtained. Main outcome was 2-year percentage change in hospital CSR. RESULTS: Among the 42 hospitals (median catchment population 530,000, median hospital CSR 643), 78.6% (33/42) were receiving INGDO support. Median change in hospital CSR (interquartile range) was 33.3% (-6.25%, 72.3%). Predictors of greater increase in CSR included higher INGDO investment (P = 0.02, simple model), reducing patient dissatisfaction (P = 0.03, simple model), and more outreach patient screening (P = 0.002, simple and multiple model). CONCLUSIONS: Outreach cataract screening was the strongest predictor of increased surgical output. Government and INGDO investment in screening may be most likely to enhance output of county hospitals, a major goal of China's Blindness Prevention Plan.

PURPOSE: To explore factors potentially influencing the success or failure of rural Chinese hospitals in increasing cataract surgical output and quality. METHODS: Focus groups (FGs, n = 10) were conducted with hospital administrators, doctors, and nurses at 28 county hospitals in Guangdong Province. Discussions explored respondents' views on increasing surgical volume and quality and improving patient satisfaction. Respondents numerically ranked possible strategies to increase surgical volume and quality and patient satisfaction. FG transcripts were independently coded by two reviewers utilizing the constant comparative method following the grounded theory approach, and numerical responses were scored and ranked. RESULTS: Ten FGs and 77 ranking questionnaires were completed by 33 administrators, 23 doctors, and 21 nurses. Kappa values for the two coders were greater than 0.7 for all three groups. All groups identified a critical need for enhanced management training for hospital directors. Doctors and nurses suggested reducing surgical fees to enhance uptake, although administrators were resistant to this. Although doctors saw the need to improve equipment, administrators felt current material conditions were adequate. Respondents agreed that patient satisfaction was generally high, and did not view increasing patient satisfaction as a priority. CONCLUSIONS: Our findings highlight agreements and disagreements among the three stakeholder groups about improving surgical output and quality, which can inform strategies to improve cataract programs in rural China. Respondents' beliefs about high patient satisfaction are not in accord with other studies in the area, highlighting a potential area for intervention.

PURPOSE To evaluate the diagnostic performance of classification algorithms based on Linear Discriminant Analysis (LDA) and Classification And Regression Tree (CART) methods, compared with optic nerve head (ONH) and retinal nerve fiber layer (RNFL) parameters measured by high-definition optical coherence tomography (Cirrus HD-OCT) for discriminating glaucoma subjects. METHODS Consecutive glaucoma subjects (Training data = 184; Validation data = 102) were recruited from an eye center and normal subjects (n = 508) from an ongoing Singaporean Chinese population-based study. ONH and RNFL parameters were measured using a 200 × 200 scan protocol. LDA and CART were computed and areas under the receiver operating characteristic curve (AUC) compared. RESULTS Average RNFL thickness (AUC 0.92, 95% confidence interval [CI] 0.91, 0.93), inferior RNFL thickness (AUC 0.92, 95% CI 0.91, 0.93), vertical cup-disc ratio (AUC 0.91, 95% CI 0.90, 0.92) and rim area/disc area ratio (AUC 0.90, 95% CI 0.86, 0.93) discriminated glaucoma better than other parameters (P ≤ 0.033). LDA (AUC 0.96, 95% CI 0.95, 0.96) and CART (0.98, 95% CI 0.98, 0.99) outperformed all parameters for diagnostic accuracy (P ≤ 0.005). Misclassification rates in LDA (8%) and CART (5.6%) were found to be low. The AUC of LDA for the validation data was 0.98 (0.95, 0.99) and CART was 0.99 (0.99, 0.994). CART discriminated mild glaucoma from normal better than LDA (AUC 0.94 vs. 0.99, P < 0.0001). CONCLUSIONS Classification algorithms based on LDA and CART can be used in HD-OCT analysis for glaucoma discrimination. The CART method was found to be superior to individual ONH and RNFL parameters for early glaucoma discrimination.

Purpose To report on the medical treatments used for pediatric glaucomas. Patients and methods A retrospective case series consisting of reviewing the medical notes of pediatric glaucoma patients under the care of the Glaucoma Service at Moorfields Eye Hospital NHS Foundation Trust. The medical notes of 200 patients were selected. The following outcomes were assessed: (1) the use of individual medical therapies; (2) the intraocular pressure (IOP) reduction effect of individual medicines; (3) the reporting of side effects. Results Medicines were prescribed 1592 times (200 patients). The median % IOP reduction for latanoprost 50 mcg/mL was -17.2% and for the topical beta blockers was -17.7% (as monotherapy), with no statistical difference in IOP-lowering effect between all the medicines (P=0.19). Side effects were reported in 19.5% of all patients-the highest occurrence with brimonidine tartrate 0.2% (in 17% patients) and the lowest occurrence with the prostaglandin analogue and prostamide medicines (in 3.8% patients). The combination of dorzolamide hydrochloride 2%, timolol maleate 0.5% had the greatest persistence of 1 year. Conclusions The IOP-lowering effects of all the glaucoma medicines were not significantly different although the combination of dorzolamide hydrochloride 2%, timolol maleate 0.5% had the greatest persistence.

Objective To visualize the changes of the iris contour in patients with pigment dispersion syndrome after blinking, accommodation, and pharmacologic miosis using anterior segment optical coherence tomography. Design Observational case series. Participants A total of 33 eyes of 20 patients with pigment dispersion syndrome. Methods Each eye was imaged along the horizontal 0- to 180-degree meridian using the Visante Anterior Segment Imaging System (Carl Zeiss Meditec, Dublin, CA). Scans were performed at baseline and after focusing on an internal fixation target for 5 minutes, forced blinking, accommodation, and pharmacologic miosis with pilocarpine 2%. Main Outcome Measures Quantitative analysis of the changes in the iris configuration. Results After 5 minutes of continual fixation, the iris became planar with the mean ± standard deviation curvature decreasing from 214±74 μm to 67±76 μm ( P P = 0.34) and 238±119 μm ( P = 0.19) with the −3.0 and −6.0 diopter lenses, respectively. Pilocarpine-induced miosis caused the iris to assume a planar configuration in all subjects. Conclusions This study shows that the iris in pigment dispersion syndrome assumes a planar configuration when fixating and that the concavity of the iris surface is not restored by blinking. Accommodation restored the iris concavity, suggesting that the posterior curvature of the iris in pigment dispersion syndrome is induced and probably maintained, at least in part, by accommodation. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.

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