RESUMEN
The full-field stimulus test (FST) is a psychophysical technique designed for the measurement of visual function in low vision. The method involves the use of a ganzfeld stimulator, as used in routine full-field electroretinography, to deliver full-field flashes of light. This guideline was developed jointly by the International Society for Clinical Electrophysiology of Vision (ISCEV) and Imaging and Perimetry Society (IPS) in order to provide technical information, promote consistency of testing and reporting, and encourage convergence of methods for FST. It is intended to aid practitioners and guide the formulation of FST protocols, with a view to future standardisation.
Asunto(s)
Electrorretinografía , Pruebas del Campo Visual , Electrorretinografía/métodos , Sociedades Médicas , Estimulación Luminosa/métodos , Visión OcularRESUMEN
Recently, involvement of the sympathetic nervous system in bone metabolism has attracted attention. ß2-Adrenergic receptor (ß2-AR) is presented on osteoblastic and osteoclastic cells. We previously demonstrated that ß-AR blockers at low dose improve osteoporosis with hyperactivity of the sympathetic nervous system via ß2-AR blocking, while they may have a somewhat inhibitory effect on osteoblastic activity at high doses. In this study, the effects of butoxamine (BUT), a specific ß2-AR antagonist, on tooth movement were examined in spontaneously hypertensive rats (SHR) showing osteoporosis with hyperactivity of the sympathetic nervous system. We administered BUT (1 mg/kg) orally, and closed-coil springs were inserted into the upper-left first molar. After sacrifice, we calculated the amount of tooth movement and analyzed the trabecular microarchitecture and histomorphometry. The distance in the SHR control was greater than that in the Wistar-Kyoto rat group, but no significant difference was found in the SHR treated with BUT compared with the Wistar-Kyoto rat control. Analysis of bone volume per tissue volume, trabecular number, and osteoclast surface per bone surface in the alveolar bone showed clear bone loss by an increase of bone resorption in SHR. In addition, BUT treatment resulted in a recovery of alveolar bone loss. Furthermore, TH-immunoreactive nerves in the periodontal ligament were increased by tooth movement, and BUT administration decreased TH-immunoreactive nerves. These results suggest that BUT prevents alveolar bone loss and orthodontic tooth movement via ß2-AR blocking.
Asunto(s)
Antagonistas de Receptores Adrenérgicos beta 2/farmacología , Proceso Alveolar/efectos de los fármacos , Butoxamina/farmacología , Técnicas de Movimiento Dental , Fosfatasa Ácida/sangre , Proceso Alveolar/inervación , Animales , Imagenología Tridimensional/métodos , Isoenzimas/sangre , Masculino , Tamaño de los Órganos/efectos de los fármacos , Alambres para Ortodoncia , Osteocalcina/sangre , Osteoclastos/efectos de los fármacos , Osteoclastos/patología , Osteoporosis/tratamiento farmacológico , Ligamento Periodontal/inervación , Ratas , Ratas Endogámicas SHR , Ratas Endogámicas WKY , Sistema Nervioso Simpático/efectos de los fármacos , Sistema Nervioso Simpático/enzimología , Fosfatasa Ácida Tartratorresistente , Técnicas de Movimiento Dental/instrumentación , Tirosina 3-Monooxigenasa/análisis , Microtomografía por Rayos X/métodosRESUMEN
OBJECTIVES: To determine effective and efficient monitoring criteria for ocular hypertension [raised intraocular pressure (IOP)] through (i) identification and validation of glaucoma risk prediction models; and (ii) development of models to determine optimal surveillance pathways. DESIGN: A discrete event simulation economic modelling evaluation. Data from systematic reviews of risk prediction models and agreement between tonometers, secondary analyses of existing datasets (to validate identified risk models and determine optimal monitoring criteria) and public preferences were used to structure and populate the economic model. SETTING: Primary and secondary care. PARTICIPANTS: Adults with ocular hypertension (IOP > 21 mmHg) and the public (surveillance preferences). INTERVENTIONS: We compared five pathways: two based on National Institute for Health and Clinical Excellence (NICE) guidelines with monitoring interval and treatment depending on initial risk stratification, 'NICE intensive' (4-monthly to annual monitoring) and 'NICE conservative' (6-monthly to biennial monitoring); two pathways, differing in location (hospital and community), with monitoring biennially and treatment initiated for a ≥ 6% 5-year glaucoma risk; and a 'treat all' pathway involving treatment with a prostaglandin analogue if IOP > 21 mmHg and IOP measured annually in the community. MAIN OUTCOME MEASURES: Glaucoma cases detected; tonometer agreement; public preferences; costs; willingness to pay and quality-adjusted life-years (QALYs). RESULTS: The best available glaucoma risk prediction model estimated the 5-year risk based on age and ocular predictors (IOP, central corneal thickness, optic nerve damage and index of visual field status). Taking the average of two IOP readings, by tonometry, true change was detected at two years. Sizeable measurement variability was noted between tonometers. There was a general public preference for monitoring; good communication and understanding of the process predicted service value. 'Treat all' was the least costly and 'NICE intensive' the most costly pathway. Biennial monitoring reduced the number of cases of glaucoma conversion compared with a 'treat all' pathway and provided more QALYs, but the incremental cost-effectiveness ratio (ICER) was considerably more than £30,000. The 'NICE intensive' pathway also avoided glaucoma conversion, but NICE-based pathways were either dominated (more costly and less effective) by biennial hospital monitoring or had a ICERs > £30,000. Results were not sensitive to the risk threshold for initiating surveillance but were sensitive to the risk threshold for initiating treatment, NHS costs and treatment adherence. LIMITATIONS: Optimal monitoring intervals were based on IOP data. There were insufficient data to determine the optimal frequency of measurement of the visual field or optic nerve head for identification of glaucoma. The economic modelling took a 20-year time horizon which may be insufficient to capture long-term benefits. Sensitivity analyses may not fully capture the uncertainty surrounding parameter estimates. CONCLUSIONS: For confirmed ocular hypertension, findings suggest that there is no clear benefit from intensive monitoring. Consideration of the patient experience is important. A cohort study is recommended to provide data to refine the glaucoma risk prediction model, determine the optimum type and frequency of serial glaucoma tests and estimate costs and patient preferences for monitoring and treatment. FUNDING: The National Institute for Health Research Health Technology Assessment Programme.
Asunto(s)
Antihipertensivos/economía , Antihipertensivos/uso terapéutico , Glaucoma de Ángulo Abierto/prevención & control , Hipertensión Ocular/tratamiento farmacológico , Hipertensión Ocular/economía , Administración Oftálmica , Factores de Edad , Antihipertensivos/administración & dosificación , Estudios de Cohortes , Análisis Costo-Beneficio , Humanos , Presión Intraocular , Tamizaje Masivo , Modelos Teóricos , Hipertensión Ocular/epidemiología , Años de Vida Ajustados por Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de RiesgoRESUMEN
AIMS: To assess the effect of the Moorfields Reference Plane on Heidelberg Retina Tomograph (HRT) rim area repeatability and its effect on progression rates using an event analysis. METHODS: The HRT reference plane (RP) defines structures above as "rim" and below as "cup." The Moorfields RP applies the Standard RP (located 50 microm posterior to the temporal disc margin) at baseline and maintains the distance between the Standard RP and the reference ring (located in the image periphery) for follow-up images. The Moorfields RP was applied to an HRT test-retest dataset, and rim area repeatability coefficients were calculated. Repeatability coefficients were compared between the Moorfields, Standard and 320 (located 320 microm posterior to the reference ring) RPs. The Moorfields RP was applied to HRT images from 198 ocular hypertensives, acquired over 6 years. HRT progression required rim area baseline/follow-up differences exceeding the repeatability coefficient in two or more sectors, with confirmation in at least one of two consecutive images. Field progression was assessed using Advanced Glaucoma Intervention Study criteria. RESULTS: The Moorfields RP improved rim area repeatability compared with the Standard RP; repeatability was similar between the Moorfields and the 320 RP. The frequency of identified progression using Moorfields RP was 40% compared with 28% for the 320 RP. There was a greater percentage with concurrent field progression -15.1% (Moorfields RP) compared with 12.1% (320 RP). CONCLUSIONS: Although rim area repeatability was similar using the 320 RP and the Moorfields RP, the latter resulted in greater rates of detection of change.