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Browsing Research and Education by Author "Adams-Huet, Beverley"
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Item Argon Laser Trabeculoplasty (ALT): Predictors of Failure(2013-01-22) Chang, Eric; Markel, Nathan; Kooner, Karanjit; Adams-Huet, Beverley; Li, XilongPURPOSE. ALT is widely used to control intraocular pressure (IOP) in glaucoma. We wished to determine predictive factors for long term success of ALT performed by supervised residents in training on patients at a local VA Hospital in Dallas. METHODS. Charts of patients with primary open angle glaucoma who underwent ALT between 2001 and 2011 were reviewed retrospectively. Those with follow up < 3 months, prior ALT/SLT, filtering procedure or inadequate data were excluded. The dependent variable was time to failure after ALT. Failure was defined as any additional medication, ALT/SLT or glaucoma filtering surgery. All patients were treated with 360 ° ALT. Logistic regression and receiver operating characteristic (ROC) analysis was performed to assess correlation between time to failure after ALT and age, pre-op IOP, C/D ratio, visual field defect, family history, refractive error, hypertension, diabetes, number of medications, laser energy used, central corneal thickness. RESULTS. Evaluable data was obtained on 206 patients; mean age 65, 98% male, and 61% black. 40.8% (84/206) were classified as ALT failures. Failure and non-failure patients had equal follow-up duration of median 2 yr. Pre-ALT LogMar (mean (SD) 0.25 (.3) vs. 0.35 (.3)), no. of glaucoma medications (2.9 (1.0) vs. 3.3 (1.0)), and myopia (46% vs. 61%) differed, respectively, between ALT failures and non-failures (p<0.05). In multivariable logistic regression models, after adjusting for age, hypertension, and diabetes, we found that myopia was protective (odds ratio (OR) =0.39, 95% CI 0.21-0.78, p=0.005) but that higher laser energy ((OR=1.6 for a 20k increase in energy, 95% CI: 1.1-2.4, p=0.005) was associated with increased risk associated for ALT failure; model ROC AUC = 0.70 (95% CI: 0.63-0.78). DISCUSSION. Our VA patients were mainly males but had good ethnical diversity. Better response in myopia may be related to thickness of trabecular meshwork while poorer response to increased laser energy may be from thermal damage. Patients using more than three meds were on systemic carbonic anhydrase inhibitors CONCLUSIONS. ALT results were better in patients who used more than 3 meds, were myopic and required less laser energy.Item Burden of Glaucoma: Adjunct Eye Disease(2014-02-04) Parikh, Kisan; Vu, Khiem; Markel, Nathan; Adams-Huet, Beverley; Li, Xilong; Kooner, KaranjitPURPOSE: The purpose of this study was to better understand the broad impact of primary open-angle glaucoma (POAG) by identifying eye conditions commonly associated with this multifactorial disease. METHODS: An IRB-approved retrospective chart study was conducted at a major academic institution. A total of 713 ethnically diverse patients met the inclusion criteria: 411 were diagnosed with POAG and 302 were controls with no glaucoma diagnosis. Information was collected on: demographics, refractive errors, and ocular ailments. Cochran-Mantel-Haenszel tests were used to compare eye disease prevalence between the two groups. RESULTS: The POAG group (mean age: 64.3, SD=13.3) was 44% female and the control group (mean age: 64.8, SD=12.3) was 47% female. The POAG group showed a higher prevalence of astigmatism (80% vs 60%,p<0.0001), myopia (66% vs 54%,p=0.0004), legal blindness (4.6% vs 1%,p= 0.004), pseudophakia (43% vs 35%,p=0.01), blepharitis (18% vs 12%,p=0.006), retinal detachment (4.1% vs 1.3%, p=0.03), central retinal vein occlusion (CRVO) (3.4% vs 0%,p=0.001), ptosis (12% v 4%,p=0.0001), and uveitis (2.4% vs 0.3%,p=0.02). DISCUSSION: The POAG group had an increased prevalence of astigmatism, myopia, legal blindness, pseudophakia, blepharitis, retinal detachment, CRVO, ptosis, and uveitis. Some of these results are explainable and expected. Glaucoma is the second leading cause of legal blindness in the United States. In addition, myopes have an increased risk of POAG and retinal detachment compared to emmetropes. The increased prevalence of blepharitis is likely due to side-effects of glaucoma medications. Another side effect is an increased risk of cataracts, which may explain the increased prevalence of pseudophakia. Lastly, glaucoma is a known risk factor for CRVO. The results involving uveitis and ptosis are more difficult to explain. CONCLUSIONS: This study has shown that patients with POAG have a host of other ocular diseases that may affect their quality of life. Awareness of these associations and their causes would be invaluable to clinicians as they screen for and treat ocular diseases. Future work to replicate the findings of this study and the elucidation of potential mechanisms underlying these associations are indicated.Item Cataract Surgery and Intraocular Pressure (IOP)(2018-01-23) Noorani, Sahar; Deng, Ted; Yang, Alex; AlSalem, Munsif; Bowman, Wayne; Whitson, Jess; Blomquist, Preston; Mootha, Vinod; Adams-Huet, Beverley; Li, Xilong; Kooner, KaranjitPURPOSE: The effect of cataract surgery on IOP in patients with glaucoma is not well understood. We sought to analyze fluctuations in IOP in controls, glaucoma suspects, and patients with mild, moderate, and severe primary open angle glaucoma (POAG) undergoing cataract surgery in a well-diversified population. METHODS: In an IRB-approved retrospective study, 236 controls (Group A), 37 glaucoma suspects (Group B), and 96 patients with POAG (mild, moderate, severe; Groups C-E) were recruited. One eye was randomly selected per patient. Exclusion criteria included: <18 years, secondary glaucoma, one functional eye, or follow-up <3 months. Data collected included age, race, gender, glaucoma family history, CCT, axial length (AXL), anterior chamber depth (ACD), lens thickness (LT), IOP, and visual acuity (VA). Post-operative IOP and VA were determined at several intervals. Linear trends over groups A-E were made with a Jonckheere-Terpstra test. χ2 analyses were used to evaluate differences between groups A-E. Wilcoxon Rank-Sum test was used to evaluate postoperative changes. Multiple linear regression was used to evaluate predictors of IOP change at 1 year. RESULTS: IOP reduction at 1 year in groups A-E were 8.6%, 8.1%, 10.8%, 18.3%, and 9.1%, respectively. Medications at 1 year did not change significantly. In POAG eyes, higher pre-op IOP and more medications were predictive of a higher reduction in IOP at 1 year (β= -0.62, -1.60; p<0.05). In control eyes, higher pre-op IOP and higher CCT were predictive of more IOP reduction at 1 year (β= -0.53, -0.02; p<0.05). DISCUSSION: In this population, all groups showed reduction of IOP after cataract surgery. Among the glaucoma groups, severe glaucoma patients had the lowest reduction of IOP (9.1%), most probably due to reduced outflow facility. However, the medication load stayed unchanged in all groups. In the control group, pre-op IOP and thicker CCT determined post-op IOP reduction. CONCLUSION: IOP reduction one year after cataract surgery in glaucomatous eyes is dependent on higher pre-op IOP and increased glaucoma medications. In non-glaucomatous eyes, higher pre-op IOP and thick CCT determine the degree of post-operative IOP reduction.Item Does a Positive Family History of Glaucoma Foretell Severity?(2014-02-04) Vu, Khiem; Markel, Nathan; Parikh, Kisan; Adams-Huet, Beverley; Li, Xilong; Kooner, KaranjitPURPOSE/RELEVANCE: There is a threefold increase in the risk of primary open-angle glaucoma (POAG) in individuals with positive family history. We wished to see if the family history also led to a more severe form of the disease. METHODS: In an IRB-approved retrospective chart study at a university-affiliated medical center, data was collected from 224 patients diagnosed with glaucoma. Positive family history was defined by first, second, or third degree relatives affected (FHx-pos). Patients with negative family history were referred to as controls. Patients with unknown family history were excluded. Age, gender, race, BMI, cup/disk ratio (C/D), visual field defects, intraocular pressure (IOP), central corneal thickness (CCT), and current glaucoma medications were recorded. FHx-pos and control groups were compared using Fisher's Exact and Wilcoxon Rank sum tests for categorical and continuous variables, respectively. RESULTS: Among patients with glaucoma, there were 82, 120, and 22 patients with positive, negative, and unknown family history, respectively. The FHx-pos group was 47.6% white, 39% black, and 13.4% Hispanic, while the control group was 40.8% white, 40.8% black, and 18.4% Hispanic; no clinically significant differences were noted. Both groups were similar in age (63.3±14.8 vs. 64.9±11.8 years, p=0.5) and CCT (539 vs. 540 μm, p=0.8). The FHx-pos group was predominantly female (70.7% vs. 45%, p<0.001), had elevated IOPs (16.9±4.0 vs. 15.7±4.2 mm Hg, p=0.040), and were prescribed more glaucoma medications (98.9 vs. 92.5%, p=0.05). The mean C/D for both groups was approximately 0.73 (p=0.86) with the FHx-pos group having slightly more optic cupping (29.6 vs. 26.1% of patients, defined as C/D > 0.9; p=0.6). DISCUSSION: The results suggest that glaucoma patients with affected relatives tend to be female. Sex-specific genetic factors or expression may contribute to disease progression, but a full mechanism has yet to be completely delineated. The FHx-pos group also had higher IOP, required more medications, and experienced slightly more optic nerve cupping, all of which indicate a more severe form of the disease. CONCLUSION: The results of this study corroborate the importance of taking a family history of glaucoma. This is especially important for females, for whom aggressive treatment may be necessary. The gender finding merits further study into the possible heritability of predisposing factors in the pathogenesis of POAG in female populations. REFERENCES: Fingert JH. Primary open-angle glaucoma genes. Eye. 2011; 25, 587-595Item Power of OCT-A (Optical Coherence Tomography Angiography) in Glaucoma(2018-01-23) Yang, Alex; Deng, Ted; Noorani, Sahar; Li, Xilong; AlSalem, Munsif; Adams-Huet, Beverley; Kooner, KaranjitPURPOSE/RELEVANCE: OCT-A is a new non-invasive, motion contrast micro-vascular imaging modality. Using OCT-A, we analyzed vessel density measurements and structural properties in controls, glaucoma suspects and patients with mild, moderate and severe glaucoma. METHODS: In an IRB approved retrospective study, 69 controls, 36 glaucoma suspects, 54 mild glaucoma, 25 moderate glaucoma, and 12 severe glaucoma patients were studied. One eye was randomly selected per patient. Collected data included: age, race, gender, family history of glaucoma, CCT, IOP, visual field (VF) MD and PSD, cup/disc ratio (C/D), and OCT-A scanning parameters: global and sectoral optic nerve fiber thickness, ganglion cell complex thickness, disc vessel densities, retinal vessel densities, and the foveal avascular zone area. A Jonckheere-Terpstra, chi-square, independent t-test, and correlation matrix were used to determine differences between controls and glaucoma groups. RESULTS: Optic disc and retinal vessel densities showed a significant decrease as the glaucoma progressed, from mild to severe form, 52.9% to 43.1% and 48.1% to 43.4%, respectively (p<0.01). Nerve fiber layer thickness decreased from 83.0μm to 60.1μm, respectively (p<0.01). Both structural properties and vessel densities were effective at determining glaucoma stage, but neither variable was superior to the other (p=0.21). Between controls and glaucoma suspects, we noticed structural property differences, but not vessel density differences (p≤0.05). DISCUSSION: The vessel densities and structural properties from OCT-A have a significant decreasing trend as glaucoma progresses and they support the clinical diagnosis of glaucoma based on VF damage. However, in glaucoma suspects, the structural properties were reduced compared to controls, while vessel densities remained unchanged. This could suggest that structural damage may occur before vessel damage in glaucoma suspects when there is no VF defect. CONCLUSION: Optic disc and retinal vessel densities and structural properties assessed by OCT-A can provide an objective measure of glaucoma damage in the eye. Our study has shown that structural damage may occur before vessel density damage in glaucoma suspects.Item Solid Organ Transplantation & Data Mining: Bloodstream Infections Have a Significant Impact on One-Year Survival and qSOFA ≥ 2 Predicts 3-Day Mortality(2018-01-23) Liu, Terrence; Xie, Donglu; Adams-Huet, Beverley; Le, Jade; Yek, Christina; Ranganathan, Dipti; Haley, Robert W.; Greenberg, David; La Hoz, RicardoBACKGROUND: We created a retrospective and prospective database of SOT recipients using innovative data mining tools. This study describing the epidemiology of BSI in SOT serves as a proof of concept of such techniques in clinical research. METHODS: The design of the study was a retrospective single center cohort study. Data mining tools were used to extract information from the electronic medical record and merged it with data from the Scientific Registry of Transplant Recipients (SRTR) national database. First SOT from 1/1/2010-12/31/2015 were included. Charts of subjects with positive blood cultures were manually reviewed and adjudicated using CDC/NHSN and SCCM/ESICM criteria. The 1-year cumulative incidence was calculated using the Kaplan-Meier method. Cox proportional hazards models were used to identify risk factors for BSI and 1 year mortality. BSI was analyzed as a time-dependent covariate in the mortality model. Fisher's exact test and Chi-Square were used to identify risk factors for 30-day mortality and multidrug resistant organisms (MDRO). RESULTS: 917 SOT recipients met inclusion criteria. 75 patients experienced at least one BSI. The cumulative incidence was 8.4% (95% CI 6.8-10.4). The onset of the 1st BSI episode was: 30 episodes (40%) < 1 month, 33 (44%) 1-6 months and 12 (16%) > 6 months. The most common pathogens were Klebsiella sp. (16%), Vancomycin-resistant E. faecium (12%), E. Coli (12%), CoNS (12%), and Candida sp. (9.3%). Nineteen isolates (25%) were identified as MDRO; the risk of MDRO was highest < 1 month compared to 1-6 and > 6 months (44.8 vs. 12.1 vs. 16.7 p=0.01). The most common source of BSI was CLABSI (29%). In multivariable analysis the risk of BSI was associated with organ type (HR [95%CI] = Multiorgan 3.5 [1.1-11.6], liver 2.5 [1.1-5.4], heart 2.4 [1.1-5.1]) and acquisition of a BSI was associated with a higher 1-year mortality (HR=8.7 [5.1- 14.7]). In univariable analysis, a polymicrobial BSI (14.7 vs. 57.1% p=0.02), qSOFA ≥ 2 (0.0 vs. 25.5% p=0.02) and septic shock (3.9 vs. 52.2% p<0.001) were associated with an increased risk of death at 30 days. CONCLUSION: A BSI significantly impacts the 1-year survival of SOT recipients. A qSOFA ≥ 2 can be used at the bedside to identify patients at increased risk for death. Additionally this study illustrates the potential of data mining tools to study infectious complications.Item Standard Calcium Supplementation May Increase Kidney Stone Risk: A Study in Women with Postmenopausal Osteoporosis(2014-02-04) Menegaz, Colleen; Adams-Huet, Beverley; Li, Xilong; Rubin, CraigINTRODUCTION: The US prevalence of kidney stones has increased from 2.6% in 1972 to 8.4% in 2010.The majority of stones contain calcium (Ca) with hypercalciuria (hCa) highly associated with stone formation. Postmenopausal osteoporosis (pmo) is a common problem affecting 30% of postmenopausal women in the US. Supplementation with Ca and vitamin D (D) is recommended for most older women. PURPOSE: To determine the percentage of patients (pts) who become hypercalciuric while receiving Ca and D supplementation for pmo and to identify biochemical predictors for higher risk of developing hCa. METHODS: 84 ambulatory women aged ≥55 yrs in a RT comparing alendronate (ALN) and sustained-release sodium fluoride (SRF) for the tx of pmo received standard Ca and D supplements. 24-hr urinary Ca (uCa) and deoxypyridinoline and serum D, PTH and bone-specific alk. phos. were measured at 0 and 12 mos. We determined the percentage of pts who became hypercalciuric (uCa >250 mg/24h) during tx. to identify predictors of hCa. Changes in biochemical variables were assessed with mixed model repeated measures analysis. Logistic regression analysis was used to assess predictors of elevated uCa and construct receiver operating characteristic (ROC) curves. RESULTS: 42 pts were randomized to ALN and 42 to SRF. 67 pts completed ≥ one yr. 90% (27/30) of the ALN group and 92% (33/36) of the SRF group had normal uCa excretion at baseline. Patients with normal uCa at baseline experienced significant increases in uCa in the first year (ALN p=0.01, SRF p<0.0001). However, baseline hypercalciurics experienced no significant increase in uCa from baseline after Ca and D supplementation. In all, 13% (4/30) of ALN pts became hypercalciuric (p= 0.41) vs. 28% (10/36) in the SRF group (p=0.002). The best-fit multi-variable model determined baseline uCa (p=0.02) and D (p=0.03) were strong predictors of hCa at 12 mo. and produced a favorable ROC curve (0.90). Baseline uCa was a consistently strong predictor of hCa and a simple logistic regression analysis generated a ROC curve (0.84) which determined that 180 mg/d uCa at baseline was a strong predictive cut-point for detection of pts at higher risk of hCa with treatment. CONCLUSION: 21% of patients became hypercalciuric on recommended doses of Ca and D. Current Ca and D supplementation practice may have significant public health consequences by contributing to the growing incidence of nephrolithiasis. Practice guidelines should consider assessing baseline 24-hr uCa in all pts and 12 mo. 24-hr uCa in pts with baseline uCa ≥of 180 mg/24h.