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Bhorade Lab - Research Opportunities

Functional Implications for Glaucoma Patients

Differences in Intraocular Pressure Measured in the Clinic and Home in Glaucoma Patients: Intraocular pressure (IOP) measurements obtained in the clinic are a key element in assessing and managing glaucoma. While certain glaucoma patients progress with their disease despite fairly low IOP measurements, other patients do not develop glaucoma despite elevated IOPs (i.e. ocular hypertension). A plausible explanation is that IOP measured in the clinic may not accurately reflect IOP measured in the homes of glaucoma patients. IOPs may be higher at an unexpected home visit compared to a scheduled clinic visit due to reasons such as decreased adherence to glaucoma medications between clinic visits. Or, IOP may be higher at the clinic compared to a home visit due to increased anxiety during the clinic visit (akin to “white-coat hypertension”). There have been no studies, to date, which have compared IOP measured in the clinic to IOP measured in the home.

Objectives:

  1. To compare IOP measured in the clinic and home in patients with glaucoma.
  2. To identify factors associated with differences in IOP measured in the clinic and home.

Study status: We are currently awaiting IRB approval for study initiation. Study involvement includes assistance in patient recruitment, IOP measurements in the clinic, IOP measurements in the home, data entry, and regular meetings with Dr. Bhorade.

On-road Driving Performance in Patients with Moderate and Advanced Glaucoma: Glaucoma patients have an increased risk of motor vehicle accidents, higher at-fault crashes and injury rates, and report more driving difficulty than individuals without glaucoma. Despite these findings many of these unsafe drivers are able to pass state licensing examinations and continue to drive, posing a significant public health risk to society. Vision requirements at state licensing exams are arbitrarily designed and vary significantly from state to state. Studies are needed to better define vision criteria for safe driving in older adults with ocular diseases such as glaucoma. This study uses an on-road driving evaluation conducted by a trained and certified driving instructor to evaluate driving skills in patients with moderate and advanced glaucoma. A comprehensive evaluation of vision, cognition, motor, gait and balance, and self-reported questionnaires (e.g. sleep, depression, driving habits) is also performed to assess combination of factors associated with risky driving behavior.

Objectives:

  1. To compare on-road driving performance in patients with moderate and advanced glaucoma to age-matched normal controls
  2. To identify factors associated with visual function (e.g. visual acuity, decreased contrast sensitivity) or a combination of factors (e.g. moderate visual field loss and borderline cognition) associated with risky driving behaviors in patients with moderate and advanced glaucoma and normal controls.

Study status: This is an on-going study with anticipated completion of participants by December, 2011. Study involvement includes patient recruitment, data entry, and regular meetings with Dr. Bhorade and a team of driving experts.

Visual Function in Glaucoma Patients: As clinicians, we evaluate the progression of glaucoma using visual fields, intraocular pressure measurements and optic disc appearance; however, the relationship between these measures and functional visual impairment is virtually unknown except through patient self-report. The goal of glaucoma management is to preserve the ability of patients with glaucoma to carry out activities of daily living in order to live safely and independently. This NIH-funded pilot study uses a comprehensive assessment of clinical, functional, and self-reported questionnaires in the clinic and home to characterize the impact of glaucoma on a person’s visual function and quality of life.

Objectives:

  1. To better understand how glaucoma affects visual function and daily life in older adults.
  2. To determine the stage of glaucoma, if predictable, at which visual impairment begins.
  3. To determine which measures best distinguish various stages of glaucoma.
  4. To determine the effects of home and clinic illumination on visual function in glaucoma patients.

Study status: This is a completed study with a large database and potential for multiple manuscripts. Study involvement includes assistance in manuscript preparation (e.g. literature review, assistance with figures/tables) and exposure to simple and complex data analysis during regular meetings with Dr. Bhorade and expert statisticians.

Dr. Anjali Bhorade:
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