Carl Vinson VA Medical Center

BACKGROUND: Parenteral nutrition (PN) is a high-alert medication available for patient care within a complex clinical process. Beyond application of best practice recommendations to guide safe use and optimize clinical outcome, several issues are better addressed through evidence-based policies, procedures, and practices. This document provides evidence-based guidance for clinical practices involving PN prescribing, order review, and preparation. METHOD: A systematic review of the best available evidence was used by an expert work group to answer a series of questions about PN prescribing, order review, compounding, labeling, and dispensing. Concepts from the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) format were applied as appropriate. The specific clinical guideline recommendations were developed using consensus prior to review and approval by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. The following questions were addressed: (1) Does education of prescribers improve PN ordering? (2) What is the maximum safe osmolarity of PN admixtures intended for peripheral vein administration? (3) What are the appropriate calcium intake and calcium-phosphate ratios in PN for optimal neonatal bone mineralization? (4) What are the clinical advantages or disadvantages of commercially available premade ("premixed") multichambered PN formulations compared with traditional/customized PN formulations? (5) What are the clinical (infection, catheter occlusion) advantages or disadvantages of 2-in-1 compared with 3-in-1 PN admixtures? (6) What macronutrient dosing limits are expected to provide for the most stable 3-in-1 admixtures? (7) What are the most appropriate recommendations for optimizing calcium (gluconate) and (Na- or K-) phosphate compatibility in PN admixtures? (8) What micronutrient contamination is present in parenteral stock solutions currently used to compound PN admixtures? (9) Is it safe to use the PN admixture as a vehicle for non-nutrient medication delivery? (10) Should heparin be included in the PN admixture to reduce the risk of central vein thrombosis? (11) What methods of repackaging intravenous fat emulsion (IVFE) into smaller patient-specific volumes are safe? (12) What beyond-use date should be used for (a) IVFE dispensed for separate infusion in the original container and (b) repackaged IVFE?

OBJECTIVE: To evaluate the capacity of a new thoracic electric bioimpedance system to estimate cardiac output compared with the conventional thermodilution method. DESIGN: Prospective, multicenter study. SETTING: A university-run county hospital, a university-run U.S. Veterans Affairs hospital, and a university-affiliated U.S. military hospital. PATIENTS: A series of 68 critically ill patients whose conditions required pulmonary artery catheter insertion. MEASUREMENTS AND MAIN RESULTS: A total of 842 simultaneous pairs of cardiac output estimations by conventional thermodilution and a new thoracic electric bioimpedance system that uses an improved signal processing technique based on an all-integer-coefficient filtering technology, using a time-frequency distribution that provides a high signal/noise ratio were evaluated. The r value was .86, r2 = .74, and p < .001 by regression analysis; the mean difference between the two methods relative to their average value was 16.6 +/- 12.9 (SD) %; the precision was 1.4 L/min or 0.8 L/min/m2; the bias was -0.013 L/min. The mean difference between successive pairs of thermodilution measurements was 8.6 +/- 0.6 (SD) %, which was about half the difference between simultaneous pairs of measurement by the two methods. The changes in impedance estimations were close to simultaneously measured changes in thermodilution estimates of cardiac output. CONCLUSIONS: The new bioimpedance system satisfactorily estimated cardiac output as measured by the thermodilution technique. The difference between the two estimations is more than made up for by the continuous noninvasive capability of the impedance system.

Hospitalization for major surgery or critical illness often associates with cognitive decline. Inflammation and dysregulation of the innate immune system can exert broad effects in the periphery and central nervous system (CNS), yet the mechanisms underlying memory impairment after surgery remain poorly understood and without effective therapy. Endogenous regulation of acute inflammation is providing novel approaches to treat several disease states including sepsis, pain, obesity and diabetes. Resolvins are potent endogenous lipid mediators biosynthesized during the resolution phase of acute inflammation that display immunoresolvent actions. Here, using a mouse model of surgery-induced cognitive decline we report that orthopedic surgery affects hippocampal neuronal-glial function, including synaptic transmission and plasticity. Systemic prophylaxis with aspirin-triggered resolvin D1 (AT-RvD1: 7S,8R,17R-trihydroxy-4Z,9E,11E,13Z,15E,19Z-docosahexaenoic acid, as little as 100 ng dose per mouse) improved memory decline following surgery and abolished signs of synaptic dysfunction. Moreover, delayed administration 24 h after surgery also attenuated signs of neuronal dysfunction postoperatively. AT-RvD1 also limited peripheral damage by modulating the release of systemic interleukin (IL)-6 and improved other clinical markers of tissue injury. Collectively, these results demonstrate a novel role of AT-RvD1 in modulating the proinflammatory milieu after aseptic injury and protecting the brain from neuroinflammation, synaptic dysfunction and cognitive decline. These findings provide novel and safer approaches to treat postoperative cognitive decline and potentially other forms of memory dysfunctions.

BACKGROUND: The purpose of this study was to identify and report the complications associated with the use of circular ring fixation in diabetic patients, and to compare the frequency of complications in patients without diabetes. We hypothesized that complications with circular ring fixation occurred more frequently in patients with diabetes than patients without diabetes. MATERIALS AND METHODS: Institutional Review Board approval was obtained and patient charts were retrospectively reviewed from June 2004 and February 2007. Fifty six consecutive patients undergoing midfoot, hindfoot and/or ankle surgery were treated with circular ring fixation which included 33 diabetic patients in the study group and 23 non-diabetic patients in the control group. Patient demographics, the duration of treatment with the external fixator, and complications were recorded. RESULTS: Males had a greater number of complications compared to females (p = 0.0014). The total number of complications was statistically greater in diabetic patients (study group) versus non-diabetic patients (control group) (p = 0.003). In multivariate logistic regression, diabetes and male sex were the only significant variables associated with wire complications (OR 7.35, 95% CI 1.93-28.04 and OR 0.22, 95% CI 0.05-8584111, respectively). CONCLUSION: Women are protected from wire complications with a risk reduction of 78% compared to males. Diabetics have a 7-fold risk for any wire complication compared to patients without diabetes. We found no adverse effects of BMI, obesity, age, smoking, neuropathy, or Charcot neuroarthropathy on a satisfactory recovery.

Abstract Complex diabetic foot ulcers ( DFUs ) with exposed tendon or bone remain a challenge. They are more susceptible to complications such as infection and amputation and require treatments that promote rapid development of granulation tissue and, ultimately, reepithelialisation. The clinical effectiveness of viable cryopreserved human placental membrane ( vCHPM ) for DFUs has been established in a level 1 trial. However, complex wounds with exposed deeper structures are typically excluded from randomised controlled clinical trials despite being common in clinical practice. We report the results of a prospective, multicentre, open‐label, single‐arm clinical trial to establish clinical outcomes when vCHPM is applied weekly to complex DFUs with exposed deep structures. Patients with type 1 or type 2 diabetes and a complex DFU extending through the dermis with evidence of exposed muscle, tendon, fascia, bone and/or joint capsule were eligible for inclusion. Of the 31 patients enrolled, 27 completed the study. The mean wound area was 14·6 cm 2 , and mean duration was 7·5 months. For patients completing the protocol, the primary endpoint, 100% wound granulation by week 16, was met by 96·3% of patients in a mean of 6·8 weeks. Complete wound closure occurred in 59·3% (mean 9·1 weeks). The 4‐week percent area reduction was 54·3%. There were no product‐related adverse events. Four patients (13%) withdrew, two (6·5%) for non‐compliance and two (6·5%) for surgical intervention.

BACKGROUND: Clinical video telehealth provides a means for increasing access to psychotherapy. Insomnia is prevalent, is associated with a number of negative sequelae, and can be effectively managed with cognitive behavioral treatment of insomnia (CBT-I). Telehealth technologies can provide a means for increasing access to CBT-I. MATERIALS AND METHODS: The Tele-Insomnia program is a Veterans Health Administration (VHA) initiative in which CBT-I is delivered in a group format by telehealth. Veterans received six weekly sessions of group CBT-I, completing the Insomnia Severity Index (ISI) and daily sleep diaries throughout treatment. Paired-samples t-tests were used to examine differences in each measure from the first to the last session of treatment. RESULTS: There were statistically and clinically significant improvements in the ISI and all sleep diary variables with the exception of total sleep time. Video quality was excellent, and there were few connectivity problems. CONCLUSIONS: Clinical video telehealth technology can be used to deliver group CBT-I in a manner that produces clinically significant improvement. This model is scalable and has been used to develop a national clinical telehealth program.

Cardiovascular disorders, such as orthostatic hypotension and supine hypertension, are common in patients with neurodegenerative synucleinopathies such as Parkinson disease (PD), and may also occur in other conditions, such as peripheral neuropathies, that result in autonomic nervous system (ANS) dysfunction. Dysfunction and degeneration of the ANS are implicated in the development of orthostatic and postprandial hypotension and impaired thermoregulation. Neurogenic orthostatic hypotension (nOH) results from sympathetic failure and is a common autonomic disorder in PD. Supine hypertension may also occur as a result of both sympathetic and parasympathetic dysfunction in conjunction with nOH in the majority of patients with PD. Management of supine hypertension in the setting of nOH can be counterintuitive and challenging. Additionally, the presence of other noncardiovascular comorbidities, such as diabetes mellitus and peripheral edema, may further contribute to the burden of disease. ANS dysfunction thus presents major healthcare implications and challenges for neurology and cardiovascular practices, necessitating an integrated neurology and cardiology management approach.

A novel, comprehensive decision-making and treatment algorithm was established within a US government-run military veteran hospital in an attempt to standardize the process of outpatient wound care and streamline costs. All patients were systematically evaluated and treated using the comprehensive algorithm over a span of nine months. After three months of adherence to the algorithm, the algorithm was modified to include ovine-based collagen extracellular matrix (CECM) dressings as a first-line conventional treatment strategy for all appropriate wounds. The purpose of this retrospective analysis was to evaluate the hospital's change in cellular and/or tissue-based graft usage and cost, as well as wound healing outcomes following modification of the wound care standardization algorithm. Data from the first quarter (Q1; three months) of protocol implementation were compared to the subsequent two quarters (six months), during which time the first-line dressing modification of the protocol was implemented. Results showed that between quarters 1 and 3, the percentage of wounds healed increased by 95.5% (24/64 to 80/109), and the average time to heal each wound decreased by 22.6% (78.8 days to 61.0 days). Cellular and/or tissue-based graft unit usage decreased by 59.7% (144 units to 58 units), and expenditures on cellular and/or tissue-based grafts decreased by 66.0% ($212,893 to $72,412). Results of this analysis displayed a trend toward decreased expenditures, faster healing times, and a greater number of healed wounds following modification of an evidence-based algorithm to incorporate CECM dressings as a first-line treatment strategy in managing chronic wounds.

SIGNIFICANCE: This investigation reports the correlation of conjunctival viral titers in adenoviral conjunctivitis with patient-reported symptoms and clinician-graded signs for 21 days of follow-up. PURPOSE: Adenoviral conjunctivitis is a highly contagious viral eye infection with significant morbidity and economic impact. This study investigates whether severity of signs and symptoms and time to viral clearance are correlated with conjunctival viral titers at baseline and during 21 days of follow-up. METHODS: The Reducing Adenoviral Patient Infected Days study was a pilot study of the efficacy of a single in-office administration of ophthalmic 5% povidone-iodine. This article outlines longitudinal analyses after the primary outcome report. Of 212 participants screened, 28 participants with quantitative polymerase chain reaction-confirmed adenoviral conjunctivitis were randomized and had follow-up visits on days 1, 2, 4, 7, 14, and 21. At each visit, clinician-graded signs, participant-reported symptoms, and a conjunctival swab for quantitative polymerase chain reaction analysis were obtained. The correlation of viral titers with symptoms and signs was calculated: (1) cross-sectionally at each visit and (2) longitudinally for 21 days using a repeated-measures mixed-effects model. RESULTS: Twenty-five of 28 participants had sufficient data for this report. Higher viral titers for 21 days were correlated with greater severity of symptoms (tearing, matting, and redness, r ≥ 0.70; P < .02) and greater severity of clinical signs (bulbar redness and serous discharge, r ≥ 0.60; P < .01). Eyes with highest baseline viral titers required longer time to viral clearance ( r = 0.59, P = .008). Signs and symptoms persisted in approximately half of the eyes even after viral clearance. CONCLUSIONS: Higher conjunctival viral titers across 21 days were strongly correlated with more severe signs and symptoms and longer time to viral clearance. Our results also indicate that symptoms and signs can persist after viral clearance.

BACKGROUND: We assessed the implementation of telehealth-supported stewardship activities in acute-care units and long-term care (LTC) units in Veterans' Administration medical centers (VAMCs). DESIGN: Before-and-after, quasi-experimental implementation effectiveness study with a baseline period (2019-2020) and an intervention period (2021). SETTING: The study was conducted in 3 VAMCs without onsite infectious disease (ID) support. PARTICIPANTS: The study included inpatient providers at participating sites who prescribe antibiotics. INTERVENTION: During 2021, an ID physician met virtually 3 times per week with the stewardship pharmacist at each participating VAMC to review patients on antibiotics in acute-care units and LTC units. Real-time feedback on prescribing antibiotics was given to providers. Additional implementation strategies included stakeholder engagement, education, and quality monitoring. METHODS: The reach-effectiveness-adoption-implementation-maintenance (RE-AIM) framework was used for program evaluation. The primary outcome of effectiveness was antibiotic days of therapy (DOT) per 1,000 days present aggregated across all 3 sites. An interrupted time-series analysis was performed to compare this rate during the intervention and baseline periods. Electronic surveys, periodic reflections, and semistructured interviews were used to assess other RE-AIM outcomes. RESULTS: = .22); thereafter DOT remained stable in both settings. Providers generally appreciated feedback and collaborative discussions. CONCLUSIONS: The implementation of our telehealth program was associated with reductions in antibiotic use in the LTC units but not in the smaller acute-care units. Overall, providers perceived the intervention as acceptable. Wider implementation of telehealth-supported stewardship activities may achieve reductions in antibiotic use.

The aim of this study is to describe the appearance of intra-arterial administration of 18F-fluorodeoxyglucose (18F-FDG). The effect of this finding on the standard uptake values (SUVs) is also briefly discussed. Three cases of 18F-FDG positron emission tomography (PET) scans, detected over 2 years (2004-2006), with different presentations producing hot forearm and hot hand signs are described. It was shown that intra-arterial injections of 18F-FDG producing "the hot forearm sign" and the hot hand sign" are similar to the glove pattern of uptake noted following intra-arterial administration of technetium-99m methylene diphosphonate. Following intra-arterial injection, uptake of 18F-FDG is accentuated by hypoxia and exercise. A comparison is also made with the pattern of soft-tissue uptake seen following true intravenous injections with similar pre-injection vein enhancement techniques to the intra-arterial injections. Evaluation of the maximum intensity projection (MIP) and transaxial PET/CT fusion images of the arm, forearm and hand helps to confirm the diagnosis. Hands are often not included in PET/CT imaging and therefore cases might be missed. In conclusion, intra-arterial injection of 18F-FDG produces a "hot forearm sign" and "hot hand sign". Hands are often not included in PET/CT imaging, and therefore the presence of hot forearm sign should suggest further investigation. It should be mentioned in the radiology report, as it may alter the sensitivity and specificity of the SUV value.

PURPOSE: Settlement of fluorine-18 fluorodeoxyglucose ([18F]-FDG) in the urinary bladder is often noted in whole body PET/CT scan images with full urinary bladder but never received any careful attention. Purpose of this communication is to determine the clinical utility and application of this unreported phenomenon. METHODS: Four cases seen in the span of two years (2004 to 2006) exhibiting phenomenon of settlement of [18F]-FDG in the urinary bladder are being reported. One case with air in the urinary bladder is also reported to cover the differential diagnosis. RESULTS: All four patients showing this phenomenon had features of infection in the body/urine. CONCLUSION: Presence of this phenomenon demands careful evaluation of the urine by the clinician hence must be reported. This phenomenon can be confusing when there is air in the urinary bladder and this should be ruled out.

The Clinical Anxiety Scale, the Generalized Contentment Scale, the Revised UCLA Loneliness Scale, and the Problem-Solving Inventory were administered to nine male veterans in a Domiciliary Care for Homeless Veterans program. All four rapid assessment instruments were administered when the veterans were admitted into the program, and again after 3 months of participation. The program had an intense focus on individual and group counseling. A t test for correlated means was conducted on the pretest-posttest scores of each instrument. All results were statistically significant, suggesting that this program is effective in helping reduce homeless veterans' feelings of anxiety, depression, and loneliness, and helping them gain confidence in their problem-solving abilities.

Purpose: Accurate diagnosis of adenoviral conjunctivitis (Ad-Cs) is important for timely and appropriate patient management to reduce disease transmission. This study assessed the diagnostic accuracy of a commercially available point-of-care adenovirus immunoassay and determined whether its predictive accuracy is influenced by signal intensities of test result bands. Methods: Point-of-care immunoassay (AdenoPlus) testing and quantitative polymerase chain reaction (qPCR) testing was performed on conjunctival swab samples obtained from eyes of 186 eligible adult participants with presumed infectious conjunctivitis and symptoms of ≤4 days. Masked observers assessed signal intensities of the immunoassay test and control bands using densitometry. Results: Ad-Cs was confirmed by qPCR in 28 of the 56 eyes that tested positive on the AdenoPlus, a 50% positive predictive value (95% confidence interval [CI] = 36.9, 63.1). No adenovirus was detected by qPCR in 128 of 130 eyes that tested negative on AdenoPlus, a 98.5% negative predictive value (CI = 96.3, 100). Sensitivity and specificity were 93% (CI = 84.4, 100) and 82% (CI = 76.0, 88.1), respectively. Viral titers significantly correlated with ratio of test band signal intensities (R2 = 0.32, P = 0.002). Higher positive predictive value was associated with higher densitometry ratios (receiver operating characteristic [ROC] area = 0.71; 95% CI = 0.59, 0.83). Conclusions: Densitometric analyses suggest that the diagnostic accuracy of AdenoPlus is influenced by the signal intensity of the test result bands. Visual comparison of the test band intensities by clinicians could reduce the false positive rate of point-of-care immunoassays and aid in the diagnosis of viral infections. Translational Relevance: Ratiometric densitometry of point-of-care immunoassays could aid clinicians' decision making in diagnosing infectious diseases, including Ad-Cs.

When a U.S. Navy aircraft carrier battle group deploys overseas, the ship's medical department is responsible for more than 10,000 personnel and their numerous musculoskeletal injuries. This paper reviews the effectiveness of having a U.S. Navy physical therapist and physical therapy technician onboard the USS Carl Vinson during its most recent deployment to the Persian Gulf. Physical therapy had 3,373 patient visits during the ship's 1998-1999 Western Pacific deployment. Having physical therapy personnel onboard resulted in fewer patient visits to sick call for musculoskeletal problems and fewer evacuations compared with other similar carrier deployments. Providing physical therapy at the "tip of the spear" is an effective, beneficial, and cost-saving landmark improvement in providing quality medical care to the fleet. The lessons learned from this experience will assist in clarifying the role of physical therapy in future military support operations and sustained deployments.

Objective: To evaluate the capacity of a new thoracic electric bioimpedance system to estimate cardiac output compared with the conventional thermodilution method. Design: Prospective, multicenter study. Setting: A university-run county hospital, a university-run U.S. Veterans Affairs hospital, and a university-affiliated U.S. military hospital. Patients: A series of 68 critically ill patients whose conditions required pulmonary artery catheter insertion. Measurements and Main Results: A total of 842 simultaneous pairs of cardiac output estimations by conventional thermodilution and a new thoracic electric bioimpedance system that uses an improved signal processing technique based on an all-integer-coefficient filtering technology, using a time-frequency distribution that provides a high signal/noise ratio were evaluated. The r value was .86, r2 = .74, andp< .001 by regression analysis; the mean difference between the two methods relative to their average value was 16.6 ± 12.9 (sd) %; the precision was 1.4 L/min or 0.8 L/min/m2; the bias was -0.013 L/min. The mean difference between successive pairs of thermodilution measurements was 8.6 ± 0.6 (SD) %, which was about half the difference between simultaneous pairs of measurement by the two methods. The changes in impedance estimations were close to simultaneously measured changes in thermodilution estimates of cardiac output. Conclusions: The new bioimpedance system satisfactorily estimated cardiac output as measured by the thermodilution technique. The difference between the two estimations is more than made up for by the continuous noninvasive capability of the impedance system. (Crit Care Med 1994; 22:1907-1912)

OBJECTIVES: A new method of interpretation of Three Phase Bone Scan (TPBS) scan based upon the normal physiological vascular endothelial related response. MATERIALS AND METHODS: Fifty cases of TPBS were evaluated. Thirteen were normal. In remaining 37 positive studies, 20 showed localized hyperemic response. All localized hyperemic responses except one with vascular endothelial dysfunction were without infection (95.0%). Infection could be ruled out in absence of generalized massive flow and pool response. All 17 cases with generalized massive hyperemic response had infection, consistent with infection or CRPS/RSD. Micro-bacterial or histological confirmation of infection was obtained in 11 cases. All 11 cases with confirmed infection showed generalized massive hyperemic response (100.0%). Two were CRPS/RSD and 2 cases were of cellulitis (100.0%). Among remaining 2, one refused surgery and other was lost to follow-up. Additionally, 20 published cases in the literature of osteomyelitis were also analyzed. Nineteen cases of bone and joint infection, (osteomyelitis/arthritis/cellulitis) except one with endothelial dysfunction showed generalized massive increased flow and pool response (95.0%). All published cases of osteomyelitis in the literature showed generalized massive hyperemic response (100.0%). RESULTS: The data clearly indicated that 100% of the cases of bone infection (osteomyelitis/arthritis/cellulitis) and cases of CRPS/RSD showed generalized massive flow and pool pattern. Infection could be ruled out in absence of generalized massive flow and pool response. All 100% published cases of osteomyelitis in the literature showed positive vascular endothelial response. CONCLUSION: By incorporating the concept of vascular endothelial related response causing massive vasodilatation in infection, the interpretation of the TPBS can be more précised as it is based upon the normal physiology. Larger studies are recommended.

Aseptic meningitis as an initial and isolated manifestation of systemic lupus erythematosus (SLE) is extremely rare. About a third of patients with SLE have neuropsychiatric manifestations; however, less than 2% develop aseptic meningitis. Therefore, SLE as a cause of aseptic meningitis is commonly overlooked and leads to delayed or even missed diagnosis. We report a case of aseptic meningitis that was later discovered to be SLE and where instituting appropriate treatment led to clinical improvement.

This article describes a preliminary effort to evaluate inpatient psychiatric services at the Carl Vinson DVA Medical Center in Dublin, Georgia. The facility annually treats a large number of veterans for a variety of psychiatric disorders. To determine whether these veterans improved following care, a simple pretest-posttest group design was employed, using the SCL-90-R, to assess psychiatric symptomatology before and after inpatient treatment. Both statistically significant and practically meaningful improvements in symptomatology were evident at discharge. While the research design does not permit causal inferences, low-cost evaluations such as this one simply demonstrating that patients get better are important first steps in empirically determining the efficacy of inpatient psychiatric services, and represent one means of demonstrating accountable practice.

PURPOSE: Previous studies have demonstrated that visual function as measured by contrast sensitivity (CS) improves in primary open-angle glaucoma (POAG) patients following beta-blocker therapy and trabeculoplasty. There is evidence that ocular hypotensive agents, such as latanoprost, may provide benefit in terms of improved visual function, despite relatively small differences in the ocular hypotensive effect, when compared to other drugs. The aim of this study was to prospectively compare the effects of latanoprost and timolol maleate in Gelrite on CS. METHODS: Twenty (20) POAG patients on a monotherapy treatment regimen of topical beta blockade and with clinically stable intraocular pressure (IOP) were recruited for this single-masked, randomized, crossover study. Subjects were randomized to begin treatment with latanoprost 0.005% once-daily in the evening or timolol maleate 0.5% in Gelrite once-daily in the morning. At the end of a 3-month treatment period, each subject was crossed over to receive the alternative treatment for 3 months. Blood pressure, heart rate, IOP, and CS were assessed at baseline and after 4, 12, 16, and 24 weeks of treatment. Static central contrast sensitivity was evaluated at four spatial frequencies, 3, 6, 12, and 18 cycles/degree. Visual-field sensitivity was evaluated by using a commercially available program. Static threshold visual-field sensitivity was assessed at baseline and after 12 and 24 weeks of treatment. RESULTS: Subjects who were treated for 3 months with latanoprost, after being switched from timolol, experienced an improvement in CS at 3 cpd (P = 0.03). Conversely, subjects who were treated for 3 months with timolol, after being switched from latanoprost, demonstrated a significant loss in CS at 3 cpd (P = 0.04) and at 18 cpd (P = 0.03). Changes in CS occurred without a corresponding change in IOP, since there were no between-group differences (P > 0.05) at the end of each treatment phase. CONCLUSIONS: Compared with timolol maleate in Gelrite, latanoprost appears to significantly improve, or at least maintain, central visual function, as measured by CS, at different spatial frequencies in patients with POAG.