SMOKING AS AN UNFAVORABLE LIFESTYLE FACTOR FOR THE PROGRESSION OF PRIMARY OPEN-ANGLE GLAUCOMA

To compare the factors associated with the progression of primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). This prospective study analyses clinical data of POAG and PACG patients followed up for 6 years. The progression of glaucomatous optic neuropathy (GON) was determined using perimetry and spectral optical coherence tomography (OCT). The value of each diagnostic indicator (z-value) was calculated using the Wilcoxon-Mann-Whitney test and the area under the ROC-curve (AUC) to identify the parameters reliably associated with the progression in both groups of patients. According to OCT, 47.3% of PACG patients and 52.46% of POAG patients had GON progressing, while according to perimetry, these figures were 21.8% and 23%, respectively. The common factors associated with progression of these glaucoma forms were age (AUC 0.7, z -1.9 in PACG and AUC 0.7, z -2.9 in POAG) and maximum IOP (0.7; -2.7 in PACG and 0.79; -5.4 in POAG). The progression of PACG is associated with lens size (0.7; -2.4), subfoveal choroidal thickness (AUC 0.8, z -3.3) and peripapillary choroidal thickness (0.79; -3.2), resistive index in the vortex veins (0.81; -3.3) and their end diastolic blood flow velocity (0.83; 3.2). The progression of POAG is associated with a thin peripapillary (0.75; 2.6) and subfoveal choroid (0.74; 2.5), increased resistive index in the posterior short ciliary arteries (0.8; -2.3), and initial retinal nerve fiber layer (RNFL) thickness: 0.69; 2.9. The progression of POAG and PACG has only two common factors - age and maximum IOP. The progression of PACG is mainly related to the lens size, venous dysfunction and the choroid expansion, while the progression of POAG is related to the initial RNFL thickness, reduced arterial blood flow and choroid thinning.

To assess the effect of diabetes mellitus (DM) type 2 on the functional progression of primary open-angle glaucoma (POAG) by comparing the rate of progression (RoP) of POAG in eyes with and without diabetes. In a retrospective observasional study from our practice were included 32 followed-up POAG patients with accompanying disease DM type 2 (60 eyes) (group I, POAG + DM) and 32 patients with POAG without DM (58 eyes) (group II, POAG-DM). The groups were matched by age and gender but not by stage of POAG iat the start of investigation. The mean period of disease tracking was 6.0 ± 3.4 years (from 2 to14 years) for POAG + DM group and 5.4 ± 2.3 years (from 2 to 10 years) for POAG -DM group. Visual field (VF) changes were determined by standard automatic perimetry, Humphrey analyzer, program 30 - 2. For each eye the slope of MD (Mean deviation) changes over time was calculated and the RoP was established. A significant difference was observed for initial MD values in eyes of both groups: -5.52dB in groupI vs. -10.66 dB in group II. The number and percentage of eyes with initially severe VF losses was three times higher in group II: 21 eyes (36.2%) vs. 7 eyes (11.7%). A real progression in one or both eyes was established in 21 patients of POAG + DM group and in 25 patients of POAG-DM group. During the follow-up period the progressing eyes were 34 eyes (56.7%) in POAG + DM group and in 38 eyes (65.5%) in POAG-DM group. The difference between both groups was not significant (P > 0.05) about progressing eyes. The mean value of RoP in the progressing eyes was - 0.98 ± 1.12/year in POAG + DM group and - 0.78 ± 0.66/year in POAG-DM group. Although RoP was larger in progressing POAG + DM, no significant difference was found in both groups (Z - 0.017, Sig 0.986, Mann-Whitney Test). The real influence of DM on functional progression of POAG was not established in this comparative study. The rate of progression in POAG eyes with DM type 2 was slightly higher but without statistical significance. It was due to the significantly greater percentage of eyes with severe visual field changes in POAG patients without DM. The severity of POAG influences the assessment of the functional progression in eyes with and without DM.

The diagnosis of primary open-angle glaucoma (POAG) progression based on structural imaging such as color fundus photos (CFPs) is challenging due to the limited number of early biomarkers, as commonly determined by clinicians, and the inherent variability in optic nerve heads (ONHs) between individuals. Moreover, while visual function is the main concern for glaucoma patients, and the ability to infer future visual outcome from imaging will benefit patients by early intervention, there is currently no available tool for this. To detect glaucoma progression from ocular hypertension both structurally and functionally, and identify potential objective early biomarkers associated with progression, we developed and evaluated deep convolutional long short-term memory (CNN-LSTM) neural network models using longitudinal CFPs from the Ocular Hypertension Treatment Study (OHTS). Patients were categorized into four diagnostic groups for model input: healthy, POAG with optic disc changes, POAG with visual field (VF) changes, and POAG with both optic disc and VF changes. Gradient-weighted class activation mapping (Grad-CAM) was employed for the post hoc visualization of image features, which may be associated with the objective POAG biomarkers (rather than the biomarkers determined by clinicians). The CNN-LSTM models for the detection of POAG progression achieved promising performance results both for the structural and functional models, with an area under curve (AUC) performance of 0.894 for the disc-only group, 0.911 for the VF-only group, and 0.939 for the disc and VF group. The model demonstrated high precision (0.984) and F1-score (0.963) in the both-changes group (disc + VF). Our preliminary investigation for early POAG biomarkers with Grad-CAM feature visualization signified that retinal vasculature could serve as an early and objective biomarker for POAG progression, complementing the traditionally used optic disc features and improving clinical workflows.

Purpose Optic disc hemorrhages (DH) are one of the hallmark signs of primary open-angle glaucoma (POAG). However, due to the scarcity of longitudinal reports, the influence of baseline DH on the progression of POAG and its subtype, normal tension glaucoma (NTG), remains unclear. We conducted a systematic review with meta-analysis to determine the association of baseline DH with progression of POAG and NTG. Methods PubMed, Embase, Cochrane, SCOPUS, and Web of Science were searched from inception till July 1, 2025. POAG and NTG progressions were defined based on functional or structural changes. Following the PRISMA guidelines and a PROSPERO-registered protocol (CRD42021292572), two authors selected observational studies reporting glaucomatous progression in patients aged 18 years and above. We performed random-effects meta-analysis to estimate the pooled odds ratio (OR) for the association between baseline DH and progression of POAG and NTG. Additionally, we also performed a qualitative analysis for data on the location of DH and its association with visual field deterioration. Results We included 22 papers comprising seven prospective cohort studies and 15 retrospective cohort studies. Baseline DH was associated with the progression of POAG (OR = 4.51; 95% CI (confidence interval) = 3.24 to 6.26; I2 = 44.2%) and NTG (OR = 5.15; 95% CI = 3.72–7.14; I2 = 29%). DH were most commonly observed inferotemporally, with a topological association between the location of DH and the site of visual field deterioration. Conclusion DH is an important predictor for POAG progression, particularly for NTG. The presence of baseline DH in POAG patients may warrant closer monitoring of retinal nerve fibre layer thinning and visual field loss.

To determine the association of statins, five classes of antihypertensive medications, and proton pump inhibitors with (1) primary open-angle glaucoma (POAG) progression and (2) conversion of POAG suspects to POAG. We retrospectively investigated the records of a cohort with POAG cases and suspects from the Groningen Longitudinal Glaucoma Study. To quantify visual field (VF) deterioration in cases, we used the rate of progression of the mean deviation (MD). Suspects were considered to have converted at the time point after which two consecutive VF tests for at least one eye were abnormal (glaucoma hemifield test outside normal limits). Progression and conversion were analyzed with quantile and logistic regression, respectively, with the systemic medications as predictors, controlling for age, sex, body mass index, pretreatment IOP, corneal thickness, and baseline MD. The multivariable models were built with and without IOP intervention. No systemic medications were associated with POAG progression in the final IOP/treatment-adjusted or unadjusted model. However, angiotensin II receptor blockers (ARBs) appeared to slow progression in older patients (b = 0.014, P = 0.0001). Angiotensin-converting enzyme inhibitors (ACEIs) were significantly associated with a decrease in POAG suspect conversion in both the IOP/treatment-adjusted and -unadjusted model (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.07-0.79, P = 0.012; OR=0.24, 95% CI 0.07-0.78, P = 0.021, respectively), as were ARBs (OR 0.12, 95% CI 0.01-0.98, P = 0.014; OR 0.11, 95% CI 0.01-0.87, P = 0.005, respectively). No overall association of VF progression with systemic medication was found; ARBs delayed progression in older patients. ACEIs and ARBs were associated with lower risk of suspect conversion. The pathophysiology of this relationship is to be disentangled.

Evaluation of presumptive biomarkers of oxidative stress, immune response and apoptosis in primary open-angle glaucoma

In primary open angle glaucoma, the rate of retinal nerve fiber layer thickness decrease was negatively correlated with lamina cribrosa strain, which was associated with intraocular pressure and optic nerve head geometric factors. We hypothesized that the biomechanical deformation of the optic nerve head (ONH) contributes to the progression of primary open angle glaucoma (POAG). This study investigated the biomechanical stress and strain on the ONH in patients with POAG using computer simulations based on finite element analysis and analyzed its association with disease progression. We conducted a retrospective analysis that included patients diagnosed with early-to-moderate stage POAG. The strains and stresses on the retinal nerve fiber layer (RNFL) surface, prelaminar region, and lamina cribrosa (LC) were calculated using computer simulations based on finite element analysis. The correlations between the rate of RNFL thickness decrease and biomechanical stress and strain were investigated in both the progression and nonprogression groups. The study included 71 and 47 patients in the progression and nonprogression groups, respectively. In the progression group, the factors exhibiting negative correlations with the RNFL thickness decrease rate included the maximum and mean strain on the LC. In multivariate analysis, the mean strain on the LC was associated with optic disc radius, optic cup deepening, axial length, and mean intraocular pressure (IOP), whereas the maximum strain was only associated with mean IOP. In early-to-moderate stage POAG, the rate of RNFL thickness decrease was influenced by both the mean and maximum strain on the LC. Strains on the LC were associated with mean IOP, optic disc radius, axial length, and optic cup deepening. These results suggest that not only IOP but also ONH geometric factors are important in the progression of glaucoma.

Genetic Variants Associated With the Onset and Progression of Primary Open-Angle Glaucoma

Despite increasing evidence that cigarette smoke is a significant source of indoor fine particulate matter (PM2.5), quantitative emission factors (EFs) for PM2.5 and its toxic chemical composition in mainstream (MS) and sidestream (SS) smoke are still not well defined. In this study, we employed a custom-designed chamber to separately collect MS (intermittent puff) and SS (continuous sampling) smoke from eleven cigarette models, representing six brands and two product types, under controlled conditions. PM2.5 was collected on quartz-fiber filters and analyzed for carbon fractions (using the thermal–optical IMPROVE-A protocol), nine water-soluble inorganic ions (by ion chromatography), and twelve trace elements (via ICP-MS). SS smoke exhibited significantly higher mass fractions of total analyzed species (84.7% vs. 65.9%), carbon components (50.6% vs. 44.2%), water-soluble ions (17.1% vs. 13.7%), and elements (17.0% vs. 7.0%) compared to MS smoke. MS smoke is characterized by a high proportion of pyrolytic organic carbon fractions (OC1–OC3) and specific elements such as vanadium (V) and arsenic (As), while SS smoke shows elevated levels of elemental carbon (EC1), water-soluble ions (NH4+, NO3−), and certain elements like zinc (Zn) and cadmium (Cd). The toxicity-weighted distribution indicates that MS smoke primarily induces membrane disruption and pulmonary inflammation through semi-volatile organics and elements, whereas SS smoke enhances oxidative stress and cardiopulmonary impairment via EC-mediated reactions and secondary aerosol formation. The mean OC/EC ratio of 132.4 in SS smoke is an order of magnitude higher than values reported for biomass or fossil-fuel combustion, indicative of extensive incomplete combustion unique to cigarettes and suggesting a high potential for oxidative stress generation. Emission factors (µg/g cigarette) revealed marked differences: MS delivered higher absolute EFs for PM2.5 (422.1), OC (8.8), EC (5.0), Na+ (32.6), and V (29.2), while SS emitted greater proportions of NH4+, NO3−, Cl−, and carcinogenic metals (As, Cd, Zn). These findings provide quantitative source profiles suitable for receptor-oriented indoor source-apportionment models and offer toxicological evidence to support the prioritization of comprehensive smoke-free regulations.

Purpose: We evaluated the level of sex hormones in female primary open angle glaucoma (POAG) patients to determine whether they are associated with the onset and/or progression of POAG. Methods: The cross-sectional study enrolled 63 women with POAG and 56 healthy women as normal control subjects. Furthermore, 57 women with POAG were included and followed-up for at least two years in the cohort study. All subjects were evaluated for serum concentration of sex hormones [prolactin (PRL), luteinizing hormone (LH), testosterone (TESTO), follicle-stimulating hormone (FSH), progesterone (PROG), and estrogen (E2)] and underwent visual field (VF) examination. In the cross-sectional study, Spearman analysis, linear regression analysis, and logistic regression analysis were performed to assess risk factors for POAG in females. In the cohort study, Cox regression analyses and Kaplan-Meier survival analysis were performed to identify factors associated with VF progression in women with POAG. Results: In the cross-sectional study, the level of E2 was significantly lower in the POAG group than in the normal group (P<0.05). Multiple logistic regression showed that the decreased level of E2 was a risk factor of POAG (OR=0.27, 95% CI=0.09 – 0.78, P<0.05), especially in premenopausal subjects. In the cohort study, there were 29 non-progression subjects and 28 progression subjects. Patients in the progression group had significantly lower levels of E2 than those in the no progression group (P<0.01). The decreased level of E2 at baseline was associated with POAG progression (HR=0.08, 95% CI=0.02 – 0.46, P<0.05), especially in premenopausal subjects. POAG patients with lower baseline E2 levels had significantly lower VF non-progression rates than patients with higher E2 levels (log-rank test P<0.001), especially premenopausal subjects (log-rank test P<0.05). Additionally, logistic regression analyses, Cox regression analyses, and Kaplan-Meier survival analysis showed that PROG, LH, FSH, and TESTO were risk factors of POAG and/or significantly associated with POAG progression. Conclusions: A decreased E2 level is a POAG risk factor and is associated with VF progression in women with POAG, especially in premenopausal subjects. Additionally, other sex hormones (PROG, LH, FSH, and TESTO) might also play a role in POAG pathogenesis.

Purpose: We evaluated the level of sex hormones in female primary open angle glaucoma (POAG) patients to determine whether they are associated with the onset and/or progression of POAG. Methods: The cross-sectional study enrolled 63 women with POAG and 56 healthy women as normal control subjects. Furthermore, 57 women with POAG were included and followed-up for at least two years in the cohort study. All subjects were evaluated for serum concentration of sex hormones [prolactin (PRL), luteinizing hormone (LH), testosterone (TESTO), follicle-stimulating hormone (FSH), progesterone (PROG), and estrogen (E2)] and underwent visual field (VF) examination. In the cross-sectional study, Spearman analysis, linear regression analysis, and logistic regression analysis were performed to assess risk factors for POAG in females. In the cohort study, Cox regression analyses and Kaplan-Meier survival analysis were performed to identify factors associated with VF progression in women with POAG. Results: In the cross-sectional study, the level of E2 was significantly lower in the POAG group than in the normal group (P<0.05). Multiple logistic regression showed that the decreased level of E2 was a risk factor of POAG (OR=0.27, 95% CI=0.09 – 0.78, P<0.05), especially in premenopausal subjects. In the cohort study, there were 29 non-progression subjects and 28 progression subjects. Patients in the progression group had significantly lower levels of E2 than those in the no progression group (P<0.01). The decreased level of E2 at baseline was associated with POAG progression (HR=0.08, 95% CI=0.02 – 0.46, P<0.05), especially in premenopausal subjects. POAG patients with lower baseline E2 levels had significantly lower VF non-progression rates than patients with higher E2 levels (log-rank test P<0.001), especially premenopausal subjects (log-rank test P<0.05). Additionally, logistic regression analyses, Cox regression analyses, and Kaplan-Meier survival analysis showed that PROG, LH, FSH, and TESTO were risk factors of POAG and/or significantly associated with POAG progression. Conclusions: A decreased E2 level is a POAG risk factor and is associated with VF progression in women with POAG, especially in premenopausal subjects. Additionally, other sex hormones (PROG, LH, FSH, and TESTO) might also play a role in POAG pathogenesis.

Inder order to determine Benzopyrene (BaP) in Mainstream and Sidestream Smoke, a Solid phase extraction (SPE) cartridge was used to isolate the BaP fraction from the total particulate matter of mainstream cigarette smoke and sidestream cigarette smoke and the BaP were measured by RP-HPLC with ultraviolet detection. The result showed that the recovery rate of BaP extracted is 94.5%, compared with the relative standard of 6.95%. The yields of BaP in mainstream smoke for Virginia cigarette are higher than those for blended cigarettes. The yields of BaP in sidestream smoke are much higher than those in mainstream smoke. The proposed method involves an solid phase extract and HPLC-UV analysis procedure. With this method, the BaP yields in mainstream and sidestream cigarette smoke can be measured fast, easily and precisely using readily available apparatus and instruments.

Background: Primary open-angle glaucoma (POAG) belongs to neurodegenerative diseases. Its etiology is not fully understood. However, a lot of reports have indicated that many biochemical molecules are involved in the retinal ganglion cell damage. Therefore, the purpose of this study was to evaluate a relationship between HDAC6, CXCR3, and SIRT1 genes expression levels with the occurrence risk of POAG and its progression. Materials and methods: The study included 34 glaucoma patients and 32 subjects without glaucoma symptoms. RNA was isolated from peripheral blood lymphocytes. Level of mRNA expression was determined by real-time PCR method. Results: Our results have shown significant association of the HDAC6 and SIRT1 expression levels with progression of POAG according to rim area (RA) value, p = 0.041; p = 0.012. Moreover, the analysis of the CXCR3 expression level showed a correlation with progression of POAG based on RA and cup disc ratio (c/d) value, p = 0.006 and p = 0.012, respectively. Conclusions: The expression level of HDAC6, CXCR3, and SIRT1 genes may be involved in the progression of POAG.

The purpose of this work is to study the connection betweengenetic factors (polymorphism and expression of key genes of the biological clock (KGBC), key genes controlled by KGBC, melatonin receptors) and the diurnal oscillation of melatonin in patients with stable and progressing primary open-angle glaucoma. Materials and methods. The study involved 115 patients aged 53–86 (averagely, 68.8 ± 7.9 years) with stable and progressive glaucoma. All patients underwent primary ophthalmological examination, tested for diurnal body temperature profile, intraocular pressure (IOP), melatonin (by the DLMO protocol) and were typed for key genes of the biological clock using the real-time polymerase chain reaction. We studied the sleep phase shift to later hours in carriers of the G-allele of the melatonin receptor gene during the progression of glaucoma. Results. The study of the clinical and genotypic features of the POAG course revealed phasal shifts of the circadian rhythms of body temperature, IOP, salivary melatonin levels and sleep phases which contributed to the progression of glaucomatous optic neuropathy. Certain polymorphic variants of genes contribute to individual frequent manifestations of desynchronosis. The clock rs1801260 and MTNR1B rs10830963 gene polymorphism was found to be related to disturbances in melatonin production and sleep phase. Conclusion. Complex manifestations of circadian desynchronization accompanying the progressive course of glaucoma are the late phase of rhythms and a decrease in sleep duration, body temperature, salivary melatonin and IOP, internal desynchronization between IOP and body temperature, IOP and sleep, evening dyslipidemia. The revealed patterns open up prospects for future studies of the relationship between polymorphism and daily changes of the expression of key genes in the biological clock with the risk of progression of primary open angle glaucoma.

The yield of selected components in the mainstream and sidestream smoke for cigarettes of different tobacco types and a set of Kentucky Reference cigarettes have been measured. The BAT ‘fishtail’ chimney apparatus was used in conjunction with standard FTC Cambridge pad collection apparatus for the simultaneous collection of both sidestream (SS) and mainstream (MS) cigarette smoke, respectively. Comparison of MS FTC yields and MS yields from the BAT MS/SS smoke collection device showed that the smoke yields for the products of this study were similar for the two methods. Sidestream to mainstream smoke ratios (SS/MS) for TPM, nicotine, HO, ‘tar’, CO and COwere similar to those reported in the literature, despite the variety of collection devices employed in literature reports. The total nicotine accountabilities for the single tobacco cigarettes and the set of Reference cigarettes of this study were relatively constant (~53 %). Enantiomeric separation of the alkaloids in the different smoke streams was accomplished by chiral gas chromatography-mass selective detection. The levels and the enantiomeric ratios of nicotine and nornicotine varied in the smoke streams of the different cigarettes. The level and enantiomeric ratios of anaba-sine and anatabine in sidestream smoke were below detection limits of the method employed. The enantio-meric ratios of these secondary alkaloids could not be calculated. The fraction ofd -nicotine transferred to side-stream smoke did not change significantly when compared to that yielded in mainstream smoke even though the temperatures experienced during the side-stream smoke formation process are quite different (lower) from those occurring in the mainstream smoke formation process. Relatively low concentrations of the secondary alkaloids provided only a preliminary evaluation of their enantiomeric distribution in cigarette smoke.